Serpil Djemal

The clinical evolution of the 'Dahl Principle'.

The restorative management of patients with localised tooth wear is a major challenge to the dental profession. There is rarely adequate interocclusal space available to place restorations without the need for extensive tooth preparation or the involvement of many unaffected teeth. In 1975, a method was described which created interocclusal space by the use of a partial coverage appliance made of cobalt chromium alloy. The technique reduced the need for more invasive palatal reduction. This paper, with the aid of clinical case examples, highlights the development and evolution of the original removable appliance. However, there remains a need for further clinical studies to evaluate fully these techniques

The influence of specialty training, experience, discussion and reflection on decision making in modern restorative treatment planning

Aims This study was designed to determine the effect of reflection and discussion of a group of dentists with differing backgrounds and qualifications in the management of failed endodontic treatment.Materials and methods During the Dental Pan-Society plenary session (16-17 November 2007) delegates (n = 393) were asked a series of questions on the management of a case with failed endodontic treatment of four maxillary incisors restored with linked crowns in a patient with a high smile line. The case had been previously posted on the conference website in addition to being presented on the day of the forum. Responses of delegates to predetermined questions and options on the management of the case were recorded using closed-circuit devices for each individual delegate. The questions were repeated after the case was opened up for discussion by the delegates in conjunction with a panel of leading experts. The discussion topics included the factors affecting the outcome of secondary root canal treatment, post-extraction changes and the options for prosthetic replacement including the provision of implants in the aesthetic zone.Results The initial response of the majority (58%) of delegates favoured extraction and prosthetic rehabilitation over endodontic retreatment of the affected teeth. Following the discussion this figure reduced to 50%. In respect to those individuals who were specialists, extraction was again the preferred option before the discussion for periodontists (74%), prosthodontists (64%) and restorative dentists (65%). This was in contrast to endodontists who preferred endodontic retreatment, with only 30% identifying extraction as the treatment of choice. Following the discussion, the number of periodontists and endodontists who favoured extraction reduced by 3% and 5% respectively, whereas the number of prosthodontists and restorative dentistry specialists who preferred extraction increased by 2% and 4% respectively. Conclusion Reflection and discussion can make individuals reconsider their initial treatment decisions. These personal skills may become more significant when planning treatment for complex restorative cases.

Update on guidelines for selecting appropriate patients to receive treatment with dental implants: priorities for the NHS--the position after 15 years.

In 1997 the Faculty of Dental Surgery (Royal College of Surgeons, England) as part of a wider publication produced guidance on prioritisation for the selection of patients to receive treatment with dental implants within the NHS in the UK (http://www.rcseng.ac.uk/fds/publications-clinical-guidelines/clinical_guidelines/index.html). This update considers eight main groups who may benefit from treatment with osseointegrated implants. Where patients are being considered for implant-based rehabilitation, treatment plans must be weighed up against the risks, benefits and outcomes outlined in evidence-based research.

Contemporary management of tooth replacement in the traumatized dentition

Dental trauma can result in tooth loss despite best efforts at retaining and maintaining compromised teeth (Dent Traumatol, 24, 2008, 379). Upper anterior teeth are more likely to suffer from trauma, and their loss can result in significant aesthetic and functional problems that can be difficult to manage (Endod Dent Traumatol, 9, 1993, 61; Int Dent J 59, 2009, 127). Indeed, teeth of poor prognosis may not only present with compromised structure but trauma may also result in damage to the support tissues. Injury to the periodontium and alveolus can have repercussions on subsequent restorative procedures (Fig. 19). Where teeth are identified as having a hopeless prognosis either soon after the incident or at delayed presentation; planning for eventual tooth loss and replacement can begin at the early stages. With advances in both adhesive and osseointegration technologies, there are now a variety of options for the restoration of edentate spaces subsequent to dental trauma. This review aims to identify key challenges in the provision of tooth replacement in the traumatized dentition and outline contemporary methods in treatment delivery.