Faculty Bibliography

BACKGROUND: The authors assessed the extent of early childhood caries- (ECC-) related visits to emergency departments (EDs) and ambulatory surgery facilities (ASFs) in children younger than 6 years and associated treatment charges in New York state from 2004 through 2008. METHODS: The authors obtained data from the New York state's Statewide Planning and Research Cooperative System (Albany) and calculated descriptive statistics and rates according to selected indicators, as well as total and average per-visit treatment charges. RESULTS: From 2004 through 2008, the number of ECC-related visits to EDs and ASFs increased by 349 and 1,039, respectively. Most ECC-related visits were to ASFs. The total annual treatment charges increased from $18.5 million to $31.3 million from 2004 to 2008, and average per-visit charges increased from $4,237 to $5,501 during the same period. CONCLUSIONS: ECC-related visits to EDs and ASFs by children younger than 6 years and the associated treatment charges increased substantially from 2004 through 2008 in New York state. Practice Implications. Dental professionals need to determine the reasons parents seek dental care for their children in EDs and ASFs and effective strategies for preventing ECC to avoid the subsequent need for seeking dental care in EDs and ASFs.

The use of fluorides in dental public health programs has a long history. With the availability of fluoridation and other forms of fluorides, dental caries have declined dramatically in the United States. This article reviews some of the ways fluorides are used in public health programs and discusses issues related to their effectiveness, cost, and policy.

The aim of this study was to determine any existing difference in the amount of fluoride incorporated in the surface, body enamel and dentin of two groups of deciduous teeth, either exposed to pre- and postnatal fluoride supplements or to postnatal fluoride only. One hundred and eighty five subjects with intact deciduous incisors were selected from a randomized, double blind study of the caries preventive efficacy of prenatal fluoride (F) supplementation. Surface and body enamel samples were obtained by the acid etch biopsy technique. Dentin microsamples were obtained by drilling to a depth of 100 microm using the microdrill biopsy technique. It was concluded that fluoride exposure during the prenatal period offered no additional measurable fluoride uptake by dental tissues other than that attributable to postnatal fluoride alone.

The purpose of this study was to evaluate the effect of bilateral disk displacement without reduction (BDDN) on the skeletal and dental pattern of affected individuals. There were 59 symptomatic female patients and 46 asymptomatic normal female volunteers. All study participants had bilateral high-resolution magnetic resonance imaging scans in the sagittal (closed and open) and coronal (closed) planes to evaluate the temporomandibular joints. Linear and angular cephalometric measurements were taken to evaluate the skeletal, denture base, and dental characteristics of the two groups. A smaller cranial base length (Ba-Na) was found in the symptomatic group. The facial plane angle was smaller, and the angle of convexity was larger because of the retropositioned mandible. The lower denture base was also retruded as shown by the smaller SNB angle. The BDDN group exhibited a larger overjet. The mandibular plane angle was steeper, the Y-axis was more vertical (S-Gn to FH), the posterior ramal height (Ar-Go) was shorter, and the angle between the mandibular and the palatal plane (PP to MP angle) was increased in the symptomatic group. No significant dental differences were found. This study showed that alterations in skeletal morphology might be associated with BDDN. This study suggests that subjects with BDDN may manifest altered craniofacial morphology. The clinician should be aware of that possibility, especially for the growing patients and the surgical candidates.

PURPOSE: The authors evaluated, under conditions simulating implant placement, the cutting efficiency, durability, heat production, and wear of implant drills. MATERIALS AND METHODS: Osteotomies were performed on bovine ribs using a surgical unit mounted in a testing apparatus. A software program controlled the apparatus and recorded temperatures, depths, and drilling times. Seven brands of drills were tested (Nobel Biocare, 3i/Implant Innovations, Steri-Oss, Paragon, Implamed, Lifecore, and ITI). Spade, twist, tri-flute, and TiN-coated drill designs were evaluated and compared during 100 successive osteotomies. Scanning electron microscopic and energy-dispersive x-ray spectroscopic examinations were performed, and hardness was measured. RESULTS: Two 2-mm drills (Nobel Biocare and 3i/Implant Innovations) had mean removal rates significantly greater than the others (P < .05). The 2-mm twist drill design with a low hardness (Implamed) exhibited plastic deformation at the cutting edge, loss of cutting efficiency, and drill fracture. The TiN-coated drills (Steri-Oss and Paragon) showed greater wear and significantly lower removal rates (P < .05) than noncoated drills. Temperature increases with different drills were not significantly different at depths of 5 or 15 mm or between 2-mm or 3-mm drills. With 1 exception (the 2.3-mm Paragon drill at a depth of 15 mm), the temperatures generated by the different types of drills were not significantly different. Clinically harmful temperatures were detected only at a depth of 15 mm during 5 osteotomies and coincided with a marked decrease in the rate of drill advancement with a resulting continuous drilling action. DISCUSSION: Temperatures generated at depths of 5 and 15 mm by the different drill types and diameters were not significantly different and, with only 5 exceptions, were clinically safe. Several differences between brands were noted in regard to cutting efficiency and durability, underscoring the importance of material selection and quality on drill performance. CONCLUSIONS: Drill design, material, and mechanical properties significantly affect cutting efficiency and durability. Coolant availability and temperature were the predominant factors in determining bone temperatures. Implant drills can be used several times without resulting in bone temperatures that are potentially harmful. Continuous drilling in deep osteotomies can produce local temperatures that might be harmful to the bone.

