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Objective To evaluate the outcomes of Secondary Alveolar Bone Grafting (SABG) in patients treated either in daycare or with multiple day hospitalization (MDH) in relation to costs and complication rates. Design Retrospective comparative cohort study. Setting The data was collected from two settings: Postoperative daycare or MDH after oral cleft surgery in an Academic Medical Center in The Netherlands. Patients Data of 137 patients with unilateral Cleft lip, alveolus, and palate (CLAP) treated between 2006-2018 were evaluated. Registered clinical variables: age, gender, cleft subtype, bone donor site, type of hospitalization, length of stay, additional surgery, complications, surgeons, and costs. Interventions Closure of the alveolar cleft with/without closure of the anterior palate. Main outcome measures Univariate analyses. Results Of the 137 patients, 46.7% were treated in MDH, and 53.3% in daycare. Total costs for daycare were significantly lower ( P Conclusions Daycare after alveolar cleft surgery is about as safe as MDH, but significantly cheaper.

Purpose To assess if Dutch children with Autism Spectrum Disorder (ASD) regularly visit a dentist and to evaluate parent’s satisfaction on the care provided. Methods Parents of ASD children (2–18 years) were invited to fill out a survey. The survey consisted of questions regarding ASD severity, frequency of dental visits, history of dental pain, type of dental practice and parents’ satisfaction. Results were analysed using Chi square and Mann–Whitney U tests (α = 5%). Results Of the 246 returned questionnaires, 19 were excluded (incomplete or unconfirmed ASD diagnosis). All children visited a dentist at least once and 5% of them had their last visit more than 12 months ago. According to parents, 15% of the children did not receive the needed care when they had toothache and 21% of the parents were unsatisfied with the current dental care provided. No difference was found between satisfied and unsatisfied parents in type of dental practice visited (p > 0.05). The children of unsatisfied parents reported more often pain during the last year (p = 0.013) and had a more severe type of ASD (p = 0.016). Conclusions The majority of Dutch ASD children investigated regularly visit a dentist and 21% of the parents is unsatisfied with the dental care provided.

Background The aim of this study was to compare the trabecular bone microstructures of anterior and posterior edentulous regions of human mandible using cone-beam computed tomography (CBCT) and micro computed tomography (µCT). Methods Twenty volumes of interests consisting of six anterior and fourteen posterior edentulous regions were obtained from human mandibular cadavers. A CBCT system with a resolution of 80 µm (3D Accuitomo 170, J. Morita, Kyoto, Japan) and a µCT system with a resolution of 35 µm (SkyScan 1173, Kontich, Belgium) were used to scan the mandibles. Three structural parameters namely, trabecular number (Tb.N), trabecular thickness (Tb.Th), and trabecular separation (Tb.Sp) were analysed using CTAn software (v 1.11, SkyScan, Kontich, Belgium). For each system, the measurements obtained from anterior and posterior regions were tested using independent sample t-test. Subsequently, all measurements between systems were tested using paired t-test. Results In CBCT, all parameters of the anterior and posterior mandible showed no significant differences (p > 0.05). However, µCT showed a significant different of Tb.Th (p = 0.023) between anterior and posterior region. Regardless of regions, the measurements obtained using both imaging systems were significantly different (p ≤ 0.021) for Tb.Th and Tb.N. Conclusions The current study demonstrated that only the variation of Tb.Th between anterior and posterior edentulous region of mandible can be detected using µCT. In addition, CBCT is less feasible than µCT in assessing trabecular bone microstructures at both regions.

Objectives: To investigate which opinions among dentists are associated with level of technology use, when characteristics of the dentist and dental practice, as well as motivating work aspects are taken into account. Methods: A total of 1000 general dental practitioners in the Netherlands received a questionnaire on digital technologies they use, opinions on using technologies and related motivating work aspects. Questions were derived from expert interviews, the Dentists’ Experienced Job Resources Scale and literature on technology implementation. Technology use was measured as the number of technologies used, and divided into three technology user groups: low (using 0-4 technologies, mostly administrative and radiographic technologies), intermediate (using 5-7, more varied technologies) and high technology users (using 8-12, including more innovative diagnostic technologies). Opinions on technology use and motivating work aspects were analysed using principal components analysis (PCA) and exploratory factor analysis. Scores on all components and factors were calculated for each respondent by computing the mean of all valid responses on the underlying items. Differences in these scale scores on opinions among the technology user groups were assessed using one-way analysis of variance and Kruskal–Wallis tests. A multiple linear regression analysis assessed the association of scale scores about opinions on technology use with the sum of technologies used, taking into account motivating work aspects and characteristics of the dentist and dental practice. Results: The response rate was 31%. Dentists who were high technology users perceived technologies as yielding more improvements in quality of care, adding more value to the dental practice and being easier to use, than low technology users. High technology users thought technologies added more value to their work and they reported higher skills and resources. They also focused more on technologies and thought these are more ready to use than low technology users. High technology users derived more motivation from “Immediate results” and “Craftsmanship” than low technology users. Personal and practice characteristics, motivating work aspects, and the opinion scales “Focus” and “Added value to dentist” explained 50% of the variance in the number of technologies a dentist uses. Conclusion: Opinions on digital technologies among dentists and motivating work aspects vary with level of technology use. Being more focused on technologies and perceiving a higher added value from using them are associated with using more digital dental technologies, when taking into account motivating work aspects and characteristics of the dentist and dental practice.

Purpose: The aim of this 1-year randomized trial was to evaluate and compare the clinical and radiographic performance of four immediately loaded mini dental implants (MDIs) and two immediately loaded standard-sized tissue-level (STL) implants, placed in the interforaminal region of the mandible and used to retain mandibular overdentures (IODs) in completely edentulous patients. Materials and Methods: A total of 50 completely edentulous patients wearing conventional maxillary dentures and complaining about insufficient retention of their mandibular dentures were divided into two groups; 25 patients received four MDIs and 25 patients received two STL implants. The marginal bone loss (MBL) at the mesial and distal sides of each implant was assessed by means of standardized intraoral radiographs after a period of 1 year. Implant success and survival rates were also calculated. Results: Immediate loading was possible for all patients in the first group. In the second group, an immediate loading protocol could not be applied for 10 patients. These patients were treated with a delayed loading protocol. A mean MBL of 0.42 ± 0.56 mm for the MDIs and 0.54 ± 0.49 mm for the immediately loaded STL implants was recorded at the end of the evaluation period. There was no statistically significant difference between the MDIs and the immediately loaded STL implants. Two MDIs failed, resulting in a survival rate of 98%. The success rate was 91%. For the immediately loaded conventional implants, the survival rate was 100% and the success rate 96.7% after 1 year of function. However, in 10 patients, the immediate loading protocol could not be followed. Conclusion: Considering the limitations of this short-term clinical study, immediate loading of four unsplinted MDIs or two splinted STL implants to retain mandibular overdentures seems to be a feasible treatment option. The marginal bone level changes around the MDIs were well within the clinically acceptable range.

