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PubMed1997

Dentists' attitudes to the shortened dental arch concept.

The aim of restorative dentistry in high-risk groups tends to shift over time from the preservation of complete dental arches towards the preservation of functional dental arches, using a functionally oriented approach. An example of this approach, aimed at limited treatment goals, is the shortened dental arch (SDA) concept. The objective of this study was to investigate dentists' attitudes to the SDA concept in general practice. A questionnaire seeking information pertaining to the attitudes and application of the SDA concept in clinical practice was sent to all dentally qualified members of staff in the field of restorative dentistry in the Nijmegen School of Dentistry (n = 64). From a 64% response, it was found that all but one of the respondents view the SDA concept as having a useful place in clinical practice. Although the respondents indicated only regular or occasional use of SDA in < 10% of patients, the outcome of SDA management was generally satisfactory or at least sufficient, notably in the care of special category patients. The findings support the view that the SDA concept has a role in contemporary clinical practice.

Attitude of Health Personnel↗
PubMed1997

Recognition of veneer restorations by dentists and beautician students.

Three types of veneer restorations (VRs) were evaluated for recognition by two groups of observers to study the aesthetic result. The different types of VRs were: porcelain, direct resin composite and indirect resin composite. One month after insertion of the VRs, colour transparencies were made of smiling patients randomly selected from a group of 112 patients participating in a clinical trial. The slides were evaluated by five dentists who were not familiar with the patients and by 25 beautician students (BS). Dentists were asked to locate the VRs which were present in the patients and to specify the type of VR. BS were only asked to locate the VRs. To trace a possible relationship between the aesthetic result of the treatment and a number of variables, ANOVA was applied to evaluate the variables: 'discolouration of the teeth' before treatment, 'type of VR' and 'number of VRs'. Agreements in judgement were expressed in Cohen-Kappa coefficients. The results showed that the dentists could locate the VRs quite well (Kappa coefficient 0.64 +/- 0.28) but for BS this was lower (Kappa coefficient 0.43 +/- 0.27). The more VRs were made in one patient, the more difficult it was to locate them correctly. The other variables had no significant effect on the recognition of the VRs. It was not possible for the dentist observers to differentiate between the types of VRs.

Adult↗
PubMed1998

Long-term strength of aesthetic restoratives.

Glass-ionomer cements have established an important role in clinical dentistry since their introduction over 20 years ago. More recently, in an attempt to enhance the strength of the material, resin additions have been made to conventional glass-ionomer cements. This study established the long term flexural strength of two hybrid glass-ionomer cements, by use of a bi-axial flexural strength test (Shell test), and compared the values with those obtained for a light curing composite resin and a conventional glass-ionomer cement. The results demonstrated that those materials with a high resin component relying on polymerization as the main method of setting had a greater initial flexural strength than those with little or no resin addition. Those materials where the glass-ionomer acid-base reaction provided a substantial contribution to the setting reaction showed an increase in strength as they matured, whereas a decline in strength with time was observed for those materials where the resin setting reaction predominated.

Acrylic Resins↗
PubMed2002

The effects of mouthrinses on microhardness and colour stability of aesthetic restorative materials.

Detrimental effects exerted on oral and dental tissues by frequent mouthrinse use are observed, but studies about their effects on aesthetic restorative materials are limited. In this study, the purpose was to examine the effects of three proprietary mouthrinses on three different aesthetic restorative materials. Mouthrinses were used as treatment groups, while distilled water served as the control. From a total of 72 specimens, each experimental group consisting of 24 samples were prepared from each restorative test material by using metal moulds. The samples were stored in 20 mL of one of the mouthrinses for 12 h, which was reported as the equivalent time to 1 year of 2-min daily mouthrinse use. Changes between baseline and after treatment measurements of surface microhardness and colour of the test materials were established by using Vickers microhardness tester and spectrophotometer. Statistical analyses were performed by analysis of variance (anova), with Bonferroni correction. The level of significance was set as 0.05 in all tests. There were no significant interactions between the test solutions and the test materials with regard to microhardness (P > 0.05), and colour changes of the materials (P > 0.05). Effects of mouthrinses on restorative materials may differ depending on many in vivo factors that could not be replicated in vitro. Therefore, routine assessment of the effects of mouthrinses on aesthetic restorative materials is recommended.

Analysis of Variance↗
PubMed2005

[The need for orthodontic treatment. Justification and methods of evaluation (part 1)].

Most adolescents in developing countries undergo orthodontic treatment. Three main reasons are routinely cited to justify the provision of orthodontic treatment i.e. the improvement of facial and/or dental aesthetic, the preservation of the health and functioning of the dentition. Orthodontic indices have been devised to minimise the subjectivity related to the classic orthodontic diagnosis. These indices can be classified under five headings: nosological, epidemiological, treatment need, outcome and complexity.

