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BACKGROUND In Australia, because of inequity in dental service accessibility and affordability, patients can see general medical practitioners (GPs) for acute dental conditions. METHODS This cross-sectional study consisted of surveys distributed to the board registered GPs practising in Australia. The main outcome measures included statistical analysis of GPs managing different dental emergency scenarios and their confidence and expectations in managing dental emergencies. RESULTS A total of 425 GPs participated in the study. The sample primarily consisted of GPs practising in metropolitan clinics (n = 315). Most participants reported that they would refer to the dentist for mobilized tooth (n = 402). There was a negative correlation between GPs with 5-29 years of experience and traumatized tooth management (P

The clinical use of all-ceramic crowns and fixed partial dentures has seen widespread adoption over the past few years due to their increasing durability and longevity. However, the application of inlays as an abutment design has not been as readily embraced because of their relatively high failure rates. With the use of an idealized inlay preparation design and prosthesis form which better distributes the tensile stresses, it is possible to utilize the inlay as support for an all-ceramic fixed partial denture. Utilizing a three-dimensional finite element analysis, a direct comparison of the inlay supported all-ceramic bridge against the traditional full crown supported all-ceramic bridge is made. The results demonstrate that peak stresses in the inlay bridge are around 20% higher than in the full crown supported bridge with von Mises peaking at about 730 MPa when subjected to theoretical average maximum bite force in the molar region of 700 N, which is similar to the ultimate tensile strengths of current zirconia based ceramics.

Dental biomaterials are widely used in all areas of routine dental practice. There are mainly two methods for their application. Firstly, dental biomaterials are placed into living tissues, such as teeth, to fill the space. Secondly, dental devices such as crown and bridge restorations and dentures are fabricated using various materials to restore the morphology and function of the dentition. Crown and bridge restorations are one of the main treatment methods used by general practitioners to achieve lifelike restoration of form and function. The recent introduction of osseointegrated implants has expanded the application of crown and bridge restorations for partially edentulous patients. Mechanical durability and precision fit are mandatory requirements for crowns and bridges. The development of various casting alloys and precise casting systems has contributed to the successful use of metal-based restorations. However, patient requests for more aesthetic and biologically 'safe' materials has led to an increased demand for metal-free restorations. There is also a growing demand to provide all-ceramic restorations more routinely. New materials such as highly sintered glass, polycrystalline alumina, zirconia based materials and adhesive monomers, will assist dentists to meet this demand. In addition, new fabrication systems combined with computer-assisted fabrication systems (dental CAD/CAM) and various networks are now available. Dental technology was centred on lost-wax casting technology but we now face a revolution in crown and bridge fabrication. This article reviews the history and recent status of dental CAD/CAM, the application of CAD/CAM fabricated tooth-coloured glass ceramic crowns, and the application of all-ceramic crowns and bridges using CAD/CAM fabricated zirconia based frameworks.

In recent years fibre-reinforced resin composites (FRCs) have gained increasing acceptance in mainstream prosthodontics as viable alternatives to alloy-based restorations. A combination of good aesthetics and fracture toughness validates their use in a diverse range of clinical applications. In this case report an indirect resin-bonded fibre-reinforced composite anterior bridge incorporating a novel design is described. At 24-months recall the prosthesis was problem free and the patient was very happy with the treatment outcome. While definitive long-term data about their clinical performance is scarce, fibre-reinforced resin composite prostheses appear to have a worthwhile role in the conservative treatment of short edentulous spaces.

These two case reports highlight the enormous clinical difficulties faced by dentists in providing satisfactory long-term dental care to patients who suffer from Epidermolysis bullosa. Problems of bullae formation in oral soft tissues and subsequent scarring are outlined in relation to the difficulty of maintaining satisfactory oral hygiene and a diet leading to minimal dental caries experience. The behavioural problems of maintaining patient compliance for preventive and restorative dentistry in this painful and debilitating disease are illustrated in these case reports. Difficulties in providing restorative care, either under local anaesthesia or general anaesthesia are discussed, and a novel replacement of non-viable carious anterior teeth using a nine-unit porcelain fused to metal Rochette type bridge is presented. Dental management of patients with Epidermolysis bullosa should commence at birth, and non-compliance in dental attendances should be followed up by social workers to prevent the disastrous oral morbidity that frequently occurs in such patients.

Background This study is the last in a series detailing an investigation into the all-ceramic, inlay supported fixed partial denture, the major concern of which has been the examination of the stress responses of the bridge via the use of finite element analysis (FEA) and its validation. The progression from a classic FEA to the current extended or enriched FEA (XFEA) will be described and the validation performed. Methods XFEA modelling was compared and validated against the experimental model analysis (EMA) as described in a previous study. Results The two EMA load case fracture strengths of 160 N and 313 N compared favourably with the best two fracture predictions from the XFEA of 185 N and 213 N (maximum principal stress criterion) respectively, with the origin of fracture and overall trajectory and pattern of crack propagation agreeing very well. Conclusions XFEA load prediction is within 15% of the EMA in the best case. The sensitivity of the bridges to loading position variations was accurately predicted by the XFEA, together with the change in fracture origin from the molar to premolar embrasures. With this, the authors believe that they have provided a convincing validation, both qualitatively and quantitatively, of an anatomically realistic dental bridge.

