Category: Dentistry

Crowns date back almost 4,000 years. Skeletons in Asia have revealed golden caps and gold tooth replacements on teeth. Unlike back then dentistry has become more esthetic with patients wanting tooth-colored crowns instead of gold or alloys. Patients prefer people not knowing they have received dental work. A purpose to a crown is to protect the structure of the tooth after the dentist has prepped it permanently. Crowns come in many types of materials that can be fabricated by the dentist or sent out to a laboratory. A laboratory is used when the patient wants a more natural looking tooth or a crown fused to metal. With this method it can take up to a week or two to get the crown back from the laboratory. The second way is having a machine called the CEREC make a crown in the dental office. This has machine been around for decades. The Difference between the traditional crowns and the CEREC is crowns are made fast, easy, and precise. It can all be done from the dental office if the equipment is available. But like all products available there can be pros and cons to CEREC and traditional crowns.

CEREC short for Chairside Economical Restoration of Esthetic Ceramics has been used for many years with great results. This machine has a camera attachment that goes in the patient’s mouth and takes multiple pictures of the tooth that has been prepped by the dentist for a crown. The pictures are then sent to a computer that inputs the information and designs a perfect crown for that patient. In the article ‘What Is CEREC in Dentistry?’ it says, “There is no need for a temporary restoration if the treatment is completed in the dental office”. This is also true because you do not have to make a temporary crown. This is an extra step that would be totally eliminated from the process.

You then choose a block of material that will be carved into the patient’s crown. This block will be made out of a ceramic material. You would first need to know what color shade your patient’s teeth are to best match them. The great things about CEREC crowns are they are fabricated same day. Patients really appreciate this because they do not have to wait a week or two to get it back from the laboratory. In the article ‘Advantages and Disadvantages of Same Day CEREC Crown’, it says, “If you are a very busy person, multiple visits to a dentist for a dental crown are the last thing you want. Same day CEREC crowns make the process less complicated and a lot faster”. That is a big plus for the patient and the office because instead of two appointments they only need one.

CEREC crowns are used most often for posterior teeth but can be used anywhere else in the mouth. It all depends on the patient and the dentist opinion. You typically would not want a CEREC crown for an anterior tooth because of how unrealistic the material can look. The ceramic materials for anterior teeth are not esthetically pleasing and would look un-natural to the naked eye. Since the crown is done in one appointment it will be more cost effective to the patient. CEREC does not have the ability to make metal crowns. This is a reason they can be less durable because they can only be made out of ceramic material. This is a big reason why CEREC crowns are less durable and can last a patient less time than a traditional laboratory crown.

Traditional laboratory fabricated crowns are still used a lot in dentistry. If done correctly a lab-fabricated crown can be made out to look the most natural in a patient’s mouth. There are a few reasons why a crown is needed on a tooth for example, protect it from decay, keep the tooth from breaking, or to restore a broken tooth etc. Lab fabricated crowns tend to be more expensive like the article ‘CEREC or Lab Made Crowns? Pros & Cons’ it says, “Lab-made crowns are a traditional and effective method for teeth restoration. They are made of a combination of porcelain and metal. The pros are that traditional crowns are durable and look like natural teeth. Typically, the fit of these crowns are well-aligned with your natural bite”. Traditional crowns are made with both metals and porcelain making them stronger than CEREC crowns.

When a crown has metal attached to the porcelain it will add to the expense, but to the durability as well. This type of crown is called porcelain fused to metal crown. These crowns have both the durability and esthetic you would want in a crown. On the outside they look like a normal tooth and on the inside, they have metal, which bonds to a tooth structure very well. Traditional crowns are made from metals and ceramics and other materials as well. The increase of strength is also because the variety of material options a lab has. With CEREC you can only use ceramic material that comes in ceramic blocks. Traditional crowns are made by different choices of porcelain and metals and painted by skilled hands to mimic that natural appearance of the patients nearby teeth. This allows the crown to look natural in appearance.

The process of sending out a patient’s information to the laboratory is a procedure that has to be followed to detail. This will ensure your patient will get the best crown back from the laboratory. The dental assistant will first take a shade of the patients tooth while the patient is waiting for the anesthesia to take effect. The second step would be to take a preliminary impression of the tooth that will be getting that crown. This step is very important because you will be making a temporary crown with this impression. The temporary crown will be seated like the name says, temporarily waiting for the final crown to come back from the laboratory. You also want to take an impression of the opposing arch to have a centric occlusion of the patient’s mouth. The lab technician uses this information for the final crown adjustments. With all of this you will also be sending a bite registration, which will also be used by the lab techs to help them make final modifications to make the crown perfect for the patient. All this information will be sent over with a slip filled out for the laboratory. There are many steps to follow with traditional crowns unlike the CEREC. Traditional crowns are especially important when you are working with a patient’s front tooth. Since this is the first impression someone makes you want the front teeth to look the most natural and appealing. An advantage of a traditional crown is that they are much stronger. The strength is much higher because the lab can have a combination of metals and porcelain that can be utilized. The metals bond to the tooth a lot stronger. For that reason, they are more resilient to fracture making them tough.

From the diagram below you could tell the majority of people preferred the PRM (porcelain fused to metal). This crown has both the durability and the esthetics patients really like. When you are paying for a crown, it is important to also note the force that is applied in that area. The dentist will make that a big factor of what crown will best suit your situation. After reviewing all my information gathered on these two types of crowns a lot of factors play a role. If I were a busy person, I would most likely go with the CEREC crown because it would complement my schedule. Yet, I would have to recognize the area where that crown would go. You are getting what you pay for so, knowing that a CEREC might not last as long I would preferably go with the porcelain fused to metal crown. Like I said before you get both the durability and the esthetic appeal. The great aspects of dentistry are understanding you have options on your choice of materials, durability, and compatibility. Every person has a different situation and depending on yours choosing what best fits you, it’s what truly matters.

Works Cited

1. ‘Advantages and Disadvantages of Same Day CEREC Crowns’. Judy Mejido DMD PA Miami Florida, 15 July 2018, http://a1care.org/blog/advantages-and-disadvantages-of-same-day-cerec-crowns/
2. Peak Dentistry. ‘CEREC or Lab Made Crowns? Pros & Cons’. Peak Dentistry, 15 Nov. 2019, http://peakdentistrync.com/blog/cerec-or-lab-made-crowns/
3. StackPath, www.dentistryiq.com/dentistry/restorative-cosmetic-and-whitening/article/16348313/what-you-said-about-restorative-materials
4. ‘What Are the Differences Between CEREC and Lab Made Dental Crowns’. Sutra Dental Spa, www.sutrads.com/practice-news/what-is-the-difference-between-cerec-and-lab-made-dental-crowns/
5. ‘What Is CEREC in Dentistry?’ Colgate® Oral Care, www.colgate.com/en-us/oral-health/basics/dental-visits/what-is-cerec-in-dentistry

This assignment will critically analyze the differences of various governing bodies. There are three main governing bodies. Such organizations are the International Standard Organization (ISO), the European Commission (CE) and the British Standard Institution (BSI).

