The document is a presentation on post-orthodontic demineralization. It begins with an overview stating that it will discuss the brief etiology and relevant research on the topic, provide recommendations for prevention both before and during orthodontic treatment, and recommendations for clinical management after treatment completion. It then covers some key points on the basics of demineralization being caused by the interaction of bacteria, substrate, and pH over time. It also summarizes some relevant research studies that found prevalence can vary widely but generally agree orthodontic patients have an increased risk, with the highest risk areas being the maxillary and mandibular first molars, maxillary lateral incisors, and mandibular lateral incisors
This study analyzed clinical data from 108 children undergoing overnight orthokeratology treatment at a university clinic in Hong Kong. Significant reductions in spherical refractive error (58%) and improvements in unaided vision were found after just one night of lens wear. Over 80% of patients were advised to use eye drops to help remove the lenses, as corneal staining was a common complication. A patient survey found that over 90% reported good or better unaided vision after treatment and rated it as satisfactory or very good, though lens binding and eye discharge were commonly reported problems. The results suggest that overnight orthokeratology is effective and safe for reducing low to moderate myopia in children under close monitoring.
This document discusses the interface between optometry and ophthalmology regarding optometric vision therapy. It provides historical context on the evolution of orthoptics to vision therapy. It notes that while ophthalmologists pioneered orthoptics, optometrists were better suited to provide the intensive therapy it required. It also discusses ophthalmology's initiatives to discredit vision therapy through policy statements that optometry has rebutted with scholarly articles. The document aims to provide a balanced perspective to improve the interface between the two fields in serving the public.
Syllabus of PCL in ophthalmic Assistant by NHPCKapil Gautam
This document outlines the syllabus for the Licensing Examination of PCL in Ophthalmic Science/Diploma in Ophthalmic Technique in Nepal in 2021. It includes 13 topics that will be covered in the exam, along with the percentage of marks allocated to each topic. The topics cover basic sciences, anatomy and physiology, ophthalmic specialties like pharmacology, pathology, optics and refraction. It also includes operational areas like ophthalmic nursing care, assisting in ocular surgery and community ophthalmology. The document provides a brief overview of the content that will be assessed under each topic in the licensing examination.
This document provides clinical guidance on the management of osteoporosis in Malaysia. It was developed by a working group of experts and endorsed by relevant Malaysian health organizations. The guidance includes definitions of osteoporosis, recommendations for diagnosis and assessment of fracture risk, prevention strategies, and treatment options. Treatment is recommended for those with prior fractures or low bone mineral density and can involve bisphosphonates, denosumab, strontium ranelate, selective estrogen receptor modulators, and other drugs shown to reduce fracture risk. The guidance also covers osteoporosis in specific populations and implementation.
Concepts of dental occlusion and importance of six keys of occlusion in orth...Dr.Maulik patel
This document provides an overview of concepts of occlusion. It begins with introducing the importance of understanding occlusion in dentistry and orthodontics. It then discusses the development of occlusion concepts from fictional, hypothetical to factual periods. Key figures like Angle, Case and their contributions are explained.
Normal, ideal and traumatic occlusions are defined. Factors determining tooth position like forces from muscles and contacts are covered. Concepts like curves of Spee, Wilson and Monson are explained. Classifications of occlusion based on mandibular position and relationships to first molars are summarized. Finally, occlusion patterns like canine guidance and cusp-fossa are briefly described.
1. Comprehensive orthodontic treatment involves repositioning nearly all teeth to achieve an ideal occlusion. It is ideally done during adolescence when permanent teeth have erupted but growth remains.
2. Treatment involves 4 stages - alignment and leveling, correction of molar relationship and space closure, finishing, and retention.
3. The first stage, alignment and leveling, aims to align teeth and correct vertical discrepancies. This is done using round nickel-titanium wires which apply light continuous forces.
Orthodontic specialty got in a great crisis. The specialty loses patients every day, tries to compete with general dentist and uncontrolled commercial influence. We tend to blame GPs, the economic environment, but if we really want to help the specialty survive we must analyze what we as a specialty made wrong in recent years. The lecture tries to help in this analysis
This study analyzed clinical data from 108 children undergoing overnight orthokeratology treatment at a university clinic in Hong Kong. Significant reductions in spherical refractive error (58%) and improvements in unaided vision were found after just one night of lens wear. Over 80% of patients were advised to use eye drops to help remove the lenses, as corneal staining was a common complication. A patient survey found that over 90% reported good or better unaided vision after treatment and rated it as satisfactory or very good, though lens binding and eye discharge were commonly reported problems. The results suggest that overnight orthokeratology is effective and safe for reducing low to moderate myopia in children under close monitoring.
This document discusses the interface between optometry and ophthalmology regarding optometric vision therapy. It provides historical context on the evolution of orthoptics to vision therapy. It notes that while ophthalmologists pioneered orthoptics, optometrists were better suited to provide the intensive therapy it required. It also discusses ophthalmology's initiatives to discredit vision therapy through policy statements that optometry has rebutted with scholarly articles. The document aims to provide a balanced perspective to improve the interface between the two fields in serving the public.
Syllabus of PCL in ophthalmic Assistant by NHPCKapil Gautam
This document outlines the syllabus for the Licensing Examination of PCL in Ophthalmic Science/Diploma in Ophthalmic Technique in Nepal in 2021. It includes 13 topics that will be covered in the exam, along with the percentage of marks allocated to each topic. The topics cover basic sciences, anatomy and physiology, ophthalmic specialties like pharmacology, pathology, optics and refraction. It also includes operational areas like ophthalmic nursing care, assisting in ocular surgery and community ophthalmology. The document provides a brief overview of the content that will be assessed under each topic in the licensing examination.
This document provides clinical guidance on the management of osteoporosis in Malaysia. It was developed by a working group of experts and endorsed by relevant Malaysian health organizations. The guidance includes definitions of osteoporosis, recommendations for diagnosis and assessment of fracture risk, prevention strategies, and treatment options. Treatment is recommended for those with prior fractures or low bone mineral density and can involve bisphosphonates, denosumab, strontium ranelate, selective estrogen receptor modulators, and other drugs shown to reduce fracture risk. The guidance also covers osteoporosis in specific populations and implementation.
Concepts of dental occlusion and importance of six keys of occlusion in orth...Dr.Maulik patel
This document provides an overview of concepts of occlusion. It begins with introducing the importance of understanding occlusion in dentistry and orthodontics. It then discusses the development of occlusion concepts from fictional, hypothetical to factual periods. Key figures like Angle, Case and their contributions are explained.
Normal, ideal and traumatic occlusions are defined. Factors determining tooth position like forces from muscles and contacts are covered. Concepts like curves of Spee, Wilson and Monson are explained. Classifications of occlusion based on mandibular position and relationships to first molars are summarized. Finally, occlusion patterns like canine guidance and cusp-fossa are briefly described.
1. Comprehensive orthodontic treatment involves repositioning nearly all teeth to achieve an ideal occlusion. It is ideally done during adolescence when permanent teeth have erupted but growth remains.
