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Background Little attention has been paid to the effect of implant restorations on speech. Purpose The aim of this study was threefold: (1) to find out if speech problems occur after inserting a fixed provisional restoration in the edentulous maxilla; (2) to explore speech adaptation in case articulation problems arise after rehabilitation; and (3) to describe the effect of changing the shape of the restoration on improving speech. Materials and Methods Ten patients with an edentulous maxilla were treated with fixed rehabilitation on implants. Speech evaluation was performed at four occasions: before implant surgery, immediately after restoration, and 3 weeks later before and after managing the speech problem by changing the shape of the restoration if speech problems occurred. Comparative three-dimensional-analysis of casts of the restoration before and after changing the shape of the restoration was carried out. Results The majority of patients (n = 7) experienced speech problems immediately after rehabilitation. Three weeks later, none of the seven patients with deteriorated speech returned to baseline speech. Then, volumetric reduction of the palatal aspects of the (pre)molars was performed, which allowed speech to return to baseline levels in five out of seven patients. In the two remaining patients, the intervention resulted in an improvement of speech without reaching their baseline levels. Three-dimensional-analysis showed that reducing the palatal volume of the premolars was effective in correcting speech. Conclusions Speech problems may frequently occur after fixed rehabilitation of the completely edentulous maxilla. A novel speech management concept, consisting of reducing the palatal volume of the (pre)molars, is introduced, demonstrating to solve speech problems in most cases.

Background The term bone quality is often used in a dentomaxillofacial context, for example in implant planning, as bone density and bone structure have been linked to primary implant success. Purpose This research aimed to investigate the performance of adaptive thresholding of trabecular bone in cone beam CT (CBCT) images. The segmentation quality was assessed for different imaging devices and upper and lower jaws. Materials and Methods Four jaws were scanned with eight CBCT scanners and one micro-CT device. Images of the jaws were spatially aligned with the micro-CT images. Two volumes of interest for each jaw were manually delineated. Trabecular bone in the volumes of interest in the micro-CT images was segmented so that the micro-CT images could serve as high-resolution ground truth images. The volumes of interest in the CBCT images were segmented using both global and adaptive thresholding. Results Segmentation was significantly better for the lower jaw than for the upper jaw. Differences in performance between the scanners were significant for both jaws. Adaptive thresholding performed significantly better in segmenting the bone structure out of CBCT images. Conclusions When assessing jaw bone structure, the observer should always choose adaptive thresholding. It remains a challenge to identify the optimal threshold selection for the structural assessment of jaw bone.

Objectives This study aimed to assess the use of different voxel sizes of a cone-beam computed tomography (CBCT) unit for detecting root perforations of different sizes and locations ex vivo and to compare the diagnostic possibilities of CBCT with those of periapical radiography (PR).

We aimed to assess the diagnostic accuracy of different cone beam CTs (CBCTs) and the influence of field of view (FOV) in diagnosing simulated periapical lesions.6 formalin-fixed lateral mandibular specimens from pigs were used for creating 20 standardized periapical bone defects. 18 roots were selected for the control group. Three CBCT devices [Accuitomo 3D® (Morita, Kyoto, Japan), NewTom 3G (Quantitative Radiology, Verona, Italy) and Scanora® (Soredex, Tuusula, Finland)] and three FOVs (NewTom 3G® FOV 6, 9 and 12 inches) were used to scan the mandible. Five observers assessed the images, using a five-point probability scale for the presence of lesions. Specificity, sensitivity and areas under the receiver operating characteristic (ROC) curves were calculated.Sensitivity ranged from 72% to 80%. Specificity ranged from 60% to 77%. A difference in scoring between Scanora and the other two devices existed only in the control group. ROC analysis for different FOVs showed a decreased sensitivity with an increasing FOV, but this difference was not significant.the control group, there was a difference between the CBCT devices regarding their specificity. FOV size did not show any difference in diagnostic performance. In cases in which conventional radiographic methods in combination with clinical evaluation are not sufficient, CBCT may be the method of choice to assess periapical pathology. CBCT examinations should be complementary to a clinical examination and FOV adaptation can be utilized to keep the dose to the patient as low as possible.