The ISO is an organization that sets standards of materials worldwide. The BSI and CE govern standards across Britain and Europe accordingly. Although, each governing body has different standards and quality assurance. ​All governing bodies ensure that materials and appliances produced meet set criteria and are released reliably. ​These governing bodies set standards more many different materials and each organization apply different processes required to accept new materials onto the marketplace. However, different organizations have a significant impact on the production of dental appliances. Such organizations are the Medicines and Healthcare products Regulatory Agencies (MHRA), which ensures that medicines and medical devices work and are acceptably safe, and the Medical Devices Directive (MDD) which is intended to harmonize the laws regarding the medical devices inside the European Union.

This essay will be focusing on dental materials, specifically acrylic. ​Acrylic is a versatile material that is used in many dental appliances and is one of the most useable materials in dentistry. This essay will show the ways in which acrylic is tested and how it meets the standards required.

Biomaterial Testing Methods and Quality Assurance

Medical devices which are used in dentistry must be tested and approved by the governing bodies. The members of the European Committee for Standardization (CEN) will agree to the Internal Regulations which stipulate the conditions for giving this European Standard the status of a national standard with no change. CEN members are the national standards bodies of several European countries such as Austria, Belgium, Bulgaria, etc. There are three levels of European Standards managing medical devices utilized in dentistry. The level one is for the general requirements for medical devices, level two for requirements for families of medical devices utilized in dentistry and level three for determinate requirements for types of medical devices utilized in dentistry.There are no level 1 standards composed solely in regard of medical devices utilized in dentistry. This European Standard is a level two standard and requirement that apply to those things of dental equipment which are medical devices. This European Standard also shows that there are extra requirements in the level three standards. Where accessible, these are incorporated as regulating references. To cover every one of the requirements for a specific item, it is important to utilize a standard of the lowest available level. This European Standard indicates general requirements for dental equipment utilized in dentistry and which are medical devices. It incorporates requirements for proposed performance, structure characteristics, components, packaging, checking, marking and data provided by the manufacturer. BSI is the autonomous national body in charge of preparing British Standards. It displays the UK view on standards in Europe and at the worldwide level. It is joined by Royal Charter. British Standards are updated by change or revision. Clients of British Standards should ensure that they have the most recent changes or editions. It is the steady point of BSI to enhance the quality of medical products and administrations. BSI offers members an individual updating administration called PLUS which guarantees that supporters immediately get the most recent editions of standards. Because of requests for worldwide standards, it is BSI approach to supply the BSI execution of those that have been distributed as British Standards, except if generally asked (BSI, 2004).

The MHRA is the government agency which is responsible for guaranteeing that medicines and medical devices work and are acceptably safe. The MHRA is an official agency of the Department of Health in the United Kingdom (MHRA, 2013). The MDD managing the safety and marketing of every single medical device whether utilized in the public or private sector, required member of the European Community. MDD is expected to harmonize the laws identifying with medical devices inside the European Union. The UK Regulations covering these arrangements are the Medical Devices Regulations (MDR). Dental appliances which are made for a specific patient, are characterized as custom-made devices and the requirements of Annex VIII of the MDD will apply to those who wish to fabricate these items (MHRA, 2008).

CE marking must be appended to specific items sold inside European Union to demonstrate that they comply with legislation required by 18 nations in the European Community. CE marking acts as a ‘certificate’ which enables a manufacturer to allocate products inside the European market (Hill et al., 2015).

According to Bluebee (2018) ISO 13485 is a worldwide recognized medical device quality administration systems standard, which was granted to Bluebee for its plan and advancement of programming solutions and information processing algorithms planned for use in diagnostics and clinical reporting. This confirmation is granted for quality administration systems in medical devices. The performance of this accreditation further indicates Bluebee’s responsibility to supplying quality hazard-based programming improvement, regulatory compliance, quality management, and highly secured analytical workflows to clinical laboratories and diagnostic essay suppliers.

The purpose of a research paper was to provide a cross‐section of ISO 9000 quality certification diffusion after some time and its effect on industrial systems. The beginning stage of the investigation is the ISO review of ISO 9000 and ISO 14001 authentications record. Accessible information coincides to follow a synthesis of what has occurred and what is in process internationally. ISO 9000 certification has operated as a catalyst of the current inclinations, to prompt associations towards a basic model dependent on the rationale strategic quality management (Franceschini et al., 2006). Comparing different countries, the advancement of certification after some time is certainly not a modern phenomenon. In few nations ISO certification has been profoundly practiced since standards’ introduction. For example, UK, France and Germany. In some others it met with most extreme interest just in the recent years such as China and other eastern nations. In those nations in which the certification diffusion is a long‐standing phenomenon, the quantity of certificates is near to arrive at a saturation level. This impact is mainly obvious for UK, Germany and France. In these nations the market of certifications is coming to saturation. The saturation level stands for just a restricted fraction of the aggregate number of Corporation Companies (CC). The experimental saturation esteems for UK, Germany and France are 9, 8 and 2 percent of CC respectively in each nation. Quality certification diffusion started when some organizations, with the purpose of separating themselves in the business antagonism, showed a desire to give an outer and formal proof of their organizational efforts towards quality practice. For some European nations, with comparable innovative structures, the outcomes demonstrate that the anticipated normal saturation level is around 10 percent. The equivalent ‘saturation effect’ can be noticed for some other non‐European nations such as Australia, Republic of Korea, and USA (Franceschini et al., 2004). Investigating the regional share of certificates in the pass of time from January 1993 till December 2002, two components are especially relevant. A consistent and efficient decrease of European nations’ certificates and a parallel development of Far East nations’ certificates. This occurs by two essential causes. The development of quality of the market in Europe especially confirm by the accomplishment of the saturation level in many nations, and the appearing of emerging nations such as China and Republic of Korea. The main ten nations for ISO certificates in 2002 stand for more than 70 percent of the total certifications worldwide. Five of them are European nations, for example, Italy, Spain, Germany, France and UK. The first place for ISO certificates is held by China which is considered as an emerging country in the worldwide market. The adoption of ISO 9000 certifications in USA industry has lagged compared with other countries because of inquiries concerning whether the advantages of ISO 9000 enrolment were adequate to counterbalance costs and sheer complexity. The natural dynamism of USA market has also supported this behavior and did not force companies in adopting ISO 9000 certification as prominent element in business antagonism (Stevenson and Barnes, 2002).

ISO standards 10993, 14971, and 7405 determine the modes for clinical risk evaluation, test selection and test implementation. In contact with broke tissues, materials must not reduce the healing procedure. Antibacterial impacts ought to be founded on convenient controllable substances. Nanoparticles are created by intraoral grinding regardless of the substance of nanoparticles in the material, but obviously at low concentrations (Schmalz and Galler, 2017).

