Evaluation of the Accuracy of Solid Implant Casts

Purpose Materials used to fabricate the most dimensionally accurate implant casts have not been identified experimentally. The purpose of this investigation was to examine the dimensional accuracy of implant casts fabricated with different materials. Measurements of linear horizontal dimensional change and strain produced on a master framework were evaluated and correlated. Materials and Methods A master framework was fabricated to fit an aluminum five-implant model. Forty polyether implant impressions of the aluminum model were randomly grouped and poured in either Vel-mix, Die Keen, Resin Rock, or Low Fusing Alloy. A digital veneer caliper was used to measure linear distance between the most distal abutments on each of the experimental implant casts and the master model. In addition, strain values were recorded from strain gauges bonded in the mesiodistal axis of the framework, which was secured by prosthetic retaining screws torqued to 10 Ncm. Results A one-way ANOVA showed a significant difference among the four die materials in dimensional change of the experimental casts (p= .0001). A post-hoc Duncan's multiple-range test (p < .05) showed that casts fabricated with Low Fusing Alloy had the least linear dimensional change from the master cast, but the material exhibited the greatest dimensional variability. A MANOVA (Wilks' Lambda) showed significant differences in strain on the framework based upon die material (p= .015). A post-hoc Duncan's multiple-range test (p < .05) showed that Resin Rock casts induced significantly less strain on the framework than the other materials. Negligible correlation was found between the linear horizontal dimensional change and the total absolute strain on the framework. Conclusion Experimental implant casts made of Resin Rock minimized strain on the master framework and decreased the amount of framework distortion on casts of this material. Low Fusing Alloy yielded accurate casts, but highly variable linear dimensional changes in the horizontal dimension may preclude its clinical benefit.     

Evaluation of the Effects of Buccal–Palatal Bone Width on the Incidence and Height of the Interproximal Papilla Between Adjacent Implants in Esthetic Areas

Background: The presence of interproximal papilla depends on the distance between the contact point to the bone crest, as well as the mesio‐distal distance between implants or between implants and teeth. The aim of this study is to evaluate the effects of buccal–palatal bone width on the presence of the interproximal papilla between adjacent implants in esthetic areas of the mouth. Methods: The presence or absence of the gingival papilla, distance from the base of the interproximal contact to the tip of the gingival papilla (black space), distance from the base of the interproximal contact to the alveolar crest (vertical distance), alveolar bone width (bone width) between adjacent implants as well as the spacing between the implants (horizontal distance), and soft‐tissue biotype were assessed in 29 interimplant areas in the upper incisor, canine, and premolar regions of 18 patients. Results: The papilla was always present when vertical distance was ≤5 mm (P ≤0.04) and frequently present when the horizontal distance was ≥4 mm (P = 0.04). The black space was smaller when the vertical distance was ≤5 mm (P ≤0.04) and when the horizontal distance was ≥4 mm (P = 0.76). Bone width and soft‐tissue biotype did not influence the incidence of gingival papilla (P ≥0.41) and black space (P ≥0.15). Conclusion: Within the limits of this study, it can be concluded that bone width and tissue biotype do not have an effect on the incidence and height of papilla between adjacent implants in esthetic areas, and the incidence was greater when vertical distance was ≤5 mm or when horizontal distance was ≥4 mm.     

Examiner variability in the assessment of dental restorations

A series of examiner variability studies were carried out in the assessment of restorations in adults made by extended duty ancillaries (E.D.A.s). While there were some differences between the two supervising team dentists these were smaller than those found when dentists who did not work in the project were examined. The use of indirect evaluation by examining bitewing radiographs for the presence of overhangs was no improvement over the clinical examination in terms of examiner agreement, and moreover only identified half of the restorations scheduled for replacement clinically. Using the results of these experiments, it is suggested that quality control should take into account examiner variability and consequently a 3-4% sample would be sufficient to maintain standards.     

