Aim: The occlusal splint is an appliance used to influence the signs and symptoms of
temporomandibular dysfunction (TMD) and to protect the teeth from excessive wear due to
bruxism. There is no consensus in the literature about the therapeutic effect of occlusal splints,
however there is agreement on the behaviour changing effect. The explanation for this is that
because of the patients’ anticipation on the outcome of the intervention buxism decreases. This
underlines the importance of a well-fitting splint. The occlusal appliance can be manufactured
in a conventional way as by digital designing and thereafter milling the splint out of acrylic
resin. The aim of this study is to find out which method leads to a better result.
Materials and method: This study is a doubleblind randomised pilot study. The study
population was, after exclusion, a group of 34 dental students aged 20-35 years old. With these
students, alginate impressions of the upper and lower arch were made, as well as a wax bite in
maximal occlusion decreasing the vertical overbite with a minimum of 2,5 mm. One half of the
group received a conventionally manufactured splint without button anchors and the other half
received a digitally designed and milled splint. Both types of splint were of the Michigan type
with canine guidance. Research was done on the stone models, during the phase in which the
splints were placed and during a digital bite registration. The variables that have been measured
are occlusion, articulation, fit, retention and wear comfort. The programs R and IBM SPSS
were used to compare these variables in the study groups for statistical significance. In this
study a 95% confidence interval was chosen.
Results: A statistically significant difference between the two types of splint was found
in the variables fit ((U=84,000; p=0,036) and retention (p=0,001), both measured on the stone
models. In addition to that, a statistically significant difference was found in the retention
judged by the study population (p=0,01346) and the number of occlusal contact points in the
anterior region measured by the T-scan (U=78,000; p=0,020). All these mentioned differences
were in favor of the digitally designed splints. The variable occlusion in this study is subdivided
in ‘symmetrical contact between the left and the right side of the splint’, ‘the number of occlusal
contact points left and right on the splint’ and ‘simultaneous and evenly contact when coming
in occlusion’. The first two mentioned variables were measured with both articulating paper
and the T-scan and the last one mentioned was judged by the study population. Despite the fact
that no significant difference was found in the first two mentioned variables, the digitally
designed splints scored better on average than the conventionally manufactured splints which
shows a trend. This was also the case for the ‘wear comfort’ although both types of splint scored
low. This trend was not seen in the variables ‘articulation’ and ‘distribution of the bite force
measured by the T-scan’ and ‘simultaneous and evenly contact when coming in occlusion’.
Discussion and conclusion: The digitally designed and manufactured occlusal splint
scored, in most of the researched variables, better on average than the conventionally
manufactured splint. In a couple of cases this difference was also found to be statistically
significant. One can consequently say that there is a tendency in favour of the digitally
designing and manufacturing way of producing an occlusal splint.
Background Most of the Dutch youth has dental caries or have had any experience
with it. There are several treatment options when the disease is no longer under control by the
patient. Most of those treatment seem very difficult because the child is in pain, is not yet
accustomed to visiting a dentist and the treatment of young children with extensive problems
is perceived as difficult by the dentist. There needs to be a treatment method that is quick and
easy to use but relieves the patients of the pain caused by dental caries. The treatment method
in which the lesion is covered with GC Fuji Triage® without giving local anaesthesia,
preparation or excavation in combination with giving instructions to the patient and regular
fluoride application could be a method that meets the objections inherent in the more invasive
treatment methods. However, it’s unclear whether the tooth can exfoliate without interference,
whether other treatment options can be explored when there is failure, whether this method is
applicable to both occlusal and approximal lesions and whether it is applicable to both
shallow and deep carious lesions.
