Publications by authors named "Irene H Aartman"

31 Publications

Comparison of anterior and posterior trabecular bone microstructure of human mandible using cone-beam CT and micro CT.

BMC Oral Health 2021 05 8;21(1):249. Epub 2021 May 8.

Department of Oral and Maxillofacial Radiology, Academic Center for Dentistry Amsterdam (ACTA), Louwesweg 1, 1066 EA, Amsterdam, The Netherlands.

Background: The aim of this study was to compare the trabecular bone microstructures of anterior and posterior edentulous regions of human mandible using cone-beam computed tomography (CBCT) and micro computed tomography (µCT).

Methods: Twenty volumes of interests consisting of six anterior and fourteen posterior edentulous regions were obtained from human mandibular cadavers. A CBCT system with a resolution of 80 µm (3D Accuitomo 170, J. Morita, Kyoto, Japan) and a µCT system with a resolution of 35 µm (SkyScan 1173, Kontich, Belgium) were used to scan the mandibles. Three structural parameters namely, trabecular number (Tb.N), trabecular thickness (Tb.Th), and trabecular separation (Tb.Sp) were analysed using CTAn software (v 1.11, SkyScan, Kontich, Belgium). For each system, the measurements obtained from anterior and posterior regions were tested using independent sample t-test. Subsequently, all measurements between systems were tested using paired t-test.

Results: In CBCT, all parameters of the anterior and posterior mandible showed no significant differences (p > 0.05). However, µCT showed a significant different of Tb.Th (p = 0.023) between anterior and posterior region. Regardless of regions, the measurements obtained using both imaging systems were significantly different (p ≤ 0.021) for Tb.Th and Tb.N.

Conclusions: The current study demonstrated that only the variation of Tb.Th between anterior and posterior edentulous region of mandible can be detected using µCT. In addition, CBCT is less feasible than µCT in assessing trabecular bone microstructures at both regions.
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http://dx.doi.org/10.1186/s12903-021-01595-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106860PMC
May 2021

Effect of dental implant surface roughness in patients with a history of periodontal disease: a systematic review and meta-analysis.

Int J Implant Dent 2019 Feb 13;5(1):12. Epub 2019 Feb 13.

Section of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands.

Background: To review the literature on the effect of dental implant surface roughness in patients with a history of periodontal disease. The present review addresses the following focus question: Is there a difference for implant survival, mean marginal bone loss, and the incidence of bleeding on probing in periodontally compromised patients receiving a machined dental implant or rough surface dental implant?

Methods: Electronic and manual literature searches were conducted on PubMed/MEDLINE and the Cochrane Library on studies published until May 2018 to collect information about the effect of machined, moderately rough, and rough dental implant surfaces in patients with a history of periodontal disease. The outcome variables implant survival, mean marginal bone level, and the incidence of peri-implantitis and bleeding on probing were evaluated. Meta-analysis was performed to obtain an accurate estimation of the overall, cumulative results.

Results: Out of 2411 articles, six studies were included in this systematic review. The meta-analysis of the implant survival and implant mean marginal bone loss revealed a risk ratio of 2.92 (CI 95% 0.45, 18.86) for implant failure and a total mean difference of - 0.09 (CI 95% - 0.31, 0.14) for implant mean marginal bone loss measured in a total group of 215 implants, both not statistically significant.

Conclusions: Due to lack of long-term data (> 5 years), the heterogeneity and variability in study designs and lack of reporting on confounding factors, definitive conclusions on differences in implant survival, and mean marginal bone loss between machined and moderate rough implants in periodontally compromised patients cannot be drawn. Future well-designed long-term randomized controlled trials are necessary to reveal that machined surfaces are superior to moderately rough and rough surfaces in patients with a history of periodontal disease.
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http://dx.doi.org/10.1186/s40729-019-0156-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372709PMC
February 2019

Dentists' opinions on using digital technologies in dental practice.

Community Dent Oral Epidemiol 2018 04 6;46(2):143-153. Epub 2017 Oct 6.

Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.

Objectives: To investigate which opinions among dentists are associated with level of technology use, when characteristics of the dentist and dental practice, as well as motivating work aspects are taken into account.

Methods: A total of 1000 general dental practitioners in the Netherlands received a questionnaire on digital technologies they use, opinions on using technologies and related motivating work aspects. Questions were derived from expert interviews, the Dentists' Experienced Job Resources Scale and literature on technology implementation. Technology use was measured as the number of technologies used, and divided into three technology user groups: low (using 0-4 technologies, mostly administrative and radiographic technologies), intermediate (using 5-7, more varied technologies) and high technology users (using 8-12, including more innovative diagnostic technologies). Opinions on technology use and motivating work aspects were analysed using principal components analysis (PCA) and exploratory factor analysis. Scores on all components and factors were calculated for each respondent by computing the mean of all valid responses on the underlying items. Differences in these scale scores on opinions among the technology user groups were assessed using one-way analysis of variance and Kruskal-Wallis tests. A multiple linear regression analysis assessed the association of scale scores about opinions on technology use with the sum of technologies used, taking into account motivating work aspects and characteristics of the dentist and dental practice.

Results: The response rate was 31%. Dentists who were high technology users perceived technologies as yielding more improvements in quality of care, adding more value to the dental practice and being easier to use, than low technology users. High technology users thought technologies added more value to their work and they reported higher skills and resources. They also focused more on technologies and thought these are more ready to use than low technology users. High technology users derived more motivation from "Immediate results" and "Craftsmanship" than low technology users. Personal and practice characteristics, motivating work aspects, and the opinion scales "Focus" and "Added value to dentist" explained 50% of the variance in the number of technologies a dentist uses.

Conclusion: Opinions on digital technologies among dentists and motivating work aspects vary with level of technology use. Being more focused on technologies and perceiving a higher added value from using them are associated with using more digital dental technologies, when taking into account motivating work aspects and characteristics of the dentist and dental practice.
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http://dx.doi.org/10.1111/cdoe.12345DOI Listing
April 2018

Adoption and use of digital technologies among general dental practitioners in the Netherlands.

PLoS One 2015 26;10(3):e0120725. Epub 2015 Mar 26.

Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, the Netherlands.

Objectives: To investigate (1) the degree of digital technology adoption among general dental practitioners, and to assess (2) which personal and practice factors are associated with technology use.

Methods: A questionnaire was distributed among a stratified sample of 1000 general dental practitioners in the Netherlands, to measure the use of fifteen administrative, communicative, clinical and diagnostic technologies, as well as personal factors and dental practice characteristics.

Results: The response rate was 31.3%; 65.1% replied to the questionnaire on paper and 34.9% online. Each specific digital technology was used by between 93.2% and 6.8% of the dentists. Administrative technologies were generally used by more dentists than clinical technologies. Dentists had adopted an average number of 6.3 ± 2.3 technologies. 22.5% were low technology users (0 to 4 technologies), 46.2% were intermediate technology users (5 to 7 technologies) and 31.3% were high technology users (8 to 12 technologies). High technology users more frequently had a specialization (p<0.001), were younger on average (p=0.024), and worked more hours per week (p=0.003) than low technology users, and invested more hours per year in professional activities (p=0.026) than intermediate technology users. High technology use was also more common for dentists working in practices with a higher average number of patients per year (p<0.001), with more dentists working in the practice (p<0.001) and with more staff (p<0.001).

Conclusion: With few exceptions, all dentists use some or a substantial number of digital technologies. Technology use is associated with various patterns of person-specific factors, and is higher when working in larger dental practices. The findings provide insight into the current state of digital technology adoption in dental practices. Further exploration why some dentists are more reluctant to adopt technologies than others is valuable for the dental profession's agility in adjusting to technological developments.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0120725PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374680PMC
March 2016

Accuracy of trabecular bone microstructural measurement at planned dental implant sites using cone-beam CT datasets.

Clin Oral Implants Res 2014 Aug 15;25(8):941-5. Epub 2013 Apr 15.

Department of General and Specialized Dentistry, Section of Oral and Maxillofacial Radiology, Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands; Department of General Dental Practice and Oral & Maxillofacial Imaging, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia.

Objective: Cone-beam CT (CBCT) images are infrequently utilized for trabecular bone microstructural measurement due to the system's limited resolution. The aim of this study was to determine the accuracy of CBCT for measuring trabecular bone microstructure in comparison with micro CT (μCT).

Materials And Methods: Twenty-four human mandibular cadavers were scanned using a CBCT system (80 μm) and a μCT system (35 μm). Three bone microstructural parameters trabecular number (Tb.N), thickness (Tb.Th) and separation (Tb.Sp) were assessed using CTAn imaging software.

Results: Intraclass correlation coefficients (ICC) showed a high intra-observer reliability (≥ 0.996) in all parameters for both systems. The Pearson correlation coefficients between the measurements of the two systems were for Tb.Th 0.82, for Tb.Sp 0.94 and for Tb.N 0.85 (all P's<0.001). The Bland and Altman plots showed strongest agreement in Tb.N (-0.37 μm) followed by Tb.Th (1.6 μm) and Tb.Sp (8.8 μm).

Conclusions: Cone-beam CT datasets can be used to evaluate trabecular bone microstructure at dental implant sites. The accuracy for measuring Tb.N was the best followed by Tb.Th and Tb.Sp.
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http://dx.doi.org/10.1111/clr.12163DOI Listing
August 2014

The reliability of assessing rotation of teeth on photographed study casts.

Angle Orthod 2012 Nov 12;82(6):1033-9. Epub 2012 Apr 12.

Department of Orthodontics, Academic Centre for Dentistry Amsterdam, University of Amsterdam, The Netherlands.

Objective: To examine the intra- and interexaminer reliability of assessing rotation of teeth on photographed study casts. In addition, the reliability parameters of two examiners scoring in mutual consultation were compared with the reliability parameters by one observer.

Materials And Methods: Standardized photographs of sets of maxillary and mandibular plaster casts of 10 patients before treatment (T1), after treatment (T2), and a long time after retention (T3) were digitized. Tooth rotation was assessed relative to a correct position in the ideal dental arch form. A computer analysis program was used to process the measurements. Two examiners assessed each study cast twice with a washout period of 3 weeks. A third examiner assessed each cast, together with one of the other examiners. The intra- and interexaminer agreements were calculated using intraclass correlation coefficients (ICCs). Wilcoxon signed-rank tests were used to determine significant differences between the intra- and interexaminer reliability coefficients of the three examiners.

Results: The ICCs ranged from 0.430 to 0.991. Incisors showed the highest ICCs and molars showed the lowest ICCs. Intraexaminer ICCs of the experienced examiners were significantly higher than those of the examiner with less experience. No significant differences in the reliability between a single examiner and the combination of two examiners were found.

Conclusion: The method of assessing tooth rotation in the present study has proved to be reproducible, except for the molars. This method can be helpful for clinicians assessing tooth rotation from photographed study casts.
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http://dx.doi.org/10.2319/112811-733.1DOI Listing
November 2012

Histopathology of ameloblastoma of the jaws; some critical observations based on a 40 years single institution experience.

Med Oral Patol Oral Cir Bucal 2012 Jan 1;17(1):e76-82. Epub 2012 Jan 1.

VU University Medical Center (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA), Department of Oral & Maxillofacial Surgery/Oral Pathology, Amsterdam, The Netherlands.

The aim of the present study is to examine all cases of intraosseous benign ameloblastomas treated between 1970 and 2010 in a single institution and to look for a possible correlation between the histopathological aspects and the demographical and clinical parameters, as well as the treatment outcome. The data of a total number of 44 patients were retrieved from the records. Nine patients were excluded because of doubt about the correct diagnosis (8 patients) or because of an extra-osseous presentation (1 patient). No statistically significant differences were found between the histopathological (sub)types of ameloblastomas and the demographical and clinical parameters, nor between the histopathological (sub)types and treatment outcome. Of the 28 patients treated by enucleation, in 17 patients one or more recurrences occurred, with no significant predilection for any histopathological (sub)type, including the unicystic type. There were no significant differences in the recurrence rate after enucleation in patients below and above the age of 20 years either. In six out of 17 patients with a recurrence, the recurrent lesion showed a different histopathological subtype than was encountered in the primary. In two cases a change from solid/multicystic to desmoplastic ameloblastomas was noticed. In conclusion, the current histopathological classification of benign intraosseous ameloblastoma does not seem to have clinical relevance with the possible exception of the luminal unicystic ameloblastoma that has been removed in toto, unfragmented. Since no primary desmoplastic ameloblastomas were encountered in the present study no further comments can be made on this apparently rare entity.
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http://dx.doi.org/10.4317/medoral.18006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3448205PMC
January 2012

Oral cancer trends in a single head-and-neck cancer center in the Netherlands; decline in T-stage at the time of admission.

