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BACKGROUND: The aim of this study was to retrospectively analyze two different sealing techniques for sinus membrane perforations produced during sinus floor augmentation by a lateral approach. METHODS: A total of 172 lateral-approach sinus floor augmentation surgeries were performed on 130 patients. Sixty-one membrane perforations (35%) were reported. Most of the perforations were caused by accidental membrane tearing and 16 (26%) were caused by deliberate incision for mucocele removal. In 31 perforation cases (51%), the Schneiderian membrane was sealed by suturing, while the remaining 30 cases (49%) were sealed using a low-resorption collagen membrane coverage. RESULTS: Out of the 31 cases treated with a suture-sealing techniques, 26 (84%) were successful, presenting graft integration. Failure occurred in the other five (16%) cases. Out of the 30 perforations sealed with low-resorption collagen membranes, 28 (93%) presented successful graft integration, while two (7%) failed. CONCLUSIONS: Both surgical techniques yielded therapeutic success.

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Following a complete evaluation of the patient, treatment planning requires the analysis of individual teeth, accurate diagnosis, and prognosis evaluation. Currently, there is no accepted comprehensive, standardized, and meaningful classification system for the evaluation of individual teeth that offers a common language for dental professionals. A search was conducted reviewing existing literature relating to classification and prognostication of individual teeth. The dimensions determined to be of importance to gain an overall perspective of the individual relative tooth prognosis were the periodontal, restorative, endodontic, and occlusal plane perspectives. The authors present a comprehensive classification system by conjugating the literature and currently accepted concepts in dentistry. This easy-to-use system assesses the condition of individual teeth and enables a relative prognostic value to be attached to those teeth based on tooth condition and patient-level factors.

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PURPOSE: The aim of this study was to measure the increase in temperature in dental implants during the intake of hot beverages in vivo. MATERIALS AND METHODS: Eight successfully osseointegrated implants in 7 subjects were examined. Each subject was asked to drink the same volume of hot beverage. While drinking, temperature changes were recorded via 3 embedded thermocouples placed (i) in the implant's internal space, (ii) at the implant-abutment interface, and (iii) at the abutment. All thermocouples were linked to a computer and analyzed with appropriate software. RESULTS: The maximum temperatures were 47.3 degrees C at the abutment, 45.6 degrees C at the implant's internal space, and 44.6 degrees C at the implant-abutment interface. A linear correlation was found between the temperatures measured (i) at the implant abutment and in the implant's internal space, and (ii) at the abutment and at the abutment-implant interface. CONCLUSIONS: Further clinical studies are required to determine whether the habitual consumption of hot food and beverages may be considered a risk factor in the success of implant-supported prostheses.

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This article reviews current dental education economic challenges such as increasing student tuition and debt, decreasing funds for faculty salaries and the associated faculty shortage, and the high cost of clinic operations and their effect on the future of dentistry. Management tactics to address these issues are also reviewed. Despite recent efforts to change the clinical education model, implementation of proposed faculty recruitment and compensation programs, and creation of education- corporate partnerships, the authors argue that the current economics of public dental education is not sustainable. To remain viable, the dental education system must adopt transformational actions to re-engineer the program for long-term stability. The proposed re-engineering includes strategies in the following three areas: 1) educational process redesign, 2) reduction and redistribution of time in dental school, and 3) development of a regional curriculum. The intent of these strategies is to address the financial challenges, while educating adequate numbers of dentists at a reasonable cost to both the student and the institution in addition to maintaining dental education within research universities as a learned profession.

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Implants are becoming increasingly popular as a means of restoring edentulous spaces. However, many patients still cannot afford implants or do not have enough bone to support them. For these patients, removable partial dentures are an option for restoring function to their dentition. This article presents a way of considering removable partial denture design without becoming overwhelmed and frustrated with the process. Retention, support, and stability are discussed.