The most frequent adverse effect of canine impaction is resorption of the adjacent incisors. The subjective image quality and the radiographic diagnostic accuracy for detection of simulated canine-induced external root resorption lesions in maxillary lateral incisors were compared among 6 cone-beam computed tomography (CBCT) systems in vitro.A child cadaver skull in the early mixed dentition was obtained. This skull had an impacted maxillary left canine and allowed a reliable simulation. Simulated root resorption cavities were created in 8 extracted maxillary left lateral incisors by the sequential use of 0.16-mm diameter round burs in the distopalatal root surface. Cavities of varying depths were drilled in the middle or apical thirds of each tooth root according to 3 setups: slight (0.15, 0.20, and 0.30 mm), moderate (0.60 and 1.00 mm), and severe (1.50, 2.00, and 3.00 mm) resorption. The lateral incisors, including 2 intact teeth, were repositioned individually in the alveolus with approximal contacts to the impacted maxillary left canine. Six sets of radiographic images were obtained with 3D Accuitomo-XYZ Slice View Tomograph (J. Morita, Kyoto, Japan), Scanora 3D CBCT (Soredex, Tuusula, Finland), Galileos 3D Comfort (Sirona Dental Systems, Bensheim, Germany), Picasso Trio (E-WOO Technology, Giheung-gu, Republic of Korea), ProMax 3D (Planmeca OY, Helsinki, Finland), and Kodak 9000 3D (Trophy, Croissy-Beaubourg, France) for each tooth setup. The CBCT images were acquired and subsequently analyzed by 12 observers. Linear models for repeated measures were used to compare the CBCT systems for the image quality and the degree of agreement between the diagnosed severity of root resorption and the true severity.The differences in the image quality between CBCT systems were statistically significant (P 0.001). The root resorption scores between CBCT systems showed a significantly higher score for the ProMax when compared with the Galileos and the Kodak. However, the differences in agreement between the diagnosed severity of root resorption and the true severity for all resorption sizes were not significantly different (P 0.05) among the different CBCT systems.High image quality is important when detecting root resorption. The CBCT systems used in this study had high accuracy with no significant differences between them in the detection of the severity of root resorption.

This review evaluates the evidence for the diagnostic efficacy of cone beam computed tomography (CBCT) for impacted teeth and associated features. PubMed, Embase and the Cochrane Library were searched using specific indexing terms and reference lists were hand searched. Two reviewers selected relevant publications on the basis of pre-determined inclusion criteria. Original studies were assessed using a modification of the quality assessment of diagnostic accuracy studies (QUADAS) tool. The literature search yielded 96 titles, of which 7 were included in the review. There was only limited evidence for diagnostic efficacy expressed as sensitivity, specificity and predictive values. Only two studies compared CBCT and panoramic radiographs with a valid reference method and presented the results in terms of percentage of correct diagnoses. This review reveals a need for studies that meet methodological standards for diagnostic efficacy of CBCT in the diagnosis of impacted teeth.

Objectives: The aim of this study was to evaluate the variability of intensity values in cone beam computed tomography (CBCT) imaging compared with multislice computed tomography Hounsfield units (MSCT HU) in order to assess the reliability of density assessments using CBCT images. Material and methods: A quality control phantom was scanned with an MSCT scanner and five CBCT scanners. In one CBCT scanner, the phantom was scanned repeatedly in the same and in different positions. Images were analyzed using registration to a mathematical model. MSCT images were used as a reference. Results: Density profiles of MSCT showed stable HU values, whereas in CBCT imaging the intensity values were variable over the profile. Repositioning of the phantom resulted in large fluctuations in intensity values. Conclusions: The use of intensity values in CBCT images is not reliable, because the values are influenced by device, imaging parameters and positioning. To cite this article: Nackaerts O, Maes F, Yan H, Couto Souza P, Pauwels R, Jacobs R. Analysis of intensity variability in multislice and cone beam computed tomography. Clin. Oral Impl. Res. 22, 2011; 873–879. doi: 10.1111/j.1600-0501.2010.02076.x

Objectives: The aim of this in vitro study was to investigate the accuracy of fractal analysis and morphometry for bone quality assessment as measured with dual energy X-ray absorptiometry (DXA). Material and methods: Nineteen mandibular bone samples were used for the creation of artificial bone lesions (n=5) or decalcification (n=12) to simulate osteoporosis; two samples were used as controls. Cone beam computed tomography (CBCT) and DXA scans were made before and after processing the samples. The image data obtained from the CBCT scans were used to calculate the mean fractal dimension (FD), bone area and density (morphometric analysis) of the samples. Bone mineral density (BMD) was obtained from the DXA scans and set as a reference value for bone quality. The correlation between BMD and FD and between BMD and morphometric results were calculated. Results: A significant correlation between FD and BMD (ρ=+0.71 to +0.75; P

