• Case Selection Criteria for use with Resin-Infiltrative Treatment of Enamel Decalcification

      Raley, N; Clayton, Ashley; Fortson, WM; Deleon, E; Rueggeberg, FA; Department of Orthodontics, Department of Restorative Sciences (Augusta University, 2019)
      Although one of the primary aims for many orthodontic patients is to achieve improvement in their dental esthetic condition, a high percentage of these patients develop unesthetic, white spot lesions (WSL) during the course of treatment. These lesions develop due to enamel decalcification resulting from bacterial plaque accumulation around difficult to clean brackets and overlying wires and ligation devices. Acids produced locally in this retained plaque will decalcify enamel along the peripheral border of the bonded bracket. Quite often, despite repeated admonishment by the clinician to the patient to take extra care in cleansing these susceptible locations, patients return with large plaque deposits around the brackets, and evidence of the early stages of enamel decalcification: the so-called “white spot lesion” (WSL). The problem becomes obvious at the time of bracket removal, when, although the teeth may now be arranged in near-to-perfect alignment and occlusion, large, white areas of enamel decalcification are prominently displayed, denoting the exact location of where the bonded bracket used to be.
    • Does Time to the Operating Room Affect Outcomes in Odontogenic Infection Patients?

      Brown, Kiara; James, Jeffery; Department of Oral and Maxillofacial Surgery (Augusta University, 2019)
      Diagnosis and treatments of odontogenic infections is arguably one of the most important responsibilities of the Oral and Maxillofacial Surgeon. With a command of the complex anatomy of the head and neck region and armed with knowledge of the dentition that feeds into the physiopathology of the infection, oral and maxillofacial surgeons find themselves one of the only head and neck specialists able to treat this disease. Several decades ago, odontogenic infections were a significant source of morbidity at rates greater than 50% in some reports. The current trend in an increase in unsponsored patients seeking treatment. This trend has cost hospital centers upwards of millions of dollars per year. While some factors, such as patient medical complexity and increasing antibiotic resistance are known factors in increasing costs, a surgeon and facility dependent factor- time to the operating room- has not been studied. Understanding the effect of delayed surgical intervention is critical to fully understanding ways to mitigate costs associated with odontogenic infection patients.
    • In Vivo Pilot Study: Effect of Dehydration/Rehydration on Upper Anterior Tooth Color Change

      Britton, Eduardo; Nappi, A; Cao, T; Shepherd, K; Department of General Dentistry, Dental Hygiene, Department of Restorative Sciences (Augusta University Libraries, 2019)
      Isolation of tooth structure during fabrication of a bonded, direct, resin-based restoration is essential to optimizing its potential for long-term clinical success. Failure to protect etched enamel and bonding agents from contamination by saliva results in inadequate and unpredictable interfacial bonding of the restorative composite, potentially leading to marginal discoloration, open margins, recurrent decay, or ultimately to restoration loss or failure. A consequence of tooth isolation during placement of direct, esthetic restorative resins is the dehydration of enamel surfaces that will not be coated with saliva, and will, over time, lose water that has penetrated into the outer enamel layers (will dehydrate). The longer the tooth isolation time, the greater will be the subsequent loss of water from enamel. Presence of this water in enamel helps to provide for a stable tooth color. In teeth, the observed tooth color is the result of internal light penetration and interaction with tissues below the surface. Enamel is a translucent material, passing a great majority of transmitted light to fall on the more opaque and yellow-colored tissue underneath of it: dentin. In the hydrated state, enamel is more translucent than in its dehydrated state. The white opaque appearance of dehydrated enamel can be of great clinical concern, once a rubber dam has been removed, and the treated teeth with newly placed restorations are observed. Usually, because of the opaque, white nature of recently dehydrated enamel, there is an initial mismatch between an esthetic restoration just placed and its surrounding, remaining enamel. Patients are normally forwarded of this consequence, and are advised that a period of time needs to pass before the surrounding enamel becomes rehydrated, and more translucent (less opaque), before its pre-isolated color returns to a natural state. It is hoped that, at that time, the new restoration will perfectly match the color characteristics of the remaining enamel, and the recent replacement will not be visible at all, but will instead optically blend in without notice. However, prior to that time, there are definitely distinct color differences between a recently placed resin restoration and its surrounding tooth structure. To date, little-to-no information is available on the rate at which a clinician or patient can expect isolated enamel to return to its pre-isolated color, and when to expect this esthetic blending to occur.