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OBJECTIVES: The habitual consumption of extremely hot foods and beverages may affect implant treatment modality. Our objectives were to: (i) establish the maximum temperature produced intra-orally while consuming very hot substances and (ii) use these values in an ex vivo model to assess the temperature changes along the implant-bone interface. MATERIALS AND METHODS: Temperatures were measured using thermocouples linked to a computer. The thermocouple electrodes were attached to the tooth-gum interface of the interproximal areas in 14 volunteers during consumption of extremely hot foods and beverages. The in vivo measured temperature values obtained were used in an ex vivo model of a bovine mandible block with an implant and with an assembled abutment. Temperatures were measured by thermocouple electrodes attached to five locations, three of them along the implant-bone interface. RESULTS: During consumption of a hot beverage, a maximum temperature of up to 76.3 degrees C was recorded, and a calculated extreme intra-oral temperature of 61.4 degrees C was established. The ex vivo model showed a high correlation between the temperature measured at the abutment and that measured at the abutment-implant interface and inside the implant, reaching maximum temperatures close to 60 degrees C. At the mid-implant-bone and apical implant-bone interfaces, the maximum temperatures measured were 43.3 and 42 degrees C, respectively. CONCLUSIONS: The maximum temperatures measured at the implant-bone interfaces reached the temperature threshold of transient changes in bone (42 degrees C). The results of this study support the notion that intra-oral temperatures, developed during the consumption of very hot substances, may be capable of damaging peri-implant tissues.

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This article describes an optional mode of treatment for a partially edentulous patient with severe microstomia, severe changes to the intraoral soft tissues, and compromised hand function. The principles discussed in this article describe a patient with systemic sclerosis but are applicable to any patient who suffers from scarring in the oral and facial areas due to disease, trauma, or burning injuries. Since dental implants were contraindicated, it was determined that long-term comfort and function could be achieved only through the use of a removable partial denture (RPD). A Valplast flexible RPD was used because of its unique characteristics and a specially designed folded custom impression tray was used to obtain an accurate impression of hard and soft tissues. This article describes the complete process and management of the patient's needs, focusing on the decision-making process for the chosen treatment plan, the special impression technique, and the completion of the RPD.

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Recurrent aphthous stomatitis (RAS) is a common, painful, and ulcerative disorder of the oral cavity of unknown etiology. No cure exists and medications aim to reduce pain associated with ulcers through topical applications or reduce outbreak frequency with systemic medications, many having serious side effects. The purpose of this pilot study was to evaluate the potential of a product to reduce the number of outbreaks of RAS ulcers. Propolis is a bee product used in some cultures as treatment for mouth ulcers. In this randomized, double-blind, placebo-controlled study, patients were assigned to take 500 mg of propolis or a placebo capsule daily. Subjects reported a baseline ulcer frequency and were contacted biweekly to record recurrences. Data were analyzed to determine if subjects had a decrease of 50% in outbreak frequency. The data indicated a statistically significant reduction of outbreaks in the propolis group (Fisher's exact test, one sided, p = 0.04). Patients in the propolis group also self-reported a significant improvement in their quality of life (p = 0.03). This study has shown propolis to be effective in decreasing the number of recurrences and improve the quality of life in patients who suffer from RAS. Propolis should be evaluated further in a larger sample clinical trial.

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OBJECTIVE: The main objective was to compare the presence of interlayer gaps between 2 hybrid composites placed using a microlayer and a 2-layer technique. METHOD AND MATERIALS: Standardized Class 1 cavities were prepared in 40 extracted posterior teeth. Two resin composite materials were used. The control group, group A, consisted of samples of the materials extruded out of the manufacturers' syringes. Group B consisted of 10 teeth restored using 2 layers per restoration. Group C consisted of 30 teeth restored using 6 microlayers per restoration. A scanning electron microscope was used to detect voids in the samples. RESULTS: Round, well-defined voids were found in 85% to 100% of the samples within the bulks of the resin composite materials only. A statistically significant relationship between the type of composite and presence of bubbles (Fisher exact test, P = .04) was found among the 2-layer technique group. No statistically significant difference (Fisher exact test, P = .48) was found among the microlayer technique group. Irregular interlayer gaps were found in 5% to 15% of specimens within areas between bulks of composite, as detected by an electron microscope based on the different densities of the bulks of composite and the interlayer areas. No such statistically significant relationship was found (Fisher exact, P = .62) among the study groups. CONCLUSIONS: Voids are routinely found in bulks of composite materials. Higher incidences of interlayer gaps in the 2-layer samples suggest that the use of a microlayering technique may result in fewer gaps.