Objectives: To determine the diagnostic accuracy of mandibular and maxillary bone densityin detecting osteoporosis using receiver operating characteristic (ROC) analysis.Methods: 671 women between 45 years and 70 years of age underwent dual energy X-rayabsorptiometry (DXA) of the hip and lumbar spine. This was the gold standard for diagnosing osteoporosis. Intraoral radiography of the upper and lower right premolar regionwas performed, using an aluminium wedge as a densitometric reference. Jaw bone densitywas determined using dedicated software. Observer differences and ROC curves wereanalysed.Results: For detecting osteoporosis using jaw bone density, the area under the ROC curve(Az) was 0.705. For separate analysis of mandibular and maxillary films, sensitivity variedfrom 33.9% to 38.7% and specificity from 83.5% to 85.3% when using a threshold of 4.3 mm Al equivalent.Conclusions: Density of the premolar region reaches a fair diagnostic accuracy, which might improve when including additional factors in the analysis and refining the densitometric tool.

Little attention has been paid to the effect of implant restorations on speech.The aim of this study was threefold: (1) to find out if speech problems occur after inserting a fixed provisional restoration in the edentulous maxilla; (2) to explore speech adaptation in case articulation problems arise after rehabilitation; and (3) to describe the effect of changing the shape of the restoration on improving speech.Ten patients with an edentulous maxilla were treated with fixed rehabilitation on implants. Speech evaluation was performed at four occasions: before implant surgery, immediately after restoration, and 3 weeks later before and after managing the speech problem by changing the shape of the restoration if speech problems occurred. Comparative three-dimensional-analysis of casts of the restoration before and after changing the shape of the restoration was carried out.The majority of patients (n = 7) experienced speech problems immediately after rehabilitation. Three weeks later, none of the seven patients with deteriorated speech returned to baseline speech. Then, volumetric reduction of the palatal aspects of the (pre)molars was performed, which allowed speech to return to baseline levels in five out of seven patients. In the two remaining patients, the intervention resulted in an improvement of speech without reaching their baseline levels. Three-dimensional-analysis showed that reducing the palatal volume of the premolars was effective in correcting speech.Speech problems may frequently occur after fixed rehabilitation of the completely edentulous maxilla. A novel speech management concept, consisting of reducing the palatal volume of the (pre)molars, is introduced, demonstrating to solve speech problems in most cases.

The term bone quality is often used in a dentomaxillofacial context, for example in implant planning, as bone density and bone structure have been linked to primary implant success.This research aimed to investigate the performance of adaptive thresholding of trabecular bone in cone beam CT (CBCT) images. The segmentation quality was assessed for different imaging devices and upper and lower jaws.Four jaws were scanned with eight CBCT scanners and one micro-CT device. Images of the jaws were spatially aligned with the micro-CT images. Two volumes of interest for each jaw were manually delineated. Trabecular bone in the volumes of interest in the micro-CT images was segmented so that the micro-CT images could serve as high-resolution ground truth images. The volumes of interest in the CBCT images were segmented using both global and adaptive thresholding.Segmentation was significantly better for the lower jaw than for the upper jaw. Differences in performance between the scanners were significant for both jaws. Adaptive thresholding performed significantly better in segmenting the bone structure out of CBCT images.When assessing jaw bone structure, the observer should always choose adaptive thresholding. It remains a challenge to identify the optimal threshold selection for the structural assessment of jaw bone.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of clinical criteria for the diagnosis of hyposalivation in hospitalized patients. MATERIAL AND METHODS: A clinical study was carried out on 145 subjects (48 males; 97 females; aged 20 to 90 years). Each subject was clinically examined, in the morning and in the afternoon, along 1 day. A focused anamnesis allowed identifying symptoms of hyposalivation, like xerostomia complaints (considered as a reference symptom), chewing difficulty, dysphagia and increased frequency of liquid intake. Afterwards, dryness of the mucosa of the cheecks and floor of the mouth, as well as salivary secretion during parotid gland stimulation were assessed during oral examination. RESULTS: Results obtained with Chi-square tests showed that 71 patients (48.9%) presented xerostomia complaints, with a significant correlation with all hyposalivation symptoms (p