Med Oral Patol Oral Cir Bucal 2011 Nov 1;16(7):e914-8. Epub 2011 Nov 1.

Department of Oral and Maxillofacial Surgery/Pathology, VU University Medical Center (VUmc)/Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands.

Objectives: In this study we evaluated the possible epidemiologic changes of oral cancer patients in the Netherlands between the years 1980-1984 and 2000-2004. We specifically studied the differences in male-female ratio, age, TNM-stage, site distribution, and alcohol and tobacco use.

Materials And Methods: Patients from the VU University Medical Center with an oral squamous cell carcinoma of the oral cavity registered in 1980-1984 (n=200), group 1, were compared to patients registered in 2000-2004 (n=184), group 2. Trends in prevalence, site distribution, TNM-stage, alcohol and tobacco use, age and gender were studied.

Results: The male-female ratio has decreased from 1.8 to 1.2. There were no differences in age between the two groups of patients. The site distribution was similar in both groups. The most commonly involved sites were the tongue and the floor of mouth. In group 2 more patients were diagnosed with a T1 tumour. There were no differences in tobacco use between the two different groups. There were much more light drinkers (0-2 drinks per day) in group 2 than in group 1, whereas there were more heavy drinkers (>4 per day) in group 1 than in group 2 (p<0.001). This was observed in both male and female patients.

Conclusion: In our study there were no significant differences between the patients registered in the years 1980-1984 and 2000-2004 regarding the mean age of the patients, site distribution and smoking habits. The male-female ratio has decreased. In the recent group more patients were staged T1N0 and there was a strong decrease of the patients who were heavy drinkers.
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http://dx.doi.org/10.4317/medoral.17862DOI Listing
November 2011

The structure of common fears: comparing three different models.

Am J Psychol 2011 ;124(2):141-9

Department of Behavioural Sciences, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, The Netherlands.

Previous studies showed discrepant findings regarding the factor structure of common fears. The purpose of the present study was to expand on these findings and contribute to the development of a descriptive framework for a fear classification. Using data from the Dutch general population (n = 961; 50.9% women), an exploratory factor analysis was performed to delineate the multidimensional structure of 11 common fears previously used in a factor analytic study by Fredrikson, Annas, Fischer, and Wik (1996). An independent sample (n = 998; 48.3% women) was used to confirm the newly derived model by means of confirmatory factor analysis. In addition, the model was tested against the DSM-IV-TR model and a model found earlier by Fredrikson et al. (1996). Although support was found for a 3-factor solution consisting of a blood-injection-injury factor, a situational-animal factor, and a height-related factor, confirmatory factor analysis showed that this 3-factor model and the DSM-IV-TR 4-factor model fitted the data equally well. The findings suggest that the structure of subclinical fears can be inferred from the DSM classification of phobia subtypes and that fears and phobias are two observable manifestations of a fear response along a continuum.
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http://dx.doi.org/10.5406/amerjpsyc.124.2.0141DOI Listing
September 2011

Relationship between dental anomalies and orthodontic root resorption of upper incisors.

Eur J Orthod 2012 Oct 10;34(5):571-4. Epub 2011 Jul 10.

Department of Orthodontics, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, The Netherlands.

The aim of this study was to examine the potential relationship between the occurrence of orthodontic root resorption and presence of dental anomalies such as tooth agenesis and pipette-shaped roots. Dental anomalies and root resorption were assessed on dental panoramic tomographs (DPT) of 88 subjects, 27 males and 61 females, mean age 28.4 (SD = 11.3 years), selected from orthodontic patients on the basis of the following exclusion criteria: previous fixed appliance treatment, bad quality of the DPTs and no visibility of the periodontal ligament of every tooth, and younger than 15 years of age at the onset of treatment with fixed edgewise appliance lasting at least 18 months. A pipette-shaped root was identified as defined by a drawing. Tooth agenesis was assessed on DPTs and from subjects' dental history. Root resorption was calculated as the difference between the root length before and after treatment, with and without a correction factor (crown length post-treatment/crown length pre-treatment). If one of the four upper incisors showed root resorption of ≥2.3 mm with both formulas, the patient was scored as having root resorption. Chi-square tests indicated that there was no relationship between orthodontic root resorption and agenesis (P = 0.885) nor between orthodontic root resorption and pipette-shaped roots (P = 0.800). There was no relationship between having one of the anomalies and root resorption either (P = 0.750). In the present study, it was not possible to confirm on DPTs a relationship between orthodontic root resorption and dental anomalies, such as agenesis and pipette-shaped roots.
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http://dx.doi.org/10.1093/ejo/cjr056DOI Listing
October 2012

Temporomandibular disorder patients' illness beliefs and self-efficacy related to bruxism.

J Orofac Pain 2010 ;24(4):367-72

Department of Oral Kinesiology, Academic Centre for Dentistry, Amsterdam (ACTA), Amsterdam, The Netherlands.

Aims: To examine temporomandibular disorder (TMD) patients' illness beliefs and self-efficacy in relation to bruxism, and to examine whether these beliefs are related to the severity of patients' self-perceived bruxing behavior.

Methods: A total of 504 TMD patients (75% women; mean age ± SD: 40.7 ± 14.6 years), referred to the TMD Clinic of the Academic Centre for Dentistry Amsterdam, completed a battery of questionnaires, of which one inquired about the frequency of oral parafunctional behaviors, including bruxism (clenching and grinding). Patients' illness beliefs were assessed with a question about the perceived causal relationship between bruxism and TMD pain; patients' self-efficacy was assessed with questions about the general possibility of reducing oral parafunctional behaviors and patients' own appraisal of their capability to accomplish this.