The purpose of this study was to evaluate the effect of unilateral disk displacement with reduction (UDDR) on the skeletal and dental pattern of affected individuals. There were 18 symptomatic female patients and 46 asymptomatic normal female volunteers. All study participants had bilateral high-resolution magnetic resonance scans in the sagittal (closed and open) and coronal (closed) planes to evaluate the temporomandibular joints. Linear and angular cephalometric measurements were taken to evaluate the skeletal, denture base, and dental characteristics of the two groups. Analysis of variance was used to compare the symptomatic with the control subjects. A few skeletal differences were found. There was an overall reduction in length of the anterior (S-Na) and posterior (S-Ba) cranial base measurements in the UDDR group. The cranial base angle was also increased. Both upper and lower dentures bases were retropositioned. The posterior ramal height (Ar-Go) was shorter in the symptomatic group. This study showed that alterations in skeletal morphology may be associated with UDDR. The mechanisms that produce DD or the mechanisms that cause this skeletal alteration are yet to be clarified. This study suggests that subjects with UDDR may manifest altered craniofacial morphology. The clinician should be aware of this possibility, especially for growing patients.

PURPOSE: The purpose of this study was to evaluate the different variables involved in tooth cutting to characterize intrapulpal temperature generation, cutting efficiency, and bur durability when using conventional and channeled diamond burs. MATERIALS AND METHODS: Forty premolars and 60 molars were selected for the study. Four diamond burs were paired according to grit size: 125-microm grit: Brasseler Coarse (Control 1) and TDA System (Test 1) burs; and 180-microm grit: Brasseler CRF (Control 2) and NTI Turbo Diamond (Test 2) burs. Each bur was used twice when cutting the premolar teeth, whereas it was used for 60 cuts when cutting the molar teeth. The data were analyzed to compare the correlation of bur design, grit and wear, amount of pressure, advancement rate, revolutions per minute, cutting time and rate, and proximity to the pulp chamber with intrapulpal temperature generation, cutting efficiency, and bur longevity. The mean values of test and control burs in each group were compared using an ANOVA (p < 0.05 for significant differences) for temperature generation and an ANOVA and the Tukey multiple range test (p< or = 0.05) for cutting efficiency and bur longevity. RESULTS: No significant difference was found in intrapulpal temperature generation while cutting premolar and molar teeth with conventional and channeled diamond burs. In both groups, the mean temperature recorded during and after the cutting procedure was lower than the baseline temperature. For premolar teeth, no significant difference was established for control and test burs for the load required to cut into the tooth and the cutting rate. However, both test burs showed significantly fewer revolutions per minute when compared to their control counterparts. For the molar teeth, the Brasseler CRF bur required a significantly lower cutting load when compared to the NTI bur, whereas no difference was noted between the other pair of burs. The cutting rate was significantly higher for both control burs, whereas revolutions per minute (rpm) were greater for control coarser burs only. Overall, channeled burs showed a significantly lower cutting efficiency when compared to conventionally designed burs. CONCLUSION: Within the limitations of this study, channeled burs showed no significant advantage over conventional diamond burs when evaluating temperature generation and bur durability. Moreover, the cutting efficiency of conventional burs was greater than that of channeled burs.