Purpose To measure sensory disturbances of the inferior alveolar nerve (IAN) after removal of impacted mandibular third molars using cone beam computed tomography (CBCT) and dental panoramic radiography (PAN) for preoperative assessment in a randomized controlled trial and to measure the efficacy of the observers' prediction of IAN exposure at surgery based on CBCT compared with PAN. Materials and Methods The sample consisted of 86 impacted third molars (from 79 consecutive patients) in close relation to the IAN as determined by PAN and judged as showing a “moderate” risk of IAN damage. Cases presenting with no close relation between the IAN and roots and extremely risky cases with an obvious interrelation were excluded. Potential neurosensory disturbances of the lip and chin were assessed before surgery and during the postoperative recall by measuring the function of the IAN with the light-touch sensation method. Results Postoperative sensory disturbances occurred in 1 patient in the CBCT group and 1 patient in the PAN group. The light-touch sensation test showed no significant differences at the lip (P = .10) and chin (P = .17) levels for CBCT- versus PAN-based surgery. Significant differences in making a correct diagnosis of neurovascular bundle exposure at the extraction of impacted teeth were found between the 2 modalities (P = .029). Conclusions Within the limits of the present pilot study, CBCT was not superior to PAN in predicting postoperative sensory disturbances but was superior in predicting IAN exposure during third molar removal in cases judged as having “moderate” risk.

Objectives The present study evaluated the clinical validity of cone-beam computed tomography (CBCT) scans in comparison to panoramic radiographs regarding preoperative implant planning in combination with sinus grafting procedures. Materials and methods Preoperative assessment of the maxillary sinuses and implant planning using panoramic radiographs and CBCT scans was performed on 16 sinuses (13 patients) and comprised choice of treatment, timing of implant placement, sinus morphology, level of confidence, complication prediction and graft volume assessment. Six examiners were involved in the study. Results In the majority of cases there was a concordance between the treatment type based on either panoramic radiographs or CBCT. If any difference was found, this was due to an overestimation of bone quantity and quality on panoramic radiographs. The assessment of sinus morphology showed a significantly higher detection rate of sinus mucosal hypertrophy on CBCT. The most appealing result is a significant increase in surgical confidence and a significantly better prediction of complications when using CBCT. Conclusions A preoperative planning based on CBCT seems to improve sinus diagnostics and surgical confidence.

The aim of this study was to evaluate the variability of intensity values in cone beam computed tomography (CBCT) imaging compared with multislice computed tomography Hounsfield units (MSCT HU) in order to assess the reliability of density assessments using CBCT images.A quality control phantom was scanned with an MSCT scanner and five CBCT scanners. In one CBCT scanner, the phantom was scanned repeatedly in the same and in different positions. Images were analyzed using registration to a mathematical model. MSCT images were used as a reference.Density profiles of MSCT showed stable HU values, whereas in CBCT imaging the intensity values were variable over the profile. Repositioning of the phantom resulted in large fluctuations in intensity values.The use of intensity values in CBCT images is not reliable, because the values are influenced by device, imaging parameters and positioning.

Ingesloten verstandskiezen bevinden zich soms in de nabijheid van de nervus alveolaris inferior, waardoor een eventueel geplande extractie complicaties kan veroorzaken. In dergelijke gevallen is extra voorzichtigheid geboden en is het van groot belang dat de arts de extractie aan de hand van radiologisch beeldmateriaal goed kan voorbereiden.

Objectives: The OSTEODENT index is a predicted probability of osteoporosis derived from a combination of an automated analysis of a dental panoramic radiograph and clinical information. This index has been proposed as a suitable case-finding tool for identification of subjects with osteoporosis in primary dental care; however, no data exist on the relationship between OSTEODENT index and fracture risk. The aims of this study were to assess the relationship between the OSTEODENT index and hip fracture risk as determined by FRAX and to compare the performance of the OSTEODENT index and FRAX (without femoral BMD data), in determining the need for intervention as recommended in UK national treatment guidance. Study design: The study was a retrospective analysis of data from 339 female subjects (mean age 55.3 years), from 2 centers: Manchester (UK) and Leuven (Belgium). Clinical information and femoral neck BMD were available for FRAX, and dental panoramic radiographic data and clinical information were available to calculate the OSTEODENT index. Subjects were classified into "treat" or "lifestyle advice and reassurance" categories using the National Osteoporosis Guideline Group (NOGG) threshold. Results: The OSTEODENT index result was significantly related to the 10-year probability of hip fracture derived from the reference standard FRAX tool (Rs = 0.67, P

