The effect of extraction of third molars on late lower incisor crowding: a randomized controlled trial. Role of antimicrobials in third molar surgery: prospective, double blind,randomized, placebo-controlled clinical study. Anteroposterior skeletal and dental changes after early Class II treatment with bionators and headgear. Clinical and radiographic evaluation of implant-retained mandibular overdentures with immediate loading. Endodontic complications after plastic restorations in general practice. Clinical trial of a novel interdental brush cleaning system. Efficacy of an automated flossing device in different regions of the mouth. Short-term effects of fiberotomy on relapse of anterior crowding. Comparison of two chlorhexidine rinse protocols on the incidence of alveolar osteitis following the surgical removal of impacted third molars.
The problem of late mandibular incisor crowding is a well established phenomenon, the cause of which has been the substance of considerable debate over the years. A central issue is the possible role of the third molars though no definitive conclusions have been consistently drawn. This prospective study was designed to investigate the effects of randomly assigned early extraction of third molars on late crowding of the mandibular incisors. One-hundred-and-sixty-four patients entered the study from 1984 following completion of retention after orthodontic treatment. Seventy-seven patients (47%) returned for records up to a mean of 66 months later, and their start and finish study casts were digitized on a reflex microscope to determine Little's index of irregularity, intercanine width and arch length. Forty-four of the patients had been randomized to have third molars removed. There was no evidence of responder bias. Where third molars were extracted the mean increase in lower labial segment irregularity was reduced by 1.1 mm from a mean of 2.1 mm for the group where third molars were retained (P = 0.15, not statistically significant). This difference was also not considered to be clinically significant. The principal conclusion drawn from this randomized prospective study is that the removal of third molars to reduce or prevent late incisor crowding cannot be justified. To test the efficacy of two dosing regimens of antimicrobial prophylaxis during the removal of impacted lower third molars.
                Double blind, prospective, placebo-controlled trial.
                Teaching hospital, India.
                151 patients aged 19-36 having impacted lower third molars removed.
                Random allocation into three groups: placebo (n= 34), metronidazole 1g orally, 1 hour preoperatively (n= 44), or metronidazole 400mg orally eight hourly for 5 days postoperatively (n= 47). Patients were recalled on the sixth postoperative day for assessment of pain scores on the second and sixth days, swelling, differences in mouth opening between preoperative and the sixth postoperative day, and the state of the wound.
                There were no significant differences in the outcome between the three groups (P= 0.09).
                Antimicrobial prophylaxis does not seem to reduce morbidity after removal of lower third molars.
                Copyright 2001 The British Association of Oral and Maxillofacial Surgeons. In this study we examined anteroposterior cephalometric changes in children enrolled in a randomized controlled trial of early treatment for Class II malocclusion. Children, aged 9.6 +/- 0.8 years at the start of study, were randomly assigned to control (n = 81), bionator (n = 78), and headgear/biteplane (n = 90) treatments. Cephalograms were obtained initially, after Class I molars were obtained or 2 years had elapsed, after an additional 6 months during which treated subjects were randomized to retention or no retention and after a final 6 months without appliances. Calibrated examiners, blinded to group, used Johnston's analysis to measure anteroposterior cephalometric changes. Statistical analysis was used to determine annual skeletal and dental changes during treatment, retention, and follow-up, and overall. Our data reveal that both bionator and head-gear treatments corrected Class II molar relationships, reduced overjets and apical base discrepancies, and caused posterior maxillary tooth movement. The skeletal changes, largely attributable to enhanced mandibular growth in both headgear and bionator subjects, were stable a year after the end of treatment, but dental movements relapsed. The aim of this study was to evaluate and compare immediate-loaded implant-retained mandibular overdentures and delayed-loaded implant-retained mandibular overdentures.
                Ten completely edentulous male patients received 40 dental implants. Patients were randomly divided into 2 equal groups, 5 patients each. Patients of both groups received conventional maxillary complete denture and had stage 1 surgery for placing 4 dental implant fixtures, 2 on each side anterior to the mental foramina. Group A: One-stage surgical procedure and immediate loading. Patients in this group received mandibular bar-retained overdenture supported by 4 endosseous implants loaded immediately after implant placement. Group B: The original 2-stage concept and delayed loading. Patients in this group received mandibular bar-retained overdenture supported by 4 endosseous implants that remained submerged for a period of 4 months before loading. The patients were evaluated clinically and radiographically immediately after overdenture delivery and after 6 months, 12 months, 18 months, and 24 months.