Results: Sleep bruxism or awake bruxism was attributed by 66.7% and 53.8% of the patients, respectively, as a cause of TMD pain; 89.9% believed that oral parafunctions could be reduced, and 92.5% believed themselves capable of doing so. The higher a patient's bruxism frequency, the more bruxism was believed to be the cause of TMD pain (Spearman's rho 0.77 and 0.71, P < .001) and the more pessimistic the self-efficacy beliefs were about the reducibility of oral parafunctions (Kruskal-Wallis ?2 = 19.91, df = 2, P < .001; and Kruskal-Wallis ?2 = 7.15, df = 2, P = .028).

Conclusion: Most TMD patients believe in the harmfulness of bruxism and the possibility of reducing this behavior. Bruxism frequency is associated with illness beliefs and self-efficacy.
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March 2011

Assessment of dental anomalies on panoramic radiographs: inter- and intraexaminer agreement.

Eur J Orthod 2011 Jun 26;33(3):250-5. Epub 2010 Aug 26.

Department of Orthodontics, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, The Netherlands.

The presence of dental anomalies has been rated radiographically in a number of studies. However, since the reliability of the assessment of these anomalies has rarely been investigated, the aim of this study was to examine inter- and intraexaminer agreement in identifying morphological dental anomalies, such as tooth agenesis, dilacerated, pipette-shaped, blunt, pointed, and short roots. Pre-treatment panoramic radiographs of 40 patients (13 males and 27 females; mean age 27.7 ± 10.8 years) treated between 1983 and 2008 were selected. Four examiners independently assessed the radiographs twice. For a dilacerated root and agenesis, a definition was given. For pipette-shaped, blunt, or pointed roots, a drawing was shown, and for a short root, a ratio was used to identify the anomaly. Intraexaminer agreement of the assessments of the dental anomalies was presented by Cohen's Kappa and varied between -0.01 for short roots and 1.00 for agenesis. With respect to short roots, three of the examiners did not rate them to be present on at least one measurement occasion. This implies that intraexaminer agreement could not be calculated for these three examiners. Interexaminer agreement for dilacerated roots varied between 0.14 and 0.50, for pipette-shaped roots between -0.01 and 0.33, for blunt roots between 0.05 and 0.32, and for pointed roots between 0.17 and 0.37. All values for agenesis were 1.00. It can be concluded that assessing agenesis on panoramic radiographs is reliable. Rating the presence of dilacerated, pipette-shaped, blunt, pointed, and short roots on panoramic radiographs, however, does not result in a reliable assessment.
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http://dx.doi.org/10.1093/ejo/cjq061DOI Listing
June 2011

The influence of dental caries on body growth in prepubertal children.

Clin Oral Investig 2011 Apr 29;15(2):141-9. Epub 2010 Jan 29.

Department of Cariology Endodontology Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands,

Dental decay and dental treatment are suggested to be related to body growth in children. The aim of this study was first to assess the relation between dental caries and body proportions cross-sectionally in a Suriname caries child population and secondly to investigate whether dental treatment had a significant influence on body growth of these children in a randomised controlled trial using different treatment strategies. Three hundred eighty 6-year-old children with untreated dental decay participated in the study. Caries prevalence and presence of dentogenic infections were recorded. All children were randomly assigned to four different treatment groups ranging from full dental treatment to no invasive treatment at all. Body growth was evaluated by children's height, weight and body mass index. Participants were evaluated after 6 months and 1, 2 and 3 years. Cross-sectionally, negative correlations were observed between anthropometric measures and the number of untreated carious surfaces and caries experience of the children. Next, no significant differences in growth pattern between the treatment groups were observed. Based on these results, it is suggested that caries activity is a negative predictor for body growth in children and dental intervention does not show significant improvement within 3 years.
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http://dx.doi.org/10.1007/s00784-010-0380-3DOI Listing
April 2011

Referral patterns of Dutch general dental practitioners to orthodontic specialists.

Eur J Orthod 2010 Oct 18;32(5):548-54. Epub 2010 Jan 18.

Sections of Orthodontics, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, The Netherlands.

General dental practitioners (GDPs) act as gatekeepers for specialist dental care since they generally decide whether, when, and where to refer patients. It is important for orthodontists to understand the factors influencing the referral decision in order to be able to satisfy both the referring dentists and the patients. A specifically designed questionnaire was sent to a random sample of 634 GDPs in The Netherlands. In part A, general characteristics of the GDPs such as gender, years in practice, number of patients in the practice, possibilities to refer to an orthodontist, and number of patients referred to the orthodontist per year were collected. Part B assessed the importance of 20 various factors related to the GDPs' usual referral decision. Intraclass correlation coefficients (ICC) were calculated to assess the relationship in rank scores of the items of the various groups. The response rate was 60 per cent. Most GDPs (38 per cent) had the possibility to refer to three to four orthodontists, 22 per cent could choose between five and six, and 21 per cent could refer to one or two. Most GDPs (55 per cent) actually referred to one to two orthodontic specialists, while 34 per cent choose between three and four orthodontists. The rank order of the items for male and female dentists was nearly equal (ICC = 0.99, P < 0.001). The most important factors governing the choice of an orthodontic treatment provider by GDPs were patient satisfaction, favourable experience in the past, and oral hygiene monitoring by the orthodontist.
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http://dx.doi.org/10.1093/ejo/cjp148DOI Listing
October 2010

Long-term changes in graft height after maxillary sinus floor elevation with different grafting materials: radiographic evaluation with a minimum follow-up of 4.5 years.

Clin Oral Implants Res 2009 Jul;20(7):691-700

Department of Oral and Maxillofacial Surgery, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

Objective: To compare the vertical dimensional changes with regard to graft height in a long-term follow-up in patients treated with two different grafting materials used in maxillary sinus floor elevation procedures.

