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  • 文章类型: Journal Article
    目的:为临床医生在正畸治疗过程中处理白斑病变(WSLs)建立共识建议。
    方法:三个工作组成员回顾了文献,以确定在正畸治疗期间最小化WSL的最佳实践。每个声明草案都由一名主持人向工作队成员宣读,接着是投票,接受,或编辑,如有必要。然后由独立第三方以电子方式发送声明(麦哲伦医疗技术顾问公司,明尼阿波利斯,Minn)到先前形成的由20名独立私人从业者和临床院士组成的内容验证小组进行验证。
    结果:制定了21条声明,并将其用于内容验证。虽然19个陈述达到了0.78的内容验证指数(CVI),但有两个项目没有。这些项目由工作组成员根据内容验证参与者的定性反馈进行编辑。这些修订的陈述中的每一个在来自内容验证小组成员的第二次评估中确实实现了0.78的CVI,因此被包括在本文档中。
    结论:为了降低WSL的风险,在全面评估患者口腔和全身健康状况的基础上,实施个性化龋齿管理措施至关重要。对于高危正畸患者,应实施有效的在家和专业的机械和化学菌斑控制。支持预防的氟化物和诸如正畸密封剂之类的材料也应用于在高风险患者的托槽周围提供物理屏障。通过遵循这些准则,正畸专业人员可以帮助促进口腔健康并最大限度地减少修复治疗的需要。
    To establish consensus recommendations for clinicians to manage white spot lesions (WSLs) during orthodontic treatment.
    Three task force members reviewed the literature to identify best practices for minimizing WSLs during orthodontic treatment. Each draft statement was read to the task force members by a facilitator, followed by voting, accepting, or editing if necessary. The statements were then sent electronically by an independent third party (Magellan Medical Technology Consultants Inc, Minneapolis, Minn) to a previously formed content validation panel consisting of 20 independent private practitioners and clinical academicians for validation.
    Twenty-one statements were developed and sent for content validation. While 19 statements achieved a content validation index (CVI) of 0.78, two items did not. These items were edited by the task force members based on qualitative feedback from content validation participants. Each of these revised statements did achieve a CVI of 0.78 on second evaluation from the content validation panelists and therefore were included in this document.
    To reduce the risk of WSLs, it is essential to implement individualized caries management measures based on a comprehensive assessment of the patient\'s oral and systemic health. Effective at-home and professional mechanical and chemical plaque control should be implemented for high-risk orthodontic patients. Fluoride to support prevention and materials such as orthodontic sealants should also be used to provide a physical barrier around the brackets in high-risk patients. By following these guidelines, orthodontic professionals can help promote oral health and minimize the need for restorative treatment.
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  • 文章类型: Journal Article
    OBJECTIVE: Numerous studies have focused on the various complications with implant-retained restorations and a common thread in these publications is the potential for occlusal overload. The purpose of this Best Evidence Consensus Statement on implant occlusal schemes was to review the literature to determine the level of scientific evidence upon which the articles are based.
    METHODS: Limiting the search to Clinical trials, Randomized Controlled Trials, Systematic Reviews, Meta-analyses, the key words: dental implants, occlusion, found no citations. Expanding the search to Journal articles found 1,483 results, 20 of which pertained to the question. Doing a similar search including Journal Articles, the key words: dental implants and occlusal scheme found 47 citations, 17 of which were pertinent to the question.
    RESULTS: After eliminating duplicates and non-relevant articles, 15 were included in the review. Nineteen additional articles were culled by going through the reference lists in the aforementioned articles.
    CONCLUSIONS: There is a lack of scientific evidence regarding the occlusal scheme utilized with implant restorations that will minimize or eliminate complications. In light of this lack of scientific evidence, the style of occlusion a practitioner utilizes with tooth or mucosal supported prostheses may be used with implant-supported restorations until compelling evidence dictates otherwise.
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  • 文章类型: Journal Article
    OBJECTIVE: Patients in need of extensive prosthodontic treatment may need restoration of their occlusal vertical dimension (OVD) due to tooth wear, tooth loss, or changes that have occurred to existing prostheses over time. Prosthodontic treatment is based on the clinical application of the available evidence regarding interocclusal distance (IOD), the positional stability of rest vertical dimension (RVD), and the effect of altering the OVD. Hence, the purpose of this consensus document is to examine available data related to IOD, RVD, and alteration of the OVD.