The aims of this investigation were to examine the patterns of resin cement failure between debonded electrolytically etched (Maryland) bridge retainers and their respective abutment teeth and to determine if the clinical assessment of bond failure corresponded to the types of failure observed in the scanning electron microscope. Twenty-eight (18 anterior and 10 posterior), debonded bridges were examined. The results indicated that the classification of bond failures at the clinical level did not correspond to the SEM assessments of failure. It appeared from the specimens examined that loss of retention occurred as a result of resin failure within the cement layer close to the enamel-resin interface. Only one metal retainer specimen showed a small area of resin-metal failure. There appeared to be no differences in the patterns of resin failure between anterior and posterior bridges. The observations also indicated that the resin cements used for bridge cementation adhered well to electrolytically etched retainer surfaces.

The clinical performance of resin-bonded Rochette and Maryland bridges inserted by various operators at the Adelaide Dental Hospital is reported. Thirty-four Rochette bridges (30 anterior, 4 posterior) and 228 Maryland bridges (150 anterior, 78 posterior) were assessed. Clinical data were compiled on types of bridge failure, factors influencing bridge retention, and the effects of the prostheses on abutment teeth and supporting tissues. The failure rate for Rochette bridges over 6 years was 75 per cent with a median survival of 2.14 years. Debonding occurred in 70 per cent of bridge failures. The failure rate for Maryland bridges over 5 years was 42 per cent with a median survival of 2.60 years. Pontic fracture (29 per cent) and debonding (20 per cent) were the main failures observed. Porcelain pontics performed significantly better than the processed hybrid resin pontics (P < 0.01). The main reasons for debonding included occlusal stresses, non-retentive bridge designs and resin cement failure. A life-table analysis showed no significant difference in the overall cumulative survival rates between Rochette and Maryland bridges. Bridge design and the choice of pontic material and resin cement emerged as significant factors influencing the success rate of the bridges examined.

Replacement of a number of lost teeth in partially edentulous quadrants has been accomplished using a technically simple Tissue-borne, Partial Denture over a Fixed Bar (PDOFB) Appliance. The appliance offers a similar degree of comfort and aesthetic appeal to that of a fixed bridge, but is specifically designed to reduce the high occlusal loads that normally are applied to the abutment teeth during mastication. It has been used where, because of the excessive distance between the abutment teeth, or because of the poor periodontal health of the abutment teeth, the construction of conventional crowns and bridges was contraindicated. The indications for, and the construction of such an appliance are described.

Unlike their use in conventional crown and bridge, provisional restorations during implant therapy have been underutilized. Provisional restorations should be used to evaluate aesthetic, phonetic and occlusal function prior to delivery of the final implant restorations, while preserving and/or enhancing the condition of the peri-implant and gingival tissues. Provisional restorations are useful as a communication tool between members of the treatment team which, in most cases, consists of the restorative clinician, implant surgeons, laboratory technicians, and the patient. This article describes and discusses the various options for provisionalization in implant dentistry. Clinicians should be aware of the different types of provisional restorations and the indications for their use when planning implant retained restorations.

This paper describes an aesthetic and functional treatment for the replacement of a failing bridge supported by blade implants where the patient refused further surgery.

Osseointegrated dental implants are increasingly used to replace missing teeth in a variety of situations ranging from the missing single tooth to complete edentulism. The implant possibility must be carefully considered because treatment involves extended time frames, considerable expense and is not without risk. Accordingly, treatment-planning decisions should have an evidence-based strategy with appropriate risk assessment. Implant systems need to be adequately tested before they are released for general use and success rates should be assessed from peer review scientific publication data and not commercial promotional literature. It is the responsibility of the dentist to ensure the patient is educated so an informed decision can be made on difficult treatment alternatives. The clinical decision making process must respect the issues to assure quality of care and reduction of liability for negligent care. Today, the three-unit fixed bridge can no longer be considered as the standard of care for restoration of a single missing tooth. The evidence has accumulated that the single tooth implant supported replacement is more conservative, more cost-effective and more predictable with respect to long-term outcome in uncomplicated cases.

The aim of any prosthesis is to restore function and aesthetics by replacing the missing tooth with minimal risks to adjacent tissues. The options presently available to the patient for the replacement of a missing single tooth include the removable partial denture, partial and full coverage bridgework, resin-bonded bridgework and the single-tooth implant prosthesis. The relative merits and guidelines for successful application of these treatment modalities are presented.

A technique for electroforming pure gold margins on the abutment castings of bridge substructures made from gold alloys or base metals alloys has been described. The margin of gold can be burnished to compensate for errors inherent in the production of these castings and ceramic procedures. A modification of this procedure permits marginal adjustment to completed crowns and bridges with deficient margins.

Introduction Parts of a bridge are related either clinically by the dentist, the direct index, or by the technician in the laboratory, the indirect index, to assemble the parts and invest them for soldering. T o form a direct occlusal index the dentist seats the bridge parts on the teeth and usually either makes a plaster impression record' or uses a self-curing acrylic resin record from which the technician fabricates the soldering assembly. T o form a conventional indirect occlusal index for immediate soldering the technician assembles the bridge parts from the master model with either a quickcure acrylic resin' or sticky wax and impression plaster.* Errors attribute to both types of index for soldering which are undetectable until the final bridge is tried in the mouth. In view of the problems associated with occlusal indexing, a technique has been developed combining the advantages of both types of procedures and improving the end result.

— The technique of using composite resin for the adhesive in bonding acrylic or natural tooth pontics as a form of fixed prosthesis is presented.

— An alternative to extracting a periodontally involved lower incisor is presented. The crown of the incisor was bonded to the abutment teeth with adhesive composite resin and the periodontally diseased root then resected. The temporary bridge has functioned successfully for 17 months. Advantages of utilizing the patient's natural crown as a pontic in a composite resin-retained temporary bridge are discussed.