A path analysis of the utilization of dental services

In this paper Andersen's model of health services utilization is applied to the use of dental visits. This analysis builds on previous work by including clinical oral health indicators rather than self-reports as measures of need by using a path model to analyze the dynamics of predisposing, enabling and need factors on dental utilization. The sample consisted of 287 volunteers who were employees of a university health center. The path analysis using ordinary least squares found that sex was the most important variable affecting use of services. Men tended to have higher number of visits due to higher need and women more visits regardless of need. A surprising result was that income had no significant effect on volume of dental visits, which contradicts much of the literature in the area. Finally, the analysis suggests that because of the nature of clinical oral health indicators cross-sectional analysis of dental service utilization may not be appropriate.     

Dental anxiety, the parental family and regularity of dental attendance

A survey was carried out among 25-yr-old inhabitants of Amsterdam in order to study the relationship between regularity of dental attendance on the one hand and dental anxiety, dental upbringing of the respondents, dental behavior of the parents, education, sex, and the interactions between these independents, on the other. The data were analyzed hierarchically with regression analysis, the logistic approach. Dental anxiety, sex, dental upbringing and the interaction between education and anxiety, in that order, were found to be of importance for the prediction of regularity of dental attendance. Two other terms, though lacking substantial standardized regression coefficients, namely education and the interaction between education and dental upbringing, are also present in the model found. The prediction of one being a regular attender is satisfactory, but the classification of the irregular attenders is disappointing. The effect is discussed of the rather large non-response and attention is given to the effect of dental upbringing in regard to coping resources in the dental situation. It has to be concluded that other factors must be included to achieve an improvement of the classification of the irregular attenders. Dental anxiety, although of importance, cannot account for an adequate differentiation between regular and irregular attenders.     

The Economic Contribution of Dental Hygienists'' Activities to Dental Practice: Review of the Literature

This article reviews studies of dental practice and essays on practice management that have included information on the economic contributions of oral hygiene services. Several studies found that these services were less remunerative than other services and recommended that dentists delegate these functions when possible. However, one study noted that performance time, as well as delegation, influenced practice productivity and also reflected the practice's concept of care. Some practice management authors indicated that poorly managed practices without an excess of patients do not benefit economically from hiring a hygienist; but for practices with good management capabilities and an excess of patients, a hygienist may be able to make a major contribution to practice productivity. The lower remuneration for hygiene services and the high percentage of practice time required to provide a complete prophylaxis once or twice a year to each patient led several authors to doubt that dentists would or could provide these services themselves. The data in the reported studies, however, are insufficient to support firm conclusions about the profitability of hygienists' activities in dental practice.     

Dental hygienists as a new element in the oral health service in Poland

A comparison of the number, employment, utilization and activities of dental hygienists in Poland between 1977 and 1982 is described. In spite of a distinct increase in number and better distribution in the country, the employment of hygienists in the oral health service is still low. However, the majority of dental hygienists are employed in the oral health service for children, working mostly as dental assistants doing fluoride prophylaxis and dental health education in addition. The percentage of operating dental hygienists is also low. The need for their preventive activity is great, as the dental caries rate in Polish children is generally high.     

Influence of X-ray beam angulation upon the radiographic image of proximal carious lesions

Abstract Twenty-two extracted human molars and premolars with a total of34 initial proximal carious lesions were radiographed in 16 different views varying the horizontal angulation of the X-ray beam in steps of 2.5° The radiographs were read simultaneously by three observers. Clinical and radiographic diagnoses were compared. When utilizing all 16 views the concordance was 95%. All proximal surfaces were scored using four scoring classes. Surfaces without radiolucencies were scored 0, and carious surfaces were scored according to the extent of the radiolucencies. Nine sound and 12 carious surfaces were assigned identical scores in all 16 views, while 22 (65%) of the carious surfaces were assigned two, three or four different scores. Deviations from a direction of the X-ray beam tangential to the proximal surface eliciting a radiographic image belonging to a different score were measured. In 71% of the cases a deviation of 7.5° or less elicited a different score. Projectional circumstances should be taken into consideration in interpreting proximal radiolucencies.     