There is little evidence of the effect of implants restored with fixed partial dentures on oral health-related quality of life (OHRQoL) in partially edentulous Kennedy class II and III patients. The aim of this study was to determine the change in OHRQoL in Kennedy classification II and III patients treated with a two-implant-supported fixed dental prosthesis (FDP). Kennedy class II and III patients received dental implants and an FDP. Oral health-related quality of life was measured by administration of the Oral Health Impact Profile-14 (OHIP-14NL) questionnaire at intake (T1), 2 weeks after surgery (T2) and after 1 year of loading (T3). The mean OHIP score at T1 was 6·5 ± 1·2, 2·4 ± 1·0 at T2, and 0·9 ± 0·3 at T3. There was a statistically significant difference between T1 and T2 (P = 0·002) and T1 and T3 (P < 0·001) but not between T2 and T3 (P = 0·407). The OHIP score in Kennedy II patients decreased from 4·8 ± 3·2 at T1 to 1·5 ± 2·0 at T2 and 1·1 ± 1·8 at T3, and that in Kennedy III patients decreased from 8·9 ± 9·6 at T1 to 3·6 ± 8·9 at T2 and 0·8 ± 2·2 at T3. There were no statistically significant differences in the reductions in Kennedy II and III patients. Oral health-related quality of life changed positively in patients treated with implants and an FDP in both groups. There was no change in OHRQoL between the times of implant placement and FDP placement.

BACKGROUND: To review the literature on the effect of dental implant surface roughness in patients with a history of periodontal disease. The present review addresses the following focus question: Is there a difference for implant survival, mean marginal bone loss, and the incidence of bleeding on probing in periodontally compromised patients receiving a machined dental implant or rough surface dental implant?METHODS: Electronic and manual literature searches were conducted on PubMed/MEDLINE and the Cochrane Library on studies published until May 2018 to collect information about the effect of machined, moderately rough, and rough dental implant surfaces in patients with a history of periodontal disease. The outcome variables implant survival, mean marginal bone level, and the incidence of peri-implantitis and bleeding on probing were evaluated. Meta-analysis was performed to obtain an accurate estimation of the overall, cumulative results.RESULTS: Out of 2411 articles, six studies were included in this systematic review. The meta-analysis of the implant survival and implant mean marginal bone loss revealed a risk ratio of 2.92 (CI 95% 0.45, 18.86) for implant failure and a total mean difference of - 0.09 (CI 95% - 0.31, 0.14) for implant mean marginal bone loss measured in a total group of 215 implants, both not statistically significant.CONCLUSIONS: Due to lack of long-term data (> 5 years), the heterogeneity and variability in study designs and lack of reporting on confounding factors, definitive conclusions on differences in implant survival, and mean marginal bone loss between machined and moderate rough implants in periodontally compromised patients cannot be drawn. Future well-designed long-term randomized controlled trials are necessary to reveal that machined surfaces are superior to moderately rough and rough surfaces in patients with a history of periodontal disease.

Purpose: The aim of this 1-year randomized trial was to determine the stability and the magnitude of the effect of converting patients' conventional mandibular dentures to implant overdentures (IODs) on their satisfaction and oral health-related quality of life (OHRQoL). The IODs were retained either with two immediately loaded interconnected standard-diameter implants or with four immediately loaded mini dental implants (MDIs). Materials and Methods: Fifty completely edentulous subjects complaining about insufficient retention of their mandibular dentures were randomly assigned to two groups; 25 patients received IODs retained with four MDIs and 25 patients received IODs retained with two standard-sized tissue level (STL) interconnected implants. All IODs were opposed by conventional maxillary dentures. Patients rated their satisfaction on a 100-mm visual analog scale (VAS) and their quality of life on a denture-specific short version of the oral health impact profile (OHIP-20) before assignment, and after 3 and 12 months. A two-way mixed analysis of variance (ANOVA) was conducted to assess the change in time and its interaction with treatment mode on patients' overall satisfaction ratings, the total OHIP-20, and their specific domain scores. Results: Immediate loading was possible for all the patients who received the MDIs. By contrast, the immediate loading protocol could be followed for only 15 of the patients allocated to the STL implant group. For the remaining patients, a delayed loading protocol was applied. There was a significant improvement in patients' general satisfaction between baseline and 3 months and between baseline and 12 months postoperatively (F2,44 = 81.006, P < .001). This increase did not differ between the treatment groups (F4,90 = 1.838, P = .128). The results also showed a decrease in mean overall OHIP score (F2,43 = 46.863, P < .001) between baseline and 3 months and between baseline and 12 months postoperatively, indicating a higher level of OHRQoL. In addition, patients scored lower 3 and 12 months after treatment than at baseline for all seven domains. This decrease did not differ between the treatment groups (F4,88 = 0.608, P = .658). Conclusion: The results suggested that in terms of patient-based outcomes, mandibular overdentures retained by immediately loaded MDIs can offer an improvement of equal magnitude with that achieved by overdentures retained by standard-sized implants.

The first purpose of this study was to translate the Oral Behaviours Checklist (OBC) into Dutch and to examine its psychometric properties. The second purpose was to examine the correlations between scores on the OBC and facial pain, while controlling for the possible confounding effects of psychosocial factors, such as stress, depression, somatisation and anxiety. The OBC was translated, following the international RDC/TMD consortium guidelines. Its psychometric properties were examined by assessing the test-retest reliability and concurrent validity [correlations between the OBC and the previously developed Oral Parafunctions Questionnaire (OPQ)]. Participants were 155 patients with TMD (77% female; mean age and s.d. = 43·6 and 14·4 years). The translation of the OBC into Dutch proceeded satisfactorily. The psychometric properties of the Dutch OBC were good; test-retest reliability was excellent (ICC = 0·86, P < 0·001). Concurrent validity was good: the correlation between the OBC and OPQ was high (r = 0·757, P < 0·001), while the correlations between individual items ranged from 0·389 to 0·892 (P < 0·001). Similar to previous Dutch studies using the OPQ, no significant correlation was found between oral parafunctions and facial pain (r = 0·069, P = 0·892). No significant correlations could be found between oral parafunctional behaviours and facial pain.