Biocompatibility of dental materials has gained expanding enthusiasm during late decades. Therefore, legal regulations and standard test systems are accessible to assess biocompatibility. The provided information is primarily based on an audit of the respective literature in universal peer surveyed journals, on administrative documents and on ISO standards. Endpoints for dental materials are part of most of the test programs such as in vitro cytotoxicity, mainly in vitro genotoxicity, local reactions on experimental animals or in vitro simulation tests, and sensitization which is performed mainly on experimental animals (Schmalz and Arenholt-bindslev, 2007).

Poly (methyl methacrylate) (PMMA) which is also known as acrylic resin is the most common material for full and partial denture bases, and for removable appliances. It has additionally been the synthetic model for some other material improvements in dentistry, such as removable materials. The properties, behavior and handling of acrylic resin also form a basis for understanding those different materials. A polymerization reaction is created as a part of the ordinary dental processes in the laboratory, and the best possible control of this is significant when controlling the properties of the item. Depending upon the type of polymerization, PMMA resins may drain 0.1 to 5 percent of the residual monomer and added substances. Essentially methyl methacrylate (MMA) and formaldehyde, contributing to restricted allergic reactions. Studies have indicated a conceivable cancer-causing and embryotoxic potency of MMA (Bhola et al., 2010). It is important to comprehend both the heat-cured and cold-cured types, whose properties and limitations contrast due to their processing variations. Storage of MMA monomer is an issue because it is a very reactive compound. The properties of the plain item are not perfect, yet different changes to the chemistry are conceivable to obtain better behavior of the material (Darvell, 2009).

It is well known that oral and mucosal has adverse reactions to resin-based dental materials. This occurs when composite resins or denture-based materials come into direct contact with oral mucosa. Biocompatibility is characterized as the ability of a material to operate in an exact application within the sight of a fitting host reaction. This definition suggests a collaboration among a host, a material, and a normal operation of the material. Every one of the three variables must be in harmony before the material can be regarded as biocompatible (Wataha, 2001).

Resin-based dental materials incorporate composite resins, enamel and dentin adhesives, compomers, resin glass ionomer cements, and denture base materials. Biological impacts of resin-based materials on oral mucosa can be evaluated utilizing two distinct types of biocompatibility tests; in vitro tests and in vivo tests. In vitro biocompatibility tests are performed outside of a living organism. The purpose of in vitro tests is to simulate organic responses to materials when they are placed on or into tissue of the body. The limitations of in vitro tests are the absence of simulation of the in vivo circumstance, and questionable clinical importance. The majority of the cytotoxicity test strategies have three principal parts: a natural system, a cell contact, and an organic endpoint (Hanks et al., 1996).

The selection of the endpoint and the recording strategy relies upon the required information. Ordinarily in the principal stage, basic techniques dependent on membrane damage or cell viability and expansion ought to be utilized. If in the last phase of development more specific information concerning the system of the toxic activity is required, or if an extraordinary test technique requires specific endpoints, progressive strategies based on cell operation ought to be utilized. It is usually difficult to translate the seriousness of the organic response observed in the in vitro tests to clinical circumstance, even though these tests provide detailed data on natural associations between the cells and test materials. Therefore, in vivo biocompatibility tests are required to get an exact and comprehensive biological risk evaluation (Scott et al., 2004).

In vivo biocompatibility tests are performed inside a living organism. Animal tests are the most widely recognized type of in vivo tests. In animal tests material is embedded into the body of an animal to assess the topical reactions to the material. In this method of test, it is conceivable to analyze numerous complex interactions between the biological method and the material, hence it is more pertinent than in vitro tests. Nevertheless, animal tests are costly, time consuming, it is hard to control factors, and there are some ethical issues with the utilization of animals (Onay et al., 2007).

Pulpal reactions to resin-based dental materials can be surveyed utilizing different in vitro and in vivo test systems such as dentine barrier systems, 3D tooth slice organ culture, and animal and usage test. Systemic adverse reactions such as hypersensitivity and anaphylactic reactions related with resin-based dental materials have been reported. Systemic adverse impacts of resin-based materials can be surveyed by four distinct tests: allergy testing, systemic toxicity tests, estrogenicity tests, and genotoxicity tests (Pfeiffer and Rosenbauer, 2004).

Research has shown that composite resin monomers have important time dependent toxicity on human and animal lung cells. Eluates from denture base resins had prolonged toxic effects on hamster epithelial cells. Composites, compomers, and dental cements demonstrated that all tested materials were cytotoxic instantly after production and their toxic impacts were decreased after various preincubation periods in most cases (Moharamzadeh et al., 2009).

Biocompatibility of dental materials has turned into a complex issue and a matter of concern for patients, experts and administrative specialists. Thus, it has turned into a critical viewpoint for the improvement of new materials and substantial additional sources are required. Several legal regulations are successful and applicable standards accessible. Biocompatibility investigations must be incorporated at an early period of new material improvements. The exceptional use of a material must be considered when characterizing the vital tests, assessing the outcomes and decide the indications for use. Additional knowledge on the biocompatibility of dental materials has absolutely prompted a superior understanding of material tissue interaction, to the improvement of new materials and basically important safety precaution measures (Wataha, 2012)

The aim of an investigation was to survey connections of in vivo clinical performance with in vitro lab trial of dental materials including polymer-based matrices. A proof-based dentistry approach was utilized to distinguish clinical trials, basic surveys, and meta-examinations including correlations. Components affecting important relationships were reviewed. Clinical research estimations routinely incorporate 10 to 15 categories of clinical perceptions of performance. For instance, shading match, caries impedance, marginal integrity and technical failures. However, this does not correspond well with laboratory properties. Clinical tests of dental materials stand for a minor portion of the aggregate research in this field. Tests are mainly present in a small period of 2 to 5 years and are designed essentially to test the safety and efficiency of the product. A vast proportion of risk factors such as patient, design, material, intraoral location and operator, influence clinical results and are not simulated well in laboratories. Minimal long-term information exists for clinical implementation other than on composite wear. Not many significant correlations of laboratory trials and clinical outcomes are illustrated. New investigations ought to be centered on recovering restorations from service and portraying them with the same trials from typically directed in the laboratory. A lot increasingly long-term clinical tests that include 10 to 20 years of monitoring are required. Those tests ought to incorporate arranged restoration recovery to approach changes in laboratory properties of interest (Bayne, 2012).

The purpose of another research article was to evaluate the condition and success rate of removable partial dentures with various designs 10 years after insertion. Of the 101 prostheses 42.6% were in their original state, 28.7% were amended, and 28.7% had been replaced by new dentures. Therefore, 10 years after insertion 71.3% of the dentures were not replaced by new restorations. The success rate, concerning condition and function, demonstrated 36.6% successes, 23.8% partial successes, and 39.6% failures. Overall, 60.4% of the dentures were still functional. Also, only the one-third of the prostheses demonstrated neither hygienic issues nor technical failures (Wagner and Kern, 2000).

