How long should a shortened dental arch be?

Increasing numbers of older adults are retaining teeth into old age. Many of these patients refuse to wear removable partial dentures, and have a high prevalence of dental disease and heavily restored teeth. The shortened dental arch (SDA) concept is a potentially cost-effective way of managing older, partially dentate adults. However, case selection is critical and long term preservation of a functional dentition may not be possible in certain patients. This paper highlights the critical treatment planning issues and outlines treatment strategies aimed at avoiding occlusal instability in patients with shortened dental arches. CLINICAL RELEVANCE: Appropriate application of the shortened dental arch concept will provide satisfactory oral function in the long term for partially dentate adults.     

Chronic idiopathic orofacial pain. A long‐term follow‐up study

Patients suffering facial pain that does not fit with the traditional diagnostic criteria and which does not respond to dental treatment constitute a clinical problem. These patients lack a proper diagnosis and are frequently exposed to excessive and inadequate invasive treatment. The aim of this investigation was to study the long‐term development of pain and the result of treatment in a cohort of patients suffering chronic idiopathic facial pain. The 74 patients referred to the Facial Pain Diagnostic Group at the Karolinska Institute School of Dentistry between 1981 and 1992 were invited to take part in a follow‐up study. As 16 subjects were unwilling or unable to take part in the study and 13 had died, the remaining 45 were interviewed either in accordance with a standard protocol or by filling out a questionnaire mailed to them. The interview revealed that 10 were free of orofacial pain, but only 2 were totally free of pain. Over the 9–19 years' follow‐up period the relationship between facial pain and pain in the rest of the body had changed substantially. Of 14 patients and more than 100 extractions, permanent pain relief was felt by only 3 patients. It is concluded that a diagnosis was given in only 2 cases. The distribution of the pain has changed dramatically. The low success rate of invasive treatments suggests that such therapeutic methods are to be considered contraindicated in patients suffering from idiopathic orofacial pain.     

Dental maturation in short and long facial types. Is there a difference?

OBJECTIVE: The purpose of this investigation was to study the relationship between vertical skeletal growth pattern and dental maturation in children with long or short anterior facial height. MATERIALS AND METHODS: The sample consisted of the records of 312 Dutch children (153 boys and 159 girls, aged 9-12.9 years, with a mean chronological age of 11.3 years). The subjects were selected according to their lower anterior facial height as a percentage of the total facial height. Two groups, one with long and the other with short anterior facial height, were formed for further comparison. Dental age, according to Demirjian's dental maturity score, was determined for each subject. The power of the study was 79% (2-sided test) and 87% (1-sided test). RESULTS: There was no statistically significant difference in dental age score between the two extreme groups. The subjects with short anterior facial height demonstrated a slight tendency toward more advanced dental age. CONCLUSIONS: The difference in dental age between long and short facial types is not big enough to be clinically relevant.     

Orthodontic preparation for orthognathic surgery: how long does it take and why? A retrospective study

We investigated the duration of pre-operative orthodontic treatment of patients who had combined orthodontic and orthognathic treatment and examined the variables that influenced this. Records of patients who had undergone such treatment in the past 5 years were collected (n=65) from three consultant orthodontists and one Senior Specialist Registrar/Fixed Term Training Appointment (FTTA). The number of days from placement of the first active orthodontic component to the day that final planning impressions were taken was used to calculate the duration of treatment before the patient was ready for operation. The variables investigated were: sex, age, malocclusion, extractions (excluding third molars), and the clinician. The median duration of pre-operative treatment was 17 months (range 7-47). Only the orthodontist appeared to affect this duration, but this requires further investigation as it may merely reflect variation in other factors such as compliance. We conclude that patients should be informed that the pre-operative phase may last 12-24 months.     

What are the antibiotics of choice for odontogenic infections, and how long should the treatment course last?