Methods The study material was obtained from anonymous clinical records of children
with carious lesions covered with glass ionomer GC Fuji Triage® treated in referral practice
for Pediatric Dentistry in Ermelo. 140 patients enrolled in this study, a total of 690 carious
deciduous teeth were treated with GC Fuji Triage®. The following variables were measured
with each deciduous tooth: the survival (whether the coverage of the carious laesion
persevered until exfoliation), the location and depth (X-score) of the lesion and the total
duration that GC Fuji Triage® functioned as a hedge of the carious lesion. Finally, the raison
for failure was documented (minor or major failure). The data was analysed using IBM SPSS
Results Survival of deciduous teeth which are covered with GC Fuji Triage is
79,3%. 9,3% experienced minor failure, 11,4% major failure. The survival of occlusal lesions
(89,3%) is higher than the survival of approximal lesions (67,4%) and a higher survival rates
is seen at the lower X-ray scores (X-score 3: 83,5%, X-score 4: 61,5%, X-score 5 37,5%). In
premature failure of GC Fuji Triage® 9,3% of the deciduous teeth had a conventional
restoration or got a Hall-crown (minor failure). 11,4% of the deciduous teeth were extracted
Conclusion The treatment method of the disease caries in which a lesion is covered
with GC Fuji Triage® without without giving local anaesthesia, preparation or excavation in
combination with giving instructions to the patient and regular fluoride application seems to
be an alternative to the already existing treatment options of carious lesions in deciduous
teeth. The best results are seen with occlusal and shallow lesions.
Functional Capacity Evaluation Research: Report from the Third International Functional Capacity Evaluation Research Meeting.
J Occup Rehabil. 2017 Apr 08;:
Authors: Edelaar MJ, Gross DP, James CL, Reneman MF
Purpose Based on the success of the first two conferences the Third International FCE Research Conference was held in The Netherlands on September 29, 2016. The aim was to provide ongoing opportunity to share and recent FCE research and discuss its implications. Methods Invitations and call for abstracts were sent to previous attendees, researchers, practicing FCE clinicians and professionals. Fifteen abstracts were selected for presentation. The FCE research conference contained two keynote lectures. Results 54 participants from 12 countries attended the conference where 15 research projects and 2 keynote lectures were presented. The conference provided an opportunity to present and discuss recent FCE research, and provided a forum for discourse related to FCE use. Conference presentations covered aspects of practical issues in administration and interpretation; protocol reliability and validity; consideration of specific injury populations; and a focused discussion on proposed inclusion of work physiology principles in FCE testing with the Heart Rate Reserve Method. Details of this Third International FCE Research Conference are available from http://repro.rcnheliomare.nl/FCE.pdf . Conclusions Researchers, clinicians, and other professionals in the FCE area have a common desire to further improve the content and quality of FCE research and to collaborate to further develop research across systems, cultures and countries. A fourth, 2-day, International FCE research conference will be held in Valens, Switzerland in August or September 2018. A ‘FCE research Society’ will be developed.
PMID: 28389973 [PubMed – as supplied by publisher]
Gerwin Engels: Biomarkers of lung injury in cardiothoracic surgery Biomedisch ingenieur Gerwin Engels onderzocht hoe hij longschade na een operatie …
Bram Piersma: Biochemical and biomechanical regulation of the myofibroblast phenotype Het eiwit YAP blijkt een belangrijke rol te spelen bij de …
Objectives: The aim of the present study is to systematically evaluate the current
literature for the effect of ultrasonic devices, ultrasonic scalers in particularly, on
cardiac pacemakers and ICDs to add evidence based knowledge regarding health
risks of patients wearing these devices when treated with ultrasonic scalers.
Materials and methods: To conduct this systematic review the guidelines for the
Transparent Reporting of Systematic Reviews and Meta-analyses were used
(PRISMA statement). The National Library of Medicine, Washington DC (MEDLINEPubmed)
was selected in search of appropriate papers for this study. The search
was conducted starting from the earliest records until 04 May 2016. The structured
search strategy aimed at any published paper that evaluated the effect of ultrasonic
scalers on the functioning of pacemakers and/ or ICDs.
Results: The MEDLINE-Pubmed search resulted in 642 abstracts with one in
duplicate, a total of 641 abstracts remained. A total of 630 articles were excluded
after screening by title and abstract. The remaining 11 articles, consisting of in vivo
and in vitro studies, were selected for full text reading and all were eligible for the
purpose of this study. One additional paper was found eligible after reference
checking the list of the included studies. Considerable heterogeneity was observed in
the in vitro and in vivo studies. Therefore a quantitative analysis of the data was not
possible. A descriptive format was used to analyse the pooled data.
