- Email: [email protected]
Crowns aplenty
This requires that clinicians read extensively and take advantage of the internet and electronic databases to search for relevant published scientific articles. Being able to find appropriate publications and distill the important points from them, along with assessing their quality and relevance, is a valuable skill for dental practitioners. Developing this skill will provide benefits for the dentist, the patient, and the dental profession in the pursuit of providing quality dentistry.
Figure 2.—Evidence Hierarchy Clinical Practice Guidelines. Adapted from: J. Mansoor, A. Jowett & P. Coulthard. NICE or not so NICE. BDJ. 2013; 215: 209-212.
cohort studies, then randomized-controlled trials, and ultimately systematic reviews and meta-analyses.3 When seeking a particular clinical practice guideline, you should go to the National Guidelines Clearinghouse (NGC) at www.guideline.gov. These NGC guidelines are full text and many are also indexed in PubMed.
Summary Continuing education is essential for anyone working within the dental field. Technological advances develop quickly, making it crucial to stay abreast of the latest research, tools, and treatment methods. For practitioners to remain current and provide evidence-based dental care, they must assimilate scientific evidence into their practice.
Douglas Berkey, DMD, MPH, MS Editor-in-Chief, Dental Abstracts Professor Emeritus, University of Colorado, School of Dental Medicine, Aurora, CO, USA E-mail: [email protected]
References 1. Hightower Christy, Caldwell Christy: Shifting Sands: Science Researchers on Google Scholar, Web of Science, and PubMed, with Implications for Library Collections Budgets, Issues in Science and Technology Librarianship, Fall 2010. http://www. istl.org/10-fall/refereed3.html. 2. American Academy of Orthopaedic Surgeons: American Dental Association. American Academy of Orthopaedic Surgeons clinical practice guideline on prevention of orthopaedic implant infection in patients undergoing dental procedures. Rosemont (IL): American Academy of Orthopaedic Surgeons, American Dental Association, 2012. http://www.ada.org/sections/profes sionalResources/pdfs/PUDP_guideline.pdf. 3. Mansoor J, Jowett A, Coulthard P: NICE or not so NICE. Br Dent J 215:209-212, 2013.
Crowns aplenty Background.—The adult population of the United States is approximately 237 million people currently, and during 2012 about one indirect tooth unit was placed for every 2.3 adults, based on annual dental visit numbers. The number of crowns per patient is actually higher, since many adults do not visit the dentist annually. This quantity of crowns is probably higher than needed or expected. The indications for crowns and reasons for having crowns placed were reviewed to determine if more conservative options are being overlooked or ignored. Indications.—Crowns, which include all indirect onlay restorations covering all tooth cusps as well as conventional full-coverage preparations, are indicated in many instances. Teeth that have previously placed defective restorations or
active carious lesions can benefit from crowns. Posterior teeth that must have half or more of their facial-lingual cusp-tip-to cusp-tip occlusal distance removed are best managed with crowns or onlays. Anterior teeth benefit from crowns when they are missing at least half of the coronal tooth structure. Teeth with signs and symptoms of cracked-tooth syndrome, those with asymptomatic horizontal cracks, those that have been treated endodontically or heavily restored, those missing one or more cusps, hemisected teeth, and mobile teeth can all be managed well using crowns. In addition, patients may desire a more esthetic look to their restorations and choose to have crowns placed. Alternatives.—Often crowns are chosen for the management of the indicated problems without considering
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less destructive options. For example, esthetic concerns can often be managed using bleaching, orthodontic treatment, the placement of ceramic or resin veneers, the esthetic recontouring of tooth structure, gingival plastic surgery, or the placement of simple resin-based composite restorations. These options tend to be more conservative and allow patients to retain more of their own natural teeth. Perceived Advantages to Crowns.—Crowns are considered easier to prepare and seat than other preparations, making the dentist’s work less demanding. In addition, crown revenue is among the highest dentists receive. Well-made crowns also last many years, seldom break, and are unlikely to come off during use. Discussion.—Both patients and dentists appear to prefer minimally invasive procedures, yet crowns are usually not among these approaches. More consideration should be given to less aggressive procedures that can appropriately manage the patient’s problem.
Clinical Significance.—Dentistry has not yet identified a restorative material that offers all the advantages afforded by natural human enamel and dentin. Therefore the replacement of large quantities of tooth structure with a material that will not perform as well should not be the first choice. Retaining tooth structure and choosing minimally invasive approaches should be the dentist’s and patient’s first concerns.