The aim of this study was to determine whether alcohol consumption would predict mandibular bone quality and quantity in a large European female population. In total, 672 middle-aged and elderly women (45-70 yr of age; standard deviation = 6) were recruited in the study. Alcohol consumption was recorded through a self-reported questionnaire. Mandibular cortical width was measured, by five observers, in the mental foramen region on panoramic radiographs. Mandibular bone density, expressed as aluminium thickness, was recorded on intra-oral radiographs. Alcohol consumption was associated with a reduction of mandibular bone density and cortical width. This association was higher in subjects with excessive alcohol consumption, defined in the present study as > 14 units consumed per week. This study showed reduced jaw-bone quality in older individuals and in those with increased alcohol consumption.

Aim The aim of this study was to radiologically evaluate the impact of replacement therapy by monitoring bone density changes and alveolar bone level in periodontal pockets in a dog model. Material and methods Eight male beagle dogs with moderate periodontitis were enrolled in this split-mouth, double-blind randomized trial with ethical approval. Periodontal defects were surgically created bilaterally in the lower jaw. Four months later, the defects were randomly assigned to initial therapy (scaling and root planing) alone (control sites), or combined with multiple subgingival application of beneficial species. Intra-oral follow-up radiography was performed at this stage and 3 months later to verify the treatment effect. Results The bone density within periodontal pockets treated with beneficial bacteria improved significantly after 12 weeks, while this was non-significant for the control pockets, receiving a single root planing at baseline. There was a significant increase in the bone level at the end of the study for the pockets receiving beneficial bacteria. Again, no significance was noted for the control pockets. Conclusions This pilot study indicates the potential effect of a subgingival application of beneficial species in periodontal pockets, and illustrates the strength of standardized follow-up radiography to evaluate the effects of different treatment strategies on bone re-modelling.

To assess the accuracy and reliability of new software for radiodensitometric evaluations.A densitometric tool developed by MevisLab was used in conjunction with intraoral radiographs of the premolar region in both in vivo and laboratory settings. An aluminum step wedge was utilized for comparison of grey values. After computer-aided segmentation, the interproximal bone between the premolars was assessed in order to determine the mean grey value intensity of this region and convert it to a thickness in aluminum. Evaluation of the tool was determined using bone mineral density (BMD) values derived from decalcified human bone specimens as a reference standard. In vivo BMD data was collected from 35 patients as determined with dual X-ray absorptiometry (DXA). The intra and interobserver reliability of this method was assessed by Bland and Altman Plots to determine the precision of this tool.In the laboratory study, the threshold value for detection of bone loss was 6.5%. The densitometric data (mm Al eq.) was highly correlated with the jaw bone BMD, as determined using dual X-ray absorptiometry (r = 0.96). For the in vivo study, the correlations between the mm Al equivalent of the average upper and lower jaw with the lumbar spine BMD, total hip BMD and femoral neck BMD were 0.489, 0.537 and 0.467, respectively (P0.05). For the intraobserver reliability, a Bland and Altman plot showed that the mean difference +/- 1.96 SD were within +/-0.15 mm Al eq. with the mean difference value small than 0.003 mm Al eq. For the interobserver reliability, the mean difference +/-1.96 SD were within +/-0.11 mm Al eq. with the mean difference of 0.008 mm Al eq.A densitometric software tool has been developed, that is reliable for bone density assessment. It now requires further investigation to evaluate its accuracy and clinical applicability in large scale studies.

Objectives The objective of the present study was to evaluate the influence of immediate loading of implants on speech adaptation. Material and methods Ten patients (mean age 54, 6 females) were examined before surgery and 1, 3, 6 and 12 months afterwards. Articulation analysis was done using objective DAT-recoded data evaluated by two groups of speech and language therapists and a computer software program. Besides, patient VAS-scores, myofunctional problems and hearing impairment were recorded and analysed. Results In the present study only one patient suffered from deteriorated speech after immediate loading. Other patients showed unaffected or improved articulation 3 to 6 months after surgery with a strident and interdental pronunciation mostly becoming addental. Furthermore, myofunctional problems occurred in one patient, other patients adapted to the new situation after three months. Hearing impairment did not influence speech pathology in this study. Conclusion Immediate loading of oral implants does not seem to compromise the normal 3-6 months speech adaptation period. Whether such procedure presents advantages to the conventional 2-stage rehabilitation remains to be investigated.

