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Achieving profound pulpal anaesthesia in a mandibular molar diagnosed with irreversible pulpitis can be argued to be the most testing of dental anaesthetic challenges. Following discussion on the possible reasons for this occurrence in part 1, part 2 outlines the various local anaesthetic techniques that practitioners can use to overcome the acutely inflamed mandibular molar. They should then be able to apply these same principles to help anaesthetise any other tooth presenting with an acutely inflamed pulp. Techniques are discussed in detail along with key variables that have been associated with having an impact on the anaesthetic efficacy. This is to bring to light factors that can aid anaesthetic success as well as dispel common misnomers. [ABSTRACT FROM AUTHOR]

Objective To develop a national level cost model of both the direct and indirect costs of hospitalisations for impacted teeth in Australia. This model will then be used to compare a watchful monitoring strategy for impacted third molars versus prophylactic removal under GA, and calculate possible cost savings in the scenario where Australia would adopt guidelines comparable to the UK.Methods Western Australian real hospitalisation data for impacted/embedded teeth removal for 2008/2009 were extrapolated into a national, Australian-wide cost-distribution model for removal strategy. The components of a watchful monitoring strategy were calculated over a one-year, and 20-year period. Cost estimates for both strategies were then compared.Results The estimated number of hospitalisations for impacted teeth in Australia in 2008/2009 for the age group 15-34 years was 97,949. The estimated average annual direct cost was $350 million, the indirect cost was $181 million and total cost was $531 million. Individual cost of the watchful monitoring strategy over 20 years was $1,077, with an annual estimated cost of $53. The proposed guidelines would lead to an annual figure of 83,850 individuals avoiding hospitalisation and shifting to watchful monitoring strategy, and an annual reduction of costs ranging between $420-513 million.Conclusion With no evidence to support the prophylactic removal of asymptomatic wisdom teeth, a proposed watchful monitoring strategy is a more cost-effective alternative in the Australian context. [ABSTRACT FROM AUTHOR]

This article summarises recently updated guidelines produced by the Clinical Governance Directorate of the British Orthodontic Society through the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS) on the extraction of first permanent molars in children. The first permanent molar is susceptible to chronological enamel defects, molar-incisor hypomineralisation and caries, which may necessitate enforced extraction in the developing dentition. In the right circumstances, the extraction of these teeth can be followed by successful eruption of the second permanent molar and ultimately, third molar eruption to complete the molar dentition. For this reason, elective extraction of first permanent molars with a questionable long-term prognosis should be considered when planning enforced extractions. However, a number of factors can influence the decision-making process, including the necessity for a general anaesthetic to allow extraction, potential cooperation with restorative or orthodontic treatment and likely future preventative practice within the family. Moreover, the presence of any underlying malocclusion also needs to be evaluated within the context of extraction planning. The current available evidence has been evaluated and awarded a grade based upon those recommended by the Scottish Intercollegiate Guidelines Network. [ABSTRACT FROM AUTHOR]

Objectives To estimate the frequency of trigeminal nerve injuries associated with local anaesthetic administration, as experienced by UK dentists.Method A convenience sample of clinicians attending 12 study days over the UK was invited to complete an anonymised questionnaire exploring the nature of professional practice, dentists' practice demographics, experience of nerve injuries and related factors. Dental procedures related to reported trigeminal nerve injuries (TNIs) were divided into low risk, likely local anaesthetic (LA) related nerve injury, and high risk procedures, more likely to be direct nerve damage by the procedure (procedural related nerve injury). Data were analysed using Microsoft Excel and SPSS V17.Results Overall 79% of attendees completed a questionnaire (n = 415); clinicians held an average of 19 years' clinical experience. The numbers of clinicians surveyed included general dental practitioners (n = 290; 64%) and oral surgery (OS) specialists (n = 125; 36%). The estimated incidence of TNIs for the UK GDP workforce was 3,770 TNIs per year or 0.13 TNI per dentist per year. For specialists the incidence was increased to 0.39 TNI per specialist per year. Of all injuries only half were reported, mainly to indemnity organisations. LA-related injuries were most common for GDPs and third molar surgery for OS specialists. It is estimated that TNIs will occur in 1 in 3,289 high risk procedures such as third molar surgery and 1 in 14,330 for low risk procedures, such as restorative dentistry, most likely LA-related. From 25% to 29% of these dental procedures related TNIs were permanent.Conclusions Nerve-related injuries in dentistry are not uncommon. Dental practitioners should be aware of the significant disability associated with iatrogenic nerve injuries and risk factors relating to LA-related trigeminal nerve injury. Clinicians should familiarise themselves with infiltration LA-techniques that may reduce these nerve injuries and with the Care Quality Commission regulations for reporting injuries to patients as a result of treatment. [ABSTRACT FROM AUTHOR]

This paper, in discussing oro-antral fistulae and fractured tuberosities, aims to guide the dentist through the assessment and reduction of risk when removing maxillary molar teeth that are closely related to the maxillary sinus. However, complications are inevitable and the management of these will also be discussed. [ABSTRACT FROM AUTHOR]