A Symposium on the Future of Dentistry Report: Implications for the Public Sector: Dentistry''s Blueprint for the Future

This report deals with a three-year study by the American Dental Association pertaining to the Future of Dentistry. The report covers environment of dentistry, dental research, dental manpower, public and professional concerns, dental education, and dental practice. It concludes with the following recommendations: Convert public unmet need into demand for dental services. Prepare practitioners (existing and future) to be more patient/market oriented. Broaden practitioner's clinical skills and mix of services offered to the public. Influence the quality and quantity of the manpower supply. Stimulate research and development. Improve the profession's ability to favorably influence public policy.     

Dental Public Health for the 21st Century: Implications for Specialty Education and Practice

A panel of public health practitioners sponsored by the Health Resources and Services Administration met December 6–8, 1994, to examine current roles and responsibilities for dental public health workers and to recommend changes in education and training to meet challenges posed by an evolving health care system. Overall, at least the same number, if not more, dental public health personnel will be needed in the future. While some new roles were identified, the panel felt that only small numbers of personnel will be needed to fill these new roles. Not all of these roles necessarily require a dental degree. The panel felt that a need exists for more academicians for dental schools, schools of public health, dental public health residencies, and dental hygiene programs; oral epidemiologists and health services researchers; health educators; and specialists in utilization review/outcomes assessment, dental informatics, nutrition, program evaluation, and prevention. To meet these personnel needs: (1) dental public health residency programs should be structured to meet the educational needs of working public health dentists with MPH degrees through on-the-job residency programs; (2) the standards for advanced specialty education programs in dental public health should be made sufficiently flexible to include dentists who have advanced education and the requisite core public health courses; (3) flexible MPH degree programs must be available because of the rising debt of dental students and the decreased numbers of graduating dentists; (4) loan repayment should be available for dentists who have pursued public health training and are working in state or local health departments; and (5) standards for advanced education in dental public health should be developed for dental hygienists.     

Dental hygienists''influence on the patients''knowledge, motivation, self-care, and perception of change

The purpose of this study was to assess the success of the dental hygienist in the dental health education of dental patients in general dental practice. Special emphasis was laid on health education in the field of periodontics. The answers on a questionnaire of 159 dental patients who visited a dental hygienist were compared with the answers of 302 dental patients who had never visited a dental hygienist. The comparison was done by means of t-test and regression analysis on specially developed scales with regard to knowledge, motivation, self-care, and perception of change. On all scales the dental patients who visited a dental hygienist scored better. This difference remained when social demographic variables and the dentist's influence were taken into account. This indicates that the dental hygienist is successful in the behavioral aspect of her work.     

Factors influencing the local planning of dental services

Findings from a survey of 796 high school children in four districts constituting a health administrative area were examined to ascertain the factors influencing their dental disease experience, treatment received and attendance pattern. In three of the four districts, over 60% of the children were regular attenders, enjoying the benefit of less active caries than irregular attenders. However, in the remaining district, much of which consisted of depressed, inner city areas undergoing re-development, only one third were regular attenders. Several local factors, such as availability and accessibility of services, probably influenced the numbers seeking regular care, but one of the most important appeared to be the level of provision in the salaried Community Dental Service. The implications of the findings for planning improvements in local services are discussed.     

Influence of repression upon the measurement of dental anxiety

Using a non-linear, multivariate analysis, the resistance against admitting to being dentally anxious was studied. Dental anxiety was found to be repressed by a subgroup, among them more men than women, of a sample, who also repressed the feeling of low self esteem about tooth loss. Based on the results, regular and irregular dental attenders can be separated almost perfectly. The relationship with other anxiety measurements, i.e. Corah's Dental Anxiety Scale and three components discernible in Weiner's Anticipation Anxiety Level Chart, was studied.     

