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- Although medical CT imaging has been the imaging method of choice for examining hard-tissue abnormalities of the craniofacial skeleton and jaws, cone beam CT (CBCT) imaging may now be the preferred method because of reduced radiation dose.
- CBCT should not be routinely used for the diagnosis of dental caries, periodontal disease, periapical inflammatory disease, the assessment of the craniofacial skeleton, or when an assessment of soft tissues is required. For orthodontics in particular, large volume CBCT should not be used routinely for diagnosis or monitoring of treatment.
- CBCT should be used when conventional projection radiography does not provide adequate information for treatment planning. Such clinical situations may include the evaluation of persistent disease, the localization of unerupted or impacted teeth, the evaluation of palatal clefts, dentoalveolar trauma and in selected implant cases.
- To keep radiation doses to patients as low as reasonably achievable, the smallest volumes should be used for a particular imaging task.
- CBCT machines should be optimized by the operator for dose reduction before use. Consideration should be given to technical factors, voxel size and the number of acquired projections.
Reasons for recommending this article:
The guidelines are evidence-based. In fact, this is the first and currently only evidence-supported document guiding the use of CBCT in dentistry. I also like that the guidelines do not represent the opinion and experience of just one clinician with this technology.
Enamel matrix derivative for periodontal tissue regeneration
Dr. Debora Matthews is head of the division of periodontics at Dalhousie’s faculty of dentistry. Dr. Matthews, a JCDA editorial consultant, recommends:
Esposito M, Grusovin MG, Papanikolaou N, Coulthard P, Worthington HV. Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD003875. DOI: 10.1002/14651858.CD003875.pub3.
View Abstract
Key points:
- Enamel matrix derivative (EMD) contains proteins (derived from developing pig teeth) believed to regenerate periodontal tissues lost due to disease. This systematic review and meta-analysis found that after 1 year, application of EMD in addition to surgical debridement significantly improved periodontal attachment levels (1.1 mm) and reduced probing depths (0.9 mm) when compared to a placebo or a control.
- However, there was no evidence that more compromised teeth could be saved using EMD, that the amount of tissue regeneration was clinically significant, or that patients preferred the EMD treatment for esthetic reasons.
- Further, the authors report that the use of barrier membranes (guided tissue regeneration, GTR) produced a statistically significant increase in recession compared to EMD and that the GTR group had significantly more postoperative complications.
Reasons for recommending this article:
The ideal treatment for tissue lost due to periodontal disease would be one that restored tissue to its original form and function. Many surgical techniques have shown the potential to regenerate periodontal tissues, including GTR, bone grafting and the use of EMD. Other Cochrane reviews have shown that GTR and bone grafting are only slightly more effective than open flap debridement. While progress has been made in the field of regenerative therapy, the magic bullet has yet to be found.
Dental materials
Dr. N. Dorin Ruse is chair of the division of biomaterials at the faculty of dentistry, University of British Columbia. Dr. Ruse, a JCDA editorial consultant, recommends 2 review articles:
Article 1: Hickel R. Trends in materials science from the point of view of a practicing dentist. J Eur Ceram Soc. 2009;29(7):1283-9.
View Abstract
Full-text access to this article has expired.
Reasons for recommending this article:
- Dr. Hickel is a well-known dentist and researcher with a proven publishing record (>100 papers, ~1600 citations). I found his review article, which focuses mainly on dental resin composites and dental ceramics, well-written, well-referenced, and containing a wealth of information useful for a practising dentist.
- The discussion and illustrations pertaining to the longevity and cause of failure of amalgams, composites and ceramic inlays can be very helpful in treatment planning. The review briefly addresses biocompatibility issues, dental cements, dental adhesive systems, endodontic materials and CAD/CAM ceramics. The importance of the “art of dentistry,” i.e., the role played by the dentist in the success or failure of the materials, is also highlighted.
- Finally, I liked the fact that the author emphasizes the importance of educating not only students but also dentists and educators.
Article 2: Breschi L, Mazzoni A, Dorigo ED, Ferrari M. Adhesion to intraradicular dentin: a review. J Adh Sci Tech. 2009;23(7-8):1053-83.
View Abstract
Reasons for recommending this article:
I found this review paper excellent, with ample and pertinent discussion of all the aspects involved in the clinically challenging procedure of bonding fibre posts to intraradicular dentin. The review is systematically organized, well-referenced and well-illustrated—a great resource for anyone interested in this aspect of dentistry.
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