2. Treatment involves 4 stages - alignment and leveling, correction of molar relationship and space closure, finishing, and retention.
3. The first stage, alignment and leveling, aims to align teeth and correct vertical discrepancies. This is done using round nickel-titanium wires which apply light continuous forces.
Orthodontic specialty got in a great crisis. The specialty loses patients every day, tries to compete with general dentist and uncontrolled commercial influence. We tend to blame GPs, the economic environment, but if we really want to help the specialty survive we must analyze what we as a specialty made wrong in recent years. The lecture tries to help in this analysis
Case documentation and discussion for functional orthodontic case.
First step is very important step, for all colloquies the best prognosis and treatment plan obtained by perfect case preparation, documentation done in Almalak Dental and orthodontic polyclinic by Dr.Auday Mansour Altaai
The document discusses how the different dental specialties can collaborate to provide treatment for complex dental cases. It provides several examples:
1. Orthodontics can work with other specialties to treat missing teeth through space closure or opening, depending on factors like buccal occlusion and tooth shape.
2. Traumatized or fractured teeth may require orthodontic extrusion before restorative treatment, and tooth transplantation is sometimes used to replace front teeth.
3. Periodontal problems causing tooth drifting can be addressed through orthodontic realignment once disease is controlled.
4. Orthodontics can be used to improve occlusion and eliminate non-working side interferences, and may close anterior
Esthetic Evaluation of ImplantsPlaced after Orthodontic Treatment in Patients...Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the
proper treatment plan. Several treatment options exist for the replacement of congenitally missing lateral incisors.
These options include canine substitution, resin bonded fixed partial dentures, cantilevered fixed partial dentures,
conventional fixed partial dentures and single tooth implants. Depending on which treatment option is chosen, a
specific criterion has to be addressed. Interdisciplinary treatment plays a vital role to achieve an excellent, esthetic
result for a most predictable outcome. This article aims to present a case report of replacement of bilaterally
congenitally missing maxillary lateral incisors with dental implants
Key words: congenitally missing lateral incisor, interdisciplinary treatment, dental impla
This study compares the elastic properties of four orthodontic wire materials: stainless steel, cobalt-chromium, nickel-titanium, and beta-titanium. The study uses formulas to calculate ratios of bending strength, stiffness, and range for different wire configurations under bending and torsion stresses. The results show that nickel-titanium provides the most flexibility and is best for initial tooth alignment. Beta-titanium is superior for intermediate stages requiring flexibility. Stainless steel and cobalt-chromium are best for stability in the later stages.
- The document summarizes the influence of various drugs on orthodontic tooth movement. It discusses how analgesics, bisphosphonates, fluorides, corticosteroids, thyroid hormones, sex hormones, parathyroid hormone, anti-convulsants, alcohol, and prostaglandins can impact the rate and stability of tooth movement during orthodontic treatment.
- Many drugs like NSAIDs, bisphosphonates, fluorides can slow down the rate of tooth movement by inhibiting osteoclast activity and bone resorption. Corticosteroids and thyroid hormones can increase the rate but decrease the stability of tooth movement.
- The document provides details on the mechanisms of action of these drugs and recommends
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Simple and Predictable Short-Term Orthodonticstheaacd
Kelly, a 29-year-old woman, had crossed-over front teeth and lateral teeth she called "fangs." She underwent Six Month Smiles treatment with Dr. Andy Denny, which uses simple and predictable short-term orthodontics. Before treatment, Kelly's teeth were misaligned, and after 6 months of treatment with Six Month Smiles, her teeth were straightened and aligned. The Six Month Smiles treatment was able to straighten Kelly's teeth in a short period of 6 months.
The document contains before and after photos from a dental practice website showcasing the results of orthodontic treatments using aligners. There are multiple pairs of photos depicting patients' smiles before and after receiving treatments with Invisalign aligners to straighten their teeth. The document promotes the orthodontist's aligner services and treatments available at their practice.
Finishing in orthodontic treatment by Dr.kokich / fixed orthodontics courses ...Indian dental academy
Dr. Vincent Kokich is a professor of orthodontics at the University of Washington in Seattle and maintains a private practice. He has published extensively in orthodontic literature and served as president of the American Board of Orthodontics. The document discusses various factors considered in orthodontic treatment finishing, including alignment, marginal ridges, buccolingual inclination, occlusal relationships, occlusal contacts, overjet, and their assessment using the ABO grading system. It also discusses how factors like overbite and overjet can affect restorative treatments like resin bonded bridges.
Increase Practice Production with Six Month Smilestheaacd
Learn how this short-term ortho solution for your dental practice can help you increase practice production. Plus, save $200 on your Six Month Smiles course.
Effects of orthodontic & orthopedic treatment on TMJ /certified fixed orthodo...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Finite element analysis in orthodontics /certified fixed orthodontic courses ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Journal club Extraction decision making / fixed orthodontic courses/ indian d...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Study models are essential records in orthodontics that provide a 3D representation of the teeth and occlusion. A study model has two parts - the anatomic portion showing the teeth and soft tissues, and the artistic portion which is the stone base. Models need to be trimmed accurately to reproduce the dental anatomy and occlusion. Various analyses like Carey's, Ashley Howe's and Bolton's can be done on study models to assess discrepancies and plan treatment. Mixed dentition analysis using Moyer's or Tanaka-Johnston method helps predict the size of unerupted teeth.
This document discusses the biological considerations of operative dentistry related to enamel, dentin, and the dentinoenamel junction. It provides details on the structure, composition, properties and clinical significance of enamel and dentin. Key points include that enamel is the hardest substance in the body but has no self-repair ability. Dentin lines the inner walls of teeth and contains tubules that connect to the pulp and determine permeability. The dentinoenamel junction is a critical area that provides strength between the two tissues.
Dr. Tom Pitts has practiced orthodontics for over 50 years. He specializes in esthetic orthodontics and finishing. Some of his philosophies include:
- Emphasis on facial esthetics and creating full smiles and lips over strict adherence to occlusion or stability.
- Using passive self-ligation to more easily widen arches for esthetics.
- Attention to microesthetic details like contacts and proportions.
- Clinical photos at every appointment for documentation, marketing, and teaching.
- Case management through wire selection, elastics, motivation, and overcorrection to achieve ideal esthetic results.
This document discusses the third and final stage of comprehensive orthodontic treatment called "finishing". It defines finishing as correcting prior errors and detailing the case. The document outlines the goals of finishing which include enhancing aesthetics, individual tooth positioning, occlusion, and stability. It describes the standards used by the American Board of Orthodontics for grading case finishing. The document provides details on techniques for correcting tooth alignment, angulation, rotation, and achieving proper gingival levels and tooth sizes during the finishing stage.
Slide set for editors training day edited for blogAnne Littlewood
The document summarizes an agenda and presentations for a Cochrane Oral Health Group Editors' and Clinical Advisors' meeting that covered topics such as the role of editors, prioritizing review topics, introducing the MECIR standards, screening reviews for quality, and working through an example flossing review to discuss the abstract, risk of bias assessment, outcomes, summary of findings, and consistency across reviews. The National Institute for Health Research is the largest funder of the Cochrane Oral Health Group.