    METHODS: The search was limited to Clinical trials, Randomized Controlled Trials, Systematic Reviews and Meta-analyses. Key words were healthy patient, mean, range, interocclusal rest distance; healthy patient, mean, range, freeway space; and dentistry, interocclusal gap, and no citations appeared. Dentistry, interocclusal distance, revealed 5 not relevant citations. Dentistry, inter occlusal rest space, and dentistry, interocclusal rest distance, both had the same single not relevant citation. Dentistry, freeway space revealed over 7,000 citations. Dentistry, occlusal vertical dimension, revealed 253 citations, 7 of which were related to the search question but only 1 which was different from the previous search. Mandible, rest vertical dimension, age changes, found 7 citations, none relative to the question. Expanding the search to include journal article found 260 citations with only one relevant to the question. Mandible, rest vertical dimension, alteration, harm revealed no citations; mandible, occlusal vertical dimension, alteration, revealed 15 citations, 1 of which was relevant; mandible, occlusal vertical dimension, changes, revealed 75 citations, none of which were relevant; mandible, occlusal vertical dimension, rehabilitation revealed 10 citations, none of which were relevant. Expanding the search strategy to include Journal article, mandible, occlusal vertical dimension, alteration, received 159 citations, 4 of which were relevant; mandible, occlusal vertical dimension, restoration revealed 208 citations, 1 of which was relevant. Numerous other articles were culled by going through the reference lists of the aforementioned articles.
    RESULTS: For IOD, 27 articles were found relevant to the search question, which confirmed a mean of 3.0 mm with ranges from 1 to 9 mm. Five articles revealed little evidence as to whether the RVD changes during life. For OVD, 20 articles, including 4 systematic reviews, revealed some evidence that skeletal growth continues from mid adolescence into mid adulthood; strong anecdotal evidence that some unopposed teeth will continue to erupt; no clinical evidence to support the concept that abraded teeth in occlusion in a patient with bruxism will undergo continuous eruption; and some evidence from clinical case reports that restoring OVD in patients with severe abrasion is a successful treatment.
    CONCLUSIONS: There is a range of dimensions for the interocclusal distance (IOD) with many normal dental patients functioning with a higher or lower IOD than the commonly used 3.0 mm average dimension. The resting vertical dimension (RVD) is a 3-dimensional range with little evidence related to changes in the RVD during life. However, aging can cause a decrease in muscle tone which could affect the RVD. The restoration of the OVD can be successfully accomplished if proper diagnosis and treatment planning are performed.
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  • 文章类型: Practice Guideline
    本文为牙医治疗儿童龋齿提供建议,强调儿童早期龋齿(ECC),乳牙,和恒牙的咬合面。由欧洲龋齿研究组织(ORCA)和欧洲保守牙科联合会(EFCD)/德国保守牙科协会(DGZ)委员会提名的专家小组进行了共识研讨会,然后进行了e-Delphi共识过程。基于3个系统综述和非系统文献检索,提出了建议。龋齿的减少导致儿童和青少年的疾病分布沿社会梯度更加两极化,在管理各级龋齿过程时应予以考虑。比如个人,集团,或人口。控制或减少龋齿活动是成功治疗龋齿的基础。在儿童中,龋齿管理需要足够的日常口腔卫生和通过牙膏使用氟化物,由护理人员保证,特别是对于ECC预防,需要强调减少糖的摄入量。在没有不可逆牙髓炎的情况下,这些非侵入性干预措施也适用于阻止或控制初始或甚至空化的牙本质龋病变。可添加氟化物清漆或二氨基氟化银作为助剂。在凹坑和裂缝中,复合树脂材料可用作预防性密封剂和面向缺陷的微创修复。在初级磨牙中,预制金属冠比多表面填充更成功,尤其是龋齿活跃的患者。随着持续的高龋齿活动,多发性病变,有限的合作,龋齿控制应包括具有高成功率的强有力的措施,甚至包括在选定的情况下提取。这尤其适用于在全身麻醉下进行的治疗。
    This paper provides recommendations for dentists for the treatment of dental caries in children, with an emphasis on early childhood caries (ECC), primary teeth, and occlusal surfaces in permanent teeth. A consensus workshop followed by an e-Delphi consensus process was conducted with an expert panel nominated by the European Organization for Caries Research (ORCA) and European Federation of Conservative Dentistry (EFCD)/German Association of Conservative Dentistry (DGZ) boards. Based on 3 systematic reviews and a nonsystematic literature search, recommendations were developed. The caries decline has led to a more polarized disease distribution in children and adolescents along social gradients which should be taken into account when managing the caries process at all levels, such as the individual, the group, or a population. The control or reduction of caries activity is the basis for successful caries management. In children, caries management requires adequate daily oral hygiene and fluoride application via toothpaste, ensured by caregivers, and especially for ECC prevention an emphasis on sugar intake reduction is needed. These noninvasive interventions are also suitable to arrest or control initial or even cavitated dentine caries lesions in the absence of irreversible pulpitis. Fluoride varnish or silver diammine fluoride can be added as supplementary agents. In pits and fissures, composite resin materials can be used as preventive sealants and for defect-oriented minimally invasive restorations. In primary molars, preformed metal crowns are more successful than multisurface fillings, especially in caries-active patients. With persisting high caries activity, multiple lesions, and limited cooperation, caries control should consist of robust measures with high success rates, even including extraction in selected cases. This applies especially to treatments performed under general anesthesia.
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