Aim With the numbers of dental therapists involved in the delivery of dental care within the UK on the increase, and the trend towards the use of direct resin composites (composites) for the restoration of posterior teeth, this study was undertaken to describe the teaching of posterior composites in dental therapy training programmes in the UK. A secondary aim was to identify differences in techniques for posterior composites taught within these dental therapy training programmes.Methods In 2008/9, a questionnaire seeking information on the teaching of posterior composites was distributed by email to 13 centres with dental therapy training programmes in the UK. This questionnaire sought information relating to the teaching of direct posterior composites to dental therapy students, including the amounts of preclinical and clinical teaching in respect of deciduous and permanent teeth, numbers of restorations placed, contraindications to placement, and details in respect of operative techniques.Results Ten completed responses were received (response rate = 77%). In ten programmes, student dental therapists received clinical training in the placement of composite restorations in the occlusal surfaces of premolar and permanent molar teeth, and nine programmes included such training for two and three surface occlusoproximal restorations. The mean proportions of posterior restorations placed clinically by the trainee dental therapists in permanent teeth using dental amalgam and composite were 52% and 46% respectively (range: amalgam = 20–95%; composite = 5–70%).Conclusion With the exception of one programme, the teaching of posterior composites is a well established element of dental therapy training. Some variations were noted in the teaching of clinical techniques between respondent training centres. It is suggested that to ensure harmony in approaches to treatments provided by graduated therapists that training centres look to relevant consensus documents, such as those of the British Association for the Teaching of Conservative Dentistry. The findings of our study are important for the future provision of oral healthcare, given the growing evidence base in favour of minimally invasive dentistry. [ABSTRACT FROM AUTHOR]

Background There is a high level of untreated dental decay in primary teeth in Scotland. Despite evidence for the efficacy of preformed metal crowns (PMCs) for the restoration of primary molars, few are placed in general practice, possibly due to the interventive nature of the clinical procedure. There is, however, a novel way of placing PMCs involving no local anaesthesia, no caries removal and no preparation of the tooth: the Hall technique.Aim To investigate the survival of carious primary teeth treated with PMCs placed using a novel, simplified method — the Hall technique.Setting General dental practice, in Scotland.Method A retrospective analysis of practice records from one general practitioner, from 1988 to 2001. The majority of the 978 PMCs fitted on 259 children, using the Hall technique, were placed when there was clinical evidence of approximal caries into dentine. The Kaplan-Meier approach was used to analyse survival times and the Mantel-Haenszel Log rank test for comparison between tooth types.Results For all tooth types, the probability of surviving three years without being extracted or the PMC being lost, was 73.4% (95% confidence interval 70.1% to 76.4%), and for five years was 67.6% (95% confidence interval 63.3% to 71.5%). The probability of surviving without extraction alone for three years was 86.0% (95% confidence interval 83.2% to 88.4%), and for five years was 80.5% (95% confidence interval 76.5% to 83.9%).Conclusions Hall technique restorations placed on primary molars with decay clinically into dentine, by a single operator in general dental practice, have a similar success rate to some other, more conventional, restorative techniques. The technique requires further evaluation through a prospective randomised control clinical trial before its use could be generally recommended. [ABSTRACT FROM AUTHOR]

Objective To investigate the indications for and anticipated difficulty of third molar surgery between two different referral settings.Design A prospective study involving completion of a proforma pre- and post-operatively.Setting A dental teaching hospital and a specialist surgical dentistry practice in 2003.Subjects and methods Patients referred for the assessment of their third molars were recruited. Details of the clinical and radiographical assessment for each patient were recorded pre-operatively and the extent of surgery required post-operatively.Results The main indication for referral for third molar extraction was pericoronitis in both centres. A larger number of patients were assessed and treated in a shorter period of time at the surgical dentist compared with the dental hospital. The surgical dentist was accurate in his assessment of the difficulty of surgery 96% of the time compared with 66% for the dental hospital staff.Conclusions This study highlights the benefits for patients in being treated by a surgical dentist. As dental students require exposure to surgical dentistry in order to attain a level of competence, a reduction in the number of patients being referred to dental hospitals may impact upon students' ability to both assess and perform surgical procedures. This may mean that undergraduates will be less able to fulfil the recommendations of the General Dental Council.1 An outreach programme for final year dental students to surgical dentistry practices would benefit all concerned. [ABSTRACT FROM AUTHOR]

Aim To elucidate and compare patients' outcome preferences for removal and retention of mandibular third molars in Sweden and Wales.Subjects and method The subjects comprised patients referred and scheduled for removal of one or both mandibular third molars in Sweden and Wales. The multi-attribute utility (MAU) methodology was applied to study patients' preferences for outcomes of removal and retention of the mandibular third molar.Results Relative weighting of domains was similar in the two countries. 'Home and social life' received the highest relative weighting in Sweden and 'general health and wellbeing' in Wales. 'Your appearance' received the lowest relative weighting in both countries. In both Sweden and Wales operative jaw fracture was considered to be the outcome with most impact and dentigerous cyst and imbricated incisors the least impact. Outcome ranking was similar in both countries and operative outcomes were considered by patients to be more detrimental to health than retention outcomes.Conclusions This comparison showed that patients' preferences in Sweden and Wales were similar and that the outcomes of surgery were considered worse after third molar removal than retention. Patient-orientated treatment decisions were less subject to variation than clinician-orientated decisions. [ABSTRACT FROM AUTHOR]

Aims To prospectively report on the survival of resin-modified glass ionomer cement (RMGIC), photac-fil and pre-formed stainless steel crown (SSC) restorations in primary molar teeth placed over a seven-year period in a specialist paediatric dental practice under private contract of remuneration.Method All primary molar restorations placed by a specialist paediatric dentist over a seven-year period were reviewed and the outcome results recorded. Data were recorded at review visits until June 30, 2003. Data recorded included Class I restorations, Class II restorations and SSC. The Class II cavities were either mesial or distal, with or without buccal/palatal extensions. If both proximal surfaces were decayed or if after cavity preparation the resultant outline form was significantly larger than the minimal classical form, RMGIC was not used; an SSC was placed instead. Stainless steel crown preparation followed conventional guidelines. The crowns were cemented with reinforced zinc oxide and eugenol (Kalzinol). The status was recorded as satisfactory restoration, tooth exfoliated, tooth extracted for orthodontic reasons with the date of extraction, or needing replacement. If replaced then the reason for replacement was also recorded.Results A total of 544 Class I RMGICs, 962 Class II RMGICs, and 1,010 SSCs were placed. At the last review of each restoration, 98.3% of Class I, 97.3% of Class II RMGICs and 97.0% of SSCs were either satisfactory or withdrawn intact.Conclusion Under the conditions of private specialist practice-based study SSCs continued to prove very successful for the restoration of larger cavities and for pulp-treated primary molar teeth. For the smaller cavities RMGIC were also very successful. [ABSTRACT FROM AUTHOR]