Case documentation and discussion for functional orthodontic case.
First step is very important step, for all colloquies the best prognosis and treatment plan obtained by perfect case preparation, documentation done in Almalak Dental and orthodontic polyclinic by Dr.Auday Mansour Altaai
The document discusses how the different dental specialties can collaborate to provide treatment for complex dental cases. It provides several examples:
1. Orthodontics can work with other specialties to treat missing teeth through space closure or opening, depending on factors like buccal occlusion and tooth shape.
2. Traumatized or fractured teeth may require orthodontic extrusion before restorative treatment, and tooth transplantation is sometimes used to replace front teeth.
3. Periodontal problems causing tooth drifting can be addressed through orthodontic realignment once disease is controlled.
4. Orthodontics can be used to improve occlusion and eliminate non-working side interferences, and may close anterior
Esthetic Evaluation of ImplantsPlaced after Orthodontic Treatment in Patients...Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the
proper treatment plan. Several treatment options exist for the replacement of congenitally missing lateral incisors.
These options include canine substitution, resin bonded fixed partial dentures, cantilevered fixed partial dentures,
conventional fixed partial dentures and single tooth implants. Depending on which treatment option is chosen, a
specific criterion has to be addressed. Interdisciplinary treatment plays a vital role to achieve an excellent, esthetic
result for a most predictable outcome. This article aims to present a case report of replacement of bilaterally
congenitally missing maxillary lateral incisors with dental implants
Key words: congenitally missing lateral incisor, interdisciplinary treatment, dental impla
This study compares the elastic properties of four orthodontic wire materials: stainless steel, cobalt-chromium, nickel-titanium, and beta-titanium. The study uses formulas to calculate ratios of bending strength, stiffness, and range for different wire configurations under bending and torsion stresses. The results show that nickel-titanium provides the most flexibility and is best for initial tooth alignment. Beta-titanium is superior for intermediate stages requiring flexibility. Stainless steel and cobalt-chromium are best for stability in the later stages.
- The document summarizes the influence of various drugs on orthodontic tooth movement. It discusses how analgesics, bisphosphonates, fluorides, corticosteroids, thyroid hormones, sex hormones, parathyroid hormone, anti-convulsants, alcohol, and prostaglandins can impact the rate and stability of tooth movement during orthodontic treatment.
- Many drugs like NSAIDs, bisphosphonates, fluorides can slow down the rate of tooth movement by inhibiting osteoclast activity and bone resorption. Corticosteroids and thyroid hormones can increase the rate but decrease the stability of tooth movement.
- The document provides details on the mechanisms of action of these drugs and recommends
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Simple and Predictable Short-Term Orthodonticstheaacd
Kelly, a 29-year-old woman, had crossed-over front teeth and lateral teeth she called "fangs." She underwent Six Month Smiles treatment with Dr. Andy Denny, which uses simple and predictable short-term orthodontics. Before treatment, Kelly's teeth were misaligned, and after 6 months of treatment with Six Month Smiles, her teeth were straightened and aligned. The Six Month Smiles treatment was able to straighten Kelly's teeth in a short period of 6 months.
The document contains before and after photos from a dental practice website showcasing the results of orthodontic treatments using aligners. There are multiple pairs of photos depicting patients' smiles before and after receiving treatments with Invisalign aligners to straighten their teeth. The document promotes the orthodontist's aligner services and treatments available at their practice.
Finishing in orthodontic treatment by Dr.kokich / fixed orthodontics courses ...Indian dental academy
Dr. Vincent Kokich is a professor of orthodontics at the University of Washington in Seattle and maintains a private practice. He has published extensively in orthodontic literature and served as president of the American Board of Orthodontics. The document discusses various factors considered in orthodontic treatment finishing, including alignment, marginal ridges, buccolingual inclination, occlusal relationships, occlusal contacts, overjet, and their assessment using the ABO grading system. It also discusses how factors like overbite and overjet can affect restorative treatments like resin bonded bridges.
Increase Practice Production with Six Month Smilestheaacd
Learn how this short-term ortho solution for your dental practice can help you increase practice production. Plus, save $200 on your Six Month Smiles course.
Effects of orthodontic & orthopedic treatment on TMJ /certified fixed orthodo...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Finite element analysis in orthodontics /certified fixed orthodontic courses ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Journal club Extraction decision making / fixed orthodontic courses/ indian d...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Study models are essential records in orthodontics that provide a 3D representation of the teeth and occlusion. A study model has two parts - the anatomic portion showing the teeth and soft tissues, and the artistic portion which is the stone base. Models need to be trimmed accurately to reproduce the dental anatomy and occlusion. Various analyses like Carey's, Ashley Howe's and Bolton's can be done on study models to assess discrepancies and plan treatment. Mixed dentition analysis using Moyer's or Tanaka-Johnston method helps predict the size of unerupted teeth.
This document discusses the biological considerations of operative dentistry related to enamel, dentin, and the dentinoenamel junction. It provides details on the structure, composition, properties and clinical significance of enamel and dentin. Key points include that enamel is the hardest substance in the body but has no self-repair ability. Dentin lines the inner walls of teeth and contains tubules that connect to the pulp and determine permeability. The dentinoenamel junction is a critical area that provides strength between the two tissues.
Dr. Tom Pitts has practiced orthodontics for over 50 years. He specializes in esthetic orthodontics and finishing. Some of his philosophies include:
- Emphasis on facial esthetics and creating full smiles and lips over strict adherence to occlusion or stability.
- Using passive self-ligation to more easily widen arches for esthetics.
- Attention to microesthetic details like contacts and proportions.
- Clinical photos at every appointment for documentation, marketing, and teaching.
- Case management through wire selection, elastics, motivation, and overcorrection to achieve ideal esthetic results.
This document discusses the third and final stage of comprehensive orthodontic treatment called "finishing". It defines finishing as correcting prior errors and detailing the case. The document outlines the goals of finishing which include enhancing aesthetics, individual tooth positioning, occlusion, and stability. It describes the standards used by the American Board of Orthodontics for grading case finishing. The document provides details on techniques for correcting tooth alignment, angulation, rotation, and achieving proper gingival levels and tooth sizes during the finishing stage.
Slide set for editors training day edited for blogAnne Littlewood
The document summarizes an agenda and presentations for a Cochrane Oral Health Group Editors' and Clinical Advisors' meeting that covered topics such as the role of editors, prioritizing review topics, introducing the MECIR standards, screening reviews for quality, and working through an example flossing review to discuss the abstract, risk of bias assessment, outcomes, summary of findings, and consistency across reviews. The National Institute for Health Research is the largest funder of the Cochrane Oral Health Group.
Latest Classification of Periodontal disease..pptxMumtaz Ali
1. The document presents information on the classification of periodontal diseases from the World Workshop on Classification of Periodontal and Peri-implant Diseases and Conditions held in 2017.
