Browsing by Author "Milosevic, Alexander"

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Abrasion: A Common Dental Problem Revisited
(2017-02-28) Milosevic, Alexander
Abstract: Dental abrasion is most commonly seen at the cervical necks of teeth, but can occur in any area, even inter-dentally from vigorous and incorrect use of dental floss. Acid erosion has been implicated in the initiation and progress of the cervical lesion, while tooth-brush abrasion has long been held as the prime cause of cervical abrasion. Identification of the risk factors is clearly important in order to modify any habits and provide appropriate advice.
The Bilaminar (Dual-Laminate) Protective Night Guard
(2017-07) Milosevic, Alexander
Abstract: Tooth wear is an increasing problem for general dental practitioners. Attrition is associated with bruxism, primarily a stress related condition that is difficult to manage dentally. Direct composite restorations are frequently used to restore the worn anterior dentition. Soft occlusal appliances (night guards) are often prescribed in bruxism, despite debatable clinical benefit. Bilaminar (duallaminate) splints or night guards are composed of two distinct layers of ethylene-vinyl acetate; a soft inner and a harder outer layer. These occlusal appliances are cost-effective to construct, easy to fit and offer greater resistance to occlusal forces than entirely soft occlusal appliances. Patient compliance is excellent. Bilaminar night guards are proposed as an alternative occlusal appliance to prevent further attritional tooth wear from bruxism when TMD is absent and for protection of composite placed to restore the worn dentition. CPD/Clinical Relevance: The soft occlusal guard is widely used in dentistry but lacks durability and cannot be adjusted. To prevent further attrition and protect restorations, the use of a bilaminar or dual laminate material is advocated in cases of bruxism.
Clinical guidance and an evidence-based approach for restoration of worn dentition by direct composite resin
(2018-03) Milosevic, Alexander
Abstract: This paper aims to provide the dentist with practical guidance on the technique for direct composite restoration of worn teeth. It is based on current evidence and includes practical advice regarding type of composite, enamel and dentine preparation, dentine bonding and stent design. The application of direct composite has the advantage of being additive, conserving as much of the remaining worn tooth as possible, ease of placement and adjustment, low maintenance and reversibility. A pragmatic approach to management is advocated, particularly as many of the cases are older patients with advanced wear. Several cases restored by direct composite build-ups illustrate what can be achieved. The restoration of the worn dentition may be challenging for many dentists. Careful planning and simple treatment strategies, however, can prove to be highly effective and rewarding. By keeping any intervention as simple as possible, problems with high maintenance are avoided and management of future failure is made easier. An additive rather than a subtractive treatment approach is more intuitive for worn down teeth. Traditional approaches of full-mouth rehabilitation with indirect cast or milled restorations may still have their place but complex treatment modalities will inevitably be more time consuming, more costly, possibly require specialist care and still have an unpredictable outcome. Composite resin restorations are a universal restorative material familiar to dentists from early-on in the undergraduate curriculum. This review paper discusses the application of composite to restore the worn dentition.