Christensen GJ: Too many crowns? J Am Dent Assoc 144:1174-1176, 2013 Reprints available from GJ Christensen, CR Foundation, 3707 N Canyon Rd, Suite 3D, Provo, UT 84604
Edentulism care Background.—Dental practitioners tend to view any form of tooth loss as a disease that requires an intervention. Edentulism is regarded as a serious personal problem, plaguing humans for hundreds of years. With the impressive progress in materials and clinical techniques as well as better understanding of mastication, complete dentures have permitted restored function and esthetics. However, the newcomer on the scene is implant therapy, which some see as the death knell of traditional prosthodontic therapy. Complete Dentures Versus Implants.—Although the ability to successfully manage complete edentulism is fairly predictable, it is a fact that time destroys rather than heals vulnerable supporting tissues for complete dentures. In addition, patients respond to wearing dentures in many ways. Implants that osseointegrate successfully allow edentulism to be managed highly predictably with little impact related to patient responses. Edentulous patients have dramatically improved treatment choices, although practitioners can become so enamored of using one or more implants in the anterior zone of an edentulous mandible that they think ‘‘implant’’ in every case. It is insensitive to suggest that complete dentures no longer provide sufficient management for edentulism in many cases. Implications for Prosthodontics.—People are living longer and desire the ability to do so without the problems associated with edentulism. With increased age, they will suffer multiple morbidity and treatment uncertainties
120
Dental Abstracts
regardless of whether they are fitted with complete dentures or have implant-supported alternatives. Prosthodontists will remain the mediators of patient care in edentulous situations. Applied osseointegration should not become the automatic answer, or become an unneeded burden for an aging edentulous population.
Clinical Significance.—Practitioners, whether prosthodontists or other dental professionals, must consider the needs of each specific patient and not assume a ‘‘one size fits all’’ mentality. Some patients are successfully treated with complete dentures and don’t need or benefit more from implant therapy. For others, implants are the perfect way to go. We can’t let the desire to perform the newest treatment option dictate what we recommend for our patients or overlook the natural process of decline that occurs in an aging population.
Zarb GA: A panacea for the edentulous predicament? Int J Prosthodont 26:405-406, 2013 Reprints not available
Figure 2.—Evidence Hierarchy Clinical Practice Guidelines. Adapted from: J. Mansoor, A. Jowett & P. Coulthard. NICE or not so NICE. BDJ. 2013; 215: 209-212.
cohort studies, then randomized-controlled trials, and ultimately systematic reviews and meta-analyses.3 When seeking a particular clinical practice guideline, you should go to the National Guidelines Clearinghouse (NGC) at www.guideline.gov. These NGC guidelines are full text and many are also indexed in PubMed.
Summary Continuing education is essential for anyone working within the dental field. Technological advances develop quickly, making it crucial to stay abreast of the latest research, tools, and treatment methods. For practitioners to remain current and provide evidence-based dental care, they must assimilate scientific evidence into their practice.
Douglas Berkey, DMD, MPH, MS Editor-in-Chief, Dental Abstracts Professor Emeritus, University of Colorado, School of Dental Medicine, Aurora, CO, USA E-mail: [email protected]
References 1. Hightower Christy, Caldwell Christy: Shifting Sands: Science Researchers on Google Scholar, Web of Science, and PubMed, with Implications for Library Collections Budgets, Issues in Science and Technology Librarianship, Fall 2010. http://www. istl.org/10-fall/refereed3.html. 2. American Academy of Orthopaedic Surgeons: American Dental Association. American Academy of Orthopaedic Surgeons clinical practice guideline on prevention of orthopaedic implant infection in patients undergoing dental procedures. Rosemont (IL): American Academy of Orthopaedic Surgeons, American Dental Association, 2012. http://www.ada.org/sections/profes sionalResources/pdfs/PUDP_guideline.pdf. 3. Mansoor J, Jowett A, Coulthard P: NICE or not so NICE. Br Dent J 215:209-212, 2013.