Background Dental phobia is part of the Blood-Injection-Injury (B-I-I) phobia subtype of specific phobia within DSM-IV-TR. To investigate the conceptual validity of this classification, the purpose of the present study was to determine the co-occurrence of dental phobia, typical dental (and B-I-I related) fears, vasovagal fainting, and avoidance of dental care. Method Data were collected by an online survey in Dutch twin families (n = 11,213). Results Individuals with a positive screen of dental phobia (0.4% of the sample) rated typical B-I-I-related stimuli as relatively little anxiety provoking (e.g. of all 28 fears the stimulus "the sight of blood" was ranked lowest). Presence of dental phobia was significantly associated with a history of dizziness or fainting during dental treatment (OR = 3.4; 95% CI: 1.5-8.1), but of the dental phobic individuals only 13.0% reported a history of dizziness or fainting during dental treatment. Presence of dental phobia (OR = 5.0; 95% CI: 2.8-8.8) was found to be associated with avoidance of dental care, but a history of dizziness or fainting during dental treatment was not (OR = 1.0; 95% CI: 0.8-1.2). Conclusions The present findings converge to the conclusion that dental phobia should be considered a specific phobia subtype independent of the B-I-I cluster within the DSM classification system.

Purpose: Different treatment protocols in terms of number, diameter, and suprastructure design have been proposed for immediately loaded implants that are used to support mandibular overdentures opposed by maxillary conventional dentures. The aim of this study was to investigate the influence of these protocols on survival rates as well as clinical and prosthodontic outcomes. Materials and Methods: Several electronic databases were searched for all relevant articles published from 1966 to June 2014. Only randomized controlled trials and prospective studies with a minimum follow-up of 12 months were selected. The primary outcomes of interest were the success and survival rates of the implants. Prosthodontic complications were also evaluated.Results: Fourteen studies fulfilled the inclusion criteria. Of the studies identified, nine were randomized controlled trials and five were prospective studies. The mean follow-up period was 3 years or less for the vast majority of the studies. The reported survival and success rates were comparable to that of conventional loading for most of the included studies. No specific immediate loading protocol seemed to perform better in terms of clinical and prosthodontic outcomes. Conclusion: Immediate loading protocols of mandibular overdentures seem to be a viable alternative to conventional loading. It was not possible to recommend a specific treatment protocol related to the number, diameter of the implants, and attachment system used. Long-term, well-designed studies comparing different immediate loading modalities could help to establish a protocol that delivers the most clinically predictable, efficient, and cost-effective outcome for edentulous patients in need of implant overdentures.

Objective: To examine the intra- and interexaminer reliability of assessing rotation of teeth on photographed study casts. In addition, the reliability parameters of two examiners scoring in mutual consultation were compared with the reliability parameters by one observer.Materials and Methods: Standardized photographs of sets of maxillary and mandibular plaster casts of 10 patients before treatment (T1), after treatment (T2), and a long time after retention (T3) were digitized. Tooth rotation was assessed relative to a correct position in the ideal dental arch form. A computer analysis program was used to process the measurements. Two examiners assessed each study cast twice with a washout period of 3 weeks. A third examiner assessed each cast, together with one of the other examiners. The intra- and interexaminer agreements were calculated using intraclass correlation coefficients (ICCs). Wilcoxon signed-rank tests were used to determine significant differences between the intra- and interexaminer reliability coefficients of the three examiners.Results: The ICCs ranged from 0.430 to 0.991. Incisors showed the highest ICCs and molars showed the lowest ICCs. Intraexaminer ICCs of the experienced examiners were significantly higher than those of the examiner with less experience. No significant differences in the reliability between a single examiner and the combination of two examiners were found.Conclusion: The method of assessing tooth rotation in the present study has proved to be reproducible, except for the molars. This method can be helpful for clinicians assessing tooth rotation from photographed study casts.

Berggren's (1984) model of dental fear and anxiety predicts that dentally anxious individuals postpone treatment, leading to a deteriorating dental state and subsequently to fear of negative evaluations in relation to their oral condition. The present study aimed to test one of the core assumptions of this model, namely that deterioration of dental health status would mediate the effects of avoidance of dental care on self-reported fear of negative evaluation. Participants were 73 patients (mean age 38.5 yr) meeting the diagnostic and statistical manual of mental disorders - 4th edn - Text Revision (DSM-IV-TR) criteria of dental phobia. Variables in the theoretical model were operationalized with multiple measures. A series of Sobel tests indicated that mediation was present for the relationship between years of avoidance and fear of negative self-evaluation when dental health status was based on the assessment of dentists or patients' opinion of their own dental state, but not when dental health status was operationalized as decayed, missing or filled surfaces (DMFS). Although the findings are supportive of Berggren's model, other causal pathways that contribute to the perpetuation of anxiety and fear still need to be tested. The results suggest that individuals with high levels of dental anxiety would particularly benefit from interventions specifically designed to break their avoidance pattern.

Dental decay and dental treatment are suggested to be related to body growth in children. The aim of this study was first to assess the relation between dental caries and body proportions cross-sectionally in a Suriname caries child population and secondly to investigate whether dental treatment had a significant influence on body growth of these children in a randomised controlled trial using different treatment strategies. Three hundred eighty 6-year-old children with untreated dental decay participated in the study. Caries prevalence and presence of dentogenic infections were recorded. All children were randomly assigned to four different treatment groups ranging from full dental treatment to no invasive treatment at all. Body growth was evaluated by children’s height, weight and body mass index. Participants were evaluated after 6 months and 1, 2 and 3 years. Cross-sectionally, negative correlations were observed between anthropometric measures and the number of untreated carious surfaces and caries experience of the children. Next, no significant differences in growth pattern between the treatment groups were observed. Based on these results, it is suggested that caries activity is a negative predictor for body growth in children and dental intervention does not show significant improvement within 3 years.

The presence of dental anomalies has been rated radiographically in a number of studies. However, since the reliability of the assessment of these anomalies has rarely been investigated, the aim of this study was to examine inter- and intraexaminer agreement in identifying morphological dental anomalies, such as tooth agenesis, dilacerated, pipette-shaped, blunt, pointed, and short roots. Pre-treatment panoramic radiographs of 40 patients (13 males and 27 females; mean age 27.7 ± 10.8 years) treated between 1983 and 2008 were selected. Four examiners independently assessed the radiographs twice. For a dilacerated root and agenesis, a definition was given. For pipette-shaped, blunt, or pointed roots, a drawing was shown, and for a short root, a ratio was used to identify the anomaly. Intraexaminer agreement of the assessments of the dental anomalies was presented by Cohen’s Kappa and varied between −0.01 for short roots and 1.00 for agenesis. With respect to short roots, three of the examiners did not rate them to be present on at least one measurement occasion. This implies that intraexaminer agreement could not be calculated for these three examiners. Interexaminer agreement for dilacerated roots varied between 0.14 and 0.50, for pipette-shaped roots between −0.01 and 0.33, for blunt roots between 0.05 and 0.32, and for pointed roots between 0.17 and 0.37. All values for agenesis were 1.00. It can be concluded that assessing agenesis on panoramic radiographs is reliable. Rating the presence of dilacerated, pipette-shaped, blunt, pointed, and short roots on panoramic radiographs, however, does not result in a reliable assessment.

