Geert Hommez

Longitudinal study on the influence of Nd:YAG laser irradiation on microleakage associated with two filling techniques.

OBJECTIVE This study investigates the effects of Nd:YAG laser irradiation on apical and coronal seals, when used prior to two root canal filling techniques. BACKGROUND DATA Limited information exists regarding the effects of morphologic changes to dentin walls following Nd:YAG laser irradiation on the sealing ability of root fillings. METHODS Two hundred forty teeth were analyzed by observing coronal and apical leakage of Indian ink (DL), and 60 were analyzed for through-and-through leakage using the fluid transport model (FTM). The Nd:YAG laser parameters were 1.5 W, 100 mJ, and 15 Hz (four times for 5 s at 20 s intervals). Each group consisted of a lased and a nonlased subgroup: each subgroup had root fills done by either cold lateral condensation (CLC) or hybrid condensation (HC). Leakage was assessed after 48 h, and then at 1, 6, and 12 months. The DL group was divided into four groups of 15 teeth for each evaluation point. Through-and-through leakage (L in microliters/day) was measured for 48 h under a pressure of 1.2 atm using FTM, and recorded as L = 0 (L1), 0 < L <or= 10 (L2), or L > 10 (L3). RESULTS Apical and coronal dye leakage was observed in all groups. Significant differences (p < 0.05) in apical leakage were found between HC and HC + Nd after 1, 6, and 12 months, and between CLC and CLC + Nd at 6 and 12 months. No significant differences were found between laser-irradiated and non-laser-irradiated groups with FTM. CONCLUSION Pulsed Nd:YAG laser irradiation following root canal preparation may reduce apical leakage in association with hybrid gutta-percha condensation.

Analgesia (mis)usage on a dental emergency service: a patient survey

ObjectivesAnalgesics are one of the most frequently used medicines. Self-medication and misuse have been described in the literature. The purpose of this study was to document analgesic (mis)use in a population seeking emergency dental treatment.Material and methodsPatients consulting a dental emergency service were randomly asked to complete a questionnaire on analgesic use, knowledge and information on the analgesics and on their pain history. A photobook was used as an aid to identify products used. Descriptive statistics were combined with chi-square and Mann-Whitney U testing.ResultsNinety-eight patients were included. Acetaminophen (69.4%) and ibuprofen (65.3%) were the most frequently used products. Nearly half of the subjects (43.9%) combined at least two analgesics. Although 42.9% of subjects were aware of the maximum daily dose, 62.2% of the subjects exceeded this limit, specifically 76.6% of subjects using ibuprofen and 32.4% of subjects using acetaminophen overdosing. Females overdosed significantly more than males. Ingestion on medical advice did not affect the overdose rates significantly. No significant relation was found between the absence of knowledge on the maximum daily dose and actual overdosing. No higher pain reduction was found in patients overdosing analgesics. The average number of days patients experienced pain before consulting the emergency unit was 12. A significant relation was found between the lag time and overdosing.ConclusionsA large portion of the patients overdosed analgesics. Even prior medical advice did not reduce significantly overdose rates.Clinical relevanceDentists treating emergency cases clearly need to be aware of the high risk and high rates of overdosing analgesics in their patients.

A prospective study on ultra-wide diameter dental implants for immediate molar replacement

BACKGROUND Although wide diameter implants are well documented, little is known about ultra-wide diameter implants (>6 mm). This study evaluates the clinical outcome of ultra-wide diameter implants, placed in molar extraction sockets. MATERIALS AND METHODS Ultra-wide diameter implants (7-9 mm) were placed immediately after molar extraction in a 1-stage protocol, without raising a flap or using any bone grafts. After 4 months, the implant was loaded with a single screw-retained crown. Bone loss was evaluated using peri-apical radiographs. Plaque and bleeding were recorded. Crown and papilla dimensions were measured and compared with the contra-lateral tooth. RESULTS Fifty-one patients (36 male and 15 female), mean ages 61 years old, were treated with 26 implants in the maxilla and 25 implants in the mandible. The majority had a thick (#19) or medium (#31) biotype. After a mean-follow-up period of 23 months, the mean bone level was located 1.16 mm apical of the implant-abutment junction (SD 0.42, range 0.00-2.45) while the actual bone remodeling associated with socket healing resulted in a mean coronal movement of the bone level of 0.15 mm. The mean insertion torque was 116 Ncm (SD 53, range 10-250). There were no differences in papilla height (P = .55), crown length (P = .32), zenith (P = .84), and bucco-palatal dimensions (P = .38). There was a significant difference in the mesio-distal dimension (P = .01). Mean probing depth was 2.59 mm at the implant and 2.23 mm at the contra-lateral tooth (P = .001). There was significantly more plaque at the tooth compared to the implant (P = .01), but there was no significant difference in terms of bleeding on probing (P = .08). Patient satisfaction was high with 72.5% of the patients experiencing no problems at all. CONCLUSIONS Ultra-wide diameter implants have a predictable outcome, demonstrating very little bone loss. Papilla and crown dimensions were comparable to the contra-lateral natural tooth.

Improving care processes through optimized design of the operating system

The impact of the design of the operating system on operational performance is seldom discussed in health care. We conducted a comparative mixed-method case analysis of sequential-care processes in hospitals. We examined differences in the organization of sequential care processes, whether sequential care processes with fully compatible operating systems perform better than those not fully compatible with the operating system, and the causes of variation in sequential care processes. Our findings suggest that, overall, hospitals design their operating system for low turnover times and smooth transitions. They show that aligning structure and processes components with the operational system positively influences operational performance. However, we note that not all cases make optimal use of this concept. Besides special-cause variation disrupting flow efficiency, the results demonstrate that other variables that can be taken into account in planning care processes influence the process. Above that, this p...