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Advances in operative dentistry and fixed prosthodontics.

The rapid developments in biomaterials has led not only to improved materials but also to the development of clinical techniques made possible by these advances. Adhesive dentistry remains one of the fastest changing fields and this will most likely continue well into the next decade. Patients' aesthetic awareness and, to some extent, concern about amalgam has produced a growing demand for posterior tooth-coloured restorations. Originally this was met by ceramo-metal crowns and subsequently by the development of posterior composite resins. Recent development of stronger ceramics and better luting have now made all-ceramic restorations possible in posterior sites. Several new techniques for cavity preparation are emerging as alternatives to the conventional handpiece while the quest for amalgam alternatives continues. As with all recent developments there are, by definition, few long-term clinical data yet available to allow a comprehensive evaluation of the relevant materials and techniques. This paper is a summary of the most significant recent advances in fixed prosthodontics and operative dentistry.

Dental Amalgam↗

Goals and limitations of implant prosthodontics.

Goal-driven treatment plans promote an accurate differential diagnosis resulting in appropriate implant prosthodontic treatment. The identification, understanding, and acceptance of the limitations of therapy assist both the doctor and the patient in achieving their objectives and minimizing disappointments. The implementation of such a regimen helps to achieve a successful result.

Consumer Behavior↗

[Interdental papilla reconstruction with prosthodontic treatment of maxillary central incisor: case report].

PATIENT: A 20-year-old female whose chief complaint was esthetic disturbance of a crown placed on the maxillary left central incisor. DISCUSSION: The interdental papilla was reconstructed only by the prosthodontic treatment of maxillary left central incisor. This case suggests that the proximal and subgingival contours of provisional crown is very important to the reconstruction of interdental papilla, and also suggests that the transmission of the information regarding the configuration of a provisional crown to the lab side is very important. CONCLUSION: This case shows that the emergence profile of a single crown, especially of its proximal aspect, is important to reconstruct the interdental papilla.

Crowns↗

[A survey on condition of outpatients at prosthodontics II, University Hospital, Faculty of Dentistry, Tokyo Medical and Dental University].

The number of dental patients who have medical illnesses is increasing at the hospital of the Faculty of Dentistry, Tokyo Medical and Dental University. Although prosthodontic treatments are considered less invasive in all dental treatments, invasive procedures such as tooth extraction may be required occasionally. Therefore, it is necessary to treat patients in consideration of their condition. Under this situation, a clinical survey was conducted by health questionnaires answered by the patients who visited our clinic between October 1992 and March 1997. The number of patients whose illness was heart disease, hypertension, diabetes, nephritic disease, hepatitis, tuberculosis, hemodyscrasia, asthma, epilepsy, and so on during dental treatment was higher than the national average according to the Ministry of Health and Welfare. Dental psychosomatic diseases such as TMD and dental phobia were increased every year. These data reflect the contemporary disease structure in Japan characterized by the spreading of life-style related diseases and increase of neuropsychological and infectious diseases.

Adolescent↗

[Function of the central sterilization office at the Semmelweis Clinic of Conservative Dentistry and Prosthodontics].

In order to prevent cross-infection by blood borne and other pathogens central sterilization department has been constructed in the common building of the Depts. of Conservative Dentistry and Prosthodontics. Instrument sterilization is accomplished in six steps: (1) consolidation and transport of instruments, (2) cleaning, (3) packaging, (4) sterilization, (5) storage, (6) sterilizer monitoring. This process is performed by trained sterilization technicians to ensure that attending faculty, student dentists, clinical staff and patients are protected from cross-infection caused by contaminated dental instruments.

Cross Infection↗

A survey of the attitudes of members of the European Prosthodontic Association towards the shortened dental arch concept.

A survey of members of the European Prosthodontic Association was undertaken to assess their attitudes to the shortened dental arch concept, and to evaluate their experience with the approach. Data were collected using questionnaires. From an overall response of 42%, 96% of respondents agreed that the approach was acceptable in clinical practice. Almost all respondents had applied the shortened dental arch concept with 72% of respondents having treated less than 50 patients in this way over the previous 5 years. In terms of comfort and function, treatment outcome was satisfactory. However, 42% of respondents indicated that prosthetic extension of shortened dental arches was occasionally required.

Attitude of Health Personnel↗

A 10-year longitudinal study of fixed prosthodontics: clinical characteristics and outcome of single-unit metal-ceramic crowns.