The issue of prophylactic antibiotic therapy in third molar surgery is highly controversial. The current evidence questions the benefits of routine prophylactic antibiotic therapy which does not appear to overcome the risk of undesirable outcomes after third molar removal. In our opinion there is no justification for routine antibiotic prophylaxis for third molar surgery. [ABSTRACT FROM AUTHOR]

Objectives: To investigate by questionnaire, the use and selection of materials and techniques for the placement of direct restorations and the provision of endodontics and bleaching by dental practitioners in the North West of England and Scotland. Methods: A questionnaire was sent to 1,000 general dental practitioners selected at random from dentists in Scotland and the North West of England. Non-responders were sent another questionnaire after a period of 4 weeks had elapsed. Results: A total of 701 usable questionnaires were returned, giving a response rate of 70%. The most commonly used material for the restoration of Class II cavities in premolar and permanent molar teeth was amalgam (n = 605, 86%) and (n = 634, 90%) respectively. Many practitioners (n = 419, 60%) felt amalgam should continue to be used but a majority (n = 374, 66%) remained unconvinced about the merits of amalgam bonding. A minority (n = 63, 9%) of practitioners used predominantly directly placed resin composite rather than amalgam to restore Class II cavities in premolar and permanent molar teeth. Home-based vital bleaching was provided by a significant number (n = 245, 35%) of practitioners with only 18% (n = 123) providing practice-based bleaching. The most commonly used endodontic obturation technique was cold lateral condensation (n = 527, 75%) with 61% (n = 425) of respondents not using rubber dam routinely for endodontics. Conclusions: For the practitioners in this survey, amalgam was the most frequently selected direct restorative material. Few practitioners used amalgam bonding let alone direct resin composite for posterior restorations. Home-based rather than practice-based bleaching procedures were preferred, as were more traditional endodontic obturation techniques. [ABSTRACT FROM AUTHOR]

It'll never happen, it might not happen, it shouldn't happen, it happened!The risk of human error represents the greater threat to complex systems such as the delivery of healthcare rather than technical failure. Much of the legislation recently introduced in UK healthcare services, Building a Safer NHS; An Organisation with a Memory and A First Class Service evolved from a growing awareness of adverse incidents occurring in the healthcare setting. In general dental practice the absence of a trained skilled dental nurse with local knowledge of the working environment constitutes a risk to patient safety. Be this through the lack of appropriate selection, training, induction or clinical supervision of an appropriate stand in. Be it due to poor governance, audit or quality control the cost to the practitioner, practice, profession and patient can be high. To mitigate this risk a comprehensive risk management system will be needed in practice. Planning to prevent such risks requires understanding, analysing, managing and costing the risk. Success depends on robust systems for screening, contracting and training of staff within an educated team of safety orientated personnel supported by suitable frameworks for standards, resources, policies, protocols, processes and checks within a clearly identifiable chain of command. [ABSTRACT FROM AUTHOR]

Objective To determine the durability and effectiveness of a black copper cement (BCC) and a conventional glass ionomer cement (GIC) when used to restore primary molars following partial caries removal (PCR) and to compare these results with conventional cavity preparation and restoration.Design Split-mouth randomised controlled clinical trial.Setting Department of Paediatric Dentistry, Dundee Dental Hospital, Dundee, 1998-1999.Subjects Patients with previously unrestored, matched carious cavities in non-pulpally involved primary molars.Interventions Three treatment groups: (1) Partial caries removal followed by lining with BCC and restoration with GIC (PCR:BCC); (2) Partial caries removal and restoration with GIC alone (PCR:GIC), and (3) Complete caries removal and conventional restoration (CR). Restoration durability and effectiveness was assessed both clinically and radiographically over 24 months.Main outcome measures Median survival time (MST) of restorations.Results Forty-four patients (F: 31; M: 13), mean age 6.8 years (range: 3.7-9.5), had 120 restorations placed (PCR:GIC: 43; CR: 41; PCR:BCC: 36). Eighty-six molars (29 patients) (PCR:GIC: 30; CR: 29; PCR:BCC: 27) were reviewed at 24 months. The median survival times (MST) with 25% and 75% quartiles in parenthesis were as follows: PCR:BCC, MST = 24 months (6, 24); PCR:GIC, MST = 24 months (24, 24) and CR, MST = 24 months (24, 24). The MST for PCR:BCC restorations was significantly less than for PCR:GIC and CR restorations (W = 1163.5, P = 0.028 and W = 1081.0, P = 0.004 respectively).Conclusion There were no differences in the proportions of restorations lost between restoration types, although PCR:BCC restorations did have significantly more abscess/sinus formation over the 24-month study period. [ABSTRACT FROM AUTHOR]

