The aim of this field study (the "Fourth German Oral Health Study") was to obtain representative data on caries (DMFT index), periodontitis (CPI) and prosthetic status in the German population and to ...evaluate changes in the oral health of the German people as compared with the findings of the Third German Oral Health Study conducted eight years previously.
The study took the form of a population-representative cross-sectional survey with random samples, and was complemented by a questionnaire to reveal sociological as well as behavioural data.
The age cohorts in the present study were 12-year-olds (children), 15-year-olds (adolescents), 35- to 44-year-olds (adults) and 65- to 74-year-olds (senior citizens).
All age groups showed considerable improvements in oral health with respect to caries. Of the children, 70.1% were free of dentine caries and the mean DMFT value was 0.7. In adults and senior citizens both the DMFT value and the number of missing teeth and edentulousness declined. With regard to periodontal conditions, increasing prevalence of moderate and severe findings was recorded in adults and senior citizens, owing probably to the larger number of natural teeth remaining in the oral cavity.
The study documents a distinct improvement in oral health in the German population. Interrelated with the higher numbers of remaining natural teeth a higher prevalence of moderate and severe periodontal conditions in German adults and senior citizens was observed.
summary One hundred and seventy‐two fixed reconstructions (317 prosthetic units), made on 283 ITI implants in 105 patients (age range 25–86 years) with a minimum follow‐up period of 40 months, were ...taken into the study to analyse technical complication rate, complication type and costs for repair. The mean evaluation time was 62·5 ± 25·3 months. Eighty were single crowns and 92 different types of fixed partial dentures (FPDs). In 45 cases the construction was screw retained and in 127 cases cemented with zinc phosphate cement or an acrylic‐based cement. Complications occurred after a minimum period of 2 months and a maximum period of 100 months (mean: 35·9 ± 21·4 months). Fifty‐five prosthetic interventions were needed on 44 constructions (25%) of which 88% in the molar/premolar region. The lowest percentage of complications occurred in single crowns (25%), the highest in 3–4 unit FPDs (35%) and in FPDs with an extension (44%). Of the necessary clinical repair, 36% was recementing and 38% tightening the screws. Of all interventions, 14% were classified as minor (no treatment or <10 min chair time), 70% as moderate (>10 min but <60 min chair time) and 14% as major interventions (>60 min and additional costs for replacement of parts and/or laboratory). For seven patients the additional costs ranged from €28 to €840. Bruxing seemed to play a significant role in the frequency of complications. Longer constructions seemed to be more prone to complications. The relatively high occurrence of technical complications should be discussed with the patient before the start of the treatment.
The preparation of acrylic teeth in a simulated clinical environment (phantom head) plays an essential role in pre‐clinical dental education where evaluation is performed visually by instructors. The ...aim of this investigation was to verify the quality criteria of a tooth preparation for a metal‐ceramic crown (tooth No. 21) with the help of digital measurement. Thirty‐six acrylic teeth were prepared by students and one tooth was prepared ideally by a trained dentist: These were examined and compared. Five experienced instructors independently assessed the quality criteria with the use of a criterion list. Afterwards, the teeth were scanned with the 3D‐laser scanner ‘es1’ (Etkon Company, Munich, Germany). The calculation of the correlation coefficient demonstrated a satisfactory correlation between visual and digital rating concerning convergence angle, shoulder width and occlusal reduction. Greater differences between experimental groups were observed with regards to other criteria on the applied criterion list. A directed calibration of the evaluators and a re‐evaluation of some measurements would be necessary to gain more precise results.
Statement of Problem: Alternatives to metal-ceramic restorations should possess clinical durability before being recommended to the dentist. Longitudinal clinical studies are required for evaluation ...so innovative types of restorations can meet the expectations of dentists and patients.
Purpose: This study compared the performance of galvano-ceramic restorations (Auvo Galvano Crown ACG) and glass-ceramic individual crowns (Dicor) based on longitudinal clinical trials.
Material and Methods: A total of 769 galvano-ceramic single crowns (AGC) in 322 patients and 173 glass-ceramic individual crowns (Dicor) in 88 patients were reviewed for 8 years and a maximum of 11 years, respectively, after cementation. Risk of fracture was determined with use of a survival analysis (Kaplan and Meier).
