Irene H. A. Aartman

Dental management of patients using antithrombotic drugs: critical appraisal of existing guidelines

OBJECTIVES The aims were: 1) to identify the guidelines available for management of dental invasive procedures in patients on antithrombotic drugs; 2) to assess their quality with the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument; and 3) to summarize their conclusions and recommendations. STUDY DESIGN Systematic literature search for guidelines in several electronic databases. Retrieved guidelines were evaluated with the AGREE instrument for quality assessment. RESULTS The systematic search yielded 93 results, of which only 4 were evidence-based practice guidelines. Two of these guidelines could be recommended for clinical use on the basis of the AGREE instrument. These 2 guidelines drew 68 conclusions from the existing literature and provided 58 recommendations. CONCLUSIONS Two evidence-based clinical practice guidelines, satisfactorily fulfilling the criteria of the AGREE instrument and both published in 2007, advise to not routinely discontinue antiplatelet and anticoagulation medication before dental surgery. The majority of the recommendations, however, were not sufficiently linked to levels of evidence.

Value of bite-wing radiographs in a clinical epidemiological study and their effect on the DMFS index.

The aim of this study was to determine, for different age groups, the additional value of bite–wing radiographs compared to the clinical information, and to calculate the subsequent effect on the DMFS index. Subjects were 14, 17, 20, 23 years old, or in the age groups 25–34 and 35–54, who participated in a clinical epidemiological survey. After obtaining consent, bite–wings were taken of approximately 25% of the participants (n = 663). The extra diagnostic yield of the bite–wings varied between 163 and 700% for approximal dentine caries diagnosis of untreated surfaces, and between 233 and 593% for inadequate restoration judgement for filled surfaces. The DS score went up by about 20–98%, whereas the DMFS index increased between 1 and 12%, resulting in a radiographic correction factor of 1.01–1.12. In conclusion, the considerable increase in the prevalence of approximal dentinal lesions and inadequate restorations for all age groups results in higher numbers of surfaces in need of treatment, but is not accompanied by a significant increase in DMFS scores.

Histopathology of ameloblastoma of the jaws; some critical observations based on a 40 years single institution experience

The aim of the present study is to examine all cases of intraosseous benign ameloblastomas treated between 1970 and 2010 in a single institution and to look for a possible correlation between the histopathological aspects and the demographical and clinical parameters, as well as the treatment outcome. The data of a total number of 44 patients were retrieved from the records. Nine patients were excluded because of doubt about the correct diagnosis (8 patients) or because of an extra-osseous presentation (1 patient). No statistically significant differences were found between the histopathological (sub)types of ameloblastomas and the demographical and clinical parameters, nor between the histopathological (sub)types and treatment outcome. Of the 28 patients treated by enucleation, in 17 patients one or more recurrences occurred, with no significant predilection for any histopathological (sub)type, including the unicystic type. There were no significant differences in the recurrence rate after enucleation in patients below and above the age of 20 years either. In six out of 17 patients with a recurrence, the recurrent lesion showed a different histopathological subtype than was encountered in the primary. In two cases a change from solid/multicystic to desmoplastic ameloblastomas was noticed. In conclusion, the current histopathological classification of benign intraosseous ameloblastoma does not seem to have clinical relevance with the possible exception of the luminal unicystic ameloblastoma that has been removed in toto, unfragmented. Since no primary desmoplastic ameloblastomas were encountered in the present study no further comments can be made on this apparently rare entity. Key words: Odontogenic tumours, ameloblastoma, histopathology.

Craniofacial Morphology of Dutch Patients With Bilateral Cleft Lip and Palate and Noncleft Controls at the Age of 15 Years

Objective: Comparison of craniofacial morphology in bilateral cleft lip and palate patients to that of a noncleft control group at the age of 15 years. Design: A cross-sectional study of cephalometric data. Subjects and Methods: Cephalometric records of 41 consecutive patients (32 boys and 9 girls) with nonsyndromic complete bilateral cleft lip and palate born between 1973 and 1987. The patients were treated by the cleft teams of the Erasmus Medical Centre in Rotterdam and the VU University Amsterdam. The control group of normal Dutch subjects was followed in the Nijmegen Growth Study. From this population, mean cephalometric data were used. Differences in cephalometric measurements and other variables were calculated between the bilateral cleft lip and palate group and the control group. Results: Independent-sample t tests indicated that there was a statistically significant difference between the mean of the cephalometric values of the bilateral cleft lip and palate patients and the control group with respect to all cephalometric variables. Pearson correlation coefficients calculated between angle ANB and the number of operators, number of surgical procedures before 15 years of age, and the year of birth were not significant. Conclusions: Bilateral cleft lip and palate patients treated in the Amsterdam and Rotterdam cleft centers differed significantly from the control group in all measurements. A Class III development due to a less forward positioned maxilla was observed. The vertical measurements indicated a more divergent growth pattern in bilateral cleft lip and palate patients (Ans-Me/N-Me, GoGn-SN, and SN-FFH).

The Influence of Force Magnitude on Intrusion of the Maxillary Segment

The purpose of this study was to determine whether the magnitude of intrusive force to the maxillary incisors influences the rate of incisor intrusion or the axial inclination, extrusion, and narrowing of the buccal segments. Twenty patients between the ages of nine and 14 years who needed at least two mm of maxillary incisor intrusion were assigned to one of two equal groups. In group 1 patients, the teeth in the maxillary anterior segment were intruded using 40 g, whereas in group 2 patients, 80 g was used. Records were taken from each patient at the beginning and end of intrusion. There was no statistically significant difference between the 40- and 80-g groups in the rate of incisor intrusion, or the amount of axial inclination change, extrusion, and narrowing of the buccal segments.