Crowns aplenty Background.—The adult population of the United States is approximately 237 million people currently, and during 2012 about one indirect tooth unit was placed for every 2.3 adults, based on annual dental visit numbers. The number of crowns per patient is actually higher, since many adults do not visit the dentist annually. This quantity of crowns is probably higher than needed or expected. The indications for crowns and reasons for having crowns placed were reviewed to determine if more conservative options are being overlooked or ignored. Indications.—Crowns, which include all indirect onlay restorations covering all tooth cusps as well as conventional full-coverage preparations, are indicated in many instances. Teeth that have previously placed defective restorations or
active carious lesions can benefit from crowns. Posterior teeth that must have half or more of their facial-lingual cusp-tip-to cusp-tip occlusal distance removed are best managed with crowns or onlays. Anterior teeth benefit from crowns when they are missing at least half of the coronal tooth structure. Teeth with signs and symptoms of cracked-tooth syndrome, those with asymptomatic horizontal cracks, those that have been treated endodontically or heavily restored, those missing one or more cusps, hemisected teeth, and mobile teeth can all be managed well using crowns. In addition, patients may desire a more esthetic look to their restorations and choose to have crowns placed. Alternatives.—Often crowns are chosen for the management of the indicated problems without considering
Volume 59
Issue 3
2014
119
less destructive options. For example, esthetic concerns can often be managed using bleaching, orthodontic treatment, the placement of ceramic or resin veneers, the esthetic recontouring of tooth structure, gingival plastic surgery, or the placement of simple resin-based composite restorations. These options tend to be more conservative and allow patients to retain more of their own natural teeth. Perceived Advantages to Crowns.—Crowns are considered easier to prepare and seat than other preparations, making the dentist’s work less demanding. In addition, crown revenue is among the highest dentists receive. Well-made crowns also last many years, seldom break, and are unlikely to come off during use. Discussion.—Both patients and dentists appear to prefer minimally invasive procedures, yet crowns are usually not among these approaches. More consideration should be given to less aggressive procedures that can appropriately manage the patient’s problem.
Clinical Significance.—Dentistry has not yet identified a restorative material that offers all the advantages afforded by natural human enamel and dentin. Therefore the replacement of large quantities of tooth structure with a material that will not perform as well should not be the first choice. Retaining tooth structure and choosing minimally invasive approaches should be the dentist’s and patient’s first concerns.
Christensen GJ: Too many crowns? J Am Dent Assoc 144:1174-1176, 2013 Reprints available from GJ Christensen, CR Foundation, 3707 N Canyon Rd, Suite 3D, Provo, UT 84604
Edentulism care Background.—Dental practitioners tend to view any form of tooth loss as a disease that requires an intervention. Edentulism is regarded as a serious personal problem, plaguing humans for hundreds of years. With the impressive progress in materials and clinical techniques as well as better understanding of mastication, complete dentures have permitted restored function and esthetics. However, the newcomer on the scene is implant therapy, which some see as the death knell of traditional prosthodontic therapy. Complete Dentures Versus Implants.—Although the ability to successfully manage complete edentulism is fairly predictable, it is a fact that time destroys rather than heals vulnerable supporting tissues for complete dentures. In addition, patients respond to wearing dentures in many ways. Implants that osseointegrate successfully allow edentulism to be managed highly predictably with little impact related to patient responses. Edentulous patients have dramatically improved treatment choices, although practitioners can become so enamored of using one or more implants in the anterior zone of an edentulous mandible that they think ‘‘implant’’ in every case. It is insensitive to suggest that complete dentures no longer provide sufficient management for edentulism in many cases. Implications for Prosthodontics.—People are living longer and desire the ability to do so without the problems associated with edentulism. With increased age, they will suffer multiple morbidity and treatment uncertainties
120
Dental Abstracts
regardless of whether they are fitted with complete dentures or have implant-supported alternatives. Prosthodontists will remain the mediators of patient care in edentulous situations. Applied osseointegration should not become the automatic answer, or become an unneeded burden for an aging edentulous population.
Clinical Significance.—Practitioners, whether prosthodontists or other dental professionals, must consider the needs of each specific patient and not assume a ‘‘one size fits all’’ mentality. Some patients are successfully treated with complete dentures and don’t need or benefit more from implant therapy. For others, implants are the perfect way to go. We can’t let the desire to perform the newest treatment option dictate what we recommend for our patients or overlook the natural process of decline that occurs in an aging population.
Zarb GA: A panacea for the edentulous predicament? Int J Prosthodont 26:405-406, 2013 Reprints not available