      Bowerman, Brielle; Rueggeberg, FA; Brenes, C; Department of Restorative Sciences, Department of General Dentistry (Augusta University Libraries, 2019)
      A variety of manufacturing techniques have been used throughout the history of dentistry, in order to fabricate indirect restorations. Formative processes (pouring or pressing items into molds) are used when making conventional dentures, or when pressing ceramics. Recently, subtractive fabrication methods have enabled clinicians to mill a wide variety of ceramic and resin-based blanks directly into final forms, fitting the oral structures with high degrees of precision. Examples of older additive techniques include wax buildups to establish missing tooth structure for fabrication of subsequent cast restorations and the manual layering of powdered porcelains for development of ceramic facings on metallic substrates, or for ceramic veneers themselves. Tremendous advancements have been made in the field of 3D digital printing for many industrially based applications. Advances in research and development have resulted in tabletop 3D printers that produce rapid prototype specimens having very high accuracy and surface feature details. Recently, these advances have resulted in the manufacture and availability of a wide variety of 3D digital printers that dental offices now use to directly fabricate a wide range of restorative appliances (denture bases and teeth, temporary restorations, splints) as well as ancillary devices (impression trays, surgical implant guides, casts, try-in set-ups, and stents). Contemporary dental 3D printing typically involves use of near or true ultraviolet radiation (405 nm & 385 nm, respectively) in order to fabricate the basic desired form from a vat of photo-polymerizable monomers. Subsequent to initial form fabrication, the specimen is alcohol-washed of excess surface monomer, and is then subjected to an additional exposure of strong near/UV light, in order to maximize the polymerization process and provide optimal physical properties, as well as to minimize cytotoxicity resulting from leaching of unreacted, residual monomer within the bulk of the as-printed item.
    • Maxillary growth in patients with complete unilateral cleft lip and palate treated with Nasoalveolar molding

      Manente, M; Levy-Bercowski, D; Abreu, A; Fortson, W; Deleon, E; Yu, J; Looney, S; Department of Orthodontics; Department of Plastic Surgery; Department of Biostatistics and Data Science (Augusta University Libraries, 2019)
      In patients with cleft lip and/or palate (CLP), the nasolabial defect has a significant esthetic impact on the face and may impair psychosocial development. Nasoalveolar molding (NAM) is a pre-surgical orthopedic technique aimed to improve the alveolar and nasolabial morphology of patients with cleft lip and palate. This technique is used to facilitate and improve the future surgical correction in cleft lip and palate patients. Influences such as differences in patient age and gingivoperiosteoplasty procedures are among many that have made it difficult for conclusive results to be found and published on the impact of the NAM technique on maxillary growth in patients with complete unilateral cleft lip and palate (CUCLP).
    • Adjunct Post-Operative Analgesia Following Uncomplicated 3rd Molar Removal

      Benton, Bryan; James, J; Department of Oral and Maxillofacial Surgery (Augusta University Libraries, 2019)
      Extraction of 3rd molars is a routine procedure performed in Oral and Maxillofacial Surgery practices. Postoperative analgesia and recovery is a primary concern for patients undergoing removal of 3rd molars. Uncontrolled postoperative pain has been shown to interfere with quality of life, delay recovery, and even contribute to long term unfavorable sequelae of surgery such as chronic pain. Extraction of 3rd molars is widely performed on an outpatient basis and thus postoperative analgesia is patient directed, often with assistance from narcotic analgesics, NSAIDs, or a combination of these. Prescription drug abuse is a public health crisis in the United States. In 2016, 42,249 persons died of an opioid related drug overdose. Narcotic use following surgical procedures can lead to dependency and addiction. In 2016, new persistent opioid use after surgical procedures was 5.9% - 6.5%, this was similar for both minor and major surgical procedures.

      Baxter, John; Brenes, C; Rueggeberg, FA; Departments of General Dentistry; Department of Restorative Sciences (Augusta University, 2019)
      Direct, tissue-borne, full denture restoration of edentulous arches has become a well accepted restoration modality for millions of people. In this methodology, the tissue-bearing surface of a polymeric material replacing the form and structure of lost alveolar bond and overlying mucosa rests directly on the residual ridge tissue. Retention of the denture is attained through capillary adhesion forces acting to wet (cover) both the oral mucosa and the polymeric denture bases that rests upon it. Good wetting by saliva is thus one of the many critical features affecting adhesion of the denture base to the oral mucosa. Measurement of the ability of a fluid to wet a surface is performed using the shape of a fluid droplet on that surface. If the fluid wets that surface, then the droplet will spread out. If the fluid does not wet that surface, it will bead up. Quantitative measurement of fluid flow on a surface is performed using measurement of the “contact angle.” In this method, a controlled volume is dispensed onto a surface, and while viewing the interaction of that fluid in silhouette, the angle formed at the tangent of that drop and the flat surface is determined. The lower the contact angle, the more a fluid wets a surface, and the higher its value, the less wetting is that fluid on a specific surface.