Two-Year Longevity of Posterior Zirconia Multi-Unit Fixed Dental Prostheses with Monolithic Occlusal Surface

In this prospective clinical trial we observed the 2-year clinical performance of posterior tooth-supported multi-unit fixed dental prostheses (FDP) fabricated from zirconia with monolithic occlusal surfaces. Fifty multi-unit FDPs were inserted in 50 patients. After two years of clinical service, 43 restorations were reexamined as one patient had died and six patients were not available for recall. Two biological (root canal treatment: 12 and 14 months) and one technical (debonding: 12 months) complications occurred. According to the Kaplan–Meier analysis, the success rate was 93.7%, and the survival rate was 100%. The six patients who were not available for regular 2-year follow-up were examined after the official 2-year recall interval, and none of the FDPs presented complications or failures. Within the limitations of the current study, the use of multi-unit FDPs with monolithic occlusal surfaces fabricated from zirconia can be recommended for short-term use in the posterior area.

Tooth loss in complying and non-complying periodontitis patients with different periodontal risk levels during supportive periodontal care

Objectives To evaluate yearly tooth loss rate (TLR) in periodontitis patients with different periodontal risk levels who had complied or not complied with supportive periodontal care (SPC). Materials and methods Data from 168 periodontitis patients enrolled in a SPC program based on a 3-month suggested recall interval for at least 3.5 years were analyzed. For patients with a mean recall interval within 2–4 months (“compliers”) or > 4 months (“non-compliers”) with different PerioRisk levels (Trombelli et al. 2009), TLR (irrespective of the cause for tooth loss) was calculated. TLR values were considered in relation to meaningful TLR benchmarks from the literature for periodontitis patients either under SPC (0.15 teeth/year; positive benchmark) or irregularly complying with SPC (0.36 teeth/year; negative benchmark). Results In both compliers and non-compliers, TLR was significantly below or similar to the positive benchmark in PerioRisk level 3 (0.08 and 0.03 teeth/year, respectively) and PerioRisk level 4 (0.12 and 0.18 teeth/year, respectively). Although marked and clinically relevant in non-compliers, the difference between TLR of compliers (0.32 teeth/year) and non-compliers (0.52 teeth/year) with PerioRisk level 5 and the negative benchmark was not significant. Conclusion A SPC protocol based on a 3- to 6-month recall interval may effectively limit long-term tooth loss in periodontitis patients with PerioRisk levels 3 and 4. A fully complied 3-month SPC protocol seems ineffective when applied to PerioRisk level 5 patients. Clinical relevance PerioRisk seems to represent a valid tool to inform the SPC recall interval as well as the intensity of active treatment prior to SPC enrollment.

Establishing dental recall interval for Pakistani children: a longitudinal study

Objective: This study aims to determine the caries increment rate in children of 12 years of age after 6, 12 and18 months to establish appropriate dental recall interval. Subjects and Methods: Prospective longitudinal study of 18 months duration was conducted from May 2016 to October 2017 in the Bhakkar city of Punjab, Pakistan. School children of 12-years-old were selected in this study using convenience sampling. The caries progression rate was measured using Modified Beck’s method or adjusted caries increment. Descriptive analysis was conducted to estimate the response rate at baseline and at each follow-up, to estimate the number of children who attended the examinations, mean DMFT/DMFS scores and mean caries increments. Repeated measure ANOVA with post hoc test using Bonferroni correction was used to compare baseline mean caries increment with caries increment on 6, 12 and 18 months. Results: In the last follow-up, 183 children were present, giving a response rate of 81%. Significantly high caries increment among cavitated lesions was observed at 6 months (0.49±1.45, p=0.0001), 12 months (0.66±2.35, p=0.0001), and 18 months (0.86±2.39, p=0.0001) when compared with baseline caries increment. Continuous...

