Cork University Dental Hospital
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Research undertaken by staff affiliated to Cork University Dental Hospital
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Zn-Containing Membranes for Guided Bone Regeneration in Dentistry.Barrier membranes are employed in guided bone regeneration (GBR) to facilitate bone in-growth. A bioactive and biomimetic Zn-doped membrane with the ability to participate in bone healing and regeneration is necessary. The aim of the present study is to state the effect of doping the membranes for GBR with zinc compounds in the improvement of bone regeneration. A literature search was conducted using electronic databases, such as PubMed, MEDLINE, DIMDI, Embase, Scopus and Web of Science. A narrative exploratory review was undertaken, focusing on the antibacterial effects, physicochemical and biological properties of Zn-loaded membranes. Bioactivity, bone formation and cytotoxicity were analyzed. Microstructure and mechanical properties of these membranes were also determined. Zn-doped membranes have inhibited in vivo and in vitro bacterial colonization. Zn-alloy and Zn-doped membranes attained good biocompatibility and were found to be non-toxic to cells. The Zn-doped matrices showed feasible mechanical properties, such as flexibility, strength, complex modulus and tan delta. Zn incorporation in polymeric membranes provided the highest regenerative efficiency for bone healing in experimental animals, potentiating osteogenesis, angiogenesis, biological activity and a balanced remodeling. Zn-loaded membranes doped with SiO2 nanoparticles have performed as bioactive modulators provoking an M2 macrophage increase and are a potential biomaterial for promoting bone repair. Zn-doped membranes have promoted pro-healing phenotypes.
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Resin bonded bridges in patients with hypodontia: Clinical performance over a 7 year observation period.Purpose: Resin bonded bridges (RBBs) are considered a conservative option in the management of hypodontia. This study targeted to analyze the survival of resin bonded bridges provided to patients with Hypodontia by staff and students at the Department of Restorative Dentistry, University Dental School and Hospital Cork, Ireland. It was also to determine the factors that may influence the survival of RBBs in patients with hypodontia. Methods: Forty patients with hypodontia who received 65 RBBs from 2001 to 2007 were identified and contacted to be recruited for this study. Of these, nine were not contactable, and five failed to attend. Accordingly, 26 patients (65%) participated in the study, with a total of 51 RBBs. Results: Of the 51 RBBs evaluated, 44 (86%) were still in situ and functional and 7 (14%) failed. The main reason for failure was repeated debonding. The effect of age, gender, the grade of operator and experience, bridge location, design of the bridge, span length and moisture control during cementation, could not be demonstrated. Conclusion: The effect of age, gender, the grade of operator and experience, bridge location, design of the bridge, span length and moister control on RBB survival could not be demonstrated. Majority of patients with hypodontia showed satisfaction with resin bonded bridges. In replacing congenitally missing teeth in patients with hypodontia, resin-bonded bridges would be an acceptable treatment option.
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Treatment Outcomes in Trigeminal Neuralgia-A Systematic Review of Domains, Dimensions and Measures.Background: Trigeminal neuralgia (TN) is a painful disorder characterized by sudden electric shock-like pain. It is a rare condition for which multiple treatments are available, including medical and surgical. The best treatment option is yet to be defined, and this is related to the lack of definition in the treatment outcomes and outcome measures. The aim of this systematic review was to summarize all the outcomes and outcomes measures that have been published to date and highlight variability in their use. Methods: We have conducted a literature search using a wide range of databases (1946-2019 for medical and 2008-2019 for surgical treatment), for all intervention studies in TN. Four hundred and sixty-seven studies were selected for data extraction on TN classification, data collection method, intervention, and treatment outcomes mapped to the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT guidelines). Results: Most studies collected data on pain (n = 459) and side effects (n = 386) domains; however, very few collected data on the impact of treatment on physical (n = 46) and emotional functioning (n = 17) and on patient satisfaction (n = 35). There was high variability on outcome measures used for pain relief (n = 10), pain intensity (n = 9), and frequency of pain episodes (n = 3). Conclusions: A clear definition of what are the important outcomes for patients with TN is essential. The choice of standardized outcome measures allowing for consistent reporting in TN treatment will allow for comparison of studies and facilitate treatment choice for patients and clinicians thus, improving health outcomes and reducing health care cost. Keywords: BNI, The Barrow Neurology Institute Pain Intensity Scale; BPI, Brief Pain Inventory; COS, Core Outcome Set; MVD, Microvascular decompression; Outcome measures; QOL, Quality of life; Systematic review; TN, Trigeminal neuralgia; Treatment outcomes; Trigeminal neuralgia; VAS, Visual analogue scale.