The success rate of the last research paper regarding removable partial dentures indicated very satisfactory results. Nevertheless, materials must be tested in a long-term period to understand better the safety and efficiency of the products in more depth. This is because clinical results can be affected by various risk factors such as the patient, operator, material and design.

Conclusion

Medical devices which are used in dentistry must be tested and approved by the governing bodies. CEN is managing the medical devices that are used in dentistry inside European Union. CEN incorporates requirements for proposed performance, components, structure characteristics, packaging, marking and data provided by the manufacturer. BSI is the national body in charge of preparing British Standards. BSI is responsible to enhance the quality of medical products and administrations. The MHRA is an official agency of the Department of Health in the United Kingdom and is responsible for guaranteeing that medicines and medical devices work and are acceptably safe. The MDD is a European organization which is managing the safety and marketing of every single medical device in the European Union. ISO 13485 is a worldwide recognized medical device quality administration systems standard. A research paper was purposed to provide a cross‐section of ISO 9000 quality certification diffusion after some time and its effect on industrial systems. ISO 9000 certification has been profoundly practiced since standards’ introduction in few nations such as UK, France and Germany. The quantity of certificates is near to arrive at a saturation level in these countries. ISO standards 10993, 14971, and 7405 determine the modes for clinical risk evaluation, test selection and test implementation. Biocompatibility of dental materials has gained expanding enthusiasm during late decades. PMMA is the most reliable material for removable appliances. However, studies have shown a conceivable cancer-causing and embryotoxic potency of this material. Biological impacts of resin-based materials can be evaluated with in vitro and in vivo biocompatibility tests. In vitro biocompatibility tests are performed outside of a living organism, while in vivo biocompatibility tests are performed inside a living organism. Animal tests are the most widely recognized type of in vivo tests. Hypersensitivity and anaphylactic reactions related with resin-based dental materials have been reported. Composite resin monomers indicated important time dependent toxicity on human and animal lung cells. Materials must be tested in a longer period to understand better the safety and efficiency of the products. The success rate of removable partial dentures with various types of design 10 years after insertion showed 36.6% successes, 23.8% partial successes and 39.6% failures.

References

1. Bayne, S. C. (2012) ‘Correlation of Clinical Performance with ‘In Vitro Tests’ of Restorative Dental Materials that Use Polymer-Based Matrices’, Dental Materials. The Academy of Dental Materials, [Online] 28(1), pp. 52–71. doi: 10.1016/j.dental.2011.08.594. [Accessed 18 December 2018].
2. Bhola, R., Shaily M. Bhola, Hongjun Liang and Brajendra Mishra (2010) ‘Biocompatible Denture Polymers – A review’, Trends in Biomaterials and Artificial Organs, [Online] 23(3), pp. 129–136. Available at: http://medind.nic.in/taa/t10/i3/taat10i3p129.pdf [Accessed 15 December 2018].
3. Bluebee (2018) ‘Bluebee Receives ISO 13485 Medical Device Quality Standard Certification’, Entertainment Close – Up, [Online] pp. 1–3. Available at: https://search-proquest-com.ezproxy.bolton.ac.uk/docview/2061780637?OpenUrlRefId=info:xri/sid:summon&accountid=9653# [Accessed 19 December 2018].
4. BSI (2004) ‘Dentistry — Medical Devices for Dentistry — Materials’, BSI, [Online] 3(1), pp. 1–16. Available at: https://bsol-bsigroup-com.ezproxy.bolton.ac.uk/PdfViewer/Viewer?pid=000000000030184610 [Accessed 12 December 2018].
5. Darvell, B. W. (2009) ‘Acrylic’, Materials Science for Dentistry, [Online] 86(2), pp. 108–127. doi: 10.1533/9781845696672.108. [Accessed 8 December 2018].
6. Franceschini, F., Galetto, M. and Cecconi, P. (2006) ‘A Worldwide Analysis of ISO 9000 Standard Diffusion: Considerations and Future Development’, Benchmarking, [Online] 13(4), pp. 523–541. doi: 10.1108/14635770610676326. [Accessed 5 December 2018].
7. Franceschini, F., Galetto, M. and Giannì, G. (2004) ‘A New Forecasting Model for the Diffusion of ISO 9000 Standard Certifications in European Countries’, International Journal of Quality and Reliability Management, [Online] 21(1), pp. 32–50. doi: 10.1108/02656710410511687. [Accessed 19 December 2018].
8. Hanks, C. T., Wataha, J. C. and Sun, Z. (1996) ‘In Vitro Models of Biocompatibility: A Review’, Dental Materials, [Online] 12(3), pp. 186–193. doi: 10.1016/S0109-5641(96)80020-0. [Accessed 3 December 2018].
9. Hill, D., Stewart, D. and Balman, E. (2015) ‘What Is Ce Marking? How Technologies Are Classified, and How to Navigate the System’, Value in health: the journal of the International Society for Pharmacoeconomics and Outcomes Research, [Online] 18(7), p. 367. doi: 10.1016/j.jval.2015.09.730. [Accessed 20 December 2018].
10. MHRA (2008) Guidance Notes for Manufacturers of Dental Appliances, EC MEDICAL DEVICES DIRECTIVES. [Online] Available at: http://www.damas.co.uk/downloads/mhra_guidance.pdf [Accessed 19 December 2018].
11. MHRA (2013) ‘MHRA’, The Journal of Perioperative Practice, [Online] 23(3), pp. 1–14. Available at: https://search-proquest-com.ezproxy.bolton.ac.uk/docview/1315737183?accountid=9653 [Accessed 11 December 2018].
12. Moharamzadeh K., Brook IM. and Van Noort R. (2009) Biocompatibility of Resin-Based Dental Materials. Materials. [Online] 2(2), pp. 514-548. doi: 10.3390/ma2020514. [Accessed 16 December 2018].
13. Onay, E. O., Ungor, M. and Ozdemir, B. H. (2007) ‘In Vivo Evaluation of the Biocompatibility of a New Resin-Based Obturation System’, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, [Online] 104(3), pp. 60–66. doi: 10.1016/j.tripleo.2007.03.006. [Accessed 16 December 2018].
14. Pfeiffer, P. and Rosenbauer, E. U. (2004) ‘Residual Methyl Methacrylate Monomer, Water Sorption, and Water Solubility of Hypoallergenic Denture Base Materials’, Journal of Prosthetic Dentistry, [Online] 92(1), pp. 72–78. doi: 10.1016/j.prosdent.2004.04.003. [Accessed 9 December 2018].
15. Schmalz, G. and Arenholt-bindslev, D. (2007) Biocompatibility of Dental Materials. [Online] doi: 10.1016/j.cden.2007.03.003. [Accessed 7 December 2018].
16. Schmalz, G. and Galler, K. M. (2017) ‘Biocompatibility of Biomaterials – Lessons Learned and Considerations for the Design of Novel Materials’, Dental Materials. The Academy of Dental Materials, [Online] 33(4), pp. 382–393. doi: 10.1016/j.dental.2017.01.011. [Accessed 17 December 2018].
17. Scott, A., Egner, W., Gawkrodger, D. J., Hatton, P. V., Sherriff, M., Van Noort, R., Yeoman, C. and Grummitt, J. (2004) ‘The National Survey of Adverse Reactions to Dental Materials in the UK: A Preliminary Study by the UK Adverse Reactions Reporting Project’, British Dental Journal, [Online] 196(8), pp. 471–477. doi: 10.1038/sj.bdj.4811176. [Accessed 10 December 2018].
18. Stevenson, T. and Barnes, F. (2002) ‘What Industrial Marketers Need to Know Now About ISO 9000 Certification’, Industrial Marketing Management, [Online] 31(1), pp. 695–703. doi: 10.1016/S0019-8501(01)00180-8. [Accessed 9 December 2018].
19. Wagner, B. and Kern, M. (2000) ‘Clinical Evaluation of Removable Partial Dentures 10 Years After Insertion: Success Rates, Hygienic Problems, and Technical Failures’, Clinical Oral Investigations, [Online] 4(2), pp. 74–80. doi: 10.1007/s007840050119. [Accessed 15 December 2018].
20. Wataha, J. C. (2001) ‘Principles of Biocompatibility for Dental Practitioners’, Journal of Prosthetic Dentistry, [Online] 86(2), pp. 203–209. doi: 10.1067/mpr.2001.117056. [Accessed 17 December 2018].
21. Wataha, J. C. (2012) ‘Predicting Clinical Biological Responses to Dental Materials’, Dental Materials. The Academy of Dental Materials, [Online] 28(1), pp. 23–40. doi: 10.1016/j.dental.2011.08.595. [Accessed 9 December 2018].