PURPOSE: The purpose of this study was to report on the clinical characteristics and outcome of 688 single-unit metal-ceramic crowns placed in a specialist prosthodontic practice between January 1984 and December 1992. MATERIALS AND METHODS: Clinical and laboratory techniques were standardized and patients were recalled by the author between June and December of 1993. The outcome of all crowns was allocated to one of 6 fields in this assessment period. RESULTS: Clinical review examination by the author covered 87% of the crowns. Of these, 52% had been in service for 5 to 10 years and 48% for less than 5 years but more than 1 year; 67% of the crowns were placed on vital teeth and 94% were given a "good prognosis" rating at examination. The repair and failure rates of crowns in the 5 to 10 years in clinical service group were both 3%. Crowns on nonvital teeth in the same grouping had a significantly greater failure rate (5%) than crowns on vital teeth (1%), and anterior teeth had a significantly greater retreatment rate than posterior teeth. Retreatment for all 25 crowns occurred within 66 months after cementation. Tooth fracture accounted for 56% of retreatments, while caries and loss of retention accounted for only 24% of retreatments; 2% of initially vital teeth were endodontically treated during the survey period. CONCLUSION: Single-unit metal-ceramic crowns have a high expectancy of exceeding 10 years of clinical service when the described clinical and laboratory protocol is applied.

Adult↗

Prosthodontic and restorative care in the 21st century.

In a recent report on oral health, Surgeon General Satcher reminded us of the need to change the attitudes of families concerning the importance of oral health. In prosthodontics and restorative dentistry, remarkable developments are occurring daily. Specialties are changing, and different types of dental practices are emerging. The introduction of computer technology has greatly affected the way the restorative dentist practices, and the evolution of cyberschools are no longer a fantasy. Adhesive dentistry has replaced the manner in which we prepare, restore, and bond restorations to teeth. The entire field of ceramics and methods of fabricating esthetic restorations are entering a new era. The exceptional prognosis of various implant systems has changed the way we think about maintaining hopeless teeth. Through tissue engineering, the 21st century may be revolutionary in the way we replace missing teeth and lost tooth structure.

Computer-Aided Design↗

Predictable fixed prosthodontics: technique is the key to success.

This article reviews step-by-step clinical procedures for fixed prosthodontics that include a discussion of the following case parameters: (1) proper diagnosis and case selection; (2) tooth preparation; (3) soft tissue management; (4) impression making; (5) provisionalization; (6) additional laboratory diagnostic information; (7) case try in; and (8) case delivery. When the clinical principles of these procedures are faithfully followed, the success and predictability of any restorative endeavor will be greatly enhanced.

Cementation↗

The Carl O. Boucher Prosthodontic Conference spans four decades.

Dr. Carl O. Boucher was a giant in prosthodontics in the middle of last century. To honor his quest for excellence, the Ohio State University School of Dentistry established an annual conference bearing his name in 1996. This article describes the inaugural conference, the structure of the annual conference, and expanding plans to promote continuous improvement in prosthetic dentistry.

Congresses as Topic↗

The clinical operating microscope advantage in fixed prosthodontics.

Over the last 20 years, magnification and operating light have become more available to dentists in the form of head-mounted loupes and headlights. More recently, restorative dentists have utilized the multiple steps of magnification and reciprocal illumination provided by the clinical operating microscope. The advantages of this technology now are being applied to fixed prosthodontics. This article discusses the specific uses and advantages of the clinical operating microscope, specifically as they relate to optics, ergonomics, and documentation.

Dental Restoration, Permanent↗

[Clinical observation of treating nonrestorable teeth with orthodontics, periodontal therapy and prosthodontics].

PURPOSE: To evaluate the clinical results of treating nonrestorable teeth with conjunctive efforts of orthodontic-prosthodontic disciplines and periodontal therapy. METHODS: 10 cases, 8 anterior teeth, 2 premolar were selected, with a large vertical root fracture lingually or labially extending 2 to 3 mm below the gingival margin. The teeth were erupted coronally by orthodontic forces, and stabilized by the appliances for 8 weeks to 6 months, then periodontal surgery was performed, at last the final restoration was completed. RESULTS: After a series of treatments, an acceptable restoration was fabricated which fit the periodontal,restorative and esthetic requirements. Radiographs showed suitable C/R (crown and root) ratio of the final restoration. CONCLUSION: Forced eruption may be a useful approach in treating isolated nonrestorable teeth.

Dental Care↗

[Clinical evaluation on surgical implant anchorage in orthodontic and prosthodontic therapy].