General dental practitioners (GDPs) act as gatekeepers for specialist dental care since they generally decide whether, when, and where to refer patients. It is important for orthodontists to understand the factors influencing the referral decision in order to be able to satisfy both the referring dentists and the patients. A specifically designed questionnaire was sent to a random sample of 634 GDPs in The Netherlands. In part A, general characteristics of the GDPs such as gender, years in practice, number of patients in the practice, possibilities to refer to an orthodontist, and number of patients referred to the orthodontist per year were collected. Part B assessed the importance of 20 various factors related to the GDPs’ usual referral decision. Intraclass correlation coefficients (ICC) were calculated to assess the relationship in rank scores of the items of the various groups.The response rate was 60 per cent. Most GDPs (38 per cent) had the possibility to refer to three to four orthodontists, 22 per cent could choose between five and six, and 21 per cent could refer to one or two. Most GDPs (55 per cent) actually referred to one to two orthodontic specialists, while 34 per cent choose between three and four orthodontists. The rank order of the items for male and female dentists was nearly equal (ICC = 0.99, P < 0.001). The most important factors governing the choice of an orthodontic treatment provider by GDPs were patient satisfaction, favourable experience in the past, and oral hygiene monitoring by the orthodontist.

Objective: To compare the vertical dimensional changes with regard to graft height in a long-term follow-up in patients treated with two different grafting materials used in maxillary sinus floor elevation procedures.Material and methods: Twenty consecutive patients were included. One group was grafted with autogenous bone from the mandible (chin area), and the other group was augmented with a 100%β-tricalcium phosphate (β-TCP). During a 4- to 5-year period, in each patient, at least five panoramic radiographs were made. These panoramic radiographs were used for morphometric measurements, at three different locations. The three locations were the first bone to implant contact at the distal side of the second most posterior implant (L1), halfway between this implant and the most posterior implant (L2) and the site 5 mm distal to the most posterior implant (L3). The measured vertical bone heights were evaluated to assess whether there was loss of height and, if so, whether the reduction in graft height occurred in an initial healing period or whether it was an ongoing process during the whole study period.Results: There is a statistically significant reduction of vertical bone height in time at all locations (PConclusions: Both β-TCP and mandibular bone grafts resulted in radiographic reduction of the vertical height over the 5-year period following maxillary sinus floor elevation. After an initial height reduction in the first 1.5 year, subsequent changes were minimal. No significant differences were observed between the two types of grafting material. There was no statistically significant difference in reduction between the three locations for vertical bone height and graft height, respectively.

ObjectivesThe aims were: 1) to identify the guidelines available for management of dental invasive procedures in patients on antithrombotic drugs; 2) to assess their quality with the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument; and 3) to summarize their conclusions and recommendations.Study designSystematic literature search for guidelines in several electronic databases. Retrieved guidelines were evaluated with the AGREE instrument for quality assessment.ResultsThe systematic search yielded 93 results, of which only 4 were evidence-based practice guidelines. Two of these guidelines could be recommended for clinical use on the basis of the AGREE instrument. These 2 guidelines drew 68 conclusions from the existing literature and provided 58 recommendations.ConclusionsTwo evidence-based clinical practice guidelines, satisfactorily fulfilling the criteria of the AGREE instrument and both published in 2007, advise to not routinely discontinue antiplatelet and anticoagulation medication before dental surgery. The majority of the recommendations, however, were not sufficiently linked to levels of evidence.

Objectives: To determine appearance concerns of patients presenting for cosmetic treatment.Methods: This cross-sectional comparative study included consecutive patients of six different cosmetic clinics (n = 170), and a sample of the general population (n = 878). A study-specific self-report questionnaire was administered to document demographic and appearance concerns. Presence of body dysmorphic disorder (BDD) was assessed based on DSM-IV criteria.Results: Cosmetic dental patients did not differ from the reference sample with regard to happiness and satisfaction as regards their appearance. However, differences were found with regard to frequency of previous general cosmetic (16.5% versus 5.9%) and cosmetic dental (47.9% versus 24.8%) procedures. Furthermore, a significantly higher proportion of the cosmetic dental patients sufficed for the two key screening criteria of BDD (9.5% versus 5.5%), and for the full diagnostic screening of BDD (4.2% versus 1.5%) compared with the respondents of the reference group.Conclusions: The results suggest that symptoms of BDD are relatively common among patients attending cosmetic clinics. It is important to assess the long-term effects of comprehensive cosmetic procedures, particularly in patients with disproportionate appearance concerns.

Objective: Comparison of craniofacial morphology in bilateral cleft lip and palate patients to that of a noncleft control group at the age of 15 years. Design: A cross-sectional study of cephalometric data. Subjects and Methods: Cephalometric records of 41 consecutive patients (32 boys and 9 girls) with nonsyndromic complete bilateral cleft lip and palate born between 1973 and 1987. The patients were treated by the cleft teams of the Erasmus Medical Centre in Rotterdam and the VU University Amsterdam. The control group of normal Dutch subjects was followed in the Nijmegen Growth Study. From this population, mean cephalometric data were used. Differences in cephalometric measurements and other variables were calculated between the bilateral cleft lip and palate group and the control group. Results: Independent-sample t tests indicated that there was a statistically significant difference between the mean of the cephalometric values of the bilateral cleft lip and palate patients and the control group with respect to all cephalometric variables. Pearson correlation coefficients calculated between angle ANB and the number of operators, number of surgical procedures before 15 years of age, and the year of birth were not significant. Conclusions: Bilateral cleft lip and palate patients treated in the Amsterdam and Rotterdam cleft centers differed significantly from the control group in all measurements. A Class III development due to a less forward positioned maxilla was observed. The vertical measurements indicated a more divergent growth pattern in bilateral cleft lip and palate patients (Ans-Me/N-Me, GoGn-SN, and SN-FFH).

Relatively little is known about the anxiety-provoking capacity of the various objects and situations characteristic of the dental setting. The aims of the current study were to establish a hierarchy of anxiety-provoking capacities of a large set of dental stimuli and to determine the differences in relation to gender, age, ethnicity, and level of dental trait anxiety. An additional aim was to derive an estimate of the number of stimuli to be presented to anxious patients in order to obtain full coverage of their dental fears. A questionnaire describing 67 potentially anxiety-provoking stimuli was constructed and presented to 960 adults. The results indicated that invasive stimuli (e.g. surgical procedures) were rated as the most anxiety provoking and that non-invasive stimuli (e.g. the dentist as a person) were the least anxiety provoking. The fear-evoking capacity of the dental stimuli varied with gender, age, ethnicity, and level of dental trait anxiety, whereas the rank order of these stimuli appeared to be independent of these factors. Furthermore, it appeared that the top 25 most anxiety-provoking objects and situations found in the current study contained only eight (28%) stimuli, which had been taken into account in previous research. The present findings support the need for assessment procedures using a broad spectrum of potentially anxiety-provoking stimuli.