Risk-based, 6-monthly and 24-monthly dental check-ups for adults: the INTERVAL three-arm RCT

Background Traditionally, patients are encouraged to attend dental recall appointments at regular 6-month intervals, irrespective of their risk of developing dental disease. Stakeholders lack evidence of the relative effectiveness and cost-effectiveness of different recall strategies and the optimal recall interval for maintenance of oral health. Objectives To test effectiveness and assess the cost–benefit of different dental recall intervals over a 4-year period. Design Multicentre, parallel-group, randomised controlled trial with blinded clinical outcome assessment at 4 years and a within-trial cost–benefit analysis. NHS and participant perspective costs were combined with benefits estimated from a general population discrete choice experiment. A two-stratum trial design was used, with participants randomised to the 24-month interval if the recruiting dentist considered them clinically suitable. Participants ineligible for 24-month recall were randomised to a risk-based or 6-month recall interval. Setting UK primary care dental practices. Participants Adult, dentate, NHS patients who had visited their dentist in the previous 2 years. Interventions Participants were randomised to attend for a dental check-up at one of three dental recall intervals: 6-month, risk-based or 24-month recall. Main outcomes Clinical – gingival bleeding on probing; patient – oral health-related quality of life; economic – three analysis frameworks: (1) incremental cost per quality-adjusted life-year gained, (2) incremental net (societal) benefit and (3) incremental net (dental health) benefit. Results A total of 2372 participants were recruited from 51 dental practices; 648 participants were eligible for the 24-month recall stratum and 1724 participants were ineligible. There was no evidence of a significant difference in the mean percentage of sites with gingival bleeding between intervention arms in any comparison. For the eligible for 24-month recall stratum: the 24-month (n = 138) versus 6-month group (n = 135) had an adjusted mean difference of –0.91 (95% confidence interval –5.02 to 3.20); the risk-based (n = 143) versus 6-month group had an adjusted mean difference of –0.98 (95% confidence interval –5.05 to 3.09); the 24-month versus risk-based group had an adjusted mean difference of 0.07 (95% confidence interval –3.99 to 4.12). For the overall sample, the risk-based (n = 749) versus 6-month (n = 737) adjusted mean difference was 0.78 (95% confidence interval –1.17 to 2.72). There was no evidence of a difference in oral health-related quality of life between intervention arms in any comparison. For the economic evaluation, under framework 1 (cost per quality-adjusted life-year) the results were highly uncertain, and it was not possible to identify the optimal recall strategy. Under framework 2 (net societal benefit), 6-month recalls were the most efficient strategy with a probability of positive net benefit ranging from 78% to 100% across the eligible and combined strata, with findings driven by the high value placed on more frequent recall services in the discrete choice experiment. Under framework 3 (net dental health benefit), 24-month recalls were the most likely strategy to deliver positive net (dental health) benefit among those eligible for 24-month recall, with a probability of positive net benefit ranging from 65% to 99%. For the combined group, the optimal strategy was less clear. Risk-based recalls were more likely to be the most efficient recall strategy in scenarios where the costing perspective was widened to include participant-incurred costs, and in the Scottish subgroup. Limitations Information regarding factors considered by dentists to inform the risk-based interval and the interaction with patients to determine risk and agree the interval were not collected. Conclusions Over a 4-year period, we found no evidence of a difference in oral health for participants allocated to a 6-month or a risk-based recall interval, nor between a 24-month, 6-month or risk-based recall interval for participants eligible for a 24-month recall. However, people greatly value and are willing to pay for frequent dental check-ups; therefore, the most efficient recall strategy depends on the scope of the cost and benefit valuation that decision-makers wish to consider. Future work Assessment of the impact of risk assessment tools in informing risk-based interval decision-making and techniques for communicating a variable recall interval to patients. Trial registration Current Controlled Trials ISRCTN95933794. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme [project numbers 06/35/05 (Phase I) and 06/35/99 (Phase II)] and will be published in full in Health Technology Assessment; Vol. 24, No. 60. See the NIHR Journals Library website for further project information.