Adolescent↗
PubMed2001

A comparison of the reliability and validity of 3 occlusal indexes of orthodontic treatment need.

Several occlusal indexes are currently used to ascertain eligibility for orthodontic treatment. A comparison of 3 indexes of orthodontic treatment need was made with the consensus opinion of a panel of 15 experienced orthodontists. Sets of study casts (170) representing the full spectrum of malocclusions were selected. An examiner, calibrated in the Dental Aesthetic Index, the Handicapping Labiolingual Deviation with the California Modification, and the Index of Orthodontic Treatment Need, scored the casts. The panel of orthodontists individually rated the same casts for their degree of orthodontic treatment need. The mean rating of the panel on the need for treatment was used as the gold standard for evaluating the validity of the indexes. Intrarater and interrater reliability was high (kappa > 0.8). Overall accuracy of the indexes, as reflected in area under receiver-operating characteristic curves, was also high: Dental Aesthetic Index, 95%; Handicapping Labiolingual Deviation with the California Modification, 94%; and Index of Orthodontic Treatment Need, 98%. Cutoff points for the indexes that resulted in the closest agreement with the gold standard differed from the published cutoff points for the indexes. The indexes appear to be valid measures of treatment need as perceived by orthodontists. The published cutoff points for the indexes were more conservative in assigning patients for treatment than a panel of orthodontists. However, adjusting the cutoff points moved all 3 indexes into close agreement with the experts.

California↗
PubMed2001

From amalgam to composite: selection of restorative materials and restoration longevity in Finland.

The aim of this study was to obtain information on restorative dental care in Finland and to analyze the changes in treatment over a 5-year period. A random sample of dentists was drawn from the registers of the health authorities and the dental association in Finland, and in the spring of 1997 a questionnaire was sent requesting the dentists to record information for each restoration placed during a given period. A total of 1,229 dentists were contacted, and 659 responded. The dentists treated 5,305 adults during the study period and placed 6,322 restorations. The most common restorative material was composite resin, which was used in 74.9% of the restorations, whereas amalgam was used in 4.8% and glass ionomers in 9.4% of the restorations. The median ages of failed restorations were nearly 12 years for amalgam, slightly less than 5 years for composite, and slightly more than 4 years for glass ionomer. The results indicate that clinical dentistry in Finland has made a definite step towards the post-amalgam era. However, the functional periods of the failed tooth-colored restorations were disappointingly short and warrant some serious consideration.

Adolescent↗
PubMed2001

Morphological, functional and aesthetic criteria of acceptable mature occlusion.

At present, there are no generally accepted criteria that could easily be applied to the evaluation of occlusal acceptability in clinical examinations at population level. The present study analyses the opinions of Finnish orthodontists and general practitioners on the characteristics required for acceptable occlusion in the full permanent dentition. A questionnaire was sent to all 37 health centres where at least one orthodontist was employed, 31 regionally comparable health centres without an orthodontist, 12 private orthodontists, and 13 orthodontists working at university dental clinics. Seventy-four orthodontists returned the questionnaire giving a response rate of 80 per cent. They were asked to give their views on the importance of morphology, function, long-term stability, and dental appearance as elements of acceptable occlusion. They were also encouraged to indicate other significant characteristics and requested to assess the relative significance of these features. In general, the respondents expressed the need to assess morphological, functional and aesthetic aspects of occlusion as a whole. Good function, rather than morphology, was considered to be the most important feature of an acceptable occlusion, with a relative significance of 40 per cent (range 20-90 per cent). According to the respondents, the acceptability of occlusion is determined not only by morphological features, but also by the functional status and long-term stability, as well as by the patient's opinion of the dental appearance.

Adult↗
PubMed2002

The Aesthetic Component of the Index of Orthodontic Treatment Need validated against lay opinion.

This study aimed to determine the threshold of aesthetic impairment where orthodontic treatment would be sought by a sample of lay people. Using the 10-grade Aesthetic Component (AC) scale of the Index of Orthodontic Treatment Need (IOTN), 215 university students selected the level of aesthetic impairment that represented the point at which they would seek orthodontic treatment. Only nine (4.3 per cent) of the respondents recorded a threshold grade beyond grade 5 in the AC. The AC photograph grade 4 was found to be the most commonly selected threshold photograph. Subjects who visited the dentist every 6 months were more likely to choose a threshold photograph closer to the attractive end of the scale than those who visited their dentist less frequently (P < 0.01). This study, using lay people rather than dental health professionals, suggests that as currently used the AC does not reflect society's aesthetic expectations. The results indicate that when using the AC of the IOTN the 'no need for treatment' category should be grades 1-3 of the AC, rather than grades 1-4.

Adolescent↗
PubMed2006

Orthodontic treatment need in French schoolchildren: an epidemiological study using the Index of Orthodontic Treatment Need.