In five out of ten in vitro studies EMI (electromagnetic interference) with pacemaker
and/or ICDs was found when using ultrasonic dental scalers. This occurred when the
handle of the ultrasonic scaler was in close proximity towards the device in three of
those studies. In the remaining two studies interference at larger distances was
detected, but this was most probably because of interference with the telemetry
connection between pacemaker/ICD and the cardiac programmer device. None of
the in vivo studies demonstrated EMI in pacemakers and/or ICDs affecting the
functioning of these devices when using ultrasonic scalers. Interference with cardiac
programmers was also found to occur in vivo.
Conclusion: The findings of this literature study suggest that it is safe to use
ultrasonic scalers with patients who are fitted with a pacemaker and/or ICD. There is
no evidence these devices interfere with normal cardiac device function or damage
the device properties when interference takes place. When maintaining the
precaution distance of 10-15 cm. towards the cardiac device, no significant effect on
these devices is observed when using ultrasonic dental scalers.
Objective: To evaluate the long-term outcomes of implant-supported maxillary overdenture, of simultaneous implant placement with the alveolar ridge expansion technique in the maxilla with insufficiency of alveolar ridges (SPLIMP) and the oral health –related quality of life (OHRQoL) of these patients.
Materials and methods: 22 patients of the Spaarne Gasthuis in Haarlem and Hoofddorp and the Red Cross Hospital in Beverwijk with insufficiency of alveolar ridges were treated using the SPLIMP technique participated in this study. The OHRQoL was determined by the patients at home. The clinical examination includes evaluation of implants osseo-integration, a X-ray was made to evaluate the bone loss comparing to the first taken X-ray taken after SPLIMP. Paired samples t-test was used to compare means. Also the effect of different bone augmentation materials and a resorbable membrane was evaluated using an ANOVA test.
Results: All implants were osseointegrated and no implant was lost. Regarding the bone loss, no significant differences were found between additional bone augmentation materials and without additional materials, Also no significant difference was found if a resorbable membrane was used.
Conclusions: Within the limitations of this study, SPLIMP has a high survival rate. The procedure seems to be save and predictable. Patients receiving implant-supported maxillary overdenture after SPLIMP have low scores on the OHIP-NL49.
Aim The aim of this research was to investigate the validity and reliability of volume measurements of bone with aid of the cone beam CT scanner. The influence of applied materials, like osteosynthesis screws and sutures, on the measurements was also investigated.
Methods A comparison is made between volume measurements on bone derived from a pig’s jaw created by the cone beam CT scanner and the golden standard. The golden standard consists of applying dental wax on the bone to avoid influx of water. The volume of the bone has been measured according to the water displacement method. A volume of water inside a beaker is compared to the watervolume after adding the bone and filling the beaker to the same level. With these measurements the bone volume can be calculated. 24 pieces of bone were used. On each piece 3 measurements were done, resulting in 72 measurements. To investigate the influence of applied materials, six bone augmentations were simulated. A CBCT scan was made after augmentation, a second CBCT scan was made after detaching the bone block from the augmentation site. The retreived volumes were compared.
Results Most of the volumes retrieved with aid of the CBCT differed significantly (α=0.05) from the measurements according to the golden standard. The measurements turn out the be very reliable. (Pearson correlatie test, r = .991, p = .000.) The influence of applied materials has not been verified in this investigation. (Wilcoxon-Signed Rank Test, z = -1.153, p = .249.)
Discussion The differences between volume measurements are mostly due to the ‘partial-volume’ effect, where voxels wich contain a little bit of bone will account for a completely filled voxel. Any trapped air bubbles during appliance of dental wax will result in a greater deviation of the retreived volumes. An analysis of grey values retreived from a CBCT scan is manually done, so the volume is also influenced by the analist. Conclusion It turns out that a volume measurement determined by the CBCT scanner is very reliable but not valid. The CBCT scanner with the used ‘threshold’ is not useful for determining exact bone volumes. Relative differences before and after bone augmentation can be measured with great reliability. The influence of applied materials like osteosynthesis-screws has not been verified.