Jaw bone density measurements are applicable in many clinical situations to assess bone tissue. To be able to implement research findings in clinical reality, tools must be simple and low cost. Intra-oral radiographs including a reference material perform well as a densitometric tool. However, the inclusion of a reference material, usually in the form of a metal wedge, is an additional burden for the dentist. The aim of this study was to evaluate whether a reference step wedge is required for accurate densitometric results. Dual energy X-ray absorptiometry measurements and densitometric measurements on intra-oral radiographs using a custom-made software were performed on bone samples from the premolar region of the mandible. Observer agreement of bone density expressed as grey value was high. The correlation between mandibular bone mineral density and the densitometric values on intra-oral radiographs was substantially higher when the aluminium step wedge was included. The Wilcoxon test revealed no significant difference between the density measurements using nine or three steps of the Al reference wedge. Density determination of grey value and mm Aleq thickness value both have good intra- and inter-observer agreement. However, jaw bone densitometry is far more accurate when including a reference wedge.

To develop a digital densitometric tool for jaw bone to analyse intraoral radiographs. To assess precision and accuracy for this tool and determine the minimal detection threshold for density changes.Bone samples deriving from the premolar region of 47 human mandibles were selected for analysis. The samples were obtained from adult cadavers in the department of anatomy (Faculty of Medicine, KULeuven) with ethical approval. Digital radiography was performed on all bone samples. Direct volumetric measurements served as gold standard density values and allowed determination of accuracy. Dual-energy X-ray absorptiometry (DXA) scans were performed on all specimens. For all radiographs, density in mm Al eq was calculated using custom-made software, Osteop. Precision and intraobserver and interobserver reliability of this method were assessed. The bone specimens were progressively decalcified. At standard time intervals the percentage of decalcification was calculated. At each decalcification step, radiographs were taken and analysed.CV was always lower than 3%, which points to a good precision of the method. Correlation between the density measurements in mm Al eq and the DXA results was 0.9, for the density measurements in mm Al eq and the direct density measurements r was 0.5. The custom-made software was able to detect a change in bone mineralization of 6.6%.The present method for bone densitometric analysis offers potentials for clinical evaluation of bone density and minute bone density changes in the jaw bone.

The aim was to explore the relation between radiographic bone quality on panoramic radiographs and relative alveolar bone level. Digital panoramic radiographs of 94 female patients were analysed (mean age, 44.5; range, 35–74). Radiographic density of the alveolar bone in the premolar region was determined using Agfa Musica® software. Alveolar bone level and bone quality index (BQI) were also assessed. Relationships between bone density and BQI on one hand and the relative loss of alveolar bone level on the other were assessed. Mandibular bone density and loss of alveolar bone level were weakly but significantly negatively correlated for the lower premolar area (r = -.27). The BQI did not show a statistically significant relation to alveolar bone level. Radiographic mandibular bone density on panoramic radiographs shows a weak but significant relation to alveolar bone level, with more periodontal breakdown for less dense alveolar bone.

The aim of this study was to gather data on occupational health effects among Flemish dentists. A questionnaire on various potential health effects was sent out to randomly selected Flemish dentists. Pilot experimental studies were performed on hearing and sensory function of the fingers on small groups of dentists. Audiometric data of both ears, gathered with an interval of 10 years, were analysed. Sensory tests of the fingers were performed for dominant and non-dominant hands in relation to exposure time to (ultra)sonic equipment. Positive responses for the questionnaire were as follows: low back pain, 54% (stress-correlated); vision problems, 52.3% (age-correlated); infections, 9%; allergies, 22.5% (mainly latex); stress level was scored 7 on a scale from 0 to 10; diminished sensitivity of the fingertips, 6% and auditory disorders, 19.6%. Pilot audiometric data showed a hearing loss at 4,000 Hz for the left ear, presumably indicative of occupational noise trauma. The two-point discrimination ability of the dominant hand tended to diminish in line with the number of years of practice. Dentists in Flanders were found to suffer from various health-related problems. More elaborate studies are required to provide more details on the risks for occupational hearing impairment and vibration hand neuropathy and to determine whether the problems described were related to the practice of dentistry.