Material And Methods: Twenty consecutive patients were included. One group was grafted with autogenous bone from the mandible (chin area), and the other group was augmented with a 100% beta-tricalcium phosphate (beta-TCP). During a 4- to 5-year period, in each patient, at least five panoramic radiographs were made. These panoramic radiographs were used for morphometric measurements, at three different locations. The three locations were the first bone to implant contact at the distal side of the second most posterior implant (L1), halfway between this implant and the most posterior implant (L2) and the site 5 mm distal to the most posterior implant (L3). The measured vertical bone heights were evaluated to assess whether there was loss of height and, if so, whether the reduction in graft height occurred in an initial healing period or whether it was an ongoing process during the whole study period.

Results: There is a statistically significant reduction of vertical bone height in time at all locations (P<0.001). The mean decrease of the total vertical height during the whole study period at the three different locations did not differ significantly for and between both grafting groups. Repeated measures analysis of variance showed that at location L1, the reduction in millimeters per month decreased in time (P=0.001). There was no difference between the grafting groups (P=0.958). Similar results were found on L2 (P=0.005). For L3, there also appeared to be a statistically significant difference in reduction in time in millimeters per month (P=0.004). There was no statistically significant difference in height reduction between locations L1, L2 and L3 for vertical bone height and graft height, respectively.

Conclusions: Both beta-TCP and mandibular bone grafts resulted in radiographic reduction of the vertical height over the 5-year period following maxillary sinus floor elevation. After an initial height reduction in the first 1.5 year, subsequent changes were minimal. No significant differences were observed between the two types of grafting material. There was no statistically significant difference in reduction between the three locations for vertical bone height and graft height, respectively.
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http://dx.doi.org/10.1111/j.1600-0501.2008.01697.xDOI Listing
July 2009

Dental management of patients using antithrombotic drugs: critical appraisal of existing guidelines.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009 May;107(5):616-24

Clinic for Medical-Dental Interaction, Academic Center for Dentistry (ACTA), Amsterdam, The Netherlands.

Objectives: The aims were: 1) to identify the guidelines available for management of dental invasive procedures in patients on antithrombotic drugs; 2) to assess their quality with the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument; and 3) to summarize their conclusions and recommendations.

Study Design: Systematic literature search for guidelines in several electronic databases. Retrieved guidelines were evaluated with the AGREE instrument for quality assessment.

Results: The systematic search yielded 93 results, of which only 4 were evidence-based practice guidelines. Two of these guidelines could be recommended for clinical use on the basis of the AGREE instrument. These 2 guidelines drew 68 conclusions from the existing literature and provided 58 recommendations.

Conclusions: Two evidence-based clinical practice guidelines, satisfactorily fulfilling the criteria of the AGREE instrument and both published in 2007, advise to not routinely discontinue antiplatelet and anticoagulation medication before dental surgery. The majority of the recommendations, however, were not sufficiently linked to levels of evidence.
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http://dx.doi.org/10.1016/j.tripleo.2009.01.038DOI Listing
May 2009

Ethnic background as a factor in temporomandibular disorder complaints.

J Orofac Pain 2009 ;23(1):38-46

Department of Oral Function, Academic Center for Dentistry Amsterdam, Amsterdam, The Netherlands.

Aims: To examine the associations between the ethnic backgrounds of temporomandibular disorder (TMD) patients in the Netherlands and the level of TMD pain complaints and psychological/behavioral factors and whether these associations are influenced by socioeconomic factors.

Methods: A sample of 504 consecutive patients from a TMD clinic completed the Research Diagnostic Criteria for TMD (RDC/TMD) Axis II questionnaire (pain intensity, pain-related disability, somatization, depression, ethnic background, and socioeconomic status), an oral parafunctions questionnaire, and questions related to stress. Ethnic background was classified, following the method of Statistics Netherlands (CBS), using the country of birth from subject and both parents. This resulted in a classification into three subgroups: Native Dutch (ND; 69.6%), Non-Native Western (NNW; 14.8%), and Non-Native Non-Western (NNNW; 15.6%). Statistics used were chi-square, one- and two-way ANOVA, and Kruskall-Wallis tests; for post-hoc interpretation, standardized residual values, Bonferroni, and Mann-Whitney U tests were used.

Results: No differences in age or gender were found between the three ethnic groups, nor were there any differences in characteristic pain intensity or oral parafunctions. However, TMD patients from the NNNW subgroup had significantly higher scores on psychological factors, namely pain-related disability, disability days, somatization, depression, and stress. These patients had a lower incidence of employment, a lower level of education, and a lower income level than patients from the ND and NNW ethnic backgrounds. Analysis of variance showed no interaction effects between ethnic background and socioeconomic factors in relation to the psychological variables mentioned.

Conclusion: Ethnic background of TMD patients in the Netherlands is associated with psychological factors, regardless of socioeconomic status, but not with TMD pain complaints or oral parafunctions.
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June 2009

The influence of cephalometrics on orthodontic treatment planning.

Eur J Orthod 2008 Dec 3;30(6):630-5. Epub 2008 Nov 3.

Section of Orthodontics, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, The Netherlands.

Since its introduction, cephalometrics, i.e. cephalometric radiography and analysis, has been used for orthodontic treatment planning. However, the effectiveness of this diagnostic method remains questionable. A randomized crossover study was designed to assess the influence of cephalometrics in orthodontic treatment planning of individual patients. Diagnostic records of 48 subjects (24 males and 24 females aged 11-14 years) were divided in two stratified groups and assigned to one of two combinations: A, dental casts only, and B, dental casts, cephalometric radiographs, and analysis. The records were presented to 10 orthodontic postgraduates and four orthodontists for formulation of orthodontic treatment plans containing a dichotomous decision regarding the use of a functional appliance (FUNC), rapid maxillary expansion (RME), and extraction (EXTR). The combination of FUNC + RME + EXTR was used as the basis of the outcome measure. Agreement on orthodontic treatment planning using all possible comparisons of diagnostic records of individual patients (AB, AA, and BB) was assessed and overall proportions of agreement (OPA) were calculated for orthodontic postgraduates and orthodontists separately. Median OPA were 0.60 (AB), 0.65 (AA), and 0.60 (BB) for orthodontic postgraduates and 0.50 (AB), 0.75 (AA), and 0.50 (BB) for orthodontists. Irrespective of the level of experience, neither consistency of orthodontic treatment planning between both combinations of diagnostic records showed a statistically significant difference (P > 0.05) using Wilcoxon signed rank test nor did consistencies and agreement of orthodontic treatment planning after the addition of cephalometrics. It appears that cephalometrics are not required for orthodontic treatment planning, as they did not influence treatment decisions.
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http://dx.doi.org/10.1093/ejo/cjn059DOI Listing
December 2008

Craniofacial morphology of Dutch patients with bilateral cleft lip and palate and noncleft controls at the age of 15 years.