Background: Gagging is a natural, protective reflex that occurs when a foreign object threats to come into the oropharynx. The gag reflex can be induced by different types of stimuli and the intensity differs for each individual. A disfunctional, extreme gag reflex can cause problems during the dental treatment or the wearing of a conventional denture. In the literature there is no agreement about the aetiology and prevalence from such a reflex. There is a lack of useful, valid measurement instruments and no consensus about the treatment method of preference.
Objective: The objective is to survey the patient population, treatment results and satisfaction among patients with gagging problemacy in a center for special dental care (CBT) in a hospital (UMCG) in Groningen, the Netherlands. Based on this, recommendations can be done to improve the treatment of patients with gagging problemacy.
Methods: It is an observational study that has been performed retrospectative. The patient list from the CBT in the UMCG was used. In the first part of the study, the patient dossiers from all patients that visited the CBT because of gagging problems from the 1st of January 2010 to the 1st of May 2016 were observed. This was followed by a structured interview with the patients who actually had been treated, provided that a VLEK (question list extreme gagging problemacy) was carried out during the intake. The structured interview contained several questions, including questions about the treatment effect on short-term and long-term, the satisfaction about treatment and positive/ negative elements of it.
Results: 116 patient dossiers were observed, of which 51 patients were selected for a structured interview. In 39 cases, a structured interview was actually performed. The majority of the referred patients consisted of male in the age of 40-60. More than half of the patients was referred by a general dental practioner. The self-reported short-term treatment effect was 4,95 on a scale from 0 (no effect) to 10 (gagging completely disappeared). The long-term effect differed not significantly (T = 94,50,
p= .180). The practioners recorded more often a positive effect for edentulous patients than for dentate patients, while not significant (U = 121, z= -2,027, p= .063). The mean rating for satisfaction about treatment was 7,95 on scale 0-10. Edentulous patiens were significant more satisfied than dentate patients (U = 97, z = -2,633,
Conclusions: Edentulous patiens are more satisfied about treatment for gagging problemacy at the center for special dental care in the UMCG than dentate patients.. This could be explained by the fact that the practioners recorded more often a positive effect for this group. Recommendations are improvement of the information provision (concerning treatment and treatment costs) and the administration with respect to appointments.
Purpose: the aim of this systematic review was to compare which bone substitution material has the best effectiveness in increasing the bone or reducing bone resorption after applying in the aveolus immediately after tooth extraction. The purpose of this comparison is to provide an up-to-date overview of the available scientific evidence of the effectiveness of various bone substitution materials for the purpose of alveolar ridge preservation.
Materials and methods: a systematic research is performed to identify and select articles who studied the effectiveness of several bone substitution materials for the purpose of alveolar ridge preservation. The data was compared with the aid of a descriptive analysis, which subdivided the data by measuring method and mean follow-up.
Results: of the 351 identified articles, 18 were included in this systematic review. In the included articles, different bone substitution materials were compared to other bone substitution materials or to control groups where no bone substitution materials were used. The comparison of clinical data revealed that Bio-Oss® has the best effectiveness after 12 weeks to 3 months, that Bio-Oss® + BPAM, CaS + DFDBA and Bio-Oss® + BioGide® have the best effectiveness after 16 weeks to 4 months and that NanoBone® + BioGide® and Bio-Oss® + BioGide® have the best effectiveness after 6 to 7 months. The comparison of radiographic data revealed that Bio-Oss® has the best effectiveness in increasing the radiographic bone density after 12 to 14 weeks and that MGCSH + ConFORM® and CRP + ConFORM® have the best effectiveness in reducing the loss of vertical bone thickness after 3 months. The comparison of histological/histomorphometric data revealed that CRP + ConFORM® have the best effectiveness in increasing the mean percentage of new/vital bone after 12 weeks to 3 months, that MEHA has the best effectiveness in increasing the mean percentage new/vital bone after 16 weeks to 4 months and that NHA + CS and BHA + CS have the best effectiveness in increasing the mean percentage of new/vital bone after 5 to 7 months.