2. The new classification updates and improves upon the 1999 classification. It includes categories for periodontal health, gingival diseases and conditions, periodontitis in four stages, peri-implant diseases and conditions, and periodontal manifestations of systemic diseases.
3. Periodontitis is now graded on a scale of A to C based on severity and risk factors to allow for a more personalized approach to diagnosis and treatment.
Chandrakant Roy has over 10 years of experience in clinical research as a research associate, clinical trial assistant, and clinical research coordinator. He has worked on Phase III and Phase IV clinical trials across various therapeutic areas. Mr. Roy holds an M.Sc. in Biomedical Sciences and a post-graduate diploma in clinical research. He is proficient in ICH GCP guidelines and has experience in clinical data management, monitoring, and pharmacovigilance activities. Currently, he works as a research associate at Quest Care Pvt Ltd conducting BA/BE studies.
This review aimed to evaluate interventions for managing external root resorption in permanent teeth. No randomized controlled trials meeting the inclusion criteria were identified. External root resorption has various classifications and causes, including trauma, orthodontic treatment, and pressure from adjacent teeth. Potential treatments include root canal treatment, surgery to remove resorbed tissue, splinting mobile teeth, and extraction. However, there is no consensus on managing different forms of external root resorption due to a lack of high-quality evidence. Future research is needed in the form of randomized controlled trials.
this is a report of my summer internship that i had done in Ruby hall clinic(550 beds) Pune.Title of my project is "Feasiablity study of implementation of personal health records in Ruby hall clinic".
MJFF’s Purpose, Promise and Plan for speeding new Parkinson’s treatments to p...Laxmi Wordham
Our world-class team monitors developments in Parkinson’s research, identifying top priorities for the field. We work closely with the Parkinson’s community to initiate, fund, and lead high-impact projects and collaborations.
Presentation from a Research Roundtable held in New York on November 12, 2011.
Int Endodontic J - 2022 - Kvist - Clinical decision making of post‐treatment ...DrDipaliShah
This document discusses clinical decision making regarding post-treatment disease in root-filled teeth. It begins by noting that 25-50% of root-filled teeth show signs of post-treatment disease on radiographs, though many are asymptomatic. There is no consensus among clinicians on how to manage such cases. The document outlines the typical options of no treatment, monitoring, extraction, or retreatment via surgical or non-surgical methods. It discusses how decisions are inherently subjective based on a clinician's knowledge and experience. Descriptive research has found wide variation in how clinicians decide to manage individual cases. The concept of "success" and "failure" integrates biological, evaluative, and normative components, but health and disease exist
This clinical guideline provides recommendations for the diagnosis and management of juvenile idiopathic arthritis (JIA) in primary care settings. It was developed by a working group including rheumatologists, GPs, and consumer representatives. The guideline is based on a review of literature from 2000-2007 as well as a previously published national guideline assessed using the AGREE instrument. It aims to support early diagnosis of JIA, appropriate referral to pediatric rheumatologists, and multidisciplinary management focusing on alleviating pain, preventing complications and joint damage, optimizing function, and improving quality of life. The guideline's recommendations cover diagnosis, pharmacological and non-pharmacological treatment options, and coordination of long-term chronic disease management for children with J
Innovation in Phase 1 Clinical DevelopmentElisa_Ramella
Practical app roaches to
phase I trial develop ment
to enable faster go / no -go
decision s, reduce co st and
speed time to market
www.phase1clinicaldevelopment.com
This document contains an outline of material to be covered by different dental faculty members. It is organized into sections based on specialty or subject area. The sections include topics on periodontology, operative dentistry procedures, oral pathology, biochemistry, general studies, head and brain anatomy, physiology, and neuroanatomy. Each faculty member's section lists the main topics or lectures they will present on.
Evidence based dentistry, public health , Prosthodontics and EBD,
history of ebd steps, evidence based medicine,evidence based practise. steps in ebd. advantages ,disadvantages, limitations.
prosthodontic considerations.
Evidence-based medicine has evolved from focusing primarily on randomized controlled trials to incorporating a broader range of evidence, including observational studies and evidence generated from practice settings. It aims to integrate the highest quality external evidence with internal organizational data and stakeholder perspectives to improve health outcomes.
This document provides course descriptions for the Doctor of Dental Surgery program at an unnamed university. It describes courses in the first year including community dentistry, gross anatomy, histology, clinical and preventive dentistry, nutrition, dental anatomy and occlusion, and the biological basis of oral health and disease. The courses cover topics like epidemiology, oral health issues, human anatomy, dental materials, and developing preventive dentistry skills. The document lists learning objectives, required textbooks, and faculty for each course.
Alaxia is a private biotech company based in Lyon, France that is dedicated to developing orphan drugs for respiratory diseases. Their lead product is Meveol, which is in early stage development for cystic fibrosis. Meveol aims to compensate for the lack of natural antimicrobial compounds in cystic fibrosis patients by delivering these compounds directly to the lung epithelium. It has demonstrated activity against pathogens commonly seen in cystic fibrosis patients such as Pseudomonas aeruginosa and Staphylococcus aureus. Alaxia is seeking funding or partnerships to further clinical development and regulatory approval of Meveol.
The document discusses standards of care in periodontics, endodontics, and prosthodontics. It covers topics such as diagnosis and treatment planning, informed consent, record keeping, use of antibiotics and analgesics, and the importance of evidence-based practices, magnification, and following specialty guidelines. Special considerations are given for surgical procedures, implants, crown lengthening and the importance of communication between specialists and general dentists.
This document provides an overview of evidence-based periodontology. It defines evidence-based periodontology as the application of evidence-based healthcare to the field of periodontology. The document discusses the development of evidence-based periodontology and its key components, advantages over traditional periodontology, and terminology used in evidence-based approaches. It also addresses searching for evidence, levels of evidence, systematic reviews, meta-analyses, and evidence-based decision making in periodontal therapy.
This document discusses the current understanding of diagnosis, clinical implications, and treatment protocols for peri-implant mucositis and peri-implantitis. It outlines the various diagnostic methods used to assess peri-implant diseases including clinical assessment using probes and indices, radiographical assessment using X-rays and CT scans, histological assessment, and microbial assessment. Treatment involves nonsurgical and surgical therapies depending on the severity and stage of the disease, with the goal of resolving inflammation and regenerating bone where needed. Ongoing supportive therapy is important for long-term success.