Cleft Palate Craniofac J 2008 Nov 11;45(6):661-6. Epub 2008 Apr 11.

Department of Orthodontics, Academic Centre of Dentistry, Amsterdam, The Netherlands.

Objective: Comparison of craniofacial morphology in bilateral cleft lip and palate patients to that of a noncleft control group at the age of 15 years.

Design: A cross-sectional study of cephalometric data.

Subjects And Methods: Cephalometric records of 41 consecutive patients (32 boys and 9 girls) with nonsyndromic complete bilateral cleft lip and palate born between 1973 and 1987. The patients were treated by the cleft teams of the Erasmus Medical Centre in Rotterdam and the VU University Amsterdam. The control group of normal Dutch subjects was followed in the Nijmegen Growth Study. From this population, mean cephalometric data were used. Differences in cephalometric measurements and other variables were calculated between the bilateral cleft lip and palate group and the control group.

Results: Independent-sample t tests indicated that there was a statistically significant difference between the mean of the cephalometric values of the bilateral cleft lip and palate patients and the control group with respect to all cephalometric variables. Pearson correlation coefficients calculated between angle ANB and the number of operators, number of surgical procedures before 15 years of age, and the year of birth were not significant.

Conclusions: Bilateral cleft lip and palate patients treated in the Amsterdam and Rotterdam cleft centers differed significantly from the control group in all measurements. A Class III development due to a less forward positioned maxilla was observed. The vertical measurements indicated a more divergent growth pattern in bilateral cleft lip and palate patients (Ans-Me/N-Me, GoGn-SN, and SN-FFH).
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http://dx.doi.org/10.1597/07-166.1DOI Listing
November 2008

Anxiety and post-traumatic stress symptoms following wisdom tooth removal.

Behav Res Ther 2008 Dec 25;46(12):1305-10. Epub 2008 Sep 25.

Academic Centre for Dentistry Amsterdam, Department of Social Dentistry and Behavioural Sciences, University of Amsterdam, Louwesweg 1, 1066 EA Amsterdam, The Netherlands.

The purpose of the present study was to determine the psychological impact of wisdom teeth removal and to identify the psychological risk factors for the development of dental anxiety and post-traumatic stress symptoms. Participants were 34 consecutive elective patients referred for surgical removal of a wisdom tooth under local anesthesia. Frequency of previous distressing dental events and general traumatic life events were assessed at baseline (t1), and emotional distress (pain, state anxiety and disturbance) immediately after treatment (t2). Post-traumatic stress responses were determined three days after treatment (t3), and at four weeks follow-up (t4), while severity of dental trait anxiety was assessed at t1 and at t4. Two patients (8%) met screening criteria for Post-Traumatic Stress Disorder (PTSD) at t4. Multivariate analysis revealed that previous exposure to distressing dental events and pre-operative anxiety level predicted anxiety level at t4, accounting for 71% of the variance. Severity of pain during treatment was a significant predictor variable of PTSD symptom severity at t4 (25% explained variance). The findings underline the importance of pain-free treatments and awareness of patients' individual predisposition to anxiety or trauma-related symptoms to reduce the risk of iatrogenic psychological harm.
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http://dx.doi.org/10.1016/j.brat.2008.09.004DOI Listing
December 2008

Dental anxiety and quality of life: the effect of dental treatment.

Community Dent Oral Epidemiol 2008 Oct;36(5):409-16

Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.

Objective: The aim of the present study was to determine the association between dental anxiety and quality of life (QoL) and to test the hypothesis that treatment of highly anxious patients would significantly enhance QoL.

Material And Methods: Subjects were 35 highly anxious dental patients of a Dutch dental fear clinic who were assessed on dental trait anxiety (DAS and S-DAI) and QoL (oral health-related QoL with the use of OHIP-14, dental anxiety-related QoL with the SADAS, and general aspects of QoL using Global Assessment of Functioning, while five different aspects of life satisfaction were quantified on a VAS-scale) both prior to and after treatment (an average of six sessions of 45-60 minutes each). Also, both objective (DMFT and dentists' judgement) and subjective (patients' judgement) indices of oral health status were recorded.

Results: Higher dental anxiety was significantly associated with lower OH-QoL as indexed by the OHIP-14 (r = 0.51-0.56, P < 0.01). Treatment was associated with marked improvement on oral health status, reduction of dental anxiety, and improvements regarding a variety of aspects of QoL (all Ps < 0.001). Reduction of dental anxiety, rather than improved oral health, was found to predict enhanced OH-QoL.

Conclusion: The results underline the importance of applying effective treatment methods for dentally anxious patients, not only with the purpose to alleviate their dental anxiety and to improve their oral health, but also because it contributes to an enhancement of their QoL.
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http://dx.doi.org/10.1111/j.1600-0528.2007.00416.xDOI Listing
October 2008

The Level of Exposure-Dental Experiences Questionnaire (LOE-DEQ): a measure of severity of exposure to distressing dental events.

Eur J Oral Sci 2008 Aug;116(4):353-61

Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Louwesweg, EA Amsterdam, the Netherlands.