Conclusion: the choice of bone substitution material that has the best effectiveness for alveolar ridge preservation depends on the measuring method and on the time of measuring. It can be concluded that the best time to place dental implants is 4 months after extraction and ridge preservation using Bio-Oss® + BPAM if the aim is the preservation of de clinical horizontal bone thickness. If preservation of the vertical bone thickness is the aim, the best time to place dental implants is 19 weeks after tooth extraction and alveolar ridge preservation with 70% FDBA + 30% DFDBA with d-PTFE membrane.
Background Type of feeding during the first period of a child’s life can play an important role in the development of their oral health. The aim of this review was to give an update of available literature on the influence of breast- and bottle-feeding on the development of caries, erosion and the occlusion in children.
Methods PubMed was searched for relevant studies published until December 2016. All studies including data on breastfeeding and/or bottle-feeding and their influence on the development of caries, erosion and the occlusion, were included. Two independent reviewers assessed the studies’ eligibility and quality, and extracted data from the included studies. Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analyses was used for quality assessment.
Results At the end of the screening process, 30 studies remained for inclusion: 20 considering caries, 1 considering erosion, and 9 considering occlusion in relation to breast- and bottle-feeding. Breastfeeding was found to have a protective effect on development of caries, but early weaning (<3 months) and prolonged breastfeeding (>24 months) were associated with higher caries experience. In addition, bottle-feeding was found to be associated with higher caries experience. Children who were weaned at an early age (<12 months) were more affected by erosion than those weaned at a later age. Breastfeeding was found to lead to normal occlusion more often than bottle-feeding. Occlusal parameters more commonly found in bottle-fed children included terminal planes that do not favour correct occlusion, unfavourable intercanine and intermolar diameters, posterior cross bite development and open bite. The quality scores of included studies showed high variety.
Conclusion Results indicate that breastfeeding has a protective effect on caries experience, reduces the risk of developing erosion and more often leads to normal occlusion compared to bottle-feeding. Further research is recommended to strengthen the evidence.
Doelstelling: In deze studie is onderzoek gedaan naar 3 verschillende sectionele matrixsystemen op contour- en contactpuntherstel bij klasse II restauraties.
Materiaal en methode: Er zijn in dit onderzoek 3 matrix-systemen getest: het Contact-matrixsysteem, V3-matrixsysteem en het Twinring-matrixsysteem. Met behulp van een kolomboor zijn in 60 KaVo-elementen identieke preparaties gemaakt die in 3 groepen zijn ingedeeld. Per onderzoeksgroep zijn 20 elementen geïncludeerd die at random zijn verdeeld. Groep 1: 20 KaVo elementen gerestaureerd met behulp van het contact-matrixsysteem. Groep 2: 20 KaVo elementen gerestaureerd met behulp van het V3-matrixsysteem. Groep 3: 20 KaVo elementen gerestaureerd met behulp van het Twinring-matrixsysteem. Deze elementen zijn beoordeeld op occluso-gingivale en bucco-linguale contour vanaf buccaal gezien en vanaf occlusaal gezien en vergeleken met een oorspronkelijk, niet-gerestaureerd KaVo-element. Met behulp van een opstelling zijn vanaf een exact identieke positie foto’s gemaakt van de elementen. De foto’s zijn geanalyseerd met behulp van Matlab en meetbaar gemaakt. Tevens is er met een flosdraad gekeken of er een contactpunt is en is er beoordeeld of er sprake is van een contactpunt of een contactvlak.
Resultaten: De gemiddelde bucco-linguale afwijking(uitgedrukt in pixels) met het oorspronkelijke element met hun standaarddeviaties zijn: groep 1(-20,54 ± -6,08) > groep 2(-16,44 ± 4,55) > groep 3(-13,61 ± 4,92). Wat betreft de occluso-gingivale contour zijn de resultaten: groep 1(-19,02 ± 6,06) > groep 3(-14,15 ± 3,11) > groep 2(-13,51 ± 3,26). Het verschil tussen groep 1 in vergelijking met groep 2 en 3 is significant, maar het verschil tussen groep 2 en 3 is niet significant.