The aim of the present study is to verify which strategy is the most effective in the treatment of dental decay of the deciduous dentition in a moderate to high caries child population under remote field conditions. This study was carried out in the rain forest of Suriname. Three hundred and eighty schoolchildren, mean age 6.1 years (SD 0.5, range 5.1-7.1 years), were randomly assigned to four different groups: full dental treatment, only extractions, only restorations (ART) and no treatment. Parameters for oral health were defined as caries prevalence (dmft), caries increment, sequela to dental caries and dental pain. Restorative dental care of the primary dentition, by means of ART, resulted in a caries increment from a dmft of 5.48 (SD 3.2) at baseline to 6.35 (SD 2.6) after 2 years (p0.05). Full dental treatment should be the strategy of choice whenever oral health care programmes are developed. However, when priorities are required due to situational, practical or economical reasons, extraction of severely decayed teeth is an effective treatment strategy.

Objective: The aim of the present study was to determine the association between dental anxiety and quality of life (QoL) and to test the hypothesis that treatment of highly anxious patients would significantly enhance QoL.Material and methods: Subjects were 35 highly anxious dental patients of a Dutch dental fear clinic who were assessed on dental trait anxiety (DAS and S-DAI) and QoL (oral health-related QoL with the use of OHIP-14, dental anxiety-related QoL with the SADAS, and general aspects of QoL using Global Assessment of Functioning, while five different aspects of life satisfaction were quantified on a VAS-scale) both prior to and after treatment (an average of six sessions of 45-60 minutes each). Also, both objective (DMFT and dentists' judgement) and subjective (patients' judgement) indices of oral health status were recorded.Results: Higher dental anxiety was significantly associated with lower OH-QoL as indexed by the OHIP-14 (r = 0.51-0.56, P < 0.01). Treatment was associated with marked improvement on oral health status, reduction of dental anxiety, and improvements regarding a variety of aspects of QoL (all Ps < 0.001). Reduction of dental anxiety, rather than improved oral health, was found to predict enhanced OH-QoL.Conclusion: The results underline the importance of applying effective treatment methods for dentally anxious patients, not only with the purpose to alleviate their dental anxiety and to improve their oral health, but also because it contributes to an enhancement of their QoL.

To understand the development of dental anxiety better and to identify those at increased risk of developing dental anxiety, the Level of Exposure-Dental Experiences Questionnaire (LOE-DEQ) was developed. The aim of the current study was to determine the psychometric properties (i.e. factor structure, reliability, and validity) of the LOE-DEQ and to determine its suitability as an additional screening instrument for dentally anxious patients. Five different samples were used: (i) highly dentally anxious patients (n = 119); (ii) general dental patients (n = 480); (iii) students (n = 186); (iv) psychiatric outpatients (n = 17); and (v) oral surgery patients (n = 34). Results of the factor analysis revealed a four-factor solution. The LOE-DEQ has sufficient internal consistency (Cronbach's alpha values ranging from 0.69 to 0.85) and satisfactory test-retest reliability (intraclass correlation coefficient = 0.78). The results further suggest that this instrument has adequate discriminant, concurrent, and predictive validity. It is concluded that the LOE-DEQ is a useful tool for assessing patients' background in terms of previous exposure to distressing dental events, which is considered a vulnerability factor in the development of dental anxiety.

PURPOSE: The aim of this study was to describe and quantify the therapeutic value of platelet concentrate on the capillary density in oral mucosal wound healing. MATERIAL AND METHODS: The subjects included 10 healthy edentulous patients who underwent bilaterally a sinus floor elevation procedure and a buccal onlay graft with autologous iliac crest bone for maxillary reconstruction. During surgery, platelet-rich plasma (PRP) was prepared from a blood sample taken from the patient. After randomization in a split-mouth design, at one side PRP was administered in the wound and at the contralateral side a placebo. At baseline, microvascular capillary density was scored with the orthogonal polarization spectral (OPS) imaging technique and repeated measurements were performed postoperatively on a daily basis until the tenth day, after which measurements were continued weekly until the fifth postoperative week. RESULTS: Ten patients, five males and five females, were included in the study with a mean age of 54.2+/-9.1 years for females and 57.6+/-6.9 years for males. Donor platelet counts from whole blood had a mean value of 248.5+/-13.5 x 10(9)/l, while the value of platelet counts in the PRP had a mean of 975.9+/-97.9 x 10(9)/l. Wound healing was significantly accelerated in the PRP-treated mucosal wounds during the first 10 postoperative days. After the second week, no obvious differences between the PRP or placebo side could be noted. CONCLUSION: PRP has a strong stimulant effect on capillary regeneration in wound healing. These effects are mainly noticeable during the early stages of wound healing

The aim of this study was to evaluate the survival of single- and two-surface atraumatic restorative treatment (ART) restorations in the primary and permanent dentitions of children from a high-caries population, in a field setting. The study was conducted in the rainforest of Suriname, South America. ART restorations, made by four Dutch dentists, were evaluated after 6 months, 1, 2, and 3 years. Four hundred seventy-five ART restorations were placed in the primary dentition and 54 in first permanent molars of 194 children (mean age 6.09 +/- 0.48 years). Three-year cumulative survivals of single- and two-surface ART restorations in the primary dentition were 43.4 and 12.2%, respectively. Main failure characteristics were gross marginal defects and total or partial losses. Three-year cumulative survival for single-surface ART restorations in the permanent dentition was 29.6%. Main failure characteristics were secondary caries and gross marginal defects. An operator effect was found only for two-surface restorations. The results show extremely low survival rates for single- and two-surface ART restorations in the primary and permanent dentitions. The variable success for ART may initiate further discussion about alternative treatment strategies, especially in those situations where choices have to be made with respect to a well-balanced, cost-effective package of basic oral health care.

ObjectivesTo investigate (1) the degree of digital technology adoption among general dental practitioners, and to assess (2) which personal and practice factors are associated with technology use.MethodsA questionnaire was distributed among a stratified sample of 1000 general dental practitioners in the Netherlands, to measure the use of fifteen administrative, communicative, clinical and diagnostic technologies, as well as personal factors and dental practice characteristics.ResultsThe response rate was 31.3%; 65.1% replied to the questionnaire on paper and 34.9% online. Each specific digital technology was used by between 93.2% and 6.8% of the dentists. Administrative technologies were generally used by more dentists than clinical technologies. Dentists had adopted an average number of 6.3±2.3 technologies. 22.5% were low technology users (0 to 4 technologies), 46.2% were intermediate technology users (5 to 7 technologies) and 31.3% were high technology users (8 to12 technologies). High technology users more frequently had a specialization (pConclusionWith few exceptions, all dentists use some or a substantial number of digital technologies. Technology use is associated with various patterns of person-specific factors, and is higher when working in larger dental practices. The findings provide insight into the current state of digital technology adoption in dental practices. Further exploration why some dentists are more reluctant to adopt technologies than others is valuable for the dental profession’s agility in adjusting to technological developments.