To understand the development of dental anxiety better and to identify those at increased risk of developing dental anxiety, the Level of Exposure-Dental Experiences Questionnaire (LOE-DEQ) was developed. The aim of the current study was to determine the psychometric properties (i.e. factor structure, reliability, and validity) of the LOE-DEQ and to determine its suitability as an additional screening instrument for dentally anxious patients. Five different samples were used: (i) highly dentally anxious patients (n = 119); (ii) general dental patients (n = 480); (iii) students (n = 186); (iv) psychiatric outpatients (n = 17); and (v) oral surgery patients (n = 34). Results of the factor analysis revealed a four-factor solution. The LOE-DEQ has sufficient internal consistency (Cronbach's alpha values ranging from 0.69 to 0.85) and satisfactory test-retest reliability (intraclass correlation coefficient = 0.78). The results further suggest that this instrument has adequate discriminant, concurrent, and predictive validity. It is concluded that the LOE-DEQ is a useful tool for assessing patients' background in terms of previous exposure to distressing dental events, which is considered a vulnerability factor in the development of dental anxiety.
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http://dx.doi.org/10.1111/j.1600-0722.2008.00542.xDOI Listing
August 2008

What are people afraid of during dental treatment? Anxiety-provoking capacity of 67 stimuli characteristic of the dental setting.

Eur J Oral Sci 2008 Feb;116(1):44-51

Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

Relatively little is known about the anxiety-provoking capacity of the various objects and situations characteristic of the dental setting. The aims of the current study were to establish a hierarchy of anxiety-provoking capacities of a large set of dental stimuli and to determine the differences in relation to gender, age, ethnicity, and level of dental trait anxiety. An additional aim was to derive an estimate of the number of stimuli to be presented to anxious patients in order to obtain full coverage of their dental fears. A questionnaire describing 67 potentially anxiety-provoking stimuli was constructed and presented to 960 adults. The results indicated that invasive stimuli (e.g. surgical procedures) were rated as the most anxiety provoking and that non-invasive stimuli (e.g. the dentist as a person) were the least anxiety provoking. The fear-evoking capacity of the dental stimuli varied with gender, age, ethnicity, and level of dental trait anxiety, whereas the rank order of these stimuli appeared to be independent of these factors. Furthermore, it appeared that the top 25 most anxiety-provoking objects and situations found in the current study contained only eight (28%) stimuli, which had been taken into account in previous research. The present findings support the need for assessment procedures using a broad spectrum of potentially anxiety-provoking stimuli.
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http://dx.doi.org/10.1111/j.1600-0722.2007.00500.xDOI Listing
February 2008

Dental enamel defects in children with coeliac disease.

Int J Paediatr Dent 2007 May;17(3):163-8

Academic Centre for Dentsitry, Amsterdam, The Netherlands.

Objective: The aim of this study was to investigate whether Dutch children with proven coeliac disease show specific dental enamel defects, and to asses whether children with the same gastrointestinal complaints, but proved no-coeliac disease, lack these specific dental enamel defects.

Materials And Methods: Eighty-one children (53 coeliac patients and 28 control subjects) were examined during the period 2003-2004 in the Oral Surgery Outpatient Clinic of the Academic Medical Centre in Amsterdam.

Result: Twenty-nine (55%) coeliac patients had enamel defects against 5 (18%) control subjects. In the coeliac disease group, the enamel defects were diagnosed as specific in 20 (38%) children, compared with 1 (4%) in the control group. Statistical analysis showed significantly more specific enamel defects in children with coeliac disease than in children in the control group (chi(2) = 12.62, d.f. = 2, P = 0.002).

Conclusion: This study showed significantly more specific enamel defects in Dutch children with coeliac disease as compared with children in the control group. Dentists could play an important role in recognizing patients with coeliac disease.
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http://dx.doi.org/10.1111/j.1365-263X.2006.00816.xDOI Listing
May 2007

Influence of the application of platelet-enriched plasma in oral mucosal wound healing.

Clin Oral Implants Res 2007 Feb;18(1):133-9

Department of Physiology, Academic Medical Center, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands.

Purpose: The aim of this study was to describe and quantify the therapeutic value of platelet concentrate on the capillary density in oral mucosal wound healing.

Material And Methods: The subjects included 10 healthy edentulous patients who underwent bilaterally a sinus floor elevation procedure and a buccal onlay graft with autologous iliac crest bone for maxillary reconstruction. During surgery, platelet-rich plasma (PRP) was prepared from a blood sample taken from the patient. After randomization in a split-mouth design, at one side PRP was administered in the wound and at the contralateral side a placebo. At baseline, microvascular capillary density was scored with the orthogonal polarization spectral (OPS) imaging technique and repeated measurements were performed postoperatively on a daily basis until the tenth day, after which measurements were continued weekly until the fifth postoperative week.

Results: Ten patients, five males and five females, were included in the study with a mean age of 54.2+/-9.1 years for females and 57.6+/-6.9 years for males. Donor platelet counts from whole blood had a mean value of 248.5+/-13.5 x 10(9)/l, while the value of platelet counts in the PRP had a mean of 975.9+/-97.9 x 10(9)/l. Wound healing was significantly accelerated in the PRP-treated mucosal wounds during the first 10 postoperative days. After the second week, no obvious differences between the PRP or placebo side could be noted.

Conclusion: PRP has a strong stimulant effect on capillary regeneration in wound healing. These effects are mainly noticeable during the early stages of wound healing.
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http://dx.doi.org/10.1111/j.1600-0501.2006.01288.xDOI Listing
February 2007

Influence of buccal segment size on prevention of side effects from incisor intrusion.

Am J Orthod Dentofacial Orthop 2006 May;129(5):658-65

Introduction: Deep overbite can be corrected by maxillary incisor intrusion. The purpose of this study was to determine whether the size of the maxillary buccal segment influences the amount of steepening, extrusion, or narrowing of the buccal segments, or the rate of intrusion that occurs with maxillary incisor intrusion.

Methods: Twenty patients, 9 to 14 years of age, seeking treatment at a private practice, were divided into 2 groups. Patients in the long buccal-segment group had maxillary buccal segments that included the canines, both premolars, and the first molars. In the short buccal-segment group, the buccal segments consisted of only the maxillary first molars. Patient records were taken at the beginning and end of maxillary incisor intrusion.

Results: Intermolar width increased slightly in the short buccal-segment group and decreased slightly in the long buccal-segment group. More steepening of the buccal segment occurred in the short buccal-segment group, and more proclination of the anterior segment in the long buccal-segment group. The size of the buccal segment had no influence on the rate of incisor intrusion or on the amount of buccal-segment extrusion. In both groups, the mean amount of incisor intrusion exceeded 2 mm.