In the everyday practice of oral and maxillofacial surgeons, empiric antibiotics are?prescribed in the face of uncertainty. Is there a highly resistant organism present? Are the old-line antibiotics no longer effective? Should a broad-spectrum antibiotic be used just to cover all the bases in this case? The surprising result of this systematic review is that when combined with appropriate surgery, the usual antibiotics are all effective. Safety and cost become the differentiating factors in this clinical decision.     

Autotransplantation of a premolar to the maxillary anterior region in young children - how long should the donor root be? A case report

Autotransplantation of premolars to anterior region after incisor loss due to trauma is accepted as the best restoration procedure with very long follow-ups. There are two main protocols: Premolars with only two thirds of the root or premolars with complete root development. Premolars with two thirds of the root completed remain vital and show complete pulp obliteration while premolars with closed apex require root canal treatment. The problem arises when the child is very young and the root of the donor premolar is developed for only one third. This case report describes the outcome of an autotransplantation of a lower first premolar with only a third of developed root to the anterior region. The donor tooth was extracted with his follicle and placed instead of tooth No. 21. For the first month esthetics was restored with a glass-fibers ribbon attached to tooth No. 11 and composite material. After a month, the crown erupted and was reshaped to mimic an incisor with composite. Orthodontic movement was performed after 5 mo, in order to alleviate the gingival contour. The final restoration was performed after 15 mo. Follow up showed full root development with normal mobility, continuous periodontal ligament and complete pulp obliteration. A multidisciplinary approach and meticulous preparation are necessary for a positive result in autotransplantation of premolars with only a third of root development to the anterior region and this case report show that this method can be performed in very young children.     

Should we recruit trainees into the Oral and Maxillofacial Surgery pathway at the beginning of the second degree to ensure the long term viability of the specialty?

There has been a sustained decline in the number of trainees applying for entry into the Oral and Maxillofacial Surgery (OMFS) training program, which has sparked further debate on the issue of OMFS training and the future of the specialty in the United Kingdom. Here I discuss the option of recruiting the trainees into the program at the beginning of their second degree to streamline the training, and to improve the recruitment drive to ensure long term viability of the specialty     

90% of fixed partial dentures survive 5 years. How long do conventional fixed partial dentures (FPDs) survive and how frequently do complications occur?

DATA SOURCES: PubMed (1966-April 2004) provided the primary data source along with the bibliographies from identified articles and reviews. STUDY SELECTION: As there were no randomised controlled trials, English language prospective and retrospective cohort studies were selected if they had a mean follow-up of >/=5 years, included patients who were clinically examined at follow-up, reported details on suprastructures and described at least one-third of reconstructions as fixed partial dentures (FPDs). DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened articles for inclusion. Disagreements were resolved by discussion and agreement determined by kappa. Three reviewers extracted data on the survival and success of the reconstructions and on biological and technical complications. Studies deemed sufficiently similar by design were pooled using negative binomial regression with robust standard errors. Ten-year survival risks were calculated using exp(-10 x failure rate) and 10-year failure risks using 1-S(10). RESULTS: 17 retrospective and two prospective cohort studies including 1764 patients with 3548 FPDs analyzed in total. Meta-analysis was undertaken and after exclusion of one outlier a 10-year FPD survival of 92% was estimated. Only four studies provided information on FPD success - pooled complication rate was 34.1/1000 FPD years (95% CI 16-74). Exclusion of one outlier resulted in an estimated 10-year success of 81.1%. Considering biological complications, the estimated 10-years risk for caries at abutments was 9.5% (95% CI 4.6-89.9) while that for FPD loss due to caries and periodontal disease were 2.6% (95% CI 1.6-4.2) and 0.5% (95% CI 0.1-2.2), respectively. Estimated 10-year risks for technical complications were: 6.4% (95% CI 3.9-10.4) for loss of retention; 2.1% (95% CI 1.4-3.2) for loss of FPD due to abutment fracture and 3.2% (95% CI 1.5-6.5) for material fractures. CONCLUSIONS: Estimated success and survival rates for conventional FPDs largely confirm those of previous reviews. Technical complications such as loss of retention, which have not been reviewed before, resulted in a greater risk of FPD loss than did biological complications.