Results: Partial ceramic cracking was observed at the time of the last recording of data in 11 galvano-ceramic crowns, 8 of the units remained in place. Two crowns became dislodged and 1 tooth exhibited a fractured root, despite an intact crown. One restoration was removed because of hypersensitivity and 1 with partial ceramic fracture. Forty-two of the glass-ceramic crowns were completely fractured. After a comparable 7 years under risk, 96.5% (±3.4; 95% confidence interval) of the galvano-ceramic premolar and molar crowns and 92% (± 8.5) of crowns placed on incisors and canines crowns were intact. The corresponding data for the glass-ceramic restorations were only 70% (± 10.6) in posterior and 82.7% (± 8.1) in anterior quadrants.
Conclusion: Long-term results of electroformed individual crown restorations were superior to glass-ceramic restorations. (J Prosthet Dent 2000;83:530-4.)
At a dental office in Münster, Germany, the majority of gold inlays incorporated between July 1969 and August 1999 (n=2,071) in 531 patients were checked with reference to the dental records and ...assessed retrospectively to determine their longevity. One hundred seventy-five gold inlays were rated as failures (no longer in situ); 10 abutment teeth were extracted. The 20-year Kaplan-Meier survival rate for restoration-bearing teeth was 98.9%, and the 25-year rate for all gold inlays 73.4% (+/- 4.0%; 95% confidence interval respectively in brackets). Gold inlays inserted in maxillary teeth had significantly better probabilities of survival after this period than those inserted in lower teeth (P=0.0002). Based on the number of surfaces involved, 52.0% (+/- 45.3) of one-surface inlays, 64.3 (+/- 7.5) of two-surface inlays, 75.8% (+/- 7.6) of three-surface inlays, and 84.8% (+/- 5.4) of inlays with more than three surfaces were still in situ after 25 years.
This study systematically searched the dental literature to identify and classify articles on the influence of prosthodontic and dental implant treatment on patient satisfaction and oral ...health-related quality of life according to their level of evidence.
A literature search was carried out for articles published between 1960 and February 2003 using an electronic key word search complemented by hand searching. The retrieved articles were subjected to inclusion and exclusion criteria. Only experimental studies were included; articles that did not focus on the effect of therapy on the patient were excluded from further processing. The levels of evidence of the articles were classified following the guidelines of the US Agency for Health Care Policy and Research.
A total of 207 publications were identified, of which 114 reports investigating 24,863 patients met the inclusion criteria. Data from the studies were analyzed using SPSS 9.0. Two thirds of the publications showed a low evidence level of III; most were conducted in patients who were edentulous or restored with complete dentures (59% of all studies). Mostly, nonstandardized, custom-made questionnaires (80%) were used. On average, 9 (SD 4.2) outcome variables were used within each trial, but clinical criteria were more often used than psychosocial criteria. The most frequently used questions concerned "chewing function" (86%), esthetics (77%), speech (68%), and general satisfaction (67%). Validated instruments, such as the Oral Health Impact Profile, were increasingly used in recent studies, which were also methodically more sufficient.
Few studies with high levels of evidence were found. Research in this field is still in a phase of development.
In a dental practice, 2328 ceramic inlays were placed in 794 patients. The restorations were manufactured chairside using Cerec technology and adhesively inserted at the same appointment. The ...clinical performance of the restorations was evaluated with the Kaplan-Meier analysis. The probability of survival was 95.5% after 9 years; 35 Cerec restorations were judged as failures. The prognosis for success was not significantly influenced by restoration size, tooth vitality, treatment of caries profunda (CP), type of tooth treated, or whether the restoration was located in the maxilla or mandible. The most common type of failure was the extraction of a tooth. In a clinical follow-up light-microscopic examination of 44 randomly selected restorations, an average composite joint width of 236.3 microns was found. 45.1% of the restorations exhibited a perfect margin, and 47.4% of the investigated joint sections showed underfilled margins.
