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Epinephrine is widely used as an additive in local anesthetics (typically in concentrations of 1:100,000) to improve the depth and duration of the anesthesia, as well as to reduce bleeding in the operative field. Epinephrine counteracts the anesthetic's localized vasodilator effects in subcutaneous and submucosal vessels, thereby reducing the risk of anesthetic toxicity by decreasing the rate of systemic absorption from the site of injection. Epinephrine is also impregnated in the cotton cord that is inserted into the sulcus between a tooth and the surrounding gingiva, as a gingival retraction cord improving access for tooth preparation and allowing dental impression material to more readily flow into the sulcus to record details of teeth prepared for crowns. The epinephrine likewise tightens the blood supply to contiguous tissue, in this manner allowing the impression to be secured without contamination by bleeding. Hypertension affects nearly 50 million people in the United States and underlies most cardiovascular disease; its diagnosis and control should be of concerned to all health-care providers. Many people have undetected hypertension, and current levels of detection and control need to be improved. Clinical implications: All health-care providers, including dentists and members of the dental team, need to be involved in the detection and management of this important public health problem. The dentist can play an important role in the detection and management of hypertension. [ABSTRACT FROM AUTHOR]

Purpose The purpose of the study was to survey program directors of postdoctoral prosthodontic programs in the United States regarding their programs' complete denture impression techniques. The key objectives of the survey were to identify the current trends in complete denture impression making and to determine which techniques and materials are taught in US postdoctoral prosthodontic programs. Materials and Methods An online survey was sent to all program directors of US postdoctoral prosthodontic programs. The survey comprised two sections: preliminary impressions and final impressions. The survey contained 22 questions that would take approximately 5 minutes to complete. All responses remained anonymous throughout the survey. Results The response rate for the survey was 87%. A majority of the programs did not separately border mold the tray prior to making the preliminary impressions (82%). The impression material of choice for the preliminary impression was irreversible hydrocolloid (88%). Selective pressure was the predominantly used impression philosophy (80%). All programs border molded the custom tray, and 95% recorded the borders in sections. The material of choice for border molding the custom tray was modeling plastic impression compound (71%). The most commonly used impression material for the final impressions was polyvinylsiloxane (PVS) (42%), and the second most commonly used impression material was polysulphide (32%). The most common technique for locating the posterior palatal seal was marking intraorally and transferring onto the final impression (65%). Most programs routinely advised their patients not to wear their existing dentures for at least 24 hours before the final impressions were made (83%). Conclusions Based on the results of this study, the following conclusions can be drawn: (1) The most commonly used material for the preliminary impression was irreversible hydrocolloid and for the final impression was PVS. (2) Modeling plastic impression compound was used by most programs to border mold the custom trays. (3) Selective pressure was the predominantly used impression philosophy. (4) A majority of the programs made a special consideration for excessive movable (flabby) tissue. (5) Most programs routinely advised their patients to not wear their existing dentures for at least 24 hours before the final impressions were made. [ABSTRACT FROM AUTHOR]

The article provides information on facial skin grafting in the U.S. The author implies that skin grafts are a valuable option for closing defects that cannot be closed mainly. Impression materials are used in various phases of denture construction, like polysiloxanes, which are also known as condensation-cured silicones.

Data sources Cochrane Oral Health's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform databasesStudy selection Randomised controlled trials (RCTs) comparing different final-impression techniques and materials for treating people with complete dentures (CD) and removable partial dentures (RPD) were included.Data extraction and synthesis Two reviewers independently extracted data and assessed risk of bias. Results were expressed as risk ratios (RR) for dichotomous outcomes, and as mean differences (MD) or standardised mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CI). Meta-analysis used a random-effects model.Results Nine studies were included, eight involving CD. Six of the CD studies were at high risk of bias, two at low risk. For complete dentures there was low-quality evidence that silicone was a better final-impression material for oral health-related quality of life than alginate. There was also very low-quality evidence of no clear differences between the single-stage impression alginate and the two stage- two step elastomer groups in participant-reported quality of life using OHIP-EDENT. The RCT involving RPD altered-cast technique versus one-piece cast technique found low quality evidence of no difference between groups, for general satisfaction at one-year follow-up.Conclusions There is no clear evidence that one technique or material has a substantial advantage over another for making complete dentures and removable partial dentures. Available evidence for the relative benefits of different denture fabrication techniques and final-impression materials is limited and is of low or very low quality. More high-quality RCTs are required.