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Impact of oral rehabilitation on the quality of life of partially dentate elders in a randomised controlled clinical trial: 2 year follow-up.This randomised clinical trial aimed to compare the impact of two different tooth replacement strategies for partially dentate older patients namely; removable partial dentures (RPDs) and functionally orientated treatment based on the shortened dental arch (SDA) concept, on Oral Health-related Quality of Life (OHrQOL). 89 patients completed a randomised clinical trial. Patients were recruited in two centres: Cork University Dental Hospital (CUDH) and a Geriatric Day Hospital (SFDH). 44 patients were randomly allocated to the RPD group and 45 to the SDA group where adhesive bridgework was used to provide 10 pairs of occluding contacts. The impact of treatment on OHrQOL was used as the primary outcome measure. Each patient completed the Oral Health Impact Profile (OHIP-14) at baseline, 1, 6, 12 and 24 months after treatment. Both treatment groups reported improvements in OHIP-14 scores at 24 months (p<0.05). For the SDA group OHIP-14 scores improved by 8.0 scale points at 12 months (p<0.001) and 5.9 scale points at 24 months (p<0.05). For the RPD group OHIP-14 scores improved by 5.7 scale points at 12 months (p<0.05) and 4.2 scale points at 24 months (p<0.05). Analysis using ANCOVA showed that there were significant between group differences recorded in both treatment centres. 24 months after intervention the SDA group recorded better OHIP-14 scores by an average of 2.9 points in CUDH (p<0.0001) and by an average of 7.9 points in SFDH (p<0.0001) compared to the RPD group. Patients in the SDA group maintained their improvements in OHrQOL scores throughout the 24 month study period. For the RPD group the initial improvement in OHrQOL score began to diminish after 6 months, particularly for those treated in SFDH. Thus, the benefits of functionally orientated treatment increased over time, particularly for the older, more systemically unwell cohort in SFDH.
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Multiple myeloma presenting as mandibular painIntroduction: Multiple myeloma (MM) is a systemic malignancy of plasma cells defined by monoclonal production of circulating immunoglobulins. Bone pain is a presenting feature in the majority of cases. Treatment may involve intravenous use of bisphosphonates, chemotherapy or haematopoietic stem cell transplantation. Here, we illustrate a first presentation of MM in a patient with mandibular pain and discuss radiographic, diagnostic and treatment challenges of orofacial issues in patients with MM. Case report: A 69-year-old lady presented to an emergency oral surgery clinic with a month-long history of unilateral left-sided pain in her jaw. Examination revealed a buccolingual swelling of 2cm diameter in the lower left premolar region. Radiographic images demonstrated a 2cm lytic lesion in her mandible corresponding with the symptomatic region. Aspiration of the lesion was performed and histological analysis indicated an abundance of atypical plasma cells. Subsequent biopsy revealed sheets of plasmacytoid cells suggesting evidence of a plasmacytoma. Skeletal survey, bone marrow biopsy and serum analysis confirmed the presence of MM. Discussion: MM, although a systemic malignancy, can present via a variety of orofacial manifestations. The presence of a lytic lesion on plain radiographs should alert the dental practitioner to the possibility of the diagnosis. Treatment of orofacial bone pain may respond to intravenous bisphosphonates but care must be taken to avoid osteonecrosis of the jaw. Conclusion: This case is an important reminder of the potential oral presentations of MM and underlines the importance of radiographic evaluation in patients with atypical symptoms and presentations.
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Adverse reactions to facial dermal fillers: a case reportOur current social and cultural environment places great importance on our appearance. Collagen, the major structural component of the dermis, serves to strengthen and support the skin. As we get older, decreased production of collagen by fibroblasts occurs, leading to loss of tissue bulk and elasticity.1 As a result, deep folds, wrinkles and rhytides can develop. Injectable soft tissue fillers (ISTFs) provide an attractive option in facial rejuvenation. ISTFs can be categorised into biodegradable and non-biodegradable substances. Biodegradable fillers (such as bovine collagen and hyaluronic acid) are safer to use; however, they have a relatively short lifespan (three to 12 months).2 Non-biodegradable fillers (such as silicone) have a longer tissue presence but cause more adverse reactions than the biodegradable fillers.3 ISTFs are usually injected into the deep dermis or the dermal-subdermal junction (Figure 1).4
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Dentists’ requirements for continuing professional development in Ireland. A pilot study conducted at University College CorkThis research was a pilot study of the ways in which the continuing professional development (CPD) needs of dentists could be provided. A web-based questionnaire facility was used to enable dental practitioners to register their level of interest in a range of clinical topics presented as CPD lectures and practical courses to provide hands-on experience. The findings were reviewed with reference to the available literature on dental CPD. The study sought to inform development of dental CPD programmes.