Outpatient, dental care of adult vulnerable patients under general anaesthesia—a retrospective evaluation of need for treatment and dental follow-up care

Objectives To analyse the treatment needs of patients who had received dental treatment under GA and the effectiveness of the treatment provided. Materials and methods Retrospective chart analysis of adult at risk and vulnerable patients requiring dental treatment under GA (2007–2017). Outcome variables were indications for GA, DMF/T, and type of treatment, failure rates of treated teeth, emergencies and recall intervals after GA. Results Four hundred fourteen subjects (median age 42 years, range 18–93 years) were assigned to four groups (people with disabilities (pwdis), dementias (pwd), dental phobias (pwph), and addictions/psychosocial disorders (pwapd)) and attended the pre-GA assessment. Of these, 247 subjects (median 37 years, range 18–93 years) were treated under GA, mostly pwdis (n = 154, 69.7%). The main indication for treatment under GA was suspicion of pain (n = 178, 72.1%). Pwd had the highest degree of restoration (46.7%), DMF/T value (23.8), and most missing teeth (5.8). Pwapd had the most decayed teeth (12.9). There was a 12-month recall augmented by 2–4 oral hygiene sessions depending on compliance. The failure rate of all treated teeth was 4%. Two dental emergencies were reported for patients who received a GA. Conclusions Dental treatment need was high for adult vulnerable people. The diagnostic groups differed mainly in their subjective reason for need of a GA, their DMF/T, treatment needs and type of treatments performed. Failure and dental emergency rates after GA were low in spite of a recall interval of 12 months. Clinical Relevance Regular annual recalls could avoid dental emergencies in patients requiring treatment under GA.

A Glass Fiber-Reinforced Resin Composite Splint to Stabilize and Replace Teeth in a Periodontally Compromised Patient

Combined periodontal and prosthodontic treatment demands of patients require a structured coordination of pretreatments and an adequate choice of restorations. This is especially true if multiple teeth are missing and insufficient crown-root ratios are obvious. A 40-year-old patient with a severe periodontitis (Stage IV, Grade C) was treated with active, nonsurgical periodontal therapy. Afterwards, a supportive periodontal therapy was provided with a recall interval of three to four months. Due to a high tooth mobility of the anterior teeth in the upper jaw and a missing left canine, a combination of a resin composite (Signum composite, Kulzer, Hanau, Germany) and a unidirectional glass prepreg fiber (Tender Fiber Quattro, MICERIUM, Avegno, Italy) was utilized to fabricate a splint in a labside approach to stabilize the remaining teeth. Moreover, an artificial denture tooth was adhesively luted to the splint. A temporary polymer-based material (Vita CAD-Temp, VITA Zahnfabrik, Bad Säckingen, Germany) was selected to supply the posterior teeth of the patient with a 3-unit fixed dental prosthesis (FDP), and both restorations were adhesively cemented. 19 months after insertion, a fracture of the fiber-reinforced resin composite splint occurred that was intraorally repaired. In spite of the fracture of the splint, all materials were functionally and esthetically stable over the follow-up period of 22 months.

Wound Lavage in Studies on Vital Pulp Therapy of Permanent Teeth with Carious Exposures: A Qualitative Systematic Review

The aim of this study was to systematically review pulp wound lavage in vital pulp therapy (VPT). A search was conducted in six life science databases to identify clinical trials carried out on permanent teeth with a carious pulp exposure and a recall interval of at least six months. Twenty-seven trials of low to moderate risk of bias (RoB-2 and ROBINS-I) were included. Data was extracted and analyzed regarding study characteristics and methods used for pulp wound lavage. The agent used for pulp wound lavage was specified in all included trials. Most of the identified trials (23/27) randomized the pulp capping material. Many (14/27) reported the use of sodium hypochlorite (NaOCl); ten used only saline or water. One trial was identified that compared pulp wound lavage with 2.5% (NaOCl) to saline, another compared 5% glutaraldehyde to water, both in immature molar pulpotomies. Both studies were underpowered. Neither showed a significant difference between treatments. The use of NaOCl was positively correlated to recent year of publication and use of hydraulic calcium silicate cements for pulp capping (p < 0.05). In conclusion, despite a lack of well-designed trials on pulp wound lavage in VPT, a trend towards using NaOCl for this purpose was observed.