                The results of clinical evaluation showed no statistical significant difference between the 2 groups regarding the effect of treatment. The radiographic assessment showed no statistical significant difference in mesial and distal alveolar bone loss at the different intervals of the follow-up period, except at the 12-month period, where immediately loaded implants showed a decrease in the amount of alveolar bone loss mesially and distally compared to delayed loaded implants.
                The results suggest that immediate-loaded implants provide promising results compared to delayed-loaded implants and can be a possible alternative procedure in implant dentistry. To test the hypothesis that dentine and pulp protection by conditioning-and-sealing is no less effective than using a conventional calcium hydroxide lining.
                A cohort of healthy adults requiring a new or replacement restoration in a posterior tooth was recruited in six general practices. All procedures received local Ethics Committee approval. Exclusion criteria included signs and symptoms of pulp necrosis or inflammation, and patients unable to commit to a long-term trial. Cavity preparations were randomized to receive a calcium hydroxide lining or conditioning-and-sealing with a smear-removing bonding system. Choice of bulk restorative material (composite resin or amalgam) was at the discretion of the dentist. The key outcome measure was evidence of pulpal breakdown identified at unscheduled (emergency) or scheduled recall examinations. Postoperative sensitivity was recorded on 100 mm VAS at 24 h, 4 days and 7 days. Pulp status was assessed at 6, 12, 24 and 36 month recall, and at any emergency recall appointment. The relationship between pre-treatment and treatment variables and pulp breakdown was assessed by logistic regression (P = 0.05).
                A total of 602 teeth were recruited, with comparable numbers of cavities lined (288, 47.8%) or conditioned and sealed (314, 52.2%). The majority (492, 81.7%) were replacement restorations, and amalgam was the most common bulk restorative material (377, 62.6%). A total of 390 (64.8%) restored teeth were reviewed at 6 months, 307 (51%) at 12 months, 363 (60.3%) at 24 months, and 279 (46.3%) at 36 months post-restoration. Sixteen cases of pulp breakdown were identified within 36 months of restoration placement, 11 presenting as emergencies and five detected at routine recall examination. Logistic regression showed that preoperative pain, cavity treatment by lining or conditioning-and-sealing and the use of rubber dam isolation had no association with pulp breakdown. Pulp breakdown was associated with deep or pulpally exposed cavities (P < 0.001, odds ratio 7.8) and with composite rather than amalgam restorations (P = 0.001, odds ratio 2.13). Re-coding to identify teeth with pulp exposures revealed that pulpal exposure was the key determinant of adverse pulp outcomes (P < 0.0001, odds ratio 28.4) and that composite resin restorations were again more likely to be associated with pulp breakdown than amalgam (P = 0.017, odds ratio 3.92).
                Considered within the context of routine primary dental care: Dentists can be confident that pulps will be equally well protected from post-restorative breakdown up to 36 months by calcium hydroxide lining and conditioning-and-sealing with adhesive resins. Residual dentine thickness appears to be a key determinant of pulp responses after restorative dental treatment. In deep and pulpally exposed cavities in posterior teeth, composites were associated with more pulpal breakdown than amalgams. This single-blind, five parallel-arm, four-week randomized clinical trial was designed to compare the efficacy of a 0.05% cetylpyridinium chloride gel-releasing interdental brush (IDB) with standard interproximal cleaning devices for plaque and gingivitis reduction, and decreased frequency in interproximal gingival bleeding.
                After consenting, participants meeting inclusion criteria brushed their teeth, received a baseline examination and a professional cleaning, and were then block-randomized into five groups, with the plaque level serving as the blocking variable. All five groups performed standard tooth brushing as a background regimen. Three of the groups were respectively assigned to one of three interdental brush regimens, the fourth group was assigned to a standard flossing regimen (positive control), and the fifth group was assigned to a standard tooth brushing only regimen (control). Clinical outcome data were collected at two and four weeks.
                Of a total of 162 starting participants, 152 completed the study. There were no baseline differences among the five groups with respect to age, interproximal plaque score, interproximal gingivitis score, or percent of interproximal bleeding on probing. After two and four weeks, the 3 IDB groups exhibited 30-40 percent lower plaque levels than the control (p < 0.05). With respect to interproximal gingival scores, the active agent IDB group exhibited a statistically significant effect after two weeks, and all three IDB groups demonstrated significantly better outcomes after four weeks (p < 0.05). At two and four weeks, the three IDB groups demonstrated a greater reduction in interproximal bleeding points upon probing compared to the two control groups (p < 0.05). The group using the 0.05% cetylpyridinium gel-releasing IDB system did not demonstrate superior clinical results when compared to the two other IDB groups.
