Charles Janus

Telemedicine Consultations in Oral and Maxillofacial Surgery: A Follow-Up Study

PURPOSE The purpose of this study was to follow up on the previous study in evaluating the efficiency and reliability of telemedicine consultations for preoperative assessment of patients. MATERIALS AND METHODS A retrospective study of 335 patients over a 6-year period was performed to evaluate success rates of telemedicine consultations in adequately assessing patients for surgical treatment under anesthesia. Success or failure of the telemedicine consultation was measured by the ability to triage patients appropriately for the hospital operating room versus the clinic, to provide an accurate diagnosis and treatment plan, and to provide a sufficient medical and physical assessment for planned anesthesia. Data gathered from the average distance traveled and data from a previous telemedicine study performed by the National Institute of Justice were used to estimate the cost savings of using telemedicine consultations over the 6-year period. RESULTS Practitioners performing the consultation were successful 92.2% of the time in using the data collected to make a diagnosis and treatment plan. Patients were triaged correctly 99.6% of the time for the clinic or hospital operating room. Most patients (98.0%) were given sufficient medical and physical assessment and were able to undergo surgery with anesthesia as planned at the clinic appointment immediately after telemedicine consultation. Most patients (95.9%) were given an accurate diagnosis and treatment plan. The estimated amount saved by providing consultation by telemedicine and eliminating in-office consultation was substantial at

Effect of restoration volume on stresses in a mandibular molar: A finite element study

134,640. CONCLUSION This study confirms the findings from previous studies that telemedicine consultations are as reliable as those performed by traditional methods.

Dental Shade Matching and Value Discernment Abilities of First-Year Dental Students: Farnsworth-Munsell 100 Hue Test and Shade Matching

STATEMENT OF PROBLEM There can be significant disagreement among dentists when planning treatment for a tooth with a failing medium-to-large--sized restoration. The clinician must determine whether the restoration should be replaced or treated with a crown, which covers and protects the remaining weakened tooth structure during function. PURPOSE The purpose of this study was to evaluate the stresses generated in different sized amalgam restorations via a computational modeling approach and reveal whether a predictable pattern emerges. MATERIAL AND METHODS A computer tomography scan was performed of an extracted mandibular first molar, and the resulting images were imported into a medical imaging software package for tissue segmentation. The software was used to separate the enamel, dentin, and pulp cavity through density thresholding and surface rendering. These tissue structures then were imported into 3-dimensional computer-aided design software in which material properties appropriate to the tissues in the model were assigned. A static finite element analysis was conducted to investigate the stresses that result from normal occlusal forces. Five models were analyzed, 1 with no restoration and 4 with increasingly larger restoration volume proportions: a normal-sized tooth, a small-sized restoration, 2 medium-sized restorations, and 1 large restoration as determined from bitewing radiographs and occlusal surface digital photographs. RESULTS The resulting von Mises stresses for dentin-enamel of the loaded portion of the tooth grew progressively greater as the size of the restoration increased. The average stress in the normal, unrestored tooth was 4.13 MPa, whereas the smallest restoration size increased this stress to 5.52 MPa. The largest restoration had a dentin-enamel stress of 6.47 MPa. A linear correlation existed between restoration size and dentin-enamel stress, with an R(2) of 0.97. CONCLUSIONS A larger restoration volume proportion resulted in higher dentin-enamel stresses under static loading. A comparison of the von Mises stresses to the yield strengths of the materials revealed a relationship between a tooths restoration volume proportion and the potential for failure, although factors other than restoration volume proportion may also impact the stresses generated in moderate-sized restorations.