Objectives: An example of technology assessment in dental care by evaluating the (cost-)effectiveness of types of three-surface inlays (gold, laboratory-fabricated ceramic, and chairside CAD/CAM ...ceramic) is provided. Methods: MEDLINE, EMBASE, and the Cochrane Library were searched for studies published between 1966 and June 2003 that reported annual survival probabilities and annual observations. The longevity of different types of inlays was measured by the number of failure-free years. Annual survival rates from different studies were pooled by weighing the rates of each study by the inverse of the variance of the effect estimate. A cost-effectiveness analysis from the perspective of German private health insurers was performed using billing charges. Results: Three, five, and two case series on laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays, respectively, were included. Over a 9-year observation period, the number of undiscounted failure-free years was 8.62 (95 percent confidence interval, 8.40–8.85), 8.65 (8.58–8.73), and 8.76 (8.72–8.80) for laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays, respectively. Laboratory-fabricated ceramic inlays were the most expensive. Conclusions: While laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays had a strikingly similar failure-free survival rate, laboratory-fabricated ceramic inlays had the highest costs and, thus, were less cost-effective than chairside CAD/CAM ceramic and gold inlays.
Verkürzte Zahnreihe Kerschbaum, T
Das Gesundheitswesen,
07/2007
Conference Proceeding
Recenzirano
Odprti dostop
Die verkürzte Zahnreihe (VZR) ist definiert als ein von distal reduzierter Zahnbogen, der bis zum zweiten Prämolaren reicht; er besteht aus 10 okkludierenden Zahnpaaren und weist eine vollständige ...Frontbezahnung auf. Bei extrem verkürzter Zahnreihe verbleiben nur noch die Frontzähne (6 Okklusionspaare).
Molaren sind epidemiologisch häufiger und gravierender durch Karies und parodontale Erkrankungen geschädigt. Damit reduziert sich die Zahl der Restzähne mit zunehmendem Alter. Man weiß aus epidemiologischen Untersuchungen, dass ein nicht geringer Teil der Erwachsenen der Altersgruppe der 35–44Jährigen mit einer mehr oder weniger ausgeprägten VZR ausgestattet sind. Nur ein Teil ist prothetisch versorgt.
Die prothetische Versorgung einer VZR hat folgende Optionen:
Ein- oder beidseitige Freiendprothese mit unterschiedlich aufwändiger Verankerung am Restgebiss
Extensions- oder Freiendbrücke
Verbundbrücke auf Implantaten oder
Rein implantatgetragene Brücke bzw. implantatgestützte Einzelkronen
Nihil (keine prothetische Versorgung)
Letztere Option geht vor allem auf
A.F. Käyser
zurück, der als einer der ersten die Frage stellte, ob das prothetische Dogma, dass alle fehlenden Zähne ersetzt werden müssen, zurecht besteht.
Folgende Probleme können mit der VZR bei fehlender Abstützung im Molarenbereich assoziiert sein:
Parodontaler Zusammenbruch und Überlastung der Restzähne; dieser kann zur Wanderung, Elongation und Auffächerung der Frontzähne, verstärktem Tiefbiss, letztlich also zum Zusammenbruch der Okklusion führen.
Der Funktionszustand der Kiefergelenke und Kaumuskulatur kann infolge der schlechteren Abstützung durch die Zähne ungünstig beeinflusst werden; als Folge können Dysfunktion und Beschwerden (CMD) registriert weren.
Unzureichende Ernährung durch mangelndes Kauvermögen.
Die möglichen Auswirkungen führten in vielen zahnärztlichen Versorgungssystemen zur Forderung,
alle
Zähne zu ersetzen; schließlich wurde daraus ein Dogma der Prothetik, mit der Folge, dass jeder Stützzonenverlust im Molarenbereich durch Zahnersatz behandelt werden sollte. Klinische Beobachtungen und eine zunehmende Anzahl von Forschungsergebnissen haben dazu geführt, dass die Notwendigkeit von Zahnersatz im Molarenbereich nur teilweise belegt werden konnte.
Resin-bonded fixed partial dentures are considered practical and conservative but have not always enjoyed longitudinal success. The long-term survival of 1637 three-unit resin-bonded fixed partial ...dentures was analyzed. A multistate analysis that included parameters such as debonding, rebonding, or renewal of the restoration was used. Five years after insertion 66.1% (±3.7%) of the originally inserted prostheses remained in place. If additional rebonding was computed, the probability of survival was 82.0% (±3.0%). Reconstruction of the metal frame after one or more dislodgements raised the success rate to 87.1% (±2.6%). Rebonded resin-bonded fixed partial dentures developed a greater risk of debonding. The risk of failure for refabricated fixed partial dentures was similar to that of the originally inserted resin-bonded fixed partial dentures. There were no signs of greater caries incidence after multiple recementation procedures.
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