                When compared to control and positive control interdental cleaning procedures, daily use of IDBs was effective in reducing interproximal plaque and gingivitis scores, as well as interproximal bleeding on probing. The benefits were evident at two weeks, but were more consistent after four weeks. The 0.05% cetylpyridinium gel-releasing IDB system did not appear to confer a consistently independent incremental benefit. Manual floss is often difficult to use, particularly in hard to reach posterior teeth. Many prefer automated flossers because of their ease of use. The aim of the present study was to compare the effectiveness of an automated flosser to manual floss for anterior, premolar, and molar teeth using the plaque index (PI) and gingival (GI) index.
                A 10-week, two-treatment period, crossover design was used. The subjects were randomly assigned to control (C), manual (M), or automated (A) groups. The PI and GI were measured interdentally at baseline and days 15 and 30. Treatment subjects were assigned to the opposite group at the second baseline visit after a 2-week washout period. Subjects brushed twice a day. Treatment subjects used their respective floss once per day. Subjects refrained from oral hygiene 24 hours before study visits. The PI was measured pre- and postintervention on days 15 and 30. Mixed-effect analysis of covariance crossover models were used to test group effects at days 15 and 30 from both periods with the corresponding mean preintervention and baseline score as covariates for PI and GI, respectively. Within-subject treatment comparisons were made, and carryover effects were evaluated.
                The majority of subjects (N = 102) were students (mean age, 23.3 +/- 5.0 [SD] years) with minimal gingivitis at baseline. At days 15 and 30, the M group had more plaque than the A group for all regions (P < or = 0.008), and the C group had more plaque than the A (P <0.001) and M groups (P < or = 0.021) for all regions. No regional treatment effect was observed for the GI. Within-subject analyses were more favorable for the A group than the M group. No significant carryover effect was observed.
                The automated flossing device removed significantly more interproximal plaque in molar, premolar, and anterior teeth compared to manual floss at days 15 and 30. There was no significant difference in interdental inflammation between groups. The effects of fiberotomy were evaluated in alleviating dental relapse of incisors after orthodontic treatment. The study sample consisted of 23 patients with crowded maxillary and mandibular incisors before orthodontic treatment. The amount of initial crowding was determined according to Little's irregularity index. Fiberotomy procedures were performed on 11 of the patients 1 week before debonding. The other 12 subjects served as the control group. All patients wore Hawley retainers. Lateral cephalometric headfilms and dental casts of the patients were taken at the beginning (T1) and at the end (T2) of treatment, 6 months into the retention phase (T3), and 1 year after orthodontic treatment (T4). Significant increase of irregularity index was noted in the control group at T3 and T4 for both maxillary and mandibular anterior segments (P <.05, P <.01). Meanwhile, in the group where circumferential supracrestal fiberotomy was performed, no significant increase of the irregularity index was noted. Alveolar osteitis (dry socket) is the most common complication following the extraction of permanent teeth. This study was undertaken to compare the effect of two chlorhexidine rinse protocols on the incidence of alveolar osteitis in patients undergoing surgical removal of impacted mandibular third molar teeth.
                A prospective randomized clinical trial was conducted among 99 subjects. Patients were randomly assigned into two groups. Subjects were instructed to rinse twice daily with 15 ml of chlorhexidine rinse 30 seconds for one week before and one week after surgery (group I) or one week after surgery (group II). Postoperatively, all patients were instructed to return in one week or sooner if bothersome pain increased or persisted. Data were collected regarding abnormal healing, presence of necrotic tissue, exposed bone, and absence of clot.
                The results indicated group I and group II were not statistically significant different in the reduction of alveolar osteitis.
                To reduce alveolar osteitis after impacted third molar surgery, it was observed use of postoperative chlorhexidine rinse was adequate. The postoperative use of chlorhexidine is more feasible than both preoperative and postoperative use.
Insufficient evidence was found to support or refute routine prophylactic removal of asymptomatic impacted wisdom teeth in adults. A single trial comparing removal versus retention found no evidence of a difference on late lower incisor crowding at 5 years, however no other relevant outcomes were measured.
Watchful monitoring of asymptomatic third molar teeth may be a more prudent strategy.