Objectives:This study aimed to evaluate the association between the extracranial and intracranial calcification depiction of the internal carotid artery (ICA), incidentally found in CBCT examinations in adults, and to discuss the conspicuous clinical implications.Methods:Out of a series of 1085 CBCT examinations, 705 CBCT scans were selected according to pre-defined criteria. The extra- and intracranial calcifications depicted along the course of the ICA were documented according to a comprehensive set of descriptive criteria.Results:In total, 799 findings were detected, 60.1% (n = 480) were intracranially and 39.9% (n = 319) were extracranially allocated. The χ2 test showed associations between all variables (p Conclusions:We found that a significant correlation exists between extra- and intracranial calcifications of the ICA. It is clear that in cases of the presence of a calcification in the ICA extracranially, the artery's intracranial portion has an increased risk of showing the same findings. CBCT imaging is widely used as a diagnostic tool, thus, our results contribute to the identification of a subgroup of patients who should undergo further medical evaluation of the atherosclerosis of the ICAs.

This questionnaire-based study investigated the traumatic background and trauma-related symptomatology among 141 treatment-seeking individuals with high levels of dental anxiety and among a low-anxious reference group consisting of 99 regular dental patients. The highly anxious individuals reported a significantly higher number of traumatic events, both within and outside the dental or medical setting, than those in the reference group (73% vs. 21%). Horrific experiences in the dental setting were the most common traumatic events reported. Of the highly anxious individuals, 46.1% indicated suffering from one or more of the post-traumatic stress disorder (PTSD) symptom clusters (re-experiencing, avoidance, loss of interest, and insomnia), while in the reference group this percentage was 6%. Severity of dental anxiety was significantly associated with number of screening criteria for specific phobia and the extent to which the anxious subjects displayed symptoms of post-traumatic stress. Two variables were uniquely predictive for positive diagnostic screens for dental phobia and PTSD: having experienced a horrific dental treatment and having been a victim of a violent crime. In conclusion, post-traumatic symptoms are common accompaniments of severe forms of dental anxiety and are experienced even when dental treatment is not imminent.

SUMMARY Dental age was studied in a sample of 451 Dutch children (226 boys and 225 girls) according to the method of Demirjian. They were born between 1972 and 1993 and were between 3 and 17 years of age at the time a dental pantomogram (DPT) was obtained. All children were placed in the age group closest to their chronological age. All 451 DPTs were scored by one examiner. A subset of 52 DPTs was scored by a second examiner and the intra-class correlation coeffi cient (ICC) and Cohen’s kappa were calculated. The ICC was 0.99 and Cohen’s kappa 0.68. Boys and girls were analysed separately. A signifi cant difference was found between chronological age and dental age. On average, the Dutch boys were 0.4 years and the girls 0.6 years ahead of the French–Canadian children analysed by Demirjian. Therefore, the French–Canadian standards were not considered suitable for Dutch children. New graphs for the Dutch population were constructed using a logistic curve with the equation Y = 100*{1/(1 + e–α(x – x0))} as a basis. The 90 per cent confi dence interval was calculated. To determine whether the logistic curve was correct, a residual analysis was carried out and scatter plots of the differences were made. The explained variance was 93.9 per cent for the boys and 94.8 per cent for the girls. Both the residual analysis and the scatter plots indicated that the logistic curve was appropriate for use with Dutch children. In addition to the graphs, tables were produced which transfer the maturity scores calculated by the method of Demirjian into Dutch dental age.

For an adequate color reproduction, it is very valuable to quantify the color distribution in human teeth accurately. The aim of this study was to determine the color relation between three tooth segments (cervical, middle and incisal) in vital upper central incisors, using digital photography.Digital recordings of 64 upper right central incisors were made using a standardized head-camera setup. The L*a*b* values of three regions were attained from the standardized digital images using software.There were statistically significant linear correlations for L* and b* between the three tooth segments (all r'sor = 0.60; p0.001). The correlation coefficient for a* was lower compared to L* and b* values. The L* and b* values of cervical and incisal tooth segment could be calculated from L* and b* values of middle tooth segment.These results show the potency for color mapping of a whole tooth surface by extrapolation of color values of only one part of the surface.

Dental anxiety is quite common in the general popu-lation (1–3). It represents a significant cause of fail-ure to consult and use dental care appropriately.While 20–30% dislike visits to a dentist so much thatthey use dental services only in the case of an emer-gency, approximately 5% of the dentally anxiousindividuals demonstrate such an excessive and’unreasonable‘ fear of dental appointments thatthese situations are entirely avoided (1).With regard to the acquisition of clinically signi-ficant dental fears it has been found that the majo-rity of the individuals who are able to recall thecircumstances that led to their condition attributethe onset of their fears to one or more traumaticdental events (4–9). One of these studies showed thatboth the extent to which earlier treatments wereperceived as traumatic, and thefrequency of remem-bered painful incidents, were positively related toreported levels of dental anxiety (5). Thus, painful,aversive or extremely frightening situations serve aspowerful conditioning experiences and thereforeplay an important role in the acquisition of dentalanxiety.Most of the research on traumatic incidents hasnot focused on fears or phobias but on pathologicalstress response syndromes, such as posttraumaticstress disorder (PTSD; 10). The fourth edition of theDiagnostic and Statistical Manual of Mental Disor-ders (DSM-IV), the most widely used psychiatricclassification system, definesPTSD as a disorder thatfollows experiencing, witnessing, or being con-fronted with events involving actual or threateningdeath, physical injury, or other threats to the phy-sical integrity of the self or others (10). To meet thecriteria for PTSD an individual must have beenexposed to a traumatic stressor and have respondedwith a subjective response of fear, helplessnessor horror. The principal clinical feature of PTSDis the painful re-experiencing of the traumaticincident in the form of recurrent and distressing

This study assessed trauma-related sequelae of 56 highly anxious patients attending a dental fear clinic. It was also examined whether such symptomatology interferes with anxiety reduction in response to a cognitive-behavioral treatment approach. About 34 patients (59%) indicated that they had experienced one or more aversive dental events that could explain the onset of their dental anxiety. There was no difference between the dental anxiety scores of patients who reported such a background and those who did not. Severity of trauma-related symptomatology was indexed by the Impact of Event Scale (IES). The mean IES score of patients with a traumatically induced dental fear was remarkably high (33.0; SD=19.7). Furthermore, there was a strong direct relationship between severity of trauma-related symptomatology and severity of dental anxiety (shared variance was 38%). Two patients (10%) met all DSM-IV diagnostic criteria for Posttraumatic Stress Disorder (PTSD) on the basis of the Self-Rating Scale for PTSD. However, no evidence was found to suggest that either a traumatic background, or level of trauma-related symptomatology, has a negative effect on treatment outcome.