Aim To determine the five-year success rates, site or sites of failure, prognostic indicators and lower lip morbidity associated with molar apicectomy using amalgam root-end filling.Design Multicentre, prospective study.Setting The departments of oral and maxillo-facial surgery in two district general hospitals.Method One thousand and seven molar apicectomy procedures, combined with amalgam root-end filling were expedited during the period 1974-1995. A five-year review of each operated tooth was carried out or attempted between 1979-2000.Results Of the 790 (78%) operated molars successfully reviewed at 5 years or later 451 (57%) exhibited 'complete healing' and 39 (5%) 'uncertain healing'. Three hundred (38%) were classified as 'unsatisfactory healing' (failures), and these included 12 which were assumed to be of periodontal origin. Whilst longitudinal root fracture, perforation and/or infection in the furcation, periodontal disease or a non-restorable crown accounted for treatment failure and often the need to remove teeth subsequently, the study probably pointed to the apical ends of the roots rather than the furcation as being the major sites at which 'unsatisfactory healing' occurred. Mandibular first molars attracted the highest 'complete healing' rate (60%) and mandibular second molars the lowest (46%). 'Good' root canal treatment (RCT) at the outset improved the prognosis of a root-end filling (REF) whilst the absence of RCT compromised it. Cystic change pointed to a better prognosis than apical granulomatous change as did a deep compared with a shallow 'bone cuff'. Disease at the furcation suggested a worse prognosis. Teeth which showed 'complete healing' at 1 year had a 75% probability of maintaining this outcome at 5 years. Sensory disturbance of variable duration occurred in the lower lip following 20-21% of mandibular molar procedures. In the majority of cases (79-80%) this had remitted within 3 months. A permanent deficit occurred in 8 patients (1%) where the apicectomy could definitely be incriminated as causative. Four were associated with first molar apicectomy and four with second molar apicectomy.Conclusions Molar apicectomy with amalgam root-end filling attracts an overall 'complete healing' rate at 5 years of 57%, the results being best with mandibular first molars and worst with mandibular second molars. The prognosis is also better where there is 'good' initial orthograde root filling, an associated radicular cyst as compared with granulomatous change and where the buccal sulcus is deep rather than shallow. It is worse when orthograde root filling is absent and when there is disease in the furcation. 'Complete healing' at 1 year can be expected to be maintained at 5 years in 75% of cases. The commonest site of subsequent periradicular rarefaction seems to be 'apical' whilst failure at the furcation is probably comparatively rare. There is a threefold increase in the occurrence of permanent lower lip sensory impairment following second molar surgery in comparison with first molar surgery, the overall incidence being 1%. [ABSTRACT FROM AUTHOR]

ObjectiveThe lag between publication of evidence for clinical practice and implementation by clinicians may be decades. Research using psychological models demonstrates that changing intention is very important in changing behaviour. This study examined an intervention (rehearsing alternative actions) to change dentists' intention to implement evidence-based practice (EBP) for third molar (TM) management.DesignRandomised controlled trial / postal.SettingPrimary care.Subjects and methodsDentists were randomly selected from the Scottish Dental Practice Board Register, then randomly allocated to intervention or control groups, and sent a questionnaire. The intervention group listed management alternatives to TM extraction prior to their TM extraction intention, and the control group did not. Based on psychological models for reducing a behaviour's frequency (EBP is weighted against TM extraction), prior listing of alternatives should decrease extraction intention.Main outcome measureIntention to extract TMs.ResultsA total of 99 dentists - 70 Males, 29 Females; mean age = 41.42 years (SD = 8.62) participated in the study. The intervention significantly influenced intention to extract TMs, as desired. Despite similar background and knowledge of management alternatives, participants in the intervention group had significantly lower intention to extract: control group mean (SD) = 0.39 (1.99); intervention group mean (SD) = -0.78 (1.89); mean difference (SE) = 1.17 (0.42); 95% confidence interval for the difference = 0.34 to 1.99.ConclusionResults suggest this intervention, which successfully influenced a proximal predictor of behaviour pertinent to dental EBP, may result in improved EBP in a service-level trial. Basing implementation interventions and trial methodology on psychological models may effectively bridge the gap between clinical guidelines and practice. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the clinical performance of a compomer material (Dyract®) in comparison with dental amalgam (Contour®) for management of proximal caries in primary molars in young children. Setting General dental practice, and a dental hospital paediatric clinic. Method This was a prospective study. A split mouth design was used with identical pairs of minimal Class II cavities, of matched tooth type in the same dental arch, usually diagnosed with the use of bitewing radiographs. Seventy-eight pairs of restorations were completed of which 60 pairs were available for evaluation after 24 months. Results Comparable retention rates were observed for both Dyract and amalgam. The retention rates were high for both materials, with only four amalgam and two Dyract restorations failing over 24 months. Significantly better marginal integrity (P< 0.05) was observed for Dyract compared with amalgam with no significant differences between the two materials for recurrent caries, wear or surface texture. Conclusions Dyract seemed to be a suitable alternative to amalgam for proximal restorations in primary molars of young children for use in general dental practice. [ABSTRACT FROM AUTHOR]

Objective: To assess the reliability of the analysis stage of quantitative light-induced fluorescence (QLF). The QLF analysis involves subjective input from the user and this study examines the influence of this on the reproducibility of the QLF data.Method: QLF images were taken of 20 human molar teeth that had been previously subjected to a demineralizing solution (phosphoric acid 37%) to create artificial white spot lesions on their buccal surfaces. Following examination of the images, 16 were chosen to represent a range of lesion size and severity. Three copies were made of the images and each was allocated a different filename. 10 examiners in three centres were asked to analyse each of the 16 images on three occasions, with at least seven days between each attempt. Simple instructions describing the analysis procedure were supplied and examiners were asked to adhere to these directions. Examiners were asked to rate each of the 16 teeth on their first attempt both quantitatively (5 point scale) and qualitatively in terms of difficulty of analysis. Data reported were the delta Q at 5% threshold for each tooth on each of three attempts.Results: Using ANOVA and paired t-tests to detect statistical differences, the three attempts of each examiner were used to determine intra-examiner reliability. Only one examiner (a novice at the technique) demonstrated differences between all three attempts and two demonstrated difference between one attempt. When the mean scores were compared to determine the inter-examiner reliability, only one examiner's results were statistically different when compared with two others.Conclusion: This study has demonstrated that the analysis stage of QLF is reliable between examiners and within multiple attempts by the same examiner, when analysing in vitro lesions. Novices at the technique should be trained before analysing experimental data. [ABSTRACT FROM AUTHOR]