Conclusions: A buccal segment that extends from canine to first molar will help minimize the side effects of incisor intrusion.
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http://dx.doi.org/10.1016/j.ajodo.2004.06.039DOI Listing
May 2006

Self-reported oral parafunctions and pain intensity in temporomandibular disorder patients.

J Orofac Pain 2006 ;20(1):31-5

Department of Oral Function, Academic Centre for Dentistry, Amsterdam (ACTA), Louwesweg 1, 1066 EA Amsterdam, The Netherlands.

Aim: To examine the relationship between different types of self-reported oral parafunctions and pain intensity in patients with temporomandibular disorders (TMD).

Methods: Two cohorts of TMD pain patients, 1 comprising 303 patients and the other comprising 226 patients, completed a 12-item oral parafunctions questionnaire as well as the Research Diagnostic Criteria Axis II questionnaire, which includes a characteristic pain intensity score (CPI). Relationships between oral parafunctions and CPI were examined; age and gender were controlled for. The effects of phrasing of the oral parafunction questions were also examined. For 1 cohort, the questions were directed at the mere occurrence of the parafunctions; in the other, the questions addressed the perceived stressfulness of parafunctional behavior to the jaw.

Results: A principal component analysis of the responses to the questionnaires led to 3 factors (scales) in both cohorts: (1) a BRUX scale for bruxism activities; (2) a BITE scale for biting activities (eg, chewing gum, nails); and (3) a SOFT scale for soft tissue activities (eg, tongue, lips). Statistical significance was reached for 2 of the 6 relationships studied (P < .05), but with a very low explained variance (approximately 3.5%).

Conclusion: No clinically relevant relationships were found between different types of self-reported oral parafunctions and TMD pain complaints.
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March 2006

Relations in color among maxillary incisors and canines.

Dent Mater 2005 Mar;21(3):187-91

Department of Dental Materials Science, Academic Centre for Dentistry Amoterdam (ACTA), Universiteit Van Amsterdam and Vrije Universiteit, Louwesweg 1, 1066 EA, Amsterdam, The Netherlands.

Objectives: To establish the strength of color relation among the maxillary central incisor, lateral incisor and canine teeth by using digital photography. This relation might be useful for the color reconstruction of the missing part of a tooth from the color obtained from neighboring teeth.

Methods: The L*a*b* values of the maxillary incisors and canines were determined in 100 subjects. Paired t-tests, Pearson correlations and linear regression analyses were used to describe the relation of the L*a*b* values between the three teeth for each segment (cervical, middle and incisal).

Results: The mean L*a*b* values of the canines differed statistically significantly from the values of the central incisors (p<0.001) except for L* and a* values in the cervical segment between the lateral incisor and canine. The color differences between the incisors were statistically significant in fewer cases. The relation in color was the highest between the cervical segments of the three teeth, with respect to L* (r = 0.45-0.65; p < 0.001), b* (r = 0.49-0.55; p < 0.001), and a* (r = 0.38-0.61; p < 0.001), and no relation was found between the incisal segments of central incisor and canine.

Significance: There is a relation in color between the maxillary incisors and canines, which is stronger between the cervical than between the middle and incisal segments. Therefore, the color prediction is most reliable when the cervical parts of the teeth are used.
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http://dx.doi.org/10.1016/j.dental.2004.03.005DOI Listing
March 2005

Relation in color of three regions of vital human incisors.

Dent Mater 2004 Nov;20(9):832-8

Department of Dental Material Sciences, ACTA, Louwesweg 1, 1066 EA Amsterdam, The Netherlands.

Objectives: For an adequate color reproduction, it is very valuable to quantify the color distribution in human teeth accurately. The aim of this study was to determine the color relation between three tooth segments (cervical, middle and incisal) in vital upper central incisors, using digital photography.

Methods: Digital recordings of 64 upper right central incisors were made using a standardized head-camera setup. The L*a*b* values of three regions were attained from the standardized digital images using software.

Results: There were statistically significant linear correlations for L* and b* between the three tooth segments (all r's > or = 0.60; p < 0.001). The correlation coefficient for a* was lower compared to L* and b* values. The L* and b* values of cervical and incisal tooth segment could be calculated from L* and b* values of middle tooth segment.

Significance: These results show the potency for color mapping of a whole tooth surface by extrapolation of color values of only one part of the surface.
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http://dx.doi.org/10.1016/j.dental.2003.10.013DOI Listing
November 2004

Microbiological and clinical effects of chlorhexidine enclosed in fixtures of 3I-Titamed implants.

Clin Oral Implants Res 2004 Apr;15(2):174-9

Clinic of Oral Implantology, Academic Center for Dentistry Amsterdam, The Netherlands.

This double-blind study used a split-mouth design to investigate the microbiological and clinical effects of 0.2% chlorhexidine enclosed in fixtures. Twelve patients had 46 fixtures implanted. At second-stage surgery, a microbiological sample (baseline sample) of the inner parts of the fixtures was taken. Then, a 0.2% chlorhexidine solution was applied into the inner space of 23 fixtures (test group), and in 23 fixtures saline was applied (control group). Abutments were installed and gingival index, plaque index and crevicular fluid flow were monitored weekly. After 6 weeks, a second microbiological sample of the inner part of the fixtures was taken. At baseline, viable bacteria were detected within 46% of the fixtures. After weeks, bacteria were found in 87% of the fixtures. The numbers of bacteria in the control group were significantly higher than those in the test group. The results indicate that, after first-stage surgery, contamination of the inner spaces of the fixtures is commonplace. Application of a 0.2% chlorhexidine solution at second-stage surgery inhibits growth or acquisition of bacteria in the fixtures. In both test and control groups, the crevicular fluid flow as well as the gingival index decreased during the experimental period. At 4, 5, and 6 weeks after chlorhexidine application, these values in the test group appeared lower, but did not attain statistical significance.
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http://dx.doi.org/10.1111/j.1600-0501.2004.00977.xDOI Listing
April 2004
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