This survey was undertaken to assess the orthodontic treatment need in a sample of 9- to 12-year-old French children (mean age: 9.77 years; standard deviation: 0.84) attending 12 different schools in the same geographic area of Ile de France. Two examiners used the Index of Orthodontic Treatment Need (IOTN) in order to estimate treatment need. Five hundred and eleven children (268 males, 243 females) who had not previously received orthodontic treatment were examined. Two examiners, who had been previously trained in the use of occlusal indices, screened all the schoolchildren. No radiographs, study casts, or previously written records of the children were used; the IOTN was calculated from direct examination. Qualitative data were analysed using the chi-square test to determine differences in treatment need between subgroups of subjects, and kappa("kappa") statistics to analyse the findings. A correlation coefficient was used to compare professional assessments. Twenty-one per cent of the children presented an objective need for orthodontic treatment, 28 per cent had crowding, 28 per cent an increased overjet, and 15 per cent an increased overbite. The dental health component (DHC) of the IOTN was found to be reliable and simple to use. The malocclusion status of French schoolchildren was lower than that recorded in epidemiological studies of European children.

Chi-Square Distribution↗
PubMed2001

The use of the Index of Orthodontic Treatment need (IOTN) in a school population and referred population.

The aim of this study is to assess the need for orthodontic treatment in a Turkish school population and a group of population referred for orthodontic treatment. The study groups were 250 school children, 11-14 years of age, and 250 patients, 11-14 years of age, referred to the department of orthodontics. The Index of Orthodontic Treatment Need (IOTN) was used by two examiner in order to estimate the treatment need. The differences between the IOTN values for the boys and girls were also not statistically significant in both groups. When the dental health component of IOTN is considered, 38.8 per cent of Turkish school population showed great need treatment, 24.0 per cent moderate need treatment and slight or no need was 37.2 per cent. On the other hand, the referred population represented an 83.2 per cent great need treatment, 12.0 per cent moderate need treatment, 4.8 per cent no need treatment according to the DHC. The AC of IOTN in school population resulted in 4.8 per cent great need, 4.8 per cent moderate need, 90.4 per cent no need. These percentage were 36.8 per cent great need, 17.6 per cent moderate need, 45.2 per cent no need in referred population. Grade 8 was 28.8 per cent out of the 36.8 per cent great need percentage in referred population. Therefore, it can be concluded that the ectopic canines were the driving factor for the referred population.

Adolescent↗
PubMed2004

Application of a digital technique in evaluating the reliability of shade guides.

There appears to be a need for a reliable method for quantification of tooth colour and analysis of shade. Therefore, the primary objective of this study was to show the applicability of graphic software in colour analysis and secondly to investigate the reliability of commercial shade guides produced by the same manufacturer, using this digital technique. After confirming the reliability and reproducibility of the digital method by using self-assessed coloured images, three shade guides of the same manufacturer were photographed in daylight and in studio environments with a digital camera and saved in tagged image file format (TIFF) format. Colour analysis of each photograph was performed using the Adobe Photoshop 4.0 graphic program. Luminosity, and red, green, blue (L and RGB) values of each shade tab of each shade guide were measured and the data were subjected to statistical analysis using the repeated measure Anova test. The L and RGB values of the images taken in daylight differed significantly from those of the images taken in studio environment (P < 0.05). In both environments, the luminosity and red values of the shade tabs were significantly different from each other (P < 0.05). It was concluded that, when the environmental conditions were kept constant, the Adobe Photoshop 4.0 colour analysis program could be used to analyse the colour of images. On the other hand, the results revealed that the accuracy of shade tabs widely being used in colour matching should be readdressed.

Color↗
PubMed2004

The influence of some different factors on the accuracy of shade selection.

The purpose of this study was to elucidate some of the factors on which accurate shade taking depends. Custom shade tabs (0.5, 1.0 and 1.5 mm porcelain thickness) were fabricated from selected Vita and Shofu porcelains. Four main factors were investigated, namely, the difference between the two types of porcelain used, the effect of light quality, the effect of porcelain thickness and the experience of the observer. The chi-square test for independence at a probability level of P <0.05 was used to analyse the results. The results indicated that in ideal light there was no difference between the two porcelains (P=0.58). The experienced observers proved better than the novice observers in ideal light conditions (P=0.003). Thickness was also significant in the overall results (P=0.0001), in that thicker samples gave more accurate results. The results indicate that in adverse light, there was an overall difference between the two porcelains (P=0.046), but no difference between the experienced and novice observers. The thickness made no difference to the experienced or the novice observer in adverse light. These results indicate that the most influential factor on shade taking was the light quality (P <0.0001); better results were obtained overall for the ideal light situation. In ideal light thicker samples gave better results (P=0.0001).

Clinical Competence↗
PubMed2006

Aesthetic effect of minor changes in incisor angulation: an internet evaluation.