Some epidemiologic evidence on the etiology of caries

ABSTRACT While laboratory research has identified multiple causal factors in dental caries, few epidemiologic studies have been conducted on large representative populations that have utilized enough variables to test the current models of causation. Data from a large, representative study were available to the authors for secondary analysis. The epidemiology of dental caries as presented in the study indicates that the caries patterns in a free-living population were consistent with an infectious and nutrition model of causality. The genetic explanation, while represented in the data, was not as consistent with the findings as the infectious and nutritional explanations.     

A Symposium on the Future of Dentistry Report: Implications for the Public Sector: Does Dentistry as We Know It Have a Future?

The American Dental Association's Strategic Plan for the Future of Dentistry is primarily a self-serving document in that it attempts to protect the dentist regardless of the changing oral health needs of the population. Marketing, even if initially successful, will not increase the absolute demand for dental services, because persons on maintenance care require less care per year than sporadic users. Higher use will be balanced by less need. Excess supply creates incentive to overtreat. Today's dentist, as the dominant provider, does not have major motivation toward prevention, either by training or economic self-interest. The paper proposes that a modified hygienist, with more diagnostic training, should become the primary dental provider, with a better trained dentist as a secondary provider, combining problem solving and "surgical" skills. These changes would function best under a system combining group practice with a national health service.     

Investigation into the relationship between deviations in X-ray angulation and images of proximal overlapping on bite-wing radiographs

Abstract Eleven child skulls were radiographed through a range of 50 degrees by varying the horizontal angulation of the X-ray beam in steps of 2 or 5 degrees. The changes in the width of overlapping contact images and the ranges through which no overlap occurred were measured. A linear relationship between changes in X-ray beam angulation and overlap width was found in all the skulls. Using the data it was calculated that for each increase in overlap width of 0.1 mm, 95% of the deviations in X-ray beam angulation were less than 2.5 degrees. The findings of this study suggested that the positioning of the X-ray beam so as to cause no overlapping is at best difficult, and at worst impossible. They also emphasize the importance of using identical projections in estimating the progress of carious lesions on radiographs since small changes can cause overlaps. The use of methods that reduce the error in repositioning the X-ray beam may be important in reducing methodological errors in clinical research.     

Investigation of lay knowledge of the management of avulsed permanent incisors

Abstract The prognosis of replanted avulsed permanent incisors depends largely on prompt and appropriate emergency management. The aim of this study was to investigate lay knowledge and attitudes in this respect. Postal questionnaires were sent to all physical education teachers, school nurses and secretaries, attendants in swimming baths and leisure centres and to 220 parents of teenage children in a defined area of North West England. The overall questionnaire response rate was 86.9%. Knowledge of methods of dealing with this problem was generally inadequate in both parents and the other groups. Although 53.6% of respondents claimed to have received first aid training only 3.1% could remember dental injuries being included. There was evidence that dental health education in this field can be effective, since the highest mean knowledge score was found in the 1 1.5% of respondents who recalled receiving advice from sources such as posters, magazines and newspapers. More than 80% of the respondents stated that they would not want to replant an avulsed incisor themselves, the main reason being lack of knowledge and training. It is suggested that there is a need for potentially effective dental health education in relation to this problem.     

Caries experience of Danish children evaluated by the Child Dental Health recording system

The purpose of this report is to describe certain features of the child dental health care in Denmark. The caries picture and the caries distribution pattern in Danish children aged 2--15 years are demonstrated and some regional variations are analyzed. The study is based on epidemiologic data collected in the school year 1977--78 from about 500 000 children being treated in accordance with the Child Dental Care Act. The data collection is being effectuated annually under a child dental health recording system, and the aim and function of this system is discussed. The mean defs- and DMFS-indices are illustrated for individual age groups reflecting the natural history of dental caries. Certain trends in relation to different geographical distributions of caries and in relation to different cohorts of children from 1972 to 1977 are discussed. The analysis of the caries picture is extended by means of the distribution pattern according to caries severity zones. Finally, the use of caries epidemiologic data for planning and resource allocation purposes is illustrated and some policy implications for the development of the child dental health services in Denmark are discussed.