South African Dental Journal

A roundabout approach to progress

The zemblanity of the NHI the inevitable discovery of what we would rather not know

Physician and Dental Surgeon's roles in diagnosing hypertension in association with Lichen Planus and Geographic Tongue - The perspective of a Clinician

What are some of the key inputs that we as the dental profession (Dentists, Therapists, Hygienists, Technicians, Specialist and Assistants) should agree upon and aim to achieve under the NHI? - An opinion piece submitted to the SADJ

Remaining dentine thickness following preparation with different glide path techniques in combination with WaveOne Gold Primary File

INTRODUCTION: This study compared minimum remaining dentine thickness values after different glide path preparation techniques, in combination with WaveOne Gold Primary (PWOG) for final canal instrumentation. METHODS: Mesiobuccal canals of 60 extracted human mandibular molars were selected and randomly divided into four groups (15 canals each). Canals were brought to patency with a # 08 K-file before glide path preparation, which was performed by a single operator. KF GROUP: pre-curved #10-15-20 stainless steel manual K-files; PF group: #10 stainless steel manual K-file followed by PathFiles #1-3; WOGG group: #10 stainless steel manual K-file followed by WaveOne Gold Glider; and NG group: no further glide path preparation. Minimum remaining dentine thicknesses were determined on Micro-Computed Tomography scans at levels 3 mm, 5 mm and 7 mm from the root apex after glide path preparation and again after final preparation with PWOG. One-way analysis of variance (ANOVA) was used to statistically compare groups. RESULTS: No statistically significant differences (p<0.05) were found amongst the groups. CONCLUSION: The least dentine preservation was seen in the group with no glide path preparation prior to PWOG instrumentation. Within the limitations of the study, all the glide path groups in combination with the PWOG instrument seemed to preserve dentine thickness adequately.

Comparing clinical outcomes of connective tissue grafts to platelet rich fibrin in gingival recession treatment - An extended case series

AIM: To appraise clinical and aesthetic outcomes of connective tissue grafts (CTG) and platelet rich fibrin (PRF) in managing marginal gingival recession METHODS AND MATERIALS: Five patients each with at least two contralateral Miller's Class I and/or Class II recession lesions underwent treatment in a case series with a randomised split-mouth design. Each site was paired with a similar contralateral lesion and randomly assigned to the CTG (control) or PRF (test) treatment. Probing depth, recession depth, recession width, clinical attachment level, keratinised tissue width and gingival thickness were recorded and the data compared. Photographs were taken at baseline and at 24-weeks to evaluate aesthetics using the Pink Esthetic Score (PES). A questionnaire was used to assess patient satisfaction with treatment outcomes. RESULTS AND CONCLUSIONS: Both treatment options resulted in improved clinical measurements but CTGs demonstrated improvements at a greater number of sites than PRF (60% to 30% respectively). The aesthetic scores improved at four sites for both CTGs and PRF with only one site in each group scoring lower, whilst elsewhere scores did not change. Patients were satisfied with the aesthetic outcomes. Both CTGs and PRF membranes can be effective in treating gingival recession, improving clinical and aesthetic outcomes.

Outcomes of mandibular Kennedy Class I and II prosthetic rehabilitation - An observational study

Loss of teeth may have a negative impact on appearance, nutrition and function. Removable prostheses for mandibular distal extension areas have been associated with more negative outcomes than with tooth-bounded saddles. AIM: To describe the outcomes of rehabilitation with Kennedy Class I and II dentures five years after insertion. METHODS: Dental laboratory and patient records were accessed to identify patients fitted with mandibular distal extension dentures between January 2011 and June 2017 by the Oral Health Centre of the University of the Western Cape. Information on the prosthesis, oral health status and study outcomes was recorded and augmented by telephonically interviewing 30 patients, randomly selected from the initial sample. RESULTS: Observed outcomes included 'low frequency of use' and 'high patient dissatisfaction.' Most common were: remakes (n=26), abutment tooth extractions (n=12) and repairs (n=9). A large proportion (n=105) of the sample received no follow-up treatment. No statistically significant associations existed between the outcomes and the variables of age, gender, type of opposing dentition, number of recalls and denture base material used. CONCLUSION: Most commonly reported oral health problem associated with wearing Kennedy Class I and II dentures was abutment tooth loss. Remakes and repairs were frequent outcomes.