The Use of Telemedicine in Oral and Maxillofacial Surgery

PURPOSE To determine if Farnsworth-Munsell 100 Hue Test, Perceptual Ability Test, gender, age, ethnicity, and time predict dental shade matching and value discernment in first-year dental students. MATERIALS AND METHODS Farnsworth-Munsell 100 Hue Test was administered to 95 first-year-dental students beneath a Judge II booth (color temperature of 6500°K, and color rendering index of 90). Students also arranged 16 masked shade tabs from a Vita Classic shade guide by value (lightest to darkest) and matched together 16 pairs of masked shade tabs from two Vita Classic shade guides. Ethnicity, age, Perceptual Ability Test scores, gender, and time to complete the tests were recorded. Associations and correlations were investigated using chi-square, Tukey-Kramer HSD, standard least square, and multilinear regression (p < 0.05). RESULTS Total error scores on the Farnsworth-Munsell 100 Hue Test ranged from 0 to 144. Forty-eight students exhibited superior color acuity, 45 average, and two poor. The mean number of correct answers for matching shade tabs together was 11.6, and 6.1 for arranging the shade tabs by value. Females performed statistically better than males on the Farnsworth-Munsell 100 Hue Test and shade tab matching. Better color discrimination identified by lower total error scores on the Farnsworth-Munsell 100 Hue Test was directly correlated to greater ability to match shade tabs together. Perceptual Ability Test scores had slight significance. As the scores increased there was slightly better performance on the Farnsworth-Munsell 100 Hue Test. Older participants performed better than younger subjects on the value test. No other correlations were significant for any of the tests. CONCLUSIONS Females and individuals who performed better on the Farnsworth-Munsell 100 Hue Test have improved dental shade-matching ability.

Factors Affecting Aesthetic Treatment Choices in Posterior Teeth

PURPOSE To determine the perceived utility and demand for the application of telemedicine for improved patient care between nonsurgical dental practitioners (GPs) and oral and maxillofacial surgeons (OMS). MATERIALS AND METHODS Two distinct questionnaires were made, one for GPs and one for OMSs. The GP questionnaire was sent to practicing Virginia Dental Association members on an e-mail list (approximately 2,200). The OMS questionnaire was sent by the Virginia Society of Oral Maxillofacial Surgery to members on an e-mail list (approximately 213). Questionnaires included questions about access to care, benefits of telemedicine consultations, reliability of telemedicine consultations, and perceived barriers against and opportunities for the implementation of telemedicine. The questionnaire was completed by 226 GP and 41 OMS respondents. RESULTS There was a significant difference among responses of GPs based on practice location: rural patients had a longer average time from referral to OMS consultation (P = .003), rural patients traveled longer distances (P < .0001), rural practitioners referred more patients (P = .0038), and rural GPs referred more single-tooth implant cases (P = .0039). GP respondents moderately agreed to statements about the benefits of telemedicine, whereas OMS respondents were more neutral. GPs responded they would refer more patients (4.4) if consultations could be performed by telemedicine. OMSs agreed that more referrals would influence their decision to provide telemedicine consultations (51%). Practitioners had neutral perceptions about the reliability of telemedicine. OMS respondents agreed they would implement telemedicine in their practice if it provided equally good consultations as in-office visits. CONCLUSION According to the present findings, telemedicine could be an important step in the right direction for overcoming current issues with patient access to care and increasing health care costs. The benefits of telemedicine technology have been documented and will continue to be seen with wider application of its use in other areas of health care such as oral and maxillofacial surgery.

Accuracy and dimensional stability of extended-pour and conventional alginate impression materials

Objectives: New developments of aesthetic restorative materials necessitate dentists choosing between aesthetic or unaesthetic restorations for posterior teeth. This study investigates correlations between dentists? choices of aesthetic or unaesthetic restorations and tooth type, as well as demographic information. The null hypothesis is that no relationship exists between treatment choices and demographic information. Materials and methods: An online survey was deployed querying participating dentists for treatment recommendations for 15 clinical cases involving posterior restorations with intraoral occlusal views and bitewing images, from a menu of treatment options. Biographical and demographic data were collected about the dentists? practices. Subjects were volunteer subscribers to an online dental magazine with an estimated subscription of over three thousand. Being a cross sectional descriptive study, there are no controls or tests for examiner reliability. Analysis was accomplished using repeated-measures logistic regression. Results: Respondents (N=300), 16.9% female, 14% foreign. Tooth type (molar or premolar), was significant in the aesthetic restoration decision (p<0.0001). Graduation decade when collapsed to graduates prior to 1980 and all others was significant (p=0.0404). Type of practice was significant when collapsed into educators, military, retired and all other types (p=0.0103). Adjusted odds of a premolar versus a molar being indicated for an aesthetic restoration is 3.67 (95% CI 3.07-4.38), and for other dentists versus educators, military and retired dentists indicating aesthetic restorations is 3.35 (95% CI 2.06-5.42). Conclusion: Despite continued improvements in aesthetic restorative materials, aesthetic restorations are still chosen for premolars significantly more than molars. Gender, nationality, decade of graduation and practice type were not significant. Practice type collapsed into educators, military and retired dentists was significant, as was graduation decade when collapsed into years prior to 1980 and all others.