Clinical outcomes of single implant supported crowns versus 3‑unit implant‑supported fixed dental prostheses in Dubai Health Authority: a retrospective study
(2021) Alhammadi, Sara; Milosevic, Alexander
Background: This study assessed retrospectively the clinical outcomes of single implant-supported crowns and implant-supported fixed dental prostheses (FDPs). Methods: This case series compared biological and technical complications in single implant-supported crowns and implant-supported bridges in a time framed sample of all patients who received dental implants between 2009 and 2016 in Dubai Health Authority. Only 3-unit implant-supported prostheses (FDPs) with one intervening pontic and an implant each end were included for comparison to single crown supported implants. Cantilevered implants, implant supported dentures and cases involving bone grafts or sinus lifts were excluded. The primary outcome measure was marginal bone loss, measured on digital radiographs taken after prosthesis placement at baseline and one year after implant loading, whilst peri-implantitis and technical complications were secondary outcomes. Mixed regression models adjusted for clustering of implants within patients was used for patient and implant factor associations. Results: A total of 454 patients (152 males; 302 females) had 1673 implants. The mean age of males (53.7 years, SD 14.6) was significantly greater than females (49.3 years, SD 12.9, p < 0.001). Mean mesial bone loss on the FDPs was significantly greater at 1 year (1.14 mm, SD 0.63) compared with the mesial surface of single implant-supported crowns (0.30 mm, SD 0.43, p < 0.001). Mean distal bone loss was also significantly greater at 1 year on the distal surfaces of implants supporting bridgework (1.29 mm, SD 0.71) compared with distal surfaces on single implant-supported crowns (0.36 mm, SD 0.54, p < 0.001). Mean marginal bone loss mesially and distally around implants placed in the lower anterior sextant was significantly greater compared to all other sites (p < 0.001). Bone loss by gender, patient’s age and medical condition was not different between the 2 implant groups. Screw loosening was the main technical complication (11.5%) whilst peri-implantitis occurred rarely (0.5%). The 66 cement retained implants had significantly more complications compared to the 1607 screw retained implants (p < 0.001). Conclusions: Mean marginal bone loss around the supporting implants of FDPs (3-unit fixed bridgework) was greater than on single implant-supported crowns at one year after implant loading. Position in the mouth was associated with bone loss. Biological and technical complications occurred rarely.
Convergence angles of all-ceramic full crown preparations performed in Dubai private practice
(2018-12-01) Abdulla, Fahad; Hassan Khamis, Amar; Milosevic, Alexander; Abuzayda, Moosa
Background: This study aimed to determine the degree of taper and total occlusal convergence angles (TOC) for all-ceramic bonded crown preparations carried out by private practitioners in Dubai, UAE. Material and Methods: A convenience sample of all-ceramic crown preparations carried out by private dental practitioners were scanned (Carestream CS 3500) from casts and the digital images assessed. The degree of taper was measured on the axial walls of each crown preparation and the bucco-lingual and mesio-distal convergence angles subsequently calculated. Results: A total of 154 dentists prepared a total of 206 crown preparations (72 anterior, 134 posterior). The mean convergence angles mesio-distally for all preparations was 24.6° (sd 11.8º), and for the bucco-lingual it was 32.6° (sd 15.3°). The mean TOC was 28.6°. In anterior preparations, the mean bucco-lingual convergence angle was 38.8° (sd 12.2°) compared to 29.3° (sd 15.5°) for posterior preparations (p<0.001). Mean mesio-distal convergence anteriorly was 20.6° (sd 10.18°) compared to 26.7° (sd 12.16°) posteriorly (p<0.001). Distal and buccal taper were significantly greater on posterior teeth (<0.001) compared to anteriors whereas lingual taper was greater on anterior teeth (p<0.001). Mesial taper was not different. Premolars had significantly lower convergence values compared to other teeth. Conclusions: Bucco-lingual and mesio-distal convergence angles significantly exceeded the clinically acceptable convergence angle of between 10° and 22°. Greater axial taper is recommended for resin bonded all-ceramic crowns but reliance on adhesion in such preparations rather than parallelism may reduce retention and have increased biologic cost to pulp health.
Direct Composite Resin for the Management of Tooth Wear: A Systematic Review
(2020) Vajani, Disha; Tejani, Tameeza Hassanali; Milosevic, Alexander
Background: This study systematically reviewed survival of direct composite to restore worn teeth. Materials and Methods: A comprehensive electronic search of databases sourced from Medline-PubMed, Embase, Cochrane Central, Scopus, Google scholar was performed on literature published between January 1990 and December 2018. Grey literature was also reviewed. Data extraction included sample size, number of composite restorations, operators, composite type, mean or total follow-up time and success rate expressed as either percent of successful restorations or median survival time (MST). Methodological quality was rated using the Joanna Briggs Institute appraisal checklist for case series. Studies on children, noncarious cervical lesions, cast and all-ceramic restorations, case reports and case series with <5 participants were excluded. Results: A total of 1563 studies were identified and 1472 were screened. Sixty-two full-text papers were assessed for eligibility which resulted in 10 studies that met inclusion criteria. These were mainly case series and assessed 3844 direct composite restorations placed in 373 patients mostly in hospital settings. Survival ranged from 50% to 99.3%. Methodological quality improved from the earlier studies and was rated low to moderate in 7 studies and good in 3. The funnel plot showed a low risk of publication bias but there was considerable heterogeneity (I2 =97.7%). There was a non-significant weak negative association between age and survival (Spearman’s rho=−0.12). Conclusion: Qualitative evaluation of the studies proved difficult because of the nature of case series but reporting improved in the later studies. Despite the generally short duration of studies, small sample sizes in terms of patient numbers and composite restorations, the survival rates of direct hybrid composite resin in the short to medium term are acceptable and support their application for the restoration of worn teeth.