Background: Objectives were to determine the likelihood that a clinician accepts an impression for a single-unit crown and document crown remake rates., Methods: The authors developed a questionnaire that asked dentists about techniques used to fabricate single-unit crowns. The authors showed dentists photographs of 4 impressions and asked them to accept or reject each impression. The authors correlated answers with dentist and practice characteristics. Other questions pertained to laboratory use and crown remake rates., Results: The response rate was 83% (1,777 of 2,132 eligible dentists). Of the 4 impressions evaluated, 3 received consistent responses, with 85% agreement. One impression was more equivocal; 52% accepted the impression. The likelihood of accepting an impression was associated significantly with the clinician's sex, race, ethnicity, and practice busyness. Clinicians produced 18 crowns per month on average, and 9% used in-office milling. Most dentists (59%) reported a remake rate of less than 2%, whereas 17% reported a remake rate greater than 4%. Lower remake rates were associated significantly with more experienced clinicians, optical impressions, and not using dual-arch trays., Conclusions: Although dentists were largely consistent in their evaluation of impressions (> 85%), nonclinical factors were associated with whether an impression was accepted or rejected. Lower crown remake rates were associated with more experienced clinicians, optical impressions, and not using dual-arch trays., Practical Implications: These results provide a snapshot of clinical care considerations among a diverse group of dentists. Clinicians can compare their own remake rates and impression evaluation techniques with those in this sample when developing best practice protocols., (Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to survey members of The American College of Prosthodontists (ACP) to evaluate current materials and methods for final impressions for complete denture prosthodontics in the United States. In addition, those methods were compared with methods and materials taught in U.S. dental schools via a second survey sent to the chairpersons of prosthodontic/restorative departments., Materials and Methods: An anonymous questionnaire was mailed to all 1762 active ACP members in the United States in 2003. A slightly modified questionnaire was also distributed to chairpersons of prosthodontic/restorative departments in the 54 U.S. dental schools. Data analysis was performed via frequency distribution and chi-square statistics., Results: Nine hundred and forty-five questionnaires were returned by members of the ACP (54% return rate) and 42 questionnaires were returned by the U.S. dental schools (78% return rate). The majority of the reporting prosthodontists (88%) and dental schools (98%) use a border-molded custom tray for final impressions for complete denture prosthodontics. The most popular material for border molding was plastic modeling compound (67% of reporting ACP members, and 95% of the responding dental schools). Variability of the materials used for final impressions was observed, with the most popular materials being polyvinylsiloxane for the ACP members (36%) and polysulfide for the dental schools (64%). Statistically significant differences were found in the materials used for border molding by prosthodontists based on the time elapsed since completion of prosthodontic training. No differences were found in the materials used for impression of edentulous arches based on years of experience. Geographic location did not influence the materials and methods used by prosthodontists for complete denture final impressions., Conclusions: There was variability of the materials and techniques used for final impressions by ACP members and dental schools; however, overall there was an agreement on the materials and techniques used by prosthodontists and dental schools. Distinct trends for increasing use of polyvinylsiloxane and polyether for border molding procedures and impressions of edentulous arches were observed both in members of the ACP and in the U.S. dental schools.

This paper presents a response to the editorial opinion expressed in the position paper "Promotion of the Use of a Thermoplastic Material to Aid in the Identification of Unidentified Human Remains," published on page 14 of this issue of the JOURNAL OF THE MASSACHUSETTS DENTAL SOCIETY. No references were cited in that paper: Because the mission of the American Board of Forensic Odontology (ABFO) is to "promote and enhance the science of forensic odontology" and realizing that the ABFO Guidelines on bite mark evidence has failed law enforcement in several high-profile cases in the past, it is necessary to publish a referenced response addressing some of the statements that were made in the ABFO article.

