Fonda G. Robinson

Osteoporosis and bisphosphonate-related osteonecrosis in a dental school implant patient population.

Purpose:Studies have demonstrated an inconsistent association between implant failure and bone mineral density. The prevalence of osteoporosis in US adults has been reported to range from 5% to 10% in women and from 2% to 4% in men. The prevalence of bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) has been reported to range from 0% to 4.3% of patients taking oral BPs. The purpose of this study was to calculate the risk of dental implant loss and the incidence of BRONJ in patients with osteoporosis at the University of Kentucky College of Dentistry (UKCD). Materials and Methods:This study analyzed data collected from patients who had implants placed between 2000 and 2004 at UKCD. Data were gathered from patient interviews regarding implant survival and patient-satisfaction parameters, and interviews were conducted either chairside at a scheduled maintenance appointment or by telephone interview. Results:Among 203 patients who received 515 implants, the prevalence of osteoporosis was 23.3% for women and 1.2% for men. None of the 20 patients who reported a history of oral BP use exhibited BRONJ, and there were no implant failures in patients with a history of osteoporosis. Conclusions:In this study, osteoporosis conferred no risk of implant failure, and oral BP therapy was not associated with BRONJ.

Evidence-Based Curriculum Reform: The Kentucky Experience

Evidence-based health care seeks to base clinical practice and decision-making on best evidence, while allowing for modifications because of patient preferences and individual clinical situations. Dentistry has been slow to embrace this discipline, but this is changing. In the Graduate Periodontology Program (GPP) of the University of Kentucky, an evidence-based clinical curriculum was implemented in 2004. The tools of evidence-based health care (EBHC) were used to create evidence-based protocols to guide clinical decision-making by faculty and residents. The program was largely successful, although certain challenges were encountered. As a result of the positive experience with the GPP, the college is implementing a wider program in which evidence-based protocols will form the basis for all patient care and clinical education in the predoctoral clinics. A primary component of this is a computerized risk assessment tool that will aid in clinical decision-making. Surveys of alumni of the periodontal graduate program show that the EBHC program has been effective in changing practice patterns, and similar follow-up studies are planned to assess the effectiveness of the predoctoral EBHC program.

Bleaching and temporomandibular disorder using a half tray design: A clinical report

A maxillary soft, custom-fitted tray was fabricated for a patient to perform nightguard vital bleaching. Treatment was interrupted after the patient experienced pain in the temporomandibular joint area shortly after wearing the bleaching prosthesis. The tray was trimmed so the labial, incisal and buccal cusps were covered and Sc) the patient had complete tooth-to-tooth contact in the maximum intercuspal position. The prosthesis proved to be retentive even without the presence of the bleaching material. The thick, sticky bleaching material was contained in the half tray design and the tray was held in place. The patient was able to continue the bleaching process for the 2-week duration necessary to achieve successful lightening of the teeth without further TMD symptoms.

Resistance of Mandibular Polyurethane Replicas to Fracture After Removal of Blocks From the Symphysis and Ramus

Background: When block grafts are harvested intraorally, the donor sites may act as stress concentrators and alter the structural integrity of the mandible. Purpose: The study aimed to compare displacement and load failure between intact polyurethane mandibular replicas and similar replicas from which blocks were taken at the symphysis or the ramus. It also aimed to identify trends of load failure. Materials and Methods: Thirty-five mandibular replicas were tested to failure with an electromagnetic material testing unit. The variables evaluated in this investigation were maximal load, displacement at maximal load, and fracture location. Results: Statistically significant differences in maximal load were detected between groups (P = 0.0008). Differences between fracture locations were also statistically significant (P < 0.0001). The mandibles from which blocks were removed at the symphysis were significantly more likely to break at a lower maximal load than were the control mandibles (P = 0.0010) or the mandibles from which blocks were removed at the ramus (P = 0.0162). They were also more likely than the control group to break at a lower displacement at maximal load (P = 0.0145). Conclusions: Location of the donor site significantly influences the structural integrity of mandibular replicas. In addition, the donor site significantly affects the location of mandibular fractures.