Effectiveness of Alcohol and Aldehyde Spray Disinfectants on Dental Impressions
(2020) Al Shikh, Ayesha; Milosevic, Alexander
Background: The gold standard for disinfection of dental impressions is by immersion although spray techniques are also available. This study compared the effectiveness of alcohol and aldehyde spray disinfectants on analogue dental impressions in a hospital setting. Materials and Methods: Impressions were swabbed after removal from the mouth (predisinfection) and after spraying (post-disinfection) with either a non-aldehyde alcohol-based disinfectant, Bossklein (Silsden, W Yorks, BD20 0EF, UK) or a glutaraldehyde-based alcohol-free disinfectant, MD520 (Dürr Dental, 74321 Bietigheim-Bissingen, Germany). Swabs were transported to the microbiology laboratory in Amies medium and plated onto sheep blood agar within 2 hrs. Plates were incubated for 3 days at 37°C then at room temperature for 3 days. After incubation, all plates were examined for microbial growth. Results: A total of 87 impressions were assessed (alginate = 41; poly-vinyl siloxane (PVS) = 31; polyether = 15). The counts were categorized into two groups: no growth or growth present. Post-disinfection contamination was present on six alginate and six PVS impressions but only one polyether impression (x2 = 1.27, P > 0.05, NSS). Analysis of post-disinfection growth according to impression and disinfectant found significantly more contaminated PVS impressions with the alcohol-based spray than with the aldehyde spray (x2 = 5.37, p < 0.05). Disinfection with the aldehyde-based spray resulted in only two contaminated impressions, both in alginate. Conclusion: Alcohol-based spray disinfection of dental impressions may be less effective than aldehyde spray and full immersion of impressions is recommended. Careful wetting or soaking of all surfaces of impressions is very important when using a spray.
The Oral Health Status of Attendees and Residents in United Arab Emirates Care Homes
(2020) Almazrooei, Banan; Amir-Rad, Fatemeh; Milosevic, Alexander
Objectives: This cross-sectional study assessed the oral health status of attendees and residents in United Arab Emirates (UAE) care homes. Materials and Methods: All care homes identified from the UAE Ministry of Health website were selected and all attendees or residents included. Medical conditions were classified according to World Health Organization (WHO) criteria. Oral and dental status was recorded on the WHO Oral Health Assessment form for adults and demographic details were recorded separately. The three examiners had training and calibration exercises before conducting the dental examinations with an overall mean inter-examiner κ of 0.67. Results: A total of 107 patients participated in the study with a mean age of 67.5 years (standard deviation [SD] = 15.65 years). The mean age of men (n = 57) (69.2 years, SD = 16.3) was not significantly different to the mean age of women (65.5 years, SD = 14.8, P > 0.05). The American Society of Anaesthesiologists (ASA) classification of mild disease was present in 71 participants, whereas 27 were classified with severe systemic disease. Multiple medical problems were common (n = 28), followed by endocrine disease (n = 26) and mental health problems (n = 20). Gingivitis and/or periodontitis were present in 58 (72%) of 81 dentate participants (26 participants were edentate). Overall mean decayed, missing, filled teeth (DMFT) was 23.2 (SD = 9.0) but mean DMFT in men was significantly greater (26.5) than women at 19.8 (P < 0.001). Age had a weak positive correlation with DMFT, Spearman’s rho = +0.43 (P < 0.001). Eighteen participants of 88 (20.5%) complained of pain or soreness at the time of examination. The frequency of tooth brushing/cleaning the mouth was not correlated to participants’ mobility (being bed-bound). Age and gender were predictive for DMFT but not education or ASA classification. Gender and ASA classification predicted periodontal status. Conclusion: Oral health was generally poor with pain and discomfort present in a high number of care home residents/attendees. Carers require training in oral health as dental care is a priority for this group.