Treatment results of CO2 laser vaporisation in a cohort of 35 patients with oral leukoplakia

OBJECTIVES The aim of the present study was to evaluate the treatment results of CO2 laser vaporisation in a well-defined cohort of patients with oral leukoplakia (OL). MATERIAL AND METHODS The group consisted of 35 patients. Before treatment, a clinical photograph and an incisional biopsy were performed in all cases. Also posttreatment results were documented with clinical photographs. The assessment of the treatment results was performed by an independent clinician who had not performed the treatment. The mean follow-up period was 61.9 months (range 12-179 months). RESULTS In 14/35 patients, there was a recurrence between 1 and 43 months (mean 18.7 months), the annual recurrence rate being approximately 8%. In three of these patients, malignant transformation occurred at a later stage. In two other patients, a malignancy occurred without a prior recurrence. In altogether 5 of 35 patients, malignant transformation occurred in a mean period of 54 months, the annual malignant transformation rate being approximately 3%. CONCLUSIONS The results in the present study are worse than those reported in the literature, perhaps owing to the use of different diagnostic criteria for OL, differences in the employed laser technique and assessment of possible recurrences by an independent clinician.

The Relation between the Point of Force Application and Flaring of the Anterior Segment

The purpose of this study was to determine whether application of an intrusive force by an intrusion arch at the distal wings of the lateral incisor brackets causes a change in the axial inclination of the anterior segment. Maxillary incisor intrusion was performed, and records were taken from 40 adolescent patients at the beginning and end of intrusion. Intrusion of the maxillary anterior segment caused a statistically significant mean increase in axial inclination of the central incisor of 8.74 degrees. The following correlations were investigated and found not statistically significant. The correlation between the (1) distance from the point of force application to the center of resistance at the start of intrusion and the change in axial inclination of the incisor, (2) distance from the point of force application to the center of resistance at the start of intrusion and the change in distance from the incisal edge to the distal side of the first molar, (3) distance from the point of intrusive force application to the center of resistance at the start of intrusion and at the end of intrusion, (4) distance from the point of intrusive force application to the center of resistance at the start of intrusion and the change in this distance between start and end of intrusion, and (5) amount of intrusion and the change in axial inclination.

Radiographic dentinal caries and its progression in occlusal surfaces in Dutch 17-year-olds: a 6-year longitudinal study

In this study, the status of 705 occlusal surfaces of first and second molars of 90 17-year-olds was analysed longitudinally in a 6-year follow-up, using a combination of clinical and radiographic information. Clinical data were derived from an epidemiological project. Each of two examiners judged all bitewing radiographs. The overall Cohen’s ĸ for interexaminer agreement of radiographic assessments was 0.77. Between the age of 17 and 23 years, about one third of sound occlusal surfaces developed a new dentinal radiolucency, and over 70% of existing radiolucencies showed progression, both irrespective of the presence of a sealant. In both examination years, almost 20% of the restored surfaces showed signs of a dentinal radiolucency. It was concluded that at the age of 17 occlusal surfaces are still highly susceptible to new dentine caries and further progression of dentinal radiolucencies already present.

DNA ploidy measurement in oral leukoplakia: different results between flow and image cytometry

The estimated prevalence of oral leukoplakia is worldwide approximately 2%, with an annual malignant transformation rate of approximately 1%. The aim of the present study was to evaluate the possible contribution of ploidy measurement to the prediction of the clinical course, in a well defined cohort of patients with oral leukoplakia. Ploidy was measured by both flow cytometry (FCM-DNA) and image cytometry (ICM-DNA) and we focussed on the comparison of the two different techniques to determine ploidy. A total of 41 patients have been included, with a mean age of 59 years (range 36-78 years). With FCM-DNA, three lesions were aneuploid, with ICM-DNA, 19 lesions were aneuploid. DNA ploidy was compared with clinicopathological and patients parameters. There were no statistically significant differences between DNA ploidy and any patient factor with both FCM-DNA and ICM-DNA. Using FCM-DNA, DNA aneuploid lesions showed statistically significant more dysplasia (p=0.04) than diploid lesions. Furthermore, DNA aneuploid lesions were more frequently encountered at high-risk locations (p=0.03) as being determined with FCM-DNA. These relations were not found when DNA ploidy was determined with ICM-DNA.

The role of a high pull headgear in counteracting side effects from intrusion of the maxillary anterior segment

Intrusion of incisors is often the preferred treatment of a deep overbite. This study focuses on deep overbite correction by intrusion of maxillary incisors. The purpose of this study is to determine whether high-pull headgear wear can prevent steepening of the buccal segment, extrusion of the buccal segment, maintain arch width, and increase the rate of incisor intrusion. The number of patients needed for this study was calculated to be 20. Patients were between nine and 14 years of age and assigned to one of two groups. In each group, intrusion of maxillary incisors was performed. Patients in one group wore a high-pull headgear at night, and patients in the other group did not. For each patient, a lateral head film, impressions with a wax bite in centric occlusion, and intraoral photographs were taken at the beginning and end of intrusion. This study demonstrated that high-pull headgear had no effect on steepening and extrusion of the buccal segments or on the rate of intrusion but did have an effect on narrowing of the buccal segments. By performing intrusion as described in this study, no statistically significant side effects were observed in the buccal segments, whereas a statistically significant amount of incisor intrusion of 2.24 mm in the no-headgear group and 2.37 mm in the headgear group was observed.