Aim: Historically the difficulty of third molar surgery has been judged using radiologically assessed dental factors specifically tooth morphology and position. This study investigated additional factors that have a bearing on the difficulty of extraction.Study Design: A prospective study undertaken by three clinical assistant grade surgeons who removed 354 single mandibular third molar teeth under day case anaesthesia over the 4-year period (1994-1998).Method: Data relating to patient, dental and surgical variables were collected contemporaneously as the patients were treated. The difficulty of extraction was estimated by the surgeons pre-operatively using dental radiographic features and compared by the same surgeon within the actual surgical difficulty encountered at surgery. Operation time strongly related to both pre and post treatment assessments of difficulty and proved to be the best measure of surgical difficulty.Results: Univariate analysis identified increased patient age, ethnic background, male gender, increased weight, bone impaction, horizontal angulation, depth of application, unfavourable root formation, proximity to inferior alveolar canal and surgeon as factors increasing operative time. Multivariate analysis showed that increasing age (P = 0.014), patient weight (P = 0.024), ethnicity (P = 0.019), application depth (P = 0.001), bone impaction (p=0.008) and unfavourable root formation (P = 0.009) were independent predictors for difficulty of extraction.Conclusions: Half of the six independent factors that predicted surgical difficulty of third molar extraction were patient variables. [ABSTRACT FROM AUTHOR]

Objective: To compare the accuracy and repeatability of three diagnostic systems (DIAGNOdent, visual and radiographic) for occlusal caries diagnosis in primary molars.Design: Two examiner, in vitro, blinded study. Histological gold standard.Materials and Methods: 58 occlusal surfaces of primary molars examined in turn by two examiners using each of three diagnostic systems (DIAGNOdent, visual and radiographic). These results were compared with a histological gold standard. Sensitivity and specificity were calculated for each diagnostic system at a range of thresholds. Inter- and intra- examiner repeatability were calculated for each diagnostic system using the kappa statistic.Main Outcome Measures: Sensitivity, specificity, inter and intra examiner repeatability for each diagnostic system.Results: The highest sensitivity values were provided by DIAGNOdent (0.77 and 0.80, examiners 1 and 2 respectively) however this was offset by a lower specificity (0.82 and 0.85) than all other systems with the exception of examiner 1 at V1 visual threshold. The DIAGNOdent gave the highest values of kappa for intra- and inter-examiner repeatability with the exception of intra-examiner repeatability for examiner 2 where visual diagnosis had the highest value of kappa.Conclusion: The DIAGNOdent was the most accurate system tested for the detection of occlusal dentine caries in primary molars. The performance of the DIAGNOdent systems was not statistically significantly better than that achieved using visual examination for non-cavitated teeth (V1 and V2 threshold). DIAGNOdent may prove useful as a predictive clinical tool, however with appropriate training visual examination may offer similar results without the need for additional equipment. [ABSTRACT FROM AUTHOR]

Objective: Aim of the present study was to evaluate the clinical suitability of the condensable metal-reinforced glass ionomer cement Hi-Dense in classes I and II cavities of primary molars.Methods: Seventeen children received a total of fifty four Hi-Dense fillings (nineteen class I and thirty five class II). The restorations were clinically assessed at baseline, after one and after two years of clinical service according to modified USPHS codes and criteria. The restorations were replicated in each recall and representative samples were qualitatively analysed under a SEM.Results: Over the observation period of two years, five restorations failed due to total retention loss, two fillings needed replacement because of persisting hypersensitivity, one filling was lost because of an unsuccessful endodontic treatment, and four restorations remained intact until natural exfoliation (Two year survival rate: 92% for Class I and 66% for Class II). The SEM analysis of surfaces and marginal areas exhibited an inferior adhesive performance primarily in proximal areas, whereas a negative step formation due to wear was frequently observed in occlusal parts.Conclusions: The results clearly indicate that the condensable, metal-reinforced GIC Hi-Dense reveals no enhanced performance and lifetime expectancy for class II restorations in primary molars when compared to other non-resin-modified GICs. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that Swedish dentists schedule more mandibular third molars for prophylactic removal compared with UK dentists and oral surgeons.Design: Clinical and radiographic information relating to a stratified sample of 36 disease-free mandibular third molars (equal distribution of males and females, patients' age, angular position and degree of impaction) was presented to 26 general dental practitioners (GDPs) and 10 oral surgeons in Sweden and 18 GDPs and 10 oral surgeons in Wales who were asked to decide whether or not the third molars should be removed.Results: There was no evidence of any difference in mean number of molars scheduled for removal by the GDPs, but the Swedish oral surgeons scheduled significantly more third molars for removal than oral surgeons in Wales.Conclusion: The less interventionist approach among oral surgeons in the UK may reflect the development and application of authoritative guidelines in the UK and an extensive debate concerning appropriateness of prophylactic removal there. [ABSTRACT FROM AUTHOR]

Objectives: To undertake a clinical trial comparing the efficiency of a compomer restoration with a glass ionomer restoration in the management of caries in primary molar teeth.Design: Subjects were admitted to the trial if they required at least one pair of restorations in primary molar teeth.Setting: Department of Child Dental Health, Newcastle Dental Hospital and School.Subject: Twenty nine children, aged 4-9 years, had 56 pairs of restorations placed between January 1995 and November 1997.Method: The durability of the restorations was assessed during a 42-month follow-up period using modified United States Public Health Service criteria. Survival analysis and the McNemar paired test were used to compare the performance of the two restorative materials.Results: The compomer restorations had a higher mean survival time (42 months, SE 1.40) compared with 37 months (SE 1.90) for the glass ionomer restorations and this was significant at the 5% level. The compomer also performed significantly better in terms of anatomical form, marginal integrity, cavo surface discoloration and maintenance of interproximal contact.Conclusions: The present trial demonstrated that Dyract compomer performed significantly better than Chemfil Superior a glass ionomer cement for all modified United States Public Health Service criteria over a period of 42 months. [ABSTRACT FROM AUTHOR]