ObjectiveCone-beam CT (CBCT) images are infrequently utilized for trabecular bone microstructural measurement due to the system's limited resolution. The aim of this study was to determine the accuracy of CBCT for measuring trabecular bone microstructure in comparison with micro CT (μCT).Materials and methodsTwenty-four human mandibular cadavers were scanned using a CBCT system (80 μm) and a μCT system (35 μm). Three bone microstructural parameters trabecular number (Tb.N), thickness (Tb.Th) and separation (Tb.Sp) were assessed using CTAn imaging software.ResultsIntraclass correlation coefficients (ICC) showed a high intra-observer reliability (≥ 0.996) in all parameters for both systems. The Pearson correlation coefficients between the measurements of the two systems were for Tb.Th 0.82, for Tb.Sp 0.94 and for Tb.N 0.85 (all P'sConclusionsCone-beam CT datasets can be used to evaluate trabecular bone microstructure at dental implant sites. The accuracy for measuring Tb.N was the best followed by Tb.Th and Tb.Sp.

ObjectivesOral leukoplakia is a potentially malignant disorder of the oral mucosa. The aim of this retrospective study was to identify the factors that possibly predict malignant transformation in a well-defined cohort of patients with a long-term follow-up. All leukoplakias were staged according to a clinicopathological classification and staging system. Furthermore, a certainty factor has been used with which the diagnosis has been established.Material and methodsThe group consisted of 144 patients. The size, presence and degree of epithelial dysplasia were incorporated into a clinicopathological classification and staging system. Initial management consisted of surgical excision, CO2 laser vaporisation or observation only. The mean follow-up period was 51.2 months (s.d. = 39.33, range 12-179 months).ResultsIn 16 of 144 patients (11%), malignant transformation occurred between 20 and 94 months (mean 57.0 months) after the first visit, the annual malignant transformation rate being approximately 2.6%. A large size of the lesion (≥ 4 cm) showed to be the only statistically significant predictor of malignant transformation (P = 0.034).ConclusionA size of ≥ 4 cm showed to be the only significant predicting factor of malignant transformation in oral leukoplakia. No other epidemiological, aetiological, clinical or histopathological parameters were of statistical significance.

The aim of the present study was to assess treatment outcome in terms of dental anxiety reduction at a post-treatment assessment and dental anxiety reduction and dental attendance one year later. Furthermore, it was determined to what extent psychopathological characteristics were related to treatment outcome. Methods: Questionnaires were sent to 280 patients treated with one of three treatment modes (i.e., behavioral management (BM), nitrous oxide sedation (NOS), and intravenous sedation (IVS)) at a dental fear clinic in The Netherlands. Dental anxiety before (T1) and after (T2) treatment was assessed using the Dental Anxiety Scale (DAS) and the Short version of the Dental Anxiety Inventory (S-DAI); the Symptom Checklist 90 (SCL-90) was used to assess general psychopathology. Dental anxiety was assessed again a year later and patients were questioned about their dental attendance pattern (T3). Results: ANOVA showed that the DAS and S-DAI scores at T2 and T3 were statistically significant lower than the initial scores. In addition, IVS patients showed less anxiety reduction than BM patients at both T2 and T3. Of the 145 patients whose last visit to the clinic was at least one year ago, 62% had visited a GDP at T3. A regression analysis revealed that, beside treatment mode, somatization, number of visits to clinic for dental treatment, and number of months between first and last visit to the clinic predicted dental anxiety at follow-up. Conclusions: It is concluded that, although a reduction in dental anxiety level was present, a relatively large proper tion of patients did not improve, in terms of both dental anxiety and dental attendance.

The aim of this study was to determine, for different age groups, the additional value of bite–wing radiographs compared to the clinical information, and to calculate the subsequent effect on the DMFS index. Subjects were 14, 17, 20, 23 years old, or in the age groups 25–34 and 35–54, who participated in a clinical epidemiological survey. After obtaining consent, bite–wings were taken of approximately 25% of the participants (n = 663). The extra diagnostic yield of the bite–wings varied between 163 and 700% for approximal dentine caries diagnosis of untreated surfaces, and between 233 and 593% for inadequate restoration judgement for filled surfaces. The DS score went up by about 20–98%, whereas the DMFS index increased between 1 and 12%, resulting in a radiographic correction factor of 1.01–1.12. In conclusion, the considerable increase in the prevalence of approximal dentinal lesions and inadequate restorations for all age groups results in higher numbers of surfaces in need of treatment, but is not accompanied by a significant increase in DMFS scores.

UNLABELLED The prevalence of clinically diagnosed approximal caries and inadequate approximal restorations is usually underestimated, when compared with radiographic assessment as a 'gold standard'. OBJECTIVE The aim of this study was to determine the degree of this underestimation in a clinical epidemiological project. METHODS Clinical data (n = 951) of 17- and 23-year-olds were collected by calibrated examiners and bitewing radiographs were taken after obtaining the participant's consent. The radiographic examination of the approximal surfaces on the radiographs of 621 participants was based on criteria derived from the clinical protocol. A second examiner judged 20% of the radiographic material to determine the interobserver agreement, using Cohen's kappa. The agreement proved to be good (kappa = 0.66) for dentine caries diagnosis, and fair (kappa = 0.44) for restoration assessment. RESULTS Of the total number of recorded decayed or inadequately restored surfaces only 10.8% and 13.8% respectively were found clinically. Of the total number of clinically sound surfaces, 10.1% had dentine caries on the bitewing radiograph. The percentage of clinically adequate restorations needing replacement was 25.7%. CONCLUSION It was concluded that the prevalence of approximal caries and inadequate restorations in this clinical epidemiological study was highly underestimated. At least for these age groups the results contain a serious warning for epidemiologists and general dental practitioners with respect to the outcome of clinical caries diagnosis.

Eur J Oral Sci, 1999The aim of the present study was to assess the reliability and (factorial)validity of the Dutch version of the Social Attributes of Dental Anxiety Scale(SADAS). A factor analysis using the English version of the SADASrevealed two separate scales. The first eight items involved unwantedpsychological upsets when patients encounter dental care directly; the fourremaining items were about social inhibitions or restrictions due to theperceived state of oral health. Psychometric properties of the Dutch versionwere assessed using a sample of 170 highly anxious dental patients of a dentalfear clinic in Amsterdam, The Netherlands. The Dental Anxiety Scale (DAS)and the Short version of the Dental Anxiety Inventory (S-DAI) were used asmeasures of dental anxiety. Factor analysis revealed that four factorsexplained 72.8% of the variance, and two forcedly extracted factors explained53.4% of the variance. Correlations indicated that the SADAS does measurea different concept than dental anxiety. In addition, t-tests indicated that theSADAS was able to discriminate between a group of non-anxious individualsand the present group of patients. In conclusion, the SADAS is a promisingnew questionnaire with moderate factorial, but with more than sufficientreliability, as well as construct and discriminant validity.Irene H. A. Aartman