Motivational interviewing in improving oral health aclinicabril2015
This systematic review analyzed randomized controlled trials that evaluated the effectiveness of motivational interviewing (MI) compared to conventional education (CE) in changing oral health behaviors and outcomes. The search yielded 221 papers, of which 20 papers describing 16 studies met the eligibility criteria. The quality of the included studies varied. Concerning periodontal health, 5 trials found MI improved oral hygiene compared to CE, while 2 trials found no difference. Two trials on smoking cessation in adolescents found no effect of MI. MI was found to outperform CE in improving outcomes in studies on preventing early childhood caries, adherence to dental appointments, and abstinence from drugs/alcohol to prevent facial injuries. The review concluded that the evidence for the effectiveness
This document summarizes Session III of a conference on pre-clinical proof-of-concept and development. The session includes an overview, discussions on what makes a clinical candidate, IND requirements, optimization of mouse models of neurodegeneration, and the value of biomarkers in preclinical development. Specific topics covered include target selection, lead optimization, pre-clinical safety and efficacy assessments, regulatory interactions, clinical trial design, and development of appropriate clinical outcomes measures. The goal is to highlight factors to consider in selecting viable clinical candidates and preparing for first-in-human studies.
Similar to Post Orthodontic Demineralization: Recommendations for Prevention and Clinical Management (20)
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in CardiologyR3 Stem Cell
Dr. David Greene, founder and CEO of R3 Stem Cell, is at the forefront of groundbreaking research in the field of cardiology, focusing on the transformative potential of stem cell therapy. His latest work emphasizes innovative approaches to treating heart disease, aiming to repair damaged heart tissue and improve heart function through the use of advanced stem cell techniques. This research promises not only to enhance the quality of life for patients with chronic heart conditions but also to pave the way for new, more effective treatments. Dr. Greene's work is notable for its focus on safety, efficacy, and the potential to significantly reduce the need for invasive surgeries and long-term medication, positioning stem cell therapy as a key player in the future of cardiac care.
Gemma Wean- Nutritional solution for Artemiasmuskaan0008
GEMMA Wean is a high end larval co-feeding and weaning diet aimed at Artemia optimisation and is fortified with a high level of proteins and phospholipids. GEMMA Wean provides the early weaned juveniles with dedicated fish nutrition and is an ideal follow on from GEMMA Micro or Artemia.
GEMMA Wean has an optimised nutritional balance and physical quality so that it flows more freely and spreads readily on the water surface. The balance of phospholipid classes to- gether with the production technology based on a low temperature extrusion process improve the physical aspect of the pellets while still retaining the high phospholipid content.
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Post Orthodontic Demineralization: Recommendations for Prevention and Clinical Management
1. JOS, November 2006
Post-Orthodontic Demineralization:
Recommendations for
Prevention & Clinical Management
Shadi S. Samawi
BDS, MMedSci (Orth.), MOrthRCSED.
1
2. Introduction Research Prevention Clinical Management Summary
… Clinical Success
in Orthodontics
2
3. Introduction Research Prevention Clinical Management Summary
DENTAL & FACIAL FUNCTIONAL
ESTHETICS OCCLUSION
TOTAL
PATIENT
MANAGEMENT
DENTAL
& PERIODONTAL
HEALTH
3
4. Introduction Research Prevention Clinical Management Summary
Function SUCCESS !
Esthetics =
Healthy
Dentition & Periodontium
4
5. Introduction Research Prevention Clinical Management Summary
Function FAILURE !?
Esthetics =
Post-Orthodontic Demineralization
(Precursor to Caries)
5
6. Introduction Research Prevention Clinical Management Summary
Overview
In This Presentation..
6
7. Introduction Research Prevention Clinical Management Summary
Overview
In This Presentation..
Brief Etiology & Clinically-Relevant Research
6
8. Introduction Research Prevention Clinical Management Summary
Overview
In This Presentation..
Brief Etiology & Clinically-Relevant Research
Recommendations for PREVENTION:
Before..
During orthodontic treatment
6
9. Introduction Research Prevention Clinical Management Summary
Overview
In This Presentation..
Brief Etiology & Clinically-Relevant Research
Recommendations for PREVENTION:
Before..
During orthodontic treatment
Recommendations for CLINICAL MANAGEMENT:
After completion of orthodontic treatment
6
10. Introduction Research Prevention Clinical Management Summary
Basics..
Bacteria Substrate
Demineralization
( Caries )
Time
7
14. Introduction Research Prevention Clinical Management Summary
The Key…
Fluoride
Best Established Remineralization Strategy
- Fluoride-enhanced precipitation of Calcium Phosphates
- Formation of Fluor-hydroxyapatite in dental tissues
9
16. Introduction Research Prevention Clinical Management Summary
Some Relevant Research..
..Prevalence reports vary widely.. %2 - %96 !
Mitchell, 1992, Br J Orth
..Loss of calcified tooth substance (Ca + P)
occurs as early as 4 weeks after bond-up !!
O’Reilly & Featherstone, 1987, AJODO
10
17. Introduction Research Prevention Clinical Management Summary
Some Relevant Research..
..Prevalence reports vary widely.. %2 - %96 !
Mitchell, 1992, Br J Orth
..Loss of calcified tooth substance (Ca + P)
occurs as early as 4 weeks after bond-up !!
O’Reilly & Featherstone, 1987, AJODO
..The opacity is an optical phenomenon
directly related to loss of subsurface minerals..
Gorelick et al, 1982, AJODO; Mellberg, 1988, Am J Dent
10
18. Introduction Research Prevention Clinical Management Summary
Some Relevant Research..
Zachrisson & Zachrisson, 1971
Zachrisson, 1977 Prevalence reports varied widely
Mizrahi, 1982 + 1983 due to different methods of
Gorelick et al, 1982 assessment !
Artün & Brobakken, 1986
Øgaard, 1989
Mitchell, 1992
Willmot & Brook, 1999
Willmot, 2000
Others …
11
19. Introduction Research Prevention Clinical Management Summary
Some Relevant Research..
Zachrisson & Zachrisson, 1971
Zachrisson, 1977 Prevalence reports varied widely
Mizrahi, 1982 + 1983 due to different methods of
Gorelick et al, 1982 assessment !
Artün & Brobakken, 1986
Øgaard, 1989 General agreement on increased
Mitchell, 1992 incidence in orthodontic patients
Willmot & Brook, 1999
Willmot, 2000
Others …
11
20. Introduction Research Prevention Clinical Management Summary
Some Relevant Research..
Zachrisson & Zachrisson, 1971
Zachrisson, 1977 Prevalence reports varied widely
Mizrahi, 1982 + 1983 due to different methods of
Gorelick et al, 1982 assessment !
Artün & Brobakken, 1986
Øgaard, 1989 General agreement on increased
Mitchell, 1992 incidence in orthodontic patients
Willmot & Brook, 1999
Willmot, 2000 Fairly-good agreement on lesion
Others … distribution, as well as tooth
groups affected
11
21. Introduction Research Prevention Clinical Management Summary
Some Relevant Research..
Localization and Distribution of White Lesions
Mizrahi,(1982 +1983)
..Opacity Index (Visual Scoring System from 0 – 3):
- Males more affected.
- Increased incidence on :
- Max. & Mand. 1st molars
- Max. lateral incisors
- Mand. Lateral incisors & Canines
- Middle & Cervical thirds of crowns most affected.
12
22. Introduction Research Prevention Clinical Management Summary
Some Relevant Research..
Localization and Distribution of White Lesions
Willmot,(2000)
Pre- & Post-treatment photographic-slide comparisons :
- In agreement with most previous reports..