Survey of Dental Implant and Restoration Selection by Prosthodontists in Dubai
(2021) Abuzayda, Moosa; Milosevic, Alexander
Background: With various surgical and prosthetic component designs being introduced in dental implants, decisions have to be made when choosing a system and a certain prosthodontic protocol. A survey of implant prosthodontic specialists has not been previously performed in the Middle East. Aim. (is study aimed to determine selection criteria and choice of dental implants and restorations by prosthodontic specialists in the Emirate of Dubai, United Arab Emirates. Materials and Methods: A validated 16- item questionnaire was used in the survey which included demographic information, implant training and experience, implant treatment planning, implant restoration, and implant system preference. (e research protocol was approved by the Research and Ethics Committees of Hamdan Bin Mohammed College of Dental Medicine and Dubai Health Authority. Prosthodontists were identified from regulatory authority websites and contacted by e-mail with the questionnaire attached. Results: A total of 84.6% (77) of the registered prosthodontists in Dubai completed the questionnaire with 66.2% reported practicing implant dentistry. Out of which, 54.9% reported surgically placing dental implants and 45.1% restore them only prosthetically. Prefabricated metal abutments were the most commonly selected abutments for single crowns (76.0%) and for fixed dental prostheses (66.7%). Screw retention is preferred mostly for single crowns (68.0%) and fixed dental prostheses (74.0%). Locators were the most commonly selected type of attachment for implant-retained/supported overdentures (49.0%). Conventional loading was the most selected type of loading in all oral conditions. Conclusion: Within the limitations of this study, it can be concluded that most prosthodontists in Dubai practice implant dentistry and more than half surgically place dental implants. Prefabricated metal abutments are the most selected type of abutments. Most prosthodontists use screw-retained implant restorations and prefer locator attachments for implant-retained/supported overdentures. Conventional loading is the most preferred implant loading method in all oral conditions. Implant company/system selections are various and there is no major preference for a certain system. (e majority of prosthodontists select implant systems based on implant features, literature review, and simplicity of restorative kit.
Tooth wear during orthodontic treatment with fixed appliances: a systematic review
(2018) Makrygiannakis, Miltiadis A.; Kaklamanos, Eleftherios G; Milosevic, Alexander; Athanasiou, Athanasios E.
Objectives: Tooth wear, additional to the physiologic alterations of the dentition, may occur during orthodontic treatment. The objective of the present review was to investigate systematically the literature relevant to its progression in patients having undergone comprehensive orthodontic treatment. Data sources: Search without restrictions in eight databases since inception and hand searching until October 2017 was performed. Data selection: Studies evaluating tooth wear immediately before and after the completion of orthodontic treatment with fixed appliance were evaluated independently and in duplicate. Data extraction: Following study retrieval and selection, data on volumetric and surface tooth wear was extracted. Individual study risk of bias assessment was performed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool, and the overall quality of the evidence was assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach. Data synthesis: All three finally included studies reported wear of teeth during the period of treatment but were at serious risk of bias. Two of them investigated tooth wear by 3D volumetric measurements and one used grading scales. The mean volume reduction was 1.02 mm3 per tooth for the incisor group [95% Confidence Interval (CI): 0.84–1.20], 1.62 mm3 for the canines [95% CI: 0.8–2.38; I2= 96%; random effects method] and 0.95 mm3 for premolars and molars [95% CI: 0.84–1.07]. The overall quality of evidence limited the confidence in the observed estimates. Conclusions: Varying degrees of tooth wear were reported after comprehensive orthodontic treatment. Further studies are needed in order to elucidate how much is associated with orthodontic treatment and/or physiologic alterations of the dentition.