“Science means constantly walking a tightrope between blind faith and curiosity; between expertise and creativity; between bias and openness; between experience and epiphany; between ambition and passion; and between arrogance and conviction – in short, between an old today and a new tomorrow”, – Heinrich Rohrer. The concepts that gave an idea of nanotechnology were first discussed in 1959 by renowned physicist Richard Feynman in his talk ‘There’s Plenty of Room at the Bottom’, in which he described the possibility of generating new materials via direct manipulation of atoms. The term ‘nano-technology’ was first used by Norio Taniguchi in 1974.

The word ‘nano’, is derived from the Greek word ‘nannos’ meaning ‘dwarf’, is a prefix that literally denotes to 1 billionth of a physical size. 1nm = 1 billionth of a meter. To put this size in to perspective put a marble next to earth. The concept of nanomedicine was 1st described by Robert A. Freitas Jr in the year 1993, after observing the advancements in nanotechnology and its potential implications in various fields. In the past 20 years various theoretical predictions have been made based on the potential applications for nanotechnology in dentistry, with guarded optimism.

Albert Einstein once said, “I have no special talent. I am only passionately curious”. For past many years People around the world have been harnessing their curiosity and transforming it in to an inquiry which has led to the process of scientific methodology that has eventually led to an unprecedented growth in research in the area of nanoscience including nanomedicine and nanodentistry. Nanodentistry is nothing but the maintenance of comprehensive oral health by employing nanomaterials, biotechnology, including tissue engineering and ultimately, dental nanorobotics. In short, the nanotechnology will help in diagnosis, treatment, as well as maintenance of any dental diseases. The newer potential treatment opportunities in dentistry may include, painless local anesthesia, renaturalization of dentition, permanent treatment for dentinal hypersensitivity, complete orthodontic realignments treatment during a single dental visit , covalently or chemically bonded diamondized enamel and dentine for the treatment of genetically or environmentally inherited diseases of dental hard tissues, and continuous oral health maintenance using mechanical dentifrobots (Chen et al., 2005).

Nanorobots will be the forerunner in complete dentition replacement therapy. In simple terms, the nanobots would be able to manufacture and deliver a biologically autologous tooth for a replacement of missing tooth and all these can be done during a single dental visit, making the whole process of tooth rehabilitation more time efficient for both dentist and patients, which in turn lead to more patient compliance. The fear of injections into the oral cavity or drills is the main reasons most people are afraid of dentistry or avoid their dental treatment. But with the help of nanobots, dentist will be able to instill a colloidal suspension containing millions of active analgesic micron-sized dental nanorobot ‘particles’ on the patient’s gingiva. Once these particles come in contact with the surface of mucosa or the crown, the pacing nanorobots reach the dentin by migrating into the gingival sulcus and passing painlessly through the lamina propria or the 1 to 3-micron thick layer of loose tissue at the cementodentinal junction or to the free nerve endings.

Various studies have shown that teeth with hypersensitivity have surface density of dentinal tubules eight times higher and twice as large diameter as non-sensitive teeth. Freitas in 2005 with various other authors stated that Reconstructive dental nanorobots, using native biological materials, could selectively and precisely occlude specific tubules within minutes, offering patients a quick and permanent cure from a life long suffering of dentinal hypersensitivity. For the cosmetic restoration due to loss of tooth structure the conventional methods usually deal with replacing upper enamel layers with covalently bonded artificial materials such as sapphire or diamond. These materials are highly susceptible to fracture, Jayraman in 2004 stated that incorporation of carbon nanotubes in to these materials can render them more fracture resistant, making a material more durable and long-lasting.

Kumar and Vijayalakshmi in 2006 concluded their study saying that when nanofillers are incorporated into vinylpolysiloxanes impression material it produces a unique siloxane impression material that has a better flow, improved hydrophilic properties, and enhanced precision details when compared to conventional impression material. Bone is a natural nanostructure that is composed of organic compounds (mainly collagen) and reinforced with inorganic ones, like calcium and phosphate. Nanotechnology aims to mimic this very same natural structure for orthopedic and dental applications and, more particularly, for the development of nanobone in a lab. The loose structure of nanocrystals with nanospores situated between them can be modified so that it can adsorb proteins due to the incorporation of silica molecule. This hydroxyapatite nanoparticle material than can be used to treat bone defects.

When implant placement is considered as a therapeutic option the major concern of a dental practitioner is osseointegration, and the main determining factors for successful osseointegration are surface contact area and surface topography of an implant surface. But with the help of nanotechnology bone growth and increased predictability can be effectively expedited with implant therapy. Studies have shown that, the addition of nanoscale deposits of hydroxyapatite and calcium phosphate on implant surface creates a more complex implant surface for osteoblast formation. Extensive research has been carried out for optimization of implant surface, and resultant new implants are superior to the conventional implant. The newer implants are more acceptable, as they have integrated nanocoatings resembling biological materials to the tissues.