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STATEMENT OF PROBLEM: Providing the dental laboratory with an accurate replication of the hard and soft tissue of a patient is important. Therefore, it is essential to examine whether clinicians critically evaluate impressions routinely before sending them to the laboratory. PURPOSE: This study evaluated the quality of impressions sent to commercial laboratories for the fabrication of fixed partial dentures (FPD) by describing the frequency of clinically detectable errors and by analyzing correlations between the various factors involved. MATERIAL AND METHODS: A total of 193 FPD impressions were evaluated, immediately after arrival at 11 dental laboratories, by 3 calibrated examiners. The impression technique and material used, tray type, and number of prepared units were recorded for each impression. Data relating to errors and faults, including defects in material polymerization, retention to tray, tissue contact by tray, crucial areas beyond tray borders, heavy-bodied material exposure through the wash material (for double-step impressions), inadequate union of materials, retraction cords embedded in impressions, and air bubbles, voids, or tears along the margin were also documented. The data were analyzed with the Pearson chi-square test (alpha = .05). RESULTS: Of the impressions, 89.1% had 1 or more observable errors. Significant correlations were found between material type and voids or tears at the finish line (Rv = 0.17, P < .025) and between material type and polymerization problems (Rv = 0.223, P < .004). CONCLUSIONS: Within the limitations of this study, impressions made with polyethers had the most detectable errors, followed by condensation-type silicones. The high frequency of detectable errors found in impressions sent for FPD fabrication is of concern.

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OBJECTIVE: Although the use of an arbitrary facebow and a full-sized articulator can reduce laboratory errors, many dentists do not use a facebow routinely because the procedure seems to be both intricate and time consuming. The purpose of the present study was to evaluate four earpiece-type facebows and the Snow facebow and to compare the time required for registration, the ease of manipulation, and cost-benefit considerations. METHOD AND MATERIALS: Twenty-five dentists who routinely used only the Snow facebow were asked, after a brief explanation, to perform registrations with the Snow facebow and four new-generation, earpiece-type facebows. The time required for each facebow registration was recorded. Dentists were also asked to fill out a questionnaire concerning ease of manipulation and cost-benefit factors. RESULTS: The Quick facebow was the facebow of choice of most of the dentists because of its favorable design and usage characteristics and cost-benefit ratio. The Artex 3-D facebow proved to be both the easiest and the fastest to manipulate. The Spring-bow and the Whip-Mix Quickmount were next in rank, and the Snow facebow scored the lowest. CONCLUSION: The use of earpiece-type facebows is both simple and fast, and practitioners judged this type of facebow to be superior to the Snow facebow.

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BACKGROUND: The purpose of this study was to compare the incidence of the complications and survival rate related to dental implants among smokers and non-smokers, and to evaluate the influence of smoking by analyzing data of 959 implants placed in 261 patients during the years 1995 to 1998. METHODS: Patients were divided into 3 groups: non-smokers, mild smokers (up to 10 cigarettes per day) and heavy smokers (more than 10 cigarettes per day); smokers were divided into 2 subgroups according to duration of smoking (less or more than 10 years). Complications included minor (spontaneous implant exposure), major (spontaneous implant exposure requiring surgical intervention), and implant failure. The influence of smoking was analyzed for the type of implant cover screw and immediate versus late implantation. RESULTS: The overall failure rate was 2% for non-smokers and 4% for all smokers. Minor and major complications were found in higher percentages (46%) in the smoking groups than in the non-smoking group (31%). A significantly higher incidence of complications was found among smokers who received dental implants with high cover screws (63%) compared to those who received dental implants with flat cover screws (27%). CONCLUSIONS: This study establishes a relationship between implant complications and smoking, implant type (external or internal hex), and time of implantation as significant factors. A higher incidence of complications was found in the smoking group, especially in implants that had a high cover screw. Most complications will not lead to failures. Immediate implants failed less frequently than non-immediate implants. Limiting or reducing smoking habits will decrease complications of endosseous dental implants.

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