- Increased incidence on :
- Upper Lateral Incisors (14.8%)
- Lower Canines (14%)
- Lower Premolars (16.2%)
- No difference between LEFT & RIGHT sides of the mouth.
13
23. Introduction Research Prevention Clinical Management Summary
Further Attempts At Localization & Measurement..
AIM: to more accurately assess location & surface areas of PWL
on upper & lower anterior teeth..
Localization & Surface Area Measurement of Post-Orthodontic White Lesions By Computerized Image Analysis
S.S. Samawi, D.R. Willmot, School of Clinical Dentistry, University of Sheffield, 2003
( under publication )
14
24. Introduction Research Prevention Clinical Management Summary
Further Attempts At Localization & Measurement..
AIM: to more accurately assess location & surface areas of PWL
on upper & lower anterior teeth..
Retrospective, Observational..Part of a wider study..
Methodology tried to overcome many problems in previous methods
of visual assessment
Localization & Surface Area Measurement of Post-Orthodontic White Lesions By Computerized Image Analysis
S.S. Samawi, D.R. Willmot, School of Clinical Dentistry, University of Sheffield, 2003
( under publication )
14
25. Introduction Research Prevention Clinical Management Summary
Further Attempts At Localization & Measurement..
Digital records of (274 teeth )
Special standardized camera setup
Polarized white light
Pre-existing lesions excluded..
Localization & Surface Area Measurement of Post-Orthodontic White Lesions By Computerized Image Analysis
S.S. Samawi, D.R. Willmot, School of Clinical Dentistry, University of Sheffield, 2003
( under publication )
15
26. Introduction Research Prevention Clinical Management Summary
Further Attempts At Localization & Measurement..
Digital records of (274 teeth )
Special standardized camera setup
Polarized white light
Pre-existing lesions excluded..
(Image Plus Pro, V 3.01) software:
labial surface into 4 quadrants
Locate + outline + measure surface
area of each lesion & quadrant
Localization & Surface Area Measurement of Post-Orthodontic White Lesions By Computerized Image Analysis
S.S. Samawi, D.R. Willmot, School of Clinical Dentistry, University of Sheffield, 2003
( under publication )
15
27. Introduction Research Prevention Clinical Management Summary
Further Attempts At Localization & Measurement..
Location:
Upper > Lower teeth..
Ging > Occ. quadrants..
U. lateral incisors &
Lr. canines most affected..
No diff. between LEFT &
RIGHT sides..
Localization & Surface Area Measurement of Post-Orthodontic White Lesions By Computerized Image Analysis
S.S. Samawi, D.R. Willmot, School of Clinical Dentistry, University of Sheffield, 2003
( under publication )
16
28. Introduction Research Prevention Clinical Management Summary
Further Attempts At Localization & Measurement..
Location:
Upper > Lower teeth..
Ging > Occ. quadrants..
U. lateral incisors &
Lr. canines most affected..
No diff. between LEFT &
RIGHT sides..
Localization & Surface Area Measurement of Post-Orthodontic White Lesions By Computerized Image Analysis
S.S. Samawi, D.R. Willmot, School of Clinical Dentistry, University of Sheffield, 2003
( under publication )
16
29. Introduction Research Prevention Clinical Management Summary
Further Attempts At Localisation & Measurment..
Surface Area:
Upper teeth > Lower teeth lesions
(sig. diff. for centrals and laterals)..
Gingival > Occlusal lesions..
Sig. Diff. in lesion size between
MESIAL & DISTAL quadrants..
No diff. between LEFT & RIGHT
sides..
Localization & Surface Area Measurement of Post-Orthodontic White Lesions By Computerized Image Analysis
S.S. Samawi, D.R. Willmot, School of Clinical Dentistry, University of Sheffield, 2003
( under publication )
17
30. Introduction Research Prevention Clinical Management Summary
So.. Why study PWL ??
Identify
Patterns..
Anticipate..
Target..
PREVENT
PWL ..?
18
31. Introduction Research Prevention Clinical Management Summary
So.. Why study PWL ??
A Notable Finding ..
(0.022” x 0.028”) bracket slot :
Sliding mechanics with (0.019” x 0.025”) SS posted arches
MG of Canines
DG of lateral incisors
19
32. Introduction Research Prevention Clinical Management Summary
Recommendations for Prevention
Preventive measures implemented:
Before beginning orthodontic treatment
During orthodontic treatment
20
33. Introduction Research Prevention Clinical Management Summary
.. Patient & Parent Education & Awareness
Before Starting Treatment are
PARAMOUNT
TO SUCCESSFUL PREVENTION..
21
34. Introduction Research Prevention Clinical Management Summary
.. Patient & Parent Education & Awareness
Before Starting Treatment are
PARAMOUNT
TO SUCCESSFUL PREVENTION..
“ Patients Don’t Know What They Want.. Until They DON’T Get It !! “
21
35. Introduction Research Prevention Clinical Management Summary
Prevention Before Orthodontic Tx
Applied
Preparation
Clinically
Instructional
(Psychological)
Preparation
22
36. Introduction Research Prevention Clinical Management Summary
Before Orthodontic Tx
23
37. Introduction Research Prevention Clinical Management Summary
Before Orthodontic Tx
Instructional (psychological) preparation :
23
38. Introduction Research Prevention Clinical Management Summary
Before Orthodontic Tx
Instructional (psychological) preparation :
Emphasizing importance of strict & properly-implemented OH
measures needed throughout Tx, at the INITIAL VISIT !
23
39. Introduction Research Prevention Clinical Management Summary
Before Orthodontic Tx
Instructional (psychological) preparation :
Emphasizing importance of strict & properly-implemented OH
measures needed throughout Tx, at the INITIAL VISIT !
Letting the patient know his/her OH will be monitored closely
each and every visit !
Providing detailed, easy-to-understand OHI at the bond-up
appointment.
23
40. Introduction Research Prevention Clinical Management Summary
Before Orthodontic Tx
..Detailed OHI..
1- Use “Props” for more visual instructions:
i.e: Actual toothbrushes, Bonded Typodonts,
OrthoWax, …etc...
Effective VISUAL Reinforcement !
24
41. Introduction Research Prevention Clinical Management Summary
Before Orthodontic Tx
..Detailed OHI..
2- How to properly use special orthodontic brushes
i.e: Ortho V-brush, Inter-dental brush
Electric toothbrush (if available), …etc..
Use the “ TELL – SHOW – DO “ technique !
25
42. Introduction Research Prevention Clinical Management Summary
Before Orthodontic Tx
..Detailed OHI..
3- Use PowerPoint Slide Shows or Photo-Books
for demonstration of technique or
undesirable effects of improper OH !
MORE Effective VISUAL Reinforcement !
26
43. Introduction Research Prevention Clinical Management Summary
Before Orthodontic Tx
..Detailed OHI..
4- Provide WRITTEN INSTRUCTIONS
such as Leaflets or Color Brochures
With OHI tips..