The Oral Health Section of the Road to Health Chart (RtHC) - How useful is it?

Oral diseases are a major worldwide public health problem. Eighty per cent of caries goes untreated, below the 50% goal set by the South African National Department of Health. 80% of the SA population depends on state services for oral healthcare. The American Academy of Pediatrics advises commencement of screening when the first tooth appears, or no later than at 12 months of age. The Road to Health Chart (RtHC) is a convenient home-based method of monitoring and improving child health. How effective is it?; METHODOLOGY: A multistage cluster sampling technique selected seventy-seven health professionals as study participants for a review of their RtHC and for questionnaires and focus group interviews RESULTS: 243 oral health pages of RtHC's were reviewed. Only 27% had completed oral health sections, of which dental professionals had better knowledge; CONCLUSION: Those who work in Baby Well clinics are ill-informed and have a lack of knowledge of the relevance and importance of the oral health section of the RtHC, which is not adequately utilized.

The Mandibular Anterior Repositioning Appliance (MARA) - A report of three cases

INTRODUCTION: The MARA (Mandibular Anterior Repositioning Appliance) is a fixed functional appliance used in the treatment of mandibular deficiencies. AIMS AND OBJECTIVES: To demonstrate the clinical capabilities, treatment effects and the expected duration of treatment when using the MARA, therefore creating awareness of the MARA as a treatment alternative to other functional appliances designed for correction of Class II malocclusions. METHODS: A retrospective study exploring the anteroposterior dimensional changes in the maxilla and mandible brought about by the MARA and the associated treatment time. The samples were the first three cases treated by a clinician inexperienced with the clinical application of the MARA and served as an ideal introduction to the treatment technique. RESULTS: In this study mandibular growth stimulation and tem-poromandibular joint remodeling may have been the main contributing factors in the resolution/improvement of the Class II malocclusions under treatment. CONCLUSION: The MARA is a useful non-compliance appliance that produces exceptional treatment results when applied in combination with full fixed appliances. The changes observed were predominantly of a skeletal nature in the anteroposterior dimension. Maxillary growth restriction may also have played a role in the correction of these treated Class II abnormalities.

Endodontic treatment of a maxillary second premolar with three roots and three root canals - A case report

INTRODUCTION: There are currently no documented publications on an endodontic procedure performed on a maxillary second premolar with three roots and three root canals within a South African population. This is a rare root canal configuration (0.3%-2%), which, according to the endodontic literature, can be related to factors such as ethnicity, racial groups, and gender. Familiarity with root canal configurations within various ethnicities and racial groups is important in understanding the nature of the root canal system for successful endodontic procedures. OBJECTIVES: The aim of this case report is to describe endodontics performed on a maxillary second premolar with three roots and three root canals, the patient being a South African female patient of African ethnicity. In addition, consideration is given to a suitable restorative option for the endodontically treated tooth. The endodontic procedure is described in detail to inform dental practitioners. The diagnosis, location, instrumentation, and obturation of all the canals were successful. The location of the three canals required a large access cavity design that reduced the strength and support of the mineralized tissues. Therefore in this study, the preferred restoration for a maxillary second premolar with three roots and three root canals is a ceramic post crown.

Denturism (Clinical Dental Technology) - A brief review

The term 'denturism' is most commonly used worldwide for either dental technicians who are trained clinically, usually in removable prosthodontics, or for people who are trained specifically in that field to carry out both the laboratory and clinical procedures. In South Africa the term used is 'clinical dental technologist' and was introduced as an amendment to the Dental Technicians Act in 1997. However, this oral health professional has never been defined and no regulations have been promulgated. The South African Dental Technician's Council will be investigating the appropriate regulatory framework to provide for the enactment of clinical dental technology, and so the purpose of this paper is to give some background to denturism in general and to make suggestions as to the guidelines to be followed were it to be established in South Africa.

What's new for the clinician? - Excerpts from and summaries of recently published papers

Ethical dilemmas when dealing with doctor Google and the importance of patient education

Maxillofacial Radiology 176