In the treatment of localized periodontitis nanobots can be used as an agent to deliver the drug precisely to the involved site. The materials that are used for this purpose is a core which is hollow from within or a nanotube. The drugs than can be incorporated in to these hollow structures, they are made up of biodegradable polymer, this allows the drug to released precisely at the active disease site, leading to more substantivity of a drug. Sub-occlusally present nanobots delivered either through tooth paste or a mouth wash can help in the treatment of halitosis by acting against the pathogenic bacteria, the nanobots transform the metabolites that are responsible for foul odor produced by these bacteria in to odorless vapors and perform continuous debridement of the tooth surface.

Charles Darwin said: “It is the long history of humankind that those who learned to collaborate and improvise most effectively have prevailed”. Even in dentistry, when we take a holistic approach to treating a disease, making our approach multidisciplinary, we can provide better treatment for patients.

As a wise man said, “No one can whistle a symphony. It takes a whole orchestra to play it”.

The visions described here may sound unlikely, implausible, or even heretic. Yet, the theoretical and applied research to turn them into reality is progressing rapidly. When it comes to making these visions in to a reality we may be bound by the limitation of the technology of our time, which is not yet fully developed to bring nanotechnology in to everyday life.

There are certain limitations to put nanotechnology into a routine dental practice such as, design and installation cost of these nanobots, maintenance, social acceptance, human safety, ethical issues, and biocompatibility. But as they say these truly are the days of ‘miracle and wonder’. Bright future lies ahead in dental field, but we shall all have to work very long and very hard to make it come to pass.

McCabe et al. defined smart materials as materials whose properties might be changed in a controlled manner by improvements, such as stress, temperature, moisture, pH and electric or magnetic fields. A key feature of smart behavior includes an ability to come back to the first state after the upgrade has been evacuated. These materials respond to environmental changes or external impacts, and are otherwise called responsive materials. The response may exhibit itself as a change in shape, stiffness, viscosity or damping. When embedded in host materials and activated, they can make up for deficiencies or breaks created, a wonder called the called self-fixing impact and keeps the material in a ‘sheltered condition’. Takagi (1990) explained them as intelligent materials that respond to ecological changes at the most ideal conditions and uncover their very own capacities as per the environment. As of now, there has been a flood in the necessity of an increasing safety margin of foundation, biomedical, and designing (car, aviation, and marine) components. This has prompted a quick increment in the advancement of savvy materials and structures, at the degrees of smaller scale and nano-scale. Astuteness of materials depicts self-flexibility, self-detecting, memory, and multiple functionalities. Dictionary definition of ‘smart’ is clever or working as though by human insight and this is what smart materials are However, as a matter of fact, materials or structures can never accomplish genuine knowledge or thinking without the addition of fake intelligence through PCs, microchip, control rationale, and control algorithms.

Smart Materials

Dentistry has experienced a time which has seen far reaching utilization of aloof and latent materials. They were planned in such a way that they do not interact with body tissues and fluids. Materials, for example, amalgam regularly decide on their ability to produce without reacting to the oral condition. This was trailed by a period when a few materials having gauge to act as active materials were noticed. The principal dynamic conduct noted in the field of dentistry was the release of fluoride from some dental materials. Based on their interactions with the environment, dental materials are right now extensively arranged as bioinert (aloof), bioactive, and bioresponsive or smart materials. The main shrewd dental materials to be used in dentistry were the nickel-titanium composites, or SMAs utilized as orthodontic wires.

Smart Materials in Pedodontic Dentistry

Glass Ionomer Cements

The smart conduct of glass-ionomers and related materials is firmly connected to their water content and the manner by which this can react to changes in the environment. On heating, increased fluid flow to the surface and rapid loss of water is the mechanism behind the watched compression. This conduct is similar to that of human dentine where similar changes are seen as a result of flow of fluids in the dentinal tubules. Hence, the glass‑ionomer materials can be said to copy the conduct of human dentine through a type of smart behavior. Due to this smart behavior of GIC, it provides great marginal adjustment to the rebuilding efforts. The other aspect of the smart behavior of GIC is the fluoride release and recharge capacity. Normally the fluoride release in products is seen as a high initial fluoride release followed by a slow abatement over a period. The smart conduct of materials containing GIC phases is attributed to their property of getting ‘energized’ when the material is washed in a high concentration of or mouthrinse of fluoride as may occur in toothpaste or mouthrinse.

Casein Phosphopeptide-Amorphous Calcium Phosphate

Fluoride take-up is impacted by the grouping of calcium and phosphate particles in the salivation or biofilm. For each two fluoride particles, ten calcium particles, and six phosphate particles are required to frame one unit cell of fluorapatite. Calcium and phosphate in solvent and insoluble structures have their very own constraints when utilized as remineralization operators, be that as it may, certain particular structures are accessible financially to improve the bioavailability of these particles. Casein phosphopeptides (CPP), a milk subordinate (casein being the transcendent phosphoprotein in ox-like milk) have been appeared to balance out calcium and phosphate as nanoclusters together with fluoride particles, saving them in a shapeless or solvent structure named as ACP. ACP, an antecedent in hydroxyapatite development, displays a high dissolvability, is promptly changed over into hydroxyapatite and shows biocompatibility with both hard and delicate tissues, making it an appropriate remineralization specialist. The idea of utilizing CPP-ACP as a remineralization operator was presented in 1998, utilizing casein for caries counteractive action was tended to during the 1980s, and ACP innovation was presented in the mid-1990s. CPP-ACP has been appeared to tie promptly to the outside of the tooth, just as to the microbes in the plaque encompassing the tooth, subsequently keeping up a high grouping of ACP in nearness to the tooth surface. ACP goes about as support to the tooth’s common resistance framework just when its required. ACP at unbiased or high pH remains ACP. In light of an acidic test (at or underneath 5.8 happens during a carious assault), there is an expansion in plaque calcium and phosphate particles which keep up the supersaturation state restraining demineralization and upgrading remineralization.

Smart Composite

It is a light-initiated alkaline, nanofilled glass restorative material. It discharges calcium, fluoride and hydroxyl particles when intraoral pH esteems dip under the basic pH of 5.5, checking the demineralization procedure of the tooth surface and making conditions great for remineralization. The material depends on mechanical maintenance, requiring no drawing and holding operator and can be sufficiently relieved in build thicknesses of up to 4 mm. The application is speedy and simple. It discovers its utilization in rebuilding of class I and class II sores in both essential and changeless teeth. Financially accessible as Ariston pH control – presented by Ivoclar Vivadent (Liechtenstein) Company. It is accessible just in a solitary all-inclusive white shade, and isn’t tooth-hued; in this way, it is reasonable just for back reclamations.