It has been suggested that patients should accept the use of the air abrasion technique over the conventional handpiece due to the reduced need for anesthesia. Technologies for both air abrasion and the conventional rotary handpiece have, in recent decades, seen major improvements, but there are no recent scientific publications that evaluate the patient's preference for these two technologies when performing a cavity preparation. This study determined the patient's preference for air abrasion or the rotary handpiece for removing occlusal fissure carious lesions in mandibular premolars. Ten healthy subjects 18 years of age or older were recruited from the General Dentistry Clinic of the University of Rochester Eastman Dental Center, with fissure caries at a DEJ depth of similar size (determined by radiographs and clinical examination) in any two mandibular premolars in opposite quadrants. Within each subject, the two methods of caries removal were randomly assigned. In one premolar, air abrasion was used for cavity preparation, and in the other premolar, a conventional rotary handpiece was used. At each visit prior to treatment, the patients were instructed to complete the Emotional Status (ES) questionnaire (SUNY University at Buffalo Craniofacial Pain Clinic) to assess differences in their emotional status between appointments. At each appointment, when the restorative treatment was completed, patients were instructed to rate their pain on the Visual Analogue Scale (VAS). A technique preference questionnaire was given after the second appointment. The subjects rated the perception of pain as significantly lower (p < 0.05) when using air abrasion (6.0 mm versus 29.6 mm). All of the patients preferred air abrasion over conventional rotary handpieces. None of the patients required anesthesia and there was no indication that the emotional status influenced the result. Air abrasion was the preferred method of cavity preparation when removing fissural caries in mandibular premolars and most subjects did not experience any pain when air abrasion was used.

STATEMENT OF PROBLEM: The application of solder material to metal frameworks could affect the porcelain-to-metal failure load and possibly compromise the longevity of porcelain-fused-to-metal crowns. PURPOSE: This in vitro study assessed the influence of solder on the porcelain failure load between metal and porcelain, using crown-shaped specimens. MATERIAL AND METHODS: Forty standardized crown patterns were fabricated on a metal die and cast with noble alloy (Protocol). The specimens were divided into test (soldered, n=20) and control (nonsoldered, n=20) groups. A 2-mm-diameter perforation was produced on the buccal surface of the test specimens, 1.5 mm apical to the junction between occlusal and buccal surfaces. The perforation was repaired with high-fusing white ceramic solder material. All castings were finished with aluminum oxide stones and airborne-particle abraded with 50-microm aluminum oxide at 75 psi of pressure. Two layers each of opaque and dentin porcelain were applied on all specimens. All crowns were subjected to a vertical compressive load with a universal testing machine at a crosshead speed of 0.5 mm/min until fracture. The loading apparatus of the device contacted the buccal cusp only. In both control and test groups, 10 crowns were loaded with a stainless steel pin (phase I) whereas the remaining 10 in each group were loaded with a carbon steel pin (phase II). Means of loads at failure were recorded in each group for each pin type and compared (soldered vs nonsoldered) by use of a t test (alpha=.05). RESULTS: Mean failure load for nonsoldered crowns was 349 +/- 63 kgf in phase I and 228 +/- 49 kgf in phase II. Soldered crowns showed a significantly lower failure load (265 +/- 82 kgf [phase I; P<.02] and 154 +/- 108 kgf [phase II; P<.04]) and a greater standard deviation. CONCLUSION: Soldered metal-porcelain crown specimens demonstrated a significantly lower load at failure. Within the limits of this study, it was concluded that solder material might negatively affect porcelain-metal crowns.

OBJECTIVE: To assess the relationship of distinct craniofacial features among family members with cleft lip and palate (CLP). METHODS: Lateral cephalometric and anthropometric measurements of the members of 28 Costa Rican families with CLP were analyzed. The distinct craniofacial features in subjects with CLP were identified by comparing their craniofacial measurements with published normative values. The presence of these features was assessed in the unaffected family members. Regression coefficients were computed to evaluate the association of the distinct craniofacial measurements between parents and their offspring with and without CLP. RESULTS: The male and female subjects with CLP were characterized by shortened head (HL), anterior cranial base (S-N), and palatal length (ANS-PNS, A-PNS) measurements as well as hyperdivergent angle of S-N plane to palatal plane (<SN-PP). All unaffected family members also had shortened S-N and ANS-PNS measurements and mothers of affected daughters also shortened HL. Mothers had a significant association in S-N, ANS-PNS, and <SN-PP measurements with their affected daughters (p <.05 for all), and fathers had a significant association in A-PNS measurement with their affected sons (p <.05). None of the associations of the distinct craniofacial measurements were significant between mothers and their unaffected daughters or between fathers and their unaffected sons. CONCLUSION: Unaffected family members of subjects with CLP also have some distinct craniofacial features, however in lesser degree. Mothers contribute more to their affected daughters' and fathers to their affected sons' distinct craniofacial morphology