Effective Reinforcement
At Home..!
27
44. Introduction Research Prevention Clinical Management Summary
Prevention Before Orthodontic Tx
Clinical Time ?
5 Minutes ..at the Initial Exam visit !
10-15 Minutes ..OHI after the Bond-up !
1 Minute ..at beginning of each visit !
28
45. Introduction Research Prevention Clinical Management Summary
Prevention Before Orthodontic Tx
Clinically-applied Preparation :
Patients with Very Poor OH before Tx are referred for
Professional Cleaning ( Scaling / Jet Cleaning..)
Proper Oral Hygiene RE-INSTRUCTION..
Monitored for 1-2 months before initiating orthodontic Tx..
29
46. Introduction Research Prevention Clinical Management Summary
Prevention Before Orthodontic Tx
30
47. Introduction Research Prevention Clinical Management Summary
Prevention Before Orthodontic Tx
Predictors For Potential Development Of PWL:
Pre-existing Poor Oral Hygiene
Anticipated Long Tx Time
Younger Age?
Inter-proximal Caries
Fornell & Twetman, 2004
30
49. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Instructional (Motivational) Methods :
Constant monitoring at each subsequent visit..
Keep parents informed about progress / Poor OH..etc..
Motivate Re-motivate WARN !
Use “ REWARD / PUNISHMENT “ techniques !
32
50. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Clinically-applied Methods :
1. Appliance System 2. Fluoride-Releasing
& Mechanics Sealants
3. Fluoride-Releasing 4. Fluoride-Releasing
Adhesives Elastomerics
33
51. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Appliance System & Mechanics :
A more refined, less “cluttered” bracket design
A Low – Friction system ( Reduced Tx time? )
Simpler – yet effective - mechanics and archwires
Less use of plaque-retaining elastomerics and Power-Chains
Bonding rather than Banding molars..?
.. SELF - LIGATING BRACKETS ..?
34
52. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Fluoride-Releasing Sealants :
Lee et al, JCO; 1973
Acid-etching then SEALING entire labial enamel surface prior to
bonding..??
..Protective coating between enamel and acidic plaque environment..??
Banks & Richmond, EJO; 1994
%72 of sample suffered decalcifications !
Wenderoth et al, 1999
Results “ ..Not encouraging..”
35
53. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
New
PulpDent Corporation
Ortho-Coat™
A fluoride releasing, light-cured resin
• Patented Embrace technology: Moisture tolerant..
• Marginal integrity and ability to prevent microleakage !
www.dentalcompare.com
www.pulpdent.com
36
55. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Fluoride-Releasing Adhesives :
Basdra et al, AJODO; 1996
In vitro comparison of :
Rely-A-Bond), Fluorobond Concise, Conventional Concise (control)
For
F. Release + Demineralization Inhibition Potential + Effects On Enamel
38
56. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Fluoride-Releasing Adhesives :
Basdra et al, AJODO; 1996
• Maximal
Fluoride release
period occurs
within 3-4 days..!
• After approx.
90 days,
almost no
residual F
release present !
39
57. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Fluoride-Releasing Adhesives :
..Removing Excess Adhesive Around Every Bracket !
40
58. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Fluoride-Releasing Elastomerics:
..Strategic (Targeted) Fluoride Release..?
AROUND BRACKET MARGINS
41
59. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Fluoride-Releasing Elastomerics:
Wiltshire, 1996
Promising Results..
Wiltshire, 1999
Further Clinical Trials needed!
Mattick et al, 2001
42
60. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Fluoride-Releasing Elastomerics:
Wiltshire, 1996
Promising Results..
Wiltshire, 1999
Further Clinical Trials needed!
Mattick et al, 2001
PROSPECTIVE RCT
Doherty et al, 2002 “..No significant anti-cariogenic
Benefits from the use
of fluoridated ligatures..”
42
61. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Fluoride-Releasing Elastomerics:
Effects on Plaque Microbiology:
“..ineffective in changing levels of
Benson et al, 2004
Streptococci or anaerobes
in plaque..”
43
62. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Fluoride-Releasing Elastomerics:
LIMITATIONS
• Short-term Fluoride release
• Ligatures become SWOLLEN & lose elasticity quickly !
44
63. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Fluoride-Releasing Elastomerics:
LIMITATIONS
• Short-term Fluoride release
• Ligatures become SWOLLEN & lose elasticity quickly !
..Currently NOT a very effective measure
against decalcification !
44
65. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Diet Control :
X
SUGARS & SWEETS
SUGARY, ACIDIC & FIZZY DRINKS
Cheese, Starchy foods (Bread & Pasta)
Fruits & Vegetables..
Water..!
46
66. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Daily Tooth brushing with Fluoride Toothpastes :
The most widely used method of delivering topical fluoride
(around 1450 ppm)
Rinsing with water after tooth brushing greatly reduces
oral fluoride retention !
Dentifrices, mouthwashes, and remineralization/caries arrestment strategies
Indiana University School of Dentistry, Oral Health Research Institute, June 2006
47
67. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Adjunctive Daily Fluoride Rinsing :
Geiger et al, 1982
Øgaard et al, 1988 + 1989
0.05% NaF (226 ppm)
And
0.2% NaF (900 ppm)
Daily / Weekly rinses:
Reduced incidence of decalcification & caries
..but NOT completely !
48
68. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Adjunctive Daily Fluoride Rinsing :
49
69. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Adjunctive Daily Fluoride Rinsing :
Benson et al, 2004
Systematic Review
15 Clinical trials ( > 700 patients)
CONCLUSION:
Topical fluoride / fluoride-containing bonding materials
effective
But.. Which method most effective..??
49
70. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Adjunctive Daily Fluoride Rinsing :
Recommendation
Daily Fluoride Rinsing ( 0.05% NaF) ..?
Dentifrices, mouthwashes, and remineralization/caries arrestment strategies
Indiana University School of Dentistry, Oral Health Research Institute, June 2006
50
71. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Adjunctive AntiPlaque / AntiMicrobial Agents :
Phenolic / Essential oil Quaternary Ammonium
Compounds Compounds
(Thymol, Eukaleptol) (Cetyl Pyridinium Chloride)
Triclosan
Dentifrices, mouthwashes, and remineralization/caries arrestment strategies
Indiana University School of Dentistry, Oral Health Research Institute, June 2006
51
72. Introduction Research Prevention Clinical Management Summary
During Orthodontic Tx
Adjunctive AntiPlaque / AntiMicrobial Agents :
Chlorhexidine
2nd line Treatment 0.2% Oral Rinse
0.05% Oral Gel
Once daily
30 sec rinse each time
Dentifrices, mouthwashes, and remineralization/caries arrestment strategies
Indiana University School of Dentistry, Oral Health Research Institute, June 2006
52
73. Introduction Research Prevention Clinical Management Summary
Recommendations for Clinical Management
Management of PWL
After orthodontic treatment
53
74. Introduction Research Prevention Clinical Management Summary
Clinical Management
Mainly Depends On Severity :
54
75. Introduction Research Prevention Clinical Management Summary
Clinical Management
Mainly Depends On Severity :
Mild
54
76. Introduction Research Prevention Clinical Management Summary
Clinical Management
Mainly Depends On Severity :
Mild Moderate
54
77. Introduction Research Prevention Clinical Management Summary
Clinical Management
Mainly Depends On Severity :
Mild Moderate Severe
54
78. Introduction Research Prevention Clinical Management Summary
High Fluoride Concentration ??