De gemiddelde maximale bucco-linguale afwijking in vergelijking met het oorspronkelijke element is: groep 1(-32,85 ± 6,92) > groep 2(-28,10 ± 6,67) > groep 3(-24,15 ± 5,23). Die van de occluso-gingivale contour zijn: groep 1(-35,6±7,34) > groep 2(-32,35 ± 4,99) > groep 3(-30,50 ± 3,47). Hierbij is het verschil tussen groep 1 en 3 wel significant maar de andere verschillen niet.
Bij alle restauraties is een contact gecreëerd met het buurelement. Bij de meeste restauraties is een contactvlak gevormd(61,67%) bij de overige elementen is een contactpunt gecreëerd(38,33%). In groep 1 komt het vaakst een contactvlak voor(85%). Bij de andere 2 groepen is dit respectievelijk 45% en 55%.
Conclusie: Bij gebruik van alle drie sectionele matrixsystemen wordt contact gecreëerd met het buurelement. Restauraties met behulp van het V3-matrixsysteem en het Twinring-matrixsysteem zorgen voor een beter contour herstel dan bij het gebruik van het contact-matrixsysteem. Echter zorgt deze laatste voor strakkere contactpunten.
Trefwoorden: Sectionele matrixsystemen, Twinring-matrixsysteem, V3-matrixsysteem, contact-matrixsysteem, contour, contactpunt.
People are getting older. Healthy aging and longer living at home is the objective in healthcare and politics. This study looked at the rapidly growing group of independently living elderly people and the factors that affect their dental visit. A questionnaire was sent to 308 patients in a general practice. The response rate was 53%. The study population was satisfied with the accessibility of the dental practice. The majority of the study population regularly came for inspection at the dentist. Impeding factors were mainly patient associated, namely: motivation, complaint motivated dental visit, planning and making of appointments, dentate status, having an additional insurance and whether to respond to a recall. Patients with additional dental insurance visited the dentist significantly more frequent. With an active recall policy, the attendance rate is likely to be increased.
Esther Nibbeling: The genetics of spinocerebellar ataxia and dystonia Moleculair bioloog Esther Nibbeling heeft acht nieuwe genen ontdekt die …
Background: Identification of a different distribution and pattern of recurrent disease in
esophageal cancer (EC) patients is important for a better understanding of tumor biology and the
effect of neoadjuvant chemoradiotherapy (nCRT). This study assessed the influence of two
different nCRT regimens (cisplatin/5-fluorouracil with 50.4 Gy (Cis/5FU) versus
carboplatin/paclitaxel with 41.4 Gy (CROSS)), on the distribution of recurrent disease and distant
metastases in EC patients.
Patient and Methods: In this retrospective study, locally advanced EC patients (stage II/III)
treated between 2002 and 2015 with nCRT followed by a curative intended esophagectomy (open
transthoracic or scopic procedure), were included. The CROSS patients were all treated in the
University Medical Center Groningen in The Netherlands and the Cis/5FU patients were treated
in the Flinders Medical Centre in Australia. We assessed the difference in site-specific tumor
recurrence. We also assessed the 5-year overall survival (OS) and 5-year disease-free survival
(DFS) with univariate and multivariate Cox regression analysis.
Results: One hundred and thirty-eight (n=138) EC patients were included in analysis. The
amount of distant metastases (P=0.039), lung metastases (P=0.017), and peritoneal metastases
(P=0.039) differed significantly between the groups. The treatment schedule was not a
prognostic factor in multivariate Cox regression analysis for both 5-year DFS (P=0.232) and 5-
year OS (P=0.602).
Conclusion: The CROSS and Cis/5FU group differed significantly in the total amount of
recurrences, with more tumor recurrences in the CROSS group. However, the 5-year OS and DFS
did not differ.