PURPOSE: To evaluate the clinical effect of implant anchorage in the correction of malocclusion and restoration of dentition defects. METHODS: 14 cases who had Angle II malocclusion as well as dentition defects and whose molars could not serve as anchorage or who had no molars at all were selected. Implants in the maxilla or mandible were served first as anchorage to correct the malocclusion and then to restore the dentition defects. RESULTS: The implant anchorage in the palate didn't move medially after the anterior teeth had been adducted by 6-8 mm. 3 cases of zygo-alveolar ridge implantation failed. 5 cases of adult Angle II division I, II malocclusions as well as Kennedy II dentition defects were orthodontically treated for 8-10 months, the lower anterior teeth were adducted by 6-8mm, aligned and the midline was corrected with no medial movement of the implant anchorage. Then the implants were used to restore the missing teeth. CONCLUSION: It is feasible and effective to use implant as anchorage in orthodontic and prosthodontic treatment in cases without available anchorage.

Dental Implantation, Endosseous↗

Computer-aided learning in prosthodontics.

Interactive video is computer-aided learning illustrated by still or moving video pictures. First introduced for the study of pathology, its application and potential in prosthodontics is reported in this article. Partial denture design was chosen as the first subject, since the systematic approach concept could easily be established by dividing the subject into five units that could individually be expanded and tested. Students are generally enthusiastic about computer-aided learning and there is considerable potential to further develop this type of learning process.

Audiovisual Aids↗

[Technology and progress in dental prosthodontics and dental materials].

This publication describes and scrutinizes new technologies in the field of prosthodontics including functional analysis and therapy, fixed and combined fixed/removable prosthetics, and implant supported/relained dentures. In spite of all new developments with regard to digitized imaging (CT;NMR) of the TMJ as well as in spite of all electronic devices for recording the mandibular movement, new therapies have not been established. The clinical examination is still of primary importance. In fixed prosthetics the different ceramic and glass/ceramic systems represent aesthetic and hygienic alternatives to single, porcelain-fused-to-metal restorations. Titanium exhibiting good biocompatibility, sufficient strength, and a low price gradually becomes of greater importance. In combined fixed/removable prosthetics the various metal-resinbonding-systems as well as the spark erosion technique--the latter being used for precision attachment work utilizing base metal alloys--can be described as major achievements in our profession. In dental implantology, a great variety of different implant systems have been introduced to the market. Based on the clinical experience of the last decade, the following can be stated: The implantological prosthetic treatment of the lower jaw using two implants and a clip-to-bar retained denture shows the best cost-risque-benefit ratio among all possible indications. In the future, more research should be directed to the prosthetic suprastructures and their influence on the long lasting success of implant supported retained constructions.

Dental Implantation↗

A rater training program in removable prosthodontics.

Four faculty members in removable prosthodontics participated in a three-phase rater training program. Nine complete dentures were given an overall rating by three outside experts to obtain an accuracy measure. A three-point rating scale was used: R (cannot be appreciably improved), S (clinically acceptable), and T (clinically unacceptable). During the pretraining phase, the average interrater reliability was .57 as estimated by intraclass correlation, and the mean accuracy correlation was .76. The rater training phase consisted of a four-hour session including presentations and discussions of rating terminology and formats, observer accuracy, and related issues. In the post-training phase, the same nine complete dentures were rated by the four faculty members, using the same three-point rating scale and a five-point scale. The average post-training interrater reliabilities were .56 and .76 on the three- and five-point scales, respectively. The mean accuracy correlation was .78.

Denture, Complete↗

A low-cost, portable removable prosthodontic treatment system for the compromised elderly.

The elderly population (people of 65 years and older), especially the compromised elderly, places an overwhelming demand on the health care system in the USA. Dentists must provide services to all segments of the elderly population, but the compromised elderly are labelled as 'poor' candidates for dental treatment because they are unlikely to cooperate, find it difficult to get to the dental surgery, or cannot pay for professional services. The authors of this paper have developed guidelines for on-site patient management using a team approach and a low-cost, portable treatment system for providing removable prosthodontic services using ligh-cured denture resin. The system is cost-effective, reduces chairside time and requires minimal patient cooperation but does not compromise the quality of care. Treatment can be provided in non-traditional settings with family members and support staff on-hand. The feasibility of this approach has been demonstrated by its use in hospitals, clinics, nursing homes and private residences.

Acrylic Resins↗