55
79. Introduction Research Prevention Clinical Management Summary
High Fluoride Concentration ??
..The opacity is an optical phenomenon
directly related to loss of subsurface minerals..
Gorelick et al, 1982, AJODO; Mellberg, 1988, Am J Dent
55
80. Introduction Research Prevention Clinical Management Summary
Effect of High Fluoride Concentration ??
56
81. Introduction Research Prevention Clinical Management Summary
Effect of High Fluoride Concentration ??
High
Fluoride
Concentration
i.e: Fluoride
varnishes,
APF gels, etc..
56
82. Introduction Research Prevention Clinical Management Summary
Effect of High Fluoride Concentration ??
High
Fluoride • Remineralization
of Surface Layer
Concentration
• Blocks Porosities
i.e: Fluoride Leading To
varnishes, Subsurface Layers
APF gels, etc..
56
83. Introduction Research Prevention Clinical Management Summary
Effect of High Fluoride Concentration ??
High
Fluoride • Remineralization
of Surface Layer
Concentration Persistant
i.e: Fluoride
• Blocks Porosities White lesions!
Leading To
varnishes, Subsurface Layers
APF gels, etc..
56
84. Introduction Research Prevention Clinical Management Summary
Recommendation
Current Research Findings:
Lesions Remineralise Slowly Through
Normal Remineralisation Potential Of Saliva
After Debonding !
57
85. Introduction Research Prevention Clinical Management Summary
Recommendation
Current Research Findings:
Lesions Remineralise Slowly Through
Normal Remineralisation Potential Of Saliva
After Debonding !
Recommendation:
AVOID HIGH FLUORIDE CONCENTRATIONS
IMMEDIATELY & UP TO 6 MONTHS
AFTER DEBONDING !
Zachrisson, 1986 - Ogaard, 1988 – Kamp, 1989 - Willmot, 2000…
57
86. Introduction Research Prevention Clinical Management Summary
Mild White-Spot Lesions
• Small streaks..
• Not a Major
Esthetic Problem
58
87. Introduction Research Prevention Clinical Management Summary
Mild White-Spot Lesions
• Natural
Remineralization
(up to 6 months)
• Small streaks.. • Avoid High F
• Not a Major Conc.
Esthetic Problem
58
88. Introduction Research Prevention Clinical Management Summary
Mild White-Spot Lesions
• Natural
Re-assess:
Remineralization
(up to 6 months)
• Micro-Abrasion
• Small streaks.. • Avoid High F • Composite
• Not a Major Conc.
Restorations?
Esthetic Problem
58
89. Introduction Research Prevention Clinical Management Summary
Moderate White-Spot Lesions
• Larger Lesions..
• Obvious
Esthetic Problem
59
90. Introduction Research Prevention Clinical Management Summary
Moderate White-Spot Lesions
• Natural
Remineralization
(up to 6 months)
• Larger Lesions.. • Avoid High F
Conc.
• Obvious
Esthetic Problem
59
91. Introduction Research Prevention Clinical Management Summary
Moderate White-Spot Lesions
Re-assess:
• Natural
Remineralization
(up to 6 months) • Micro-Abrasion
• Composite
• Larger Lesions.. • Avoid High F Facings ?
Conc. • Porcelain
• Obvious
Veneers ?
Esthetic Problem
59
92. Introduction Research Prevention Clinical Management Summary
Severe White-Spot Lesions
• Cavitation
(Caries) !
60
93. Introduction Research Prevention Clinical Management Summary
Severe White-Spot Lesions
• Immediate Restoration
• Porcelain Veneers ?
• Fluoride Application:
• Cavitation (Wait 4-6 months first !)
(Caries) !
60
94. Introduction Research Prevention Clinical Management Summary
Enamel Micro-Abrasion ( Acid-Pumice) Technique
A Conservative Approach To Dealing With Mild - Moderate PWL
..Recommended to be The First Consideration for Treatment..
Croll & Bullock, JCO, 1997
61
95. Introduction Research Prevention Clinical Management Summary
Enamel Micro-Abrasion ( Acid-Pumice) Technique
High Torque – Low RPM application of PREMA compound
Undetectable amount of enamel (50-150 microns) uniformly
removed, along with the superficial decalcified tissue..
RESULT:
A Smooth, Polished Enamel Glaze
Resistant to Demineralization
And bacterial Colonization..
Croll & Bullock, JCO, 1997
62
96. Introduction Research Prevention Clinical Management Summary
Enamel Micro-Abrasion ( Acid-Pumice) Technique
Hydrochloric/Phosphoric Acid
Fine-Grit Silicon Carbide
Water-Soluble Gel
PREMA
Croll & Bullock, JCO, 1997
63
97. Introduction Research Prevention Clinical Management Summary
Enamel Micro-Abrasion ( Acid-Pumice) Technique
PREMA compound to be used only with a Rubber Dam..
Protective Eyewear for patient, clinician and staff..
Avoid prolonged exposure of PREMA to gingival tissues !
Fluoridation is recommended after Micro-Abrasion
(4 minutes with Neutral NaF Gel)
Kamp, JCO, 1989 Croll & Bullock, JCO, 1997
64
99. Introduction Research Prevention Clinical Management Summary
Enamel Micro-Abrasion ( Acid-Pumice) Technique
Q: How much enamel
can be removed safely?
A: If concavity apparent,
Restoration is indicated!
66
100. Introduction Research Prevention Clinical Management Summary
Enamel Micro-Abrasion ( Acid-Pumice) Technique
Q: How much enamel
can be removed safely?
Q: How do we know
A: If concavity apparent,
when treatment is finished?
Restoration is indicated!
A: once wet enamel surface
shows no evidence of an opacity
after application of compound!
66
101. Introduction Research Prevention Clinical Management Summary
Summary
Post-Orthodontic Decalcification Is A Well-established &
Serious Problem In Orthodontics !
Bacteria Substrate
Demineralization
( Caries )
Time
67
105. Introduction Research Prevention Clinical Management Summary
Summary
Clinical Management Of PWL
Post - Tx:
Avoid High Fluoride Concentrations
up to 6 months Post-Debond !
71
106. Introduction Research Prevention Clinical Management Summary
Summary
Clinical Management Of PWL
Post - Tx:
Micro-Abrasion
A Conservative Approach To Dealing With Mild - Moderate PWL
1st Line Treatment
Mild PWL Natural Remineralization +/- Micro-abrasion
Moderate PWL Natural Remineralization +/- Micro-Abrasion
Severe PWL Immediate Restoration +/- Veneers?
72