In this section, we address how to customise the upper rim (aesthetic base control) to create the form of the replacement complete upper denture. The use of the facebow is also described. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical and radiological outcomes following two different, single visit vital pulp therapy techniques, in cariously exposed primary molar teeth.Setting: A paediatric dental clinic within the Dental Hospital, Newcastle upon Tyne, UK.Subjects: Fifty two child patients were sequentially enrolled in the clinical investigation, 26 males and 26 females with an age range of 3.3-12.5 years. Primary molar teeth requiring vital pulp therapy were randomly allocated to either the formocresol group (F) or the calcium hydroxide group (C). The total number of teeth treated was 84.Design: Recruitment was on the basis of strict inclusion criteria. Coronal pulp amputation was prescribed only in teeth with vital, cariously exposed pulp tissue. Treatment was undertaken between October 1994 and December 1996. All cases were reviewed using predefined clinical and radiological criteria. The statistical tests used were logistic regression of a triple nested data structure, chi-squared analysis of equality of treatment and probability of success with relation to subject age.Results: Eighty-four cariously exposed primary molars required vital pulp therapy. Forty six (55%) teeth were included in the F group and 38 (45%) allocated to the C group. Five teeth were lost to follow-up, leaving 79 teeth: forty four (56%) in group F and 35 (44%) in group C. Eighty four percent (37/44) of teeth treated with formocresol and 77 percent (27/35) treated with calcium hydroxide were classed as clinically and radiographically successful at the cut-off date, December 1997, after a mean clinical review of 22.5 months (range 6.1-38.5 months) and a mean radiographic review of 18.9 months (range 1.3-36.9 months).Conclusion: This investigation confirms the clinical efficacy of a one-fifth dilution of Buckley's Formocresol as an agent in pulp treatment of cariously exposed, vital primary molar teeth. However, calcium hydroxide in its pure, powder form is a clinically acceptable alternative when combined with strict selection criteria for this method of restorative care. There was a statistically insignificant difference in successful clinical and radiological outcome between the two treatment groups. Success was unrelated to the duration of time taken to achieve haemostasis and the presence or absence of bleeding after placement of the medicament. [ABSTRACT FROM AUTHOR]

Tooth surface loss is an increasing problem in younger individuals. Preventive strategies are essential while adhesive dentistry should be used whenever possible if restoration is necessary. [ABSTRACT FROM AUTHOR]

An infraerupted tooth is a tooth that has failed to erupt to be in line with adjacent teeth in the vertical plane of occlusion. The general dentist may be faced with this predicament which requires careful attention and thoughtful consideration in terms of long-term patient goals. It is important to diagnose infraerupted teeth and treat them in a timely fashion to help prevent unwelcome sequelae. Important interdisciplinary communication is vital between the dentist and the orthodontist to ensure that precious space and time are not lost. Here we present a review article of complications and considerations that must be taken into account when faced with a patient who has an infraerupted tooth. [ABSTRACT FROM AUTHOR]

Tooth transplantation may be the earliest form of transplantation, possibly carried out by the ancient Egyptians. The surgical technique has changed very little since its documentation in 1954 by M. L. Hale. Autogenous transplantation is the movement of one tooth from one location in the mouth to another in the same individual. Occasionally it is used to reposition teeth that have developed into an incorrect position. This is occasionally carried out for maxillary canines, but lower molar teeth are also considered, particularly when replacing a lower first permanent molar with a lower third molar. This case report focuses on the autotransplantation of a maxillary canine taken from the palate and surgically repositioned into the edentulous canine space. By using this technique a prosthetic method such as a dental implant or bridge was avoided. [ABSTRACT FROM AUTHOR]

Aim To ascertain general dental practitioners' views on the use of stainless steel (pre-formed metal) crowns to restore carious primary molars.Method Ninety-three general dental practitioners were selected at random from those practising in Lancashire, Cheshire and Greater Manchester in 2003 and interviewed separately about the clinical care they provide to the primary dentition. Before the interview participants recorded the care they would provide for a case scenario, describing a child with a carious lesion that the British Society of Paediatric Dentistry (BSPD) guidelines indicate should be treated with a stainless steel crown.Results In answering the case scenario only six (7%) of the dentists reported that they would fit a stainless steel crown. Of the 93 dentists interviewed 71% knew of the BSPD guidelines, but only 18% had ever fitted a stainless steel crown in general practice. Reasons given for not using stainless steel crowns were they are inappropriate for many children, time consuming to fit, difficult to manipulate, expensive, and ugly.Conclusion The BSPD guidelines on the use of stainless steel crowns do not reflect the views of the majority of general dental practitioners who consider these crowns unsuitable for most children and an impractical restorative technique in busy daily practice. [ABSTRACT FROM AUTHOR]

Objective This study was undertaken in order to evaluate the effects of local haemostasis on the facial swelling induced in patients undergoing surgical removal of impacted mandibular third molar teeth.Design A prospective randomised cross-over study.Setting Department of Oral and Maxillofacial Surgery, Samsun, Turkey, 2002.Materials and methods Twenty-five healthy patients who were having bilaterally symmetric, impacted third molar extraction were studied. The teeth were removed in two separate operations by two surgeons who had equal academic degrees. The patients were assigned to test and control groups by random selection. One side served as control and on the other local haemostasis was achieved by a haemostatic agent (oxidised regenerated cellulose). This was placed into the socket following gauze packing for 3 minutes (test). The operating time therefore significantly increased in the test group. Data was collected regarding the operating time, mouth opening and facial swelling.Results There were no statistically significant differences between the test and control groups for the mean values of the facial swelling and mouth opening at day 1 and 3 post-operatively (P > 0.05). Operating time was statistically longer for the test group than the control (P < 0.001).Conclusion This study has shown that establishment of local haemostasis after removal of impacted mandibular third molars is not so effective in preventing facial swelling. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect on the bond strength of modern dentine bonding agents to etched enamel of surface contamination with water.Design: Fifteen bond strength measurements were made for bonds prepared to both moist and dry etched enamel for each of three test and one control materials.Results: For two materials (Scotchbond 1 and Prime and Bond 2.1) the bond strength was not affected by the presence of water on the etched enamel surface. A mean bond strength in excess of 25 MPa was achieved for both materials under all conditions. One material (Optibond Solo) showed a 30% increase in bond strength when bonds were formed under wet condition (21.10 MPa compared with 15.35 MPa). The bond strength of the control material, a conventional unfilled bonding resin, decreased markedly with aqueous contamination (9.14 MPa compared with 26.75 MPa).Conclusion: Etched enamel should be rehydrated routinely prior to bonding composite resin to its surface using a water displacing dentine bonding system. [ABSTRACT FROM AUTHOR]