Purpose: In 2001, a survey of U.S. dental schools was conducted to determine which concepts, techniques and materials are currently prevalent in the teaching of final impression procedures for complete dentures in the predoctoral clinical curriculum., Materials and Methods: The questionnaire was mailed to the chairperson of the prosthodontic/restorative departments of 54 U.S. dental schools. Of these, 44 schools returned the completed survey resulting in a response rate of 82%., Results: Results from this survey show that the majority of schools (71%) teach the selective-pressure technique for final impression making; the majority of the schools (64%) use modeling plastic impression compound for border molding the final impression tray; 39% of the schools do not place vent holes in the final impression tray, 30% of schools place more than one hole and 27% place one hole only; the majority of the schools (98%) are using custom trays for final impressions. Ninety-eight percent of the schools are border molding the custom tray and 70% of schools are using a visible light-cured (VLC) composite resin material to make the trays. Thirty-six percent of the schools are teaching the Boucher impression technique and 34% are teaching the modified Boucher impression technique., Conclusions: Predoctoral clinical complete denture educational programs agree on many aspects of final impression making, however, there is variability in their teachings regarding the impression philosophy and the materials used.

Background: The need to disinfect impressions is crucial to prevent the transmission of infectious diseases. The authors report the results of a survey of U.S. dental laboratory directors. The survey was designed to determine how well dental laboratory personnel are communicating with dentists regarding the disinfection of impressions, and, in turn, what laboratory technicians are doing to protect themselves against microbial cross-contamination., Methods: Four hundred dental laboratory directors were selected in a blinded and random manner. To create a geographically representative sample, an equal number of laboratory directors from the East, Midwest and West were interviewed. A survey consisting of 16 open-ended questions was conducted by trained interviewers via 10- to 15-minute telephone interviews. All dental laboratory directors stated that they were thoroughly familiar with their laboratory's disinfection protocol., Results: The survey documented that the majority of impressions were made of polyvinyl (57 percent) or polyether (27 percent) materials. Only 44 percent of the respondents stated that they knew if the impressions they received had been disinfected. Twenty-three percent of the laboratory directors did not know the method of disinfection used, and 47 percent did not know the length of time involved. Forty-five percent of the respondents reported that they receive inadequate instruction in regard to disinfection techniques. No one class of impression materials was found to be more problematic than others by the laboratory directors., Conclusions: The results indicate a significant and problematic lack of communication between these team members. The responses also suggested that laboratory-perceived problems with impressions were not linked to any particular type of material, but more to the disinfection technique used., Practice Implications: Lack of communication between dentists, staff members and dental laboratory personnel, along with poor training of laboratory personnel in disinfection techniques, may have a direct effect on the prosthetic results achieved in dental practices.

A brief mail survey of North American dental schools was undertaken to ascertain the current techniques in complete denture prosthodontics regarding preliminary and final impressions, record bases, and denture teeth. Of the 64 schools surveyed, 54 responded (84%). Seventy-four percent of the respondents used only irreversible hydrocolloid (alginate) for their preliminary impressions; 15% used only modeling plastic impression compound. Eighty-one percent used only modeling plastic impression compound for border molding of the final impression tray; 7% used only polyether impression material. Forty-eight percent used only polysulfide rubber (PR) impression material for their final impression material; 4% used only polyether impression material. Only 1 school still used shellac as one of its materials for record bases. Thirty-five percent used only Triad; 35% used only acrylic resin; 24% used both of these materials. Thirteen percent of responding schools used only nonanatomic teeth. The majority (54%) used all three options (nonanatomic, semianatomic, and anatomic). Eleven percent used lingualized occlusion. As compared with a survey performed in 1985, the use of irreversible hydrocolloid as a preliminary impression material, the use of visible light-cured resins for record bases, and the use of anatomic teeth have increased. The use of plastic impression compound for border molding and PR as the final impression material has largely remained the same.

In a survey of dentists practicing in eight states, it was found that polysulfide is used by 35.8% of them for cast restorations. Polyether and hydrocolloid are the second most used materials; silicone putty/reline and double mix standard silicone follow. Epinephrine cord was chosen for gingival retraction by 73.3% of the respondents. Nonepinephrine cord is used by 23.5% of the dentists who responded.

A case of multiple animal bite wounds is presented along with the techniques used to apprehend the culprits. The victim was a 13 month-old black female who had in excess of 80 puncture wounds. Initially the wounds were thought to be caused by a mechanical instrument but, after an autopsy, were determined to be caused by a large animal. Two German shepherd dogs were apprehended and impressions of their teeth compared favorably with the wounds from both the casts made from the body and the body itself. The etiology of the wounds was further substantiated by microscopic examination of one of the wound sites. The identification of bite wounds and the techniques used to confirm the identity of the culprit are discussed.