Objective To assess differences among highly anxious dental patients assigned to different treatment modes (ie behavioural management (BM), nitrous oxide sedation (NOS), intravenous sedation (IVS)). Patients were compared with regard to psychological and dental variables before treatment (eg number of decayed teeth), and dental variables after treatment (eg number of fillings made). Design Dentists experienced in the treatment of highly anxious patients allocated patients to a treatment mode based upon their clinical judgement. Setting Centre for Special Dental Care, Amsterdam, The Netherlands. Subjects 211 patients from this dental fear clinic. Measures General psychopathology, as measured by the Symptom Checklist 90 (SCL-90), and dental anxiety (DAS, S-DAI, 10-point scale) were measured prior to treatment. From the panoramic radiograph the following pre-treatment dental variables were assessed: number of teeth, number of decayed teeth, number of retained roots, and number of root-filled teeth. After treatment, number of fillings, extractions, endodontically treated elements, number of visits, and treatment duration, were determined from the patients' records. Results Of the 144 patients who received dental treatment at the clinic, 46.5% was treated using a BM approach, 27.8% with NOS, 22.9% with IVS, and 2.8% under GA. No differences among the treatment groups were found with regard to SCL-90 and dental anxiety. The results showed that patients in the IVS group had statistically significant more decayed teeth than patients in the BM group. Furthermore, more fillings were made in the IVS group than in the BM group. Conclusion Since it appeared possible to treat a large proportion of patients by BM alone, training dentists in the application of psychological methods for the treatment of anxious patients should be stimulated. In addition, future research should seek for variables that, besides oral health, are better able to discriminate between groups of highly anxious patients than measures of dental anxiety and psychopathology.

The present study focused on a newly developed questionnaire to assess dental anxiety. The short version of the Dental Anxiety Inventory (S-DAI) contains nine items of the Dental Anxiety Inventory (DAI), which was designed to take into account three situations that may evoke dental anxiety, four time elements in which dental anxiety may be provoked, and three reactions. The aim was to assess the validity and reliability of the S-DAI in a sample of highly anxious dental patients applying for treatment at a dental fear clinic in the Netherlands. Three hundred and twenty-one patients filled out several questionnaires assessing dental anxiety (S-DAI, DAS, and a 10-point Likert-scale) and psychological complaints. Total mean score on the S-DAI for women (mean=40.5, s=5.7) was somewhat higher than for men (mean=38.8, s=6.9) (t(306)=2.35; P=0.019). Cronbach's alpha for the present sample was 0.88. Correlations with other measures of dental anxiety were 0.73 with the DAS (P

The aim of the present study was to assess psychological characteristics of highly anxious dental patients. Subjects were 321 patients (203 women) applying for treatment at a dental fear clinic in The Netherlands. Patients filled out several questionnaires to assess the amount of psychological complaints (Dutch version of the Symptom Checklist 90-Revised; SCL-90) and dental anxiety (Dental Anxiety Scale, Short version of the Dental Anxiety Inventory) approximately 4 months prior to their first appointment. The total mean score on the SCL-90 for the highly anxious patients was 142.7 (SD=47.2) for men and 166.5 (SD=64.3) for women. The SCL-90 total score and the mean scores of all subscales were significantly higher, and above the 80th percentile for most of the subscales, than the mean scores of the Dutch general population. The results indicate that patients who apply for treatment at a dental fear clinic are not just dentally anxious; they show complaints on a wide range of other psychological dimensions.

Summary Objectives: To establish the strength of color relation among the maxillary central incisor, lateral incisor and canine teeth by using digital photography. This relation might be useful for the color reconstruction of the missing part of a tooth from the color obtained from neighboring teeth. Methods: The L p a p b p values of the maxillary incisors and canines were determined in 100 subjects. Paired t-tests, Pearson correlations and linear regression analyses were used to describe the relation of the L p a p b p values between the three teeth for each segment (cervical, middle and incisal). Results: The mean L p a p b p values of the canines differed statistically significantly from the values of the central incisors ðp , 0:001Þ except for L p and a p values in the cervical segment between the lateral incisor and canine. The color differences between the incisors were statistically significant in fewer cases. The relation in color was the highest between the cervical segments of the three teeth, with respect to L p (r ¼ 0:45–0:65; p , 0:001), b p (r ¼ 0:49–0:55; p , 0:001), and a p (r ¼ 0:38–0:61; p , 0:001), and no relation was found between the incisal segments of central incisor and canine. Significance: There is a relation in color between the maxillary incisors and canines, which is stronger between the cervical than between the middle and incisal segments. Therefore, the color prediction is most reliable when the cervical parts of the teeth are used. Q 2004 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

The objective of this study was to investigate the effect of different cone beam CT scan parameters on trabecular bone microstructure measurements. A human mandibular cadaver was scanned using a cone beam CT (3D Accuitomo 170; J.Morita, Kyota, Japan). 20 cone beam CT images were obtained using 5 different fields of view (4X4 cm, 6x6 cm, 8X8 cm, 10x10 cm and 10X5 cm), 2 types of rotation steps (180 degrees and 360 degrees) and 2 scanning resolutions (standard and high). Image analysis software was used to assess the trabecular bone microstructural parameters (number, thickness and spacing). All parameters were measured twice by one trained observer. Intraclass correlation coefficients showed high intraobserver repeatability (intraclass correlation coefficient, 0.95-0.97) in all parameters across all tested scan parameters. Trabecular bone microstructural measurements varied significantly, especially in smaller fields of view (p = 0.001). There was no significant difference in the trabecular parameters when using different resolutions (number, p = 0.988; thickness, p = 0.960; spacing, p = 0.831) and rotation steps (number, p = 1.000; thickness, p = 0.954; spacing, p = 0.759). The scan field of view significantly influences the trabecular bone microstructure measurements. Rotation steps (180 degrees or 360 degrees) and resolution (standard or high) selections are not relevant.

ObjectivesThe aim of the present study was to evaluate the treatment results of CO2 laser vaporisation in a well-defined cohort of patients with oral leukoplakia (OL).Material and methodsThe group consisted of 35 patients. Before treatment, a clinical photograph and an incisional biopsy were performed in all cases. Also posttreatment results were documented with clinical photographs. The assessment of the treatment results was performed by an independent clinician who had not performed the treatment. The mean follow-up period was 61.9 months (range 12-179 months).ResultsIn 14/35 patients, there was a recurrence between 1 and 43 months (mean 18.7 months), the annual recurrence rate being approximately 8%. In three of these patients, malignant transformation occurred at a later stage. In two other patients, a malignancy occurred without a prior recurrence. In altogether 5 of 35 patients, malignant transformation occurred in a mean period of 54 months, the annual malignant transformation rate being approximately 3%.ConclusionsThe results in the present study are worse than those reported in the literature, perhaps owing to the use of different diagnostic criteria for OL, differences in the employed laser technique and assessment of possible recurrences by an independent clinician.