Aim The risk factors associated with inferior alveolar nerve damage during third molar surgery were investigated.Material and methods Surgeries performed during a period of 50 months by a single expert surgeon were reviewed. Only those surgeries that met the selected inclusion criteria were considered for this study. The following tests were applied for the statistical analysis: the Kolmogorov-Smirnov test, the principal components analysis, the Mann-Whitney U test, the two-tailed exact Fisher test and the Bonferroni sequential correction.Results The surgical difficulty index, multi-rooted third molars and changes in the inferior alveolar nerve running in relation to the tooth roots are predictors of nerve damage.Conclusions Computed tomography is mandatory when the nerve is superimposed on the tooth root on the ortopantomography.Scientific rationale for study Lower third molar extraction is one of the most common procedures in oral and maxillofacial surgery, and it is burdened by the risk of inferior alveolar nerve damage. Understanding which factors are able to predict this complication is therefore essential in correctly programming surgery.Principal findings Surgical difficulty index, multi-rooted third molars and changes in inferior alveolar nerve running in relation to the tooth roots are predictors of nerve damage.Practical implications If, on the orthopantomography, the nerve is superimposed on the tooth root, a computed tomography is mandatory to define all of these variables. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article regarding the optimum management of mandibular third molars (MTM) is presented.

Background The aim was to obtain stakeholders' views on the former London Deanery's joint educational service development initiative to train dentists with a special interest (DwSIs) in endodontics in conjunction with the National Health Services (NHS) and examine the models of care provided.Methods A convergent parallel mixed methods design including audit of four different models of care, semi-structured interviews of a range of key stakeholders (including the DwSI trainees) and questionnaire surveys of patients and primary care dentists.Results Eight dentists treated over 1,600 endodontic cases of moderate complexity over a two year training period. A retrospective audit of four schemes suggested that first molars were the most commonly treated tooth (57%; n = 341). Patients who received care in the latter stages of the initiative were 'satisfied' or 'very satisfied' with the service (89%; n = 98). Most dental practitioners agreed that having access to such services would support the care of their patients (89%; n = 215) with 88%; (n = 214) supporting the view that DwSIs should accept referrals from outside of their practice.Conclusion This initiative, developed to provide endodontic care of medium complexity in a primary care setting, received wide support from stakeholders including patients and primary care dentists. The implications for care pathways, commissioning and further research are discussed. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the medical conditions of a 61-year-old male patient with advanced periodontal pocketing in the upper right second permanent molar.

A letter to the editor is presented in response to the article "Iatrogenic mandibular fractures following removal of impacted third molars: an analysis of 130 cases" in the 2012 issue.

This article provides a summary of the efficacy, and relative efficacy, of 38 different drugs or drug combinations tested in standard postoperative pain trials. It will help clinicians and patients make informed choices about analgesia based on pain relief, duration of action, and adverse events, which can then be put into context for the individual patient, depending on local availability. This article highlights the fact that no single drug is effective in all patients - even the best drugs fail to provide good levels of pain relief in at least 30%. These patients should try a different analgesic. [ABSTRACT FROM AUTHOR]

We describe a case of swelling in the right submandibular and sublingual space caused by displacement of a lower second molar root in the submandibular space. This displacement was not recognised at the time of extraction. The techniques used to minimise the risk of accidental displacement of teeth and roots, during extraction are discussed. The importance of recognising this complication and methods of retrieval are highlighted. [ABSTRACT FROM AUTHOR]

Objectives To compare the success rate of calcium hydroxide (Ca(OH)2) pulpotomies in primary molars restored with a stainless steel crown (SSC) to that of teeth restored with amalgam and to evaluate the role of restoration failure in treatment outcome.Study design Pulpotomies were performed in 154 primary molars. Teeth were grouped according to pulpal exposure type as either mechanically or cariously exposed, with cariously exposed teeth further divided according to size of exposure site (pinpoint or larger than pinpoint). Seventy teeth were restored with amalgam and 84 with a SSC. Teeth were followed up for 12 months.Results Pulpotomy success rates were 79.9% for teeth restored with a SSC and 60% for those restored with amalgam. The difference between these rates was statistically significant (p <0.01). Restoration failure rates were 14.3% for amalgams and 2.4% for SSCs. The difference between these rates was also statistically significant (p <0.01). Among the 12 failed restorations, treatment was found to be successful in five cases (41.7%) and unsuccessful in seven cases (58.3%). This difference was not statistically significant (p >0.05).Conclusions The pulpotomy success rate for teeth restored with a SSC was higher than for those restored with amalgam. Restoration failure did not appear to have an effect on treatment prognosis. [ABSTRACT FROM AUTHOR]

