Brian D. Monteith

A comparison of Er:YAG laser and mechanical debridement for the non-surgical treatment of chronic periodontitis: A randomized, prospective clinical study

AIMS To compare a monotherapy of Er:YAG laser debridement (ERL), wavelength 2940 nm, with mechanical scaling and root planing (SRP) for the treatment of chronic periodontitis using clinical and patient-centred outcomes. METHODS Twenty-eight participants had two randomly assigned quadrants treated with ERL and two with SRP. Full-mouth plaque index, probing depth, bleeding on probing, clinical attachment level and gingival recession were recorded at baseline and 6- and 12-weeks post therapy. A questionnaire was used to assess pain, discomfort and satisfaction during and after treatment. RESULTS Twenty-two participants completed treatment and had 6- and 12-week clinical re-evaluations. SRP provided greater mean pocket depth reduction at 6- and 12-weeks (p = 0.01 and p = 0.003 respectively), and a greater reduction in pockets ≥ 4 mm at 6 weeks only (p = 0.03) compared with ERL. SRP also resulted in a significant reduction in bleeding on probing (BOP) sites at 12 weeks compared with ERL and a statistically significant greater reduction in mean clinical attachment level (CAL) at 6- (p = 0.02) and 12-weeks (p = 0.03). Patients expressed greater satisfaction with SRP on the day of treatment but were equally satisfied subsequently. CONCLUSION SRP resulted in a statistically significant greater short-term improvement in clinical parameters and patient satisfaction compared with ERL.

Effect of restorations on pulpal blood flow in molars measured by laser Doppler flowmetry.

AIM To: (i) compare laser Doppler pulpal blood flow (PBF) signals from restored and unrestored first molar teeth, (ii) investigate PBF in teeth with large and small restorations, and (iii) to relate PBF to pulp chamber dimensions on radiographs. METHODOLOGY Bitewing radiographs of young adults with restored first molars were obtained and pulp chamber dimensions measured. Subjects were divided into 2 groups: group A with a restored tooth and an unrestored contralateral (43 subjects) and group B, those with a molar with a small (usually occlusal) restoration whilst the contralateral tooth had an extensive occlusal restoration (or restorations) or restored proximal surface(s) and/or cuspal overlay (31 subjects). The 148 teeth responded to electric pulp testing, and their PBF was recorded using a laser Doppler flowmeter. Data were analysed using Students t-test. RESULTS In group A the PBF in the restored teeth was significantly lower than in unrestored contralaterals (P = 0.028) and the total pulp chamber area and that in the clinical crown were smaller (P = 0.039 and 0.021 respectively). The group B molars with large restorations had significantly lower PBF than contralaterals with small restorations (P = 0.001), and their total pulp chamber area and pulp chamber width at cervix were reduced significantly (P = 0.003 and 0.032 respectively). CONCLUSIONS In molars the size of the pulp chamber was influenced by the presence of restorations and the PBF was reduced when restorations were present. Size and extent of restorations had a significant effect on PBF.

Influence of clinical experience on the radiographic determination of endodontic working length.

AIM To determine the influence of clinical experience on the accuracy and consistency of estimation of radiographic working length (WL) for the root canal treatment of single-rooted teeth. METHODOLOGY Forty conventional WL periapical radiographs that included variations in file length were selected. They were digitally scanned and arranged in PowerPoint presentations on CDs. These were distributed to three assessor groups; fourth-year undergraduates at two stages of training (Groups 1 and 2) and endodontic postgraduates (Group 3). Participants were asked to determine the adjustment needed in millimetres to position the file tip at the correct WL for each image. A gold standard file position was provided by three experienced endodontists. For inter-group comparison of scores, the Kruskal-Wallis, ANOVA and post hoc Bonferroni tests were used. Evaluation of intra-examiner consistency was with the Kappa test. To evaluate intra-group consistency, the Wilcoxon signed rank test was used to compare the frequency of weighted correct scorings. RESULTS File adjustments of Group 3 were significantly more accurate than those of Group 1 (P = 0.006). The scores of Group 3 were also better than those of Group 2, although the difference was not significant. When the scores of the undergraduate groups were compared, the difference was not statistically significant. The consistency of the groups was not affected by a 2-week pause between assessments, and no definite pattern could be detected across any of the groups with the Kappa test. CONCLUSION Clinical experience after graduation influenced the accuracy of estimating the adjustments needed for correct radiographic WL of single-rooted teeth. The most experienced group was significantly more accurate than the other groups.

Organizational considerations for an electronic curriculum. Part II: A multimedia approach to dental education in general and to prosthodontics in particular ☆ ☆☆ ★

STATEMENT OF PROBLEM In using multimedia electronic knowledge-transfer as a tool in dental education, an overriding concern has centered on how to devise an organizational model that will accommodate the vast and diverse arrays of information involved, yet be sufficiently simple to provide students with a rational and consistent means of accessing the information they require. PURPOSE This article presents a model that adopts the Natural History of Dental Diseases as the organizing principle. This article also encourages a mindset in prosthodontics that focuses on the dynamics of energy-dispersal through the supporting structures, in an attempt to provide learners with a deeper cognitive dimension for problem solving and to facilitate their empowerment as life-long learners.