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Intracranial abscess secondary to dental infectionThe oral cavity is considered as being home to a rich and abundant microflora, including Aggregatibacter actinomycetemcomitans (A. ac tinomyc etemcomitans), which is recognised as one of the major pathogens in destructive periodontal disease.1 A cerebral abscess linked to a dental source is a rare occurrence, since in most individuals the blood-brain barrier, along with the immune response, will exclude bacteria. In this age of antibiotics and with modern living conditions, pyogenic brain infections of odontogenic origin are uncommon in western society. It has been postulated that oral microorganisms may enter the cranium by several pathways: 1) by direct extension, 2) by haematogenous spread, 3) by local lymphatics, and 4) indirectly, by extraoral odontogenic infection. Brain abscesses thought to be of dental origin have been reported to have a lethal outcome.2
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An audit of orthodontic treatment eligibility among new patients referred to a Health Service Executive orthodontic referral centreAim: The aim of this audit was to evaluate orthodontic treatment eligibility among new patients referred for assessment from primary dental care clinics in the Health Service Executive (HSE) South region to a HSE orthodontic referral centre. Method: A data collection form was designed and applied prospectively to consecutive new patient referrals who attended diagnostic clinics at the Orthodontic Unit, Cork University Dental School and Hospital, between October 2011 and February 2012. Orthodontic treatment eligibility was based on guidelines introduced by the HSE in 2007. Results: Data on 291 patients (147 males and 144 females) with a mean age of 11.6 years (SD ± 2.4 years; range 8-19 years) were evaluated. Of the 83 (29%) patients eligible for orthodontic treatment under the guidelines, the most commonly diagnosed malocclusion traits were a crossbite with greater than 2mm discrepancy between retruded contact position and intercuspal position (24 patients), followed by an overjet greater than 9mm (21 patients). Conclusions: A total of 29% of new patient referrals were deemed eligible for orthodontic treatment under HSE eligibility guidelines introduced in 2007. Reduction of new patient referrals not eligible for treatment, under these guidelines, is required to enable more efficient use of resources.
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Motivational interviewing for dental cliniciansMotivational interviewing (MI) is a client centred therapeutic approach, which has been found to be an effective intervention for healthcare change, as it helps to enhance clients’ commitment to the process of change and enables them to resolve their ambivalence to it.1 It is also highly effective when used as a prelude to treatment, for example cognitive behavioural therapy, and its effects appear to endure over time.2 This endurance is attributed to its effects on retention of what is learned and on adherence to the treatment. MI is relevant for healthcare professionals, especially those working in the medical setting where, as Miller and Rollnick3 point out, “motivational issues in patient behaviour change are quite common” (p.35). Furthermore, research has shown that clients working with MI-trained healthcare practitioners were more highly motivated to change.
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Demographics of implant placement and complications of a patient subgroup in a dental hospital population.Little has been reported about the demographics of implant placement in the Irish population and the complications that occur. This is important in terms of service planning and providing patient information.
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Supporting career choices in dentistryAbstract of Article
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Factors influencing the provision of removable partial dentures by dentists in Ireland.Factors influencing clinical treatment of partially dentate patients are varied, and there is a need to identify factors influencing success in the provision of removable partial dentures. The aim of this study was to assess the attitudes of general dental practitioners (GDPs) in Ireland towards tooth replacement and use of RPDs, in partially dentate older adults. The sample frame was the Register of Dentists in Ireland; data were also collected from a sample of dentists practising under NHS regulations in Northern Ireland. Validated questionnaires were sent to all dentists on the Register of Dentists in the Republic of Ireland, and dentists working under NHS regulations registered with the Central Services Agency in Northern Ireland. Content of the questionnaire included details of the dentist themselves, their dental practice and the profile of partial denture provision. They were also asked to give their views on factors influencing the success or failure of an RPD, the process of providing RPDs and their attitudes to RPD provision. A total of 1,143 responses were received, a response rate of 45%. A mean number of 61 RPDs per annum were provided, with 75% of dentures provided being acrylic based. Respondents indicate their belief that cobalt-chromium based dentures had a longer prognosis than acrylic dentures, but less than half (46%) claim to design the frameworks themselves. Patients' attitudes are considered influential in the success of RPD provision, and their influence on appearance is considered the most important factor influencing success. The most important factors influencing failure are: the patient not requesting a denture; an RPD restoring unbounded saddles; and, lower RPDs. Although considered important, approximately 60% of the sample do not routinely organise follow-up appointments for patients provided with RPDs. The fee structures in the DTSS and DTBS are considered a barrier to quality in the provision of partial dentures.
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Career choices on graduation a study of recent graduates from University College Cork.Irish dental graduates are eligible to enter general dental practice immediately after qualification. Unlike their United Kingdom counterparts, there is no requirement to undertake vocational training (VT) or any pre-registration training. VT is a mandatory 12-month period for all UK dental graduates who wish to work within the National Health Service. It provides structured, supervised experience in training practices and through organised study days.
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The demographic and academic profile of Irish dental school faculty members.This paper reviews the demographic, academic and professional profile of Irish dental school faculty members. Faculty duties are explored.
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Impact of chronic oral mucosal disease on daily life: preliminary observations from a qualitative study.To explore the experience of daily life of persons with chronic oral mucosal conditions.