Objective This study compared the clinical and radiographic effectiveness of mineral trioxide aggregate (MTA) and Portland cement (PC) as pulp dressing agents in carious primary teeth.Methodology Thirty carious primary mandibular molars of children aged 5-9 years old were randomly assigned to MTA or PC groups, and treated by a conventional pulpotomy technique. The teeth were restored with resin modified glass ionomer cement. Clinical and radiographic successes and failures were recorded at 6, 12, 18 and 24-month follow-up.Results All pulpotomised teeth were clinically and radiographically successful at all follow-up appointments. Six out of 15 teeth in the PC group and five out of 14 teeth in the MTA group exfoliated throughout the follow-up period. No statistically significant difference regarding dentine bridge formation was found between both groups throughout the follow-up period. As far as pulp canal obliteration is concerned, a statistically significant difference was detected at 6-month follow-up (p <0.05), since the beginning of mineralised material deposition could be radiographically detected in 100% and 57.14% of the teeth treated with PC and MTA, respectively.Conclusions PC may serve as an effective and less expensive MTA substitute in primary molar pulpotomies. Further studies and longer follow-up assessments are needed. [ABSTRACT FROM AUTHOR]

Introduction Distal caries in lower second molars has been associated with mesioangular third molars. Caries detection and restoration can be difficult. If caries progresses, root canal treatment or extraction of the second molar can be necessary.Aims To identify the prevalence of caries in lower third molars and the distal aspect of corresponding lower second molars in patients referred for lower third molar assessment.Methods Analysis of OPG X-rays for 420 consecutive patients (776 third molars) referred to three maxillofacial centres over a five month period.Results Thirty-four percent of third molars were mesioangular. There was radiographic evidence of distal second molar caries in 42% of these. When unerupted mesioangular third molars were excluded this increased to 54%. There was no difference in age or dental health of these patients compared to the whole group. There was no angulation of the mesioangular third molar for which distal caries in the second molar was more likely.Conclusion Distal caries in lower second molars related to a mesioangular third molar is a common finding in oral and maxillofacial patients in secondary care, especially if the third molar is fully or partially erupted. If such a third molar is left in situ, close monitoring and regular bitewing radiographs are recommended. [ABSTRACT FROM AUTHOR]

Introduction A prospective cohort study was undertaken to describe the incidence of dental caries, as recorded by GDPs, in the primary molar teeth of children aged approximately 3-6 years attending general dental practices in the North West of England.Method Detailed dental records of children aged 3-6 years attending 50 general dental practices were assembled over a period of three years. Data from these records were analysed to estimate caries incidence rates at the subject and tooth level.Results The study population consisted of 739 children aged between 2.8 and 6.2 years; 620 children (84%) were caries free at recruitment. The incidence of developing a first carious (into dentine) lesion in caries free children increased with age. At age four the incidence of the first carious lesion was 9.5 per 100 person years and at age seven it was 19.6 per 100 person years. The tooth specific incidence of caries was found to be approximately 5-6 times greater in children with caries at recruitment than in caries free children. A sub-analysis on 566 children that were followed for more than two years revealed that of 486 children caries free at recruitment 132 (27%) developed caries in their primary molar teeth. By contrast, of the 80 children that had caries in their molar teeth at recruitment, one had eight carious molar teeth and 57 (72%) of the remaining 79 developed new cavities during the follow up period.Conclusions Caries incidence increases with age. There is a 5-6 times difference in the incidence of new cavities between caries free children and children with caries, irrespective of when a child developed the disease. As a consequence children with the disease and without the disease should be considered as two different populations; this has implications for care strategies applied to each population. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate and compare the reasons for and pattern of extraction of first permanent molars (FPMs) in three UK dental hospitals.DesignProspective multicentre study.SettingHospital.SubjectsThree hundred children attending Manchester Dental Hospital, Liverpool Dental Hospital and Charles Clifford Dental Hospital (Sheffield) who required extraction of at least one FPM.ResultThe mean age in months was 129 (SD 22.7), 139 (SD 29.4), and 133 (SD 26.8) for Manchester, Liverpool and Sheffield respectively. Forty-five percent and 48% of children had four FPMs extracted at Manchester and Sheffield respectively, compared to 25% in Liverpool. The main reason for extraction was caries with poor prognosis (70%); molar incisor hypomineralisation was the reason for extraction in 11% of cases. General anaesthesia was the main anaesthetic method used in 77%, 55%, and 47% of cases in Manchester, Liverpool and Sheffield respectively. Sixty-eight percent of cases had not received previous treatment for the FPMs and 5% had fissure sealants detected. Forty percent of children had had previous extractions.ConclusionThe children who are attending the hospitals for extraction of FPMs tend to be older than the recommended age for achieving spontaneous space closure. This study highlights the need for extensive prevention programs targeted at those children with high caries risk. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to Peter Crawford's article commenting on the research "Preformed metal crowns for carious primary molars".

This case report illustrates an example of when an extraoral approach was successfully used to remove a lower left third molar. [ABSTRACT FROM AUTHOR]

Aberrant tooth development following facial fractures is unusual. It is commonly reported that tooth buds involved in the line of a mandibular fracture will continue to develop normally and erupt sequentially. Few cases have been cited regarding developing teeth in the line of maxillary fractures. In the case reported, the normal growth and position of a maxillary third molar can be seen to be retarded at the position of a maxillary fracture, sustained by a child in the mixed dentition phase of dental development. [ABSTRACT FROM AUTHOR]

Subcutaneous and mediastinal emphysema is a rare complication of dental extraction and the use of air turbines has often been implicated. We describe a case which highlights a serious complication of the use of an air rotor for the removal of a right second mandibular molar. [ABSTRACT FROM AUTHOR]

The article presents the dental abstract "Remaining root dentin thickness in mesiobuccal canals of maxillary first molars after attempted removal of broken instrument fragments" by Y. Gao, Y. Shen, and others and published in a 2015 issue of "Australian Endodontic Journal"

Early carious lesions in primary molar teeth treated by infiltration (Icon®) and fluoride varnish, progressed less than those treated by fluoride varnish only (p = 0.021). [ABSTRACT FROM AUTHOR]

Corrections to articles "Pre- and postoperative management techniques. Before and after. Part 1: medical morbidities" and "Pre- and postoperative management techniques. Before and after. Part 2: the removal of third molars" in the Volume 218, 2015 issue are presented.