The aim of this study was to evaluate the aesthetic assessment of different tiltings of the upper incisors with surrounding tissues. A picture of a smiling mouth revealing the upper anterior teeth from 15 to 25 was digitally transformed producing different tiltings of the incisors. These seven versions presented in a web-based survey were evaluated concerning their attractiveness. Overall 439 judges joined the evaluation. However, 249 judges were included in analysis, because only judges with normal wellbeings and completed questionnaires were accepted. These judges consisted of 38 dentists, 26 dental and 24 other students, 45 academics and 89 non-academics, while 27 gave no data about their profession. The results [median (first; third quartile)] showed significant that symmetrical incisors [67.5 (47.5; 85.0)] and minor changes in the angulation of one [65.0 (42.5; 80.0)] or both lateral incisors [65.0 (42.5; 80.0)], respectively, are aesthetically more attractive than the angulation of one [45.0 (27.5; 62.5)] or both central incisors [27.5 (16.3; 45.0)], or the combination of one tilted lateral and central incisor [37.5 (25.0; 60.0)]. These results confirm the results of a previous study where similar image versions without surrounding tissues were assessed concerning their attractiveness on printed photos.

Beauty↗
PubMed2004

Anterior tooth replacement with implants in grafted alveolar cleft sites: a case series.

When a residual edentulous space in the anterior region remains after surgical and orthodontic treatment of alveolar cleft patients, implant placement with or without additional grafting is a treatment option. We placed a total of 10 implants in nine consecutive alveolar cleft patients (five females, four males) with residual anterior edentulous spaces and non-restored neighbouring teeth. Patient age generally varied from 18 to 22 years. Additional (tertiary) bone grafting, implant placement after 3 months of graft consolidation and implant uncover after no less than 6 months was the favoured surgical protocol in the five most recent cases. Ample time was allowed to evaluate and guide the development of soft tissues, following second-stage surgery. For this purpose, temporary crowns were fabricated, adjusted and left in place for over 3-4 months in seven out of nine cases. No implants were lost after a mean observation period of 3.4 years and all implants function without objective (radiographic) or subjective problems. Aesthetics were considered acceptable in seven out of nine cases. Unsatisfactory aesthetic results originated from poor implant positioning or alignment in two patients who did not undergo tertiary bone grafting. We conclude that implant placement in alveolar cleft sites is a comprehensive but viable treatment option. Tertiary grafting of the site is recommended to achieve better ridge contour and bone height. This allows optimal implant placement and alignment.

Adolescent↗
PubMed2006

Psychological impact on implant patients' oral health-related quality of life.

OBJECTIVES: The literature has shown that patients' satisfaction with dental prostheses is associated with the existence of certain personality profiles. It is important to study such relationships in dental implant patients. MATERIAL AND METHODS: Fifty patients (28 men and 22 women), aged between 22 and 71 years (mean age 43.22 years, SD 12.24 years), who were partially edentulous and were seeking dental implant therapy were entered into this study. The patients were requested to answer two reliable and valid questionnaires--the Dental Impact on Daily Living (DIDL) and the Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI)--before implant treatment and 2-3 months after prosthodontic rehabilitation therapy. RESULTS: Certain personality traits were found to have a significant relationship with patients' satisfaction with dental implants both before and after implant therapy (P < 0.05). Neuroticism score had valuable features in predicting patients' total satisfaction ratings (P = 0), satisfaction with appearance dimension (P = 0), satisfaction with oral comfort dimension (P = 0.005) as well as satisfaction with general performance dimension (P = 0). CONCLUSION: Personality traits have an impact on patients' satisfaction with dental implant therapy. In addition, personality traits provide valuable information for the prediction of patients' satisfaction with their implant-supported prostheses. Neuroticism, openness, agreeableness and consciousness are very helpful in this regard. Neuroticism was found the main predictor of the patients' oral health-related quality of life following implant treatment.

Activities of Daily Living↗
PubMed1990

Dental treatment demands among patients in Tanzania.

The dental treatment demands of 824 patients attending regional dental clinics were recorded. Overall 86% of the patients sought treatment for pain, ranging from 77% to 97% in the different clinics. Caries was the main cause of pain. The proportion of patients with demands for aesthetics was 5%, prosthetics 2%, and check up 3%. The data indicated a need for emergency care. The type of curative treatment needed, mainly extractions, could well be performed by dental auxiliaries. Since the data was collected from patients among whom many visited the clinics in the late stages of painful oral diseases, it is assumed that it reflects only the tip of an iceberg that represents a much larger dormant demand (want) for emergency care among the population. Any strategy aiming to be effective in improving oral health should at least meet the emergency dental needs of the population. Consequently there is a definite need of data on dental treatment demands and wants for adequate planning of dental health care systems in their infancy in countries with limited financial resources.

Adolescent↗