Shape Memory

NiTi combinations exist as various gem structures at low and high temperature (martensitic and austenitic, separately). In the martensitic/little girl stage (a body-focused cubic grid), the material is delicate and pliable and can without much of a stretch be disfigured requiring just a light power. In the austenitic or parent stage (hexagonal grid), the material is very solid and hard. The cross-section association can likewise be adjusted by pressure, and on the expulsion of the pressure, the structure comes back to an austenitic stage and its unique shape; a marvel called as pressure actuated thermoelastic change. They are utilized for manufacture of sections and orthodontic wires. Too versatile wires are favored inferable from their adaptability and obstruction. SMA applies delicate, constant powers, which are in physiological reaches, over a more extended period. The unrivaled adaptability, solidness, torque capacity, when contrasted with hardened steel, is the crucial preferred position of these materials, therefore delivering more noteworthy usability and expanded patient solace. The NiTi supports are progressively agreeable for patients during establishment and furthermore during treatment. Utilization of exceptionally hot or freezing nourishment doesn’t prompt confusions in these supports if the austenite and martensite stages are all around picked. NiTi composites have additionally discovered use in revolving endodontics. Presented by Walia et al. in 1988, rotating NiTi records have made instrumentation simpler and quicker than customary hand instrumentation during the biomechanical planning of root waterway treatment. The benefit of utilizing rotating NiTi records are improved access to bended root waterways during cleaning and molding with less sidelong power applied. This lessens administrator exhaustion and gives a progressively focused channel readiness with less trench transportation, a diminished occurrence of waterway deviation, and insignificant postoperative agony to the patient.

Smart Ceramics

The procedure included machining a pre-assembled clay clear made of zirconia earthenware production with a nanocrystalline permeable structure in the presintered state, trailed by sintering. The sintered material psychologists homogeneously in every single spatial bearing to its last measurements. The material picks up its high hardness, high quality, and strength during the last sintering. The veneering of the high-quality artistic structure at that point includes the necessary tasteful and wear attributes. The procedure has points of interest of high precision in a simple, quick, and completely computerized way. This development was presented in the market as CERCON Smart Ceramics System by the dental provider DeguDent. It at that point opened up another period of pottery in dentistry. It indicated better attributes with deference than feel requests, magnificent biocompatibility, and nonattendance of extreme touchiness reactions. In pediatric dentistry, they discover use in making porcelain facade rebuilding and full cast or porcelain melded to metal crown reclamation. They likewise discover use as keen section supports containing microchip fit for estimating the powers applied to the section tooth line.

SmartPrep Burs

These are polymer made with shovel like straight cutting edges. The polymer material has been intended to be more earnestly than carious, mollified dentin yet milder than solid dentin. It is professed to evacuate carious dentin specifically; while, solid dentin isn’t influenced (insignificantly intrusive removal); the bleeding edges wear out in contact with harder materials. SmartPrep brambles are accessible in three ISO sizes 010, 014, and 018 and are intended for single-utilize just (self-restricting activity). They ought to be utilized with light weight and removal ought to be done from the middle to the outskirts to maintain a strategic distance from contact with the harder dentin.

Conclusion

Smart materials are a response to this necessity of condition amicable and responsive materials. Smart materials are another age of materials which hold a decent guarantee for the future in the field of bio-smart dentistry. They are in their underlying phases of improvement, and extensive research is required in this field of material science. Every pedodontist should know about the new materials and use in the treatment.

There are many deformities that exist in the world of dentistry ranging from the head down to the neck. Deformities are common condition that are linked to birth defects or genetics (Merriam-Webster, 2019). They can be mild abnormalities to more severe defects that can require surgical correction. Because some conditions can be severe and detrimental to the patient’s well-being, they require x-rays to evaluate the conditions to see what can be done to correct the dentofacial abnormality. In the essay I will be explaining some of the known abnormalities that can affect a patient and how they are viewed in dentistry. I will also be explaining how they can affect the way the radiographer views an x-ray and why it is important to know of these deformities before the exposure.

One of the most known oral deformities is cleft lip/cleft palate. There are different types of oral clefts. An oral cleft palate is where there is a slit in the roof (hard palate) of the mouth. This is where the hard palate has a cleft extending towards the front of the mouth but not actually reaching the incisor area. A cleft lip is where the lip has a slit, sometimes coming from inside the mouth. A cleft lip is more physically visible whereas the cleft palate can be harder to see. Oral clefts can bring on some problems during development such as feeding issues, dental issues, constant ear aches, and even speech impediments. In order to avoid these problems most clefts are surgically corrected within the first year of a child’s life. The best way to view these types of clefts in dentistry would be by preforming an occlusal projection and a panoramic projection. Most children with clefts will required braces to fix the more crocked teeth affected by the cleft and surgery (‘Cleft Lip and Cleft Palate (for Kids)’, 2019).

Another abnormality in dentistry is a torus. It’s an overgrowth of bone that grows in certain parts of the mouth. Tori tend to grow on the roof of the mouth near the midline which is also known as tori palatini, on the inside of the lower jaw also known as lingual tori, and the outside of the upper molars also known as buccal exostoses. Although they can be bothersome tori are not harmful or cancerous. They are linked to the genetics of the person. They can easily be surgically removed. In dental radiographs tori appear as slightly radiopaque masses in area that would otherwise appear more radiolucent in x-rays. Sometimes the film packets can cause issues when trying to place receptors in a patient’s mouth but once properly placed, they can easily be viewed with periapical, occlusal, and panoramic images. The receptors can cause the patient to be uncomfortable when a torus is present so to accommodate for any pain the patient might feel, modify the technique. For more comfortability with a maxillary torus place the receptor to the far side of the torus and not directly on the torus. When mandibular tori are present placing the receptor in between the tongue and the tori will provide better comfort for the patient (Iannucci, 173).

In addition, overbites and underbites are also defects that can be seen in x-rays. Overbites come from the top (maxillary) teeth protruding outward more than the bottom teeth. Underbites are the exact opposite, they come from the bottom (mandibular) teeth sticking out the mouth more than the top teeth. Overbites and underbites can either be passed on through genetics or caused by losing baby teeth or adult teeth too early. When people suck on their thumbs or leave their children with pacifiers for too long into toddler stage, it can create an overbite or underbite. The best way to view these conditions would be by panoramic projections just because panoramic images do show a full profile of a patient’s skull and dental region. If overbites and underbites are not corrected they can cause issues such as problems with eating, jaw and muscle strain, and even self-esteem problems because of the ugliness appearance. The most effective way to repair this type of deformity would be with braces although there are some more extreme cases that might require jaw re-alignment.

In conclusion, because there are so many different deformities in the dentistry world it is best for dental professionals to understand radiographs and how they work. Some deformities are harmless and need no corrections while other deformities can be more severe, requiring corrective surgery. That is why it is so very important to know how to identify normal anatomy on a dental radiograph. It is also important to know what they are identifying in order to evaluate the conditions at hand and know the best route to take when it comes to repairing and correcting a patient’s smile.

References

1. Cleft Lip and Cleft Palate (for Kids). (2019). Retrieved from https://kidshealth.org/en/kids/cleft-lip-palate.html
2. Iannucci, Joen, Laura Howerton. Dental Radiography: Principles and Techniques, 4th Edition. W.B. Saunders Company, 032011. VitalBook file.
3. Deformity. (n.d.). Retrieved from https://www.merriam-webster.com/dictionary/deformity
4. Visser, Savage, Sabol, Drs. (2018, April 12). What Causes an Overbite and Underbite? Retrieved May 15, 2017, from https://www.drssavagesabolvisser.com/causes-overbite-underbite/
5. Default – Stanford Children’s Health. (n.d.). Retrieved 2019, from https://www.stanfordchildrens.org/en/topic/default?id=overview-of-craniofacial-anomalies-90-P01830
6. Crooked Teeth, Overbite, and Underbite Treatments. (n.d.). Retrieved January 29, 2019, from https://www.webmd.com/oral-health/guide/crooked-teeth-misaligned-bites#1
7. Doran, J. G. (n.d.). Retrieved January 29, 2019, from http://www.exodontia.info/Exostoses-Osteomata.html

Laser was put in or introduced in dentistry in 1960s. Then, a persistent range of studies were made on various applications of laser in dental practice. The two major types of lasers were came in terms of clinical implementations: hard lasers such as (CO2) carbon dioxide, neodymium–yttrium aluminum garnet (Nd:YAG), and erbium–yttrium aluminum garnet (Er:YAG) with both hard and soft tissue employments. For the sake of a potential for thermal tissue damage, and high-cost, hard lasers have some limitations. Furthermore, cold or soft lasers have been predominantly utilized for biostimulation or low-level laser therapy (LLLT). Lasers are utilized in different disciplines in dentistry such as restorative dentistry wherever they are utilized for improving the resistance of dental enamel, diagnosis of caries and photopolymerization of composite resin; endodontics for bactericidal cleansing of root canal; periodontics for gingivectomy, frenectomy, gingivoplasty, and vestibuloplasty; pedodontics to get ready tooth surfaces for sealant application; and oral and maxillofacial surgery to handle and treat vascular malformation.

Dental lasers are assorted and classified with regard to the lasting medium used such as solid laser, gas laser or application in various tissues such as hard tissue or soft tissue lasers, the risk of laser usage and the range of wavelength. The literature about the inadvertent impacts or effects of laser irradiation on orodental structures is restricted and insufficient or scanty to provoke readers’ worries and concerns regarding the prospective hazards of laser therapy. Scanty and insufficient knowledge about undesirable effects of laser might give rise to sweeping and overwhelming therapeutic pitfalls; as a consequence; for this reason, a functional and an efficient treatment alternative would provide or supply as a potentially destructive modality.

The goal of the current paper was to dispute and debate laser effects on orodental soft and hard tissues during dental processes. General provisions and precautions regarding banning and prevention of laser damage to the operator and the patient have been examined and discussed several times. The side effects of the dental laser are also analyzed.

Methods

We accomplished an electronic search utilizing specialized a structured set of data held in a computer (databases) such as PubMed, Google Scholar, Science Direct, PubMed Central, and Scopus to explore relevant studies by utilizing various keywords such as, ‘dentistry’, ‘laser’, ‘side effect’, and ‘adverse effect’.

Laser Side Effects

The laser energy is turned into or converted into heat when absorbed by tissue components, such as chromophores, DNA/RNA, proteins, water, and enzymes. The tissue damage because of the thermal effects of laser is broadly and largely attributable to the degree of heating in a way that growing and increasing temperature causes or leads to more cruel and severe changes; hyperthermia begins at 42–45°C, which performs and results in shrinkage of collagen and structural alteration. Mitigation or reduction of enzymatic activity occurs or takes place at 50°C. Temperature of 60°C gives rise to or causes coagulation of collagens, protein denaturation, and membrane permeabilization. The tissue drying and formation of vacuoles happen at 100°C. Starting of vaporization and tissue carbonization is the outcome of heat over 100°C. The temperature of 300–1000°C causes or leads to thermoablation of tissues, disruption and photoablation.

The study related to the thermal impacts of Nd:YAG, argon, and CO2 laser beams on dentin, enamel, and dental pulp explained and demonstrated the potency of Nd:YAG laser beam to perforate and penetrate deeply through the dentin and enamel to the pulp. In spite of the fact that the impacts of argon laser were closely connected with the degree of enamel surface cleanliness, the superficial and deep temperatures were notified to be low even after surface cleaning. With respect to CO2 laser, very high temperatures were produced on the enamel and dentin surfaces; whilst, pulp chamber reached low temperatures.

Laser Effects on Dental Pulp

An excess in temperature of 6°C can give rise to irreversible pulpitis, whilst pulpal necrosis happens when temperature rises higher (11°C). There is no general agreement or consensus in the literature about pulpal damage made by laser thermal impacts. Some studies notified different grades of pulpal damage whilst others displayed no sign of pulpal changes in terms of laser type and power setting. In a paper by von Fraunhofer et al., the impact of Nd:YAG laser at ≤240 J on third molars within 3 minutes after extraction was explained or demonstrated that if the residual or remaining dentin thickness was greater than 1 mm, irradiation makes no significant pulpal response. Inequality, thermal harm or insult of CO2 laser at 5 × 103 J/cm2 was notified and reported to give rise to calcification in the pulp chamber and an intention or increase in pulpal volume by approximately one third. Bader and Krejci in another study, explained that laser cavity preparation rose and caused overheating of teeth leading to pulpitis. Furthermore, various temperatures were recorded according to the anatomic site of cavity preparation; Class I preparations yielded the highest values, followed by Class V cavities in enamel. Furthermore, preparation in cementum or caries removal caused the lowest temperature raise or increase.

Laser Impacts on Tooth Surface

The tooth surface maybe affected by laser irradiation likewise; for example, sufficiently great or important to be worthy of attention or significant decrease in shear bond strength of brackets to the teeth following bleaching with carbamide peroxide and diode laser has been notified or reported. In spite of the fact that Er-YAG laser irradiation with water and 35 μs pulse duration did not effect, or result in surface visible cracks, it made a 20% reduction in the bending strength of the dentin.

Histopathological Changes of Laser

The dental laser therapy makes or causes some histopathological changes also. Cell necrosis in the periodontal ligament (generally due to thermal impact) was notified 1 day after laser treatment, whilst teeth under conventional preparation elaborated or developed no evidence of cell necrosis. 15 days following treatment, increased size and number of osteocytes and osteoclasts were clear and evident in the periradicular bone in both laser and conventionally-treated teeth. Furthermore, initial bone resorption was discovered and detected in laser-treated teeth. Conventionally-treated teeth started to return to normal morphology within 30 days posttreatment. Furthermore, the laser-treated teeth exhibited cemental lysis, ankylosis, and serious or significant bone remodeling. Laser can make or cause pulpal vasodilation, and high-power lasers cause edema and occasional inflammation.

Conclusion

Regardless of many advantages of dental lasers, this method can be potentially dangerous and hazardous due to effects on dental pulp, subcutaneous and submucosal tissues, tooth surface, and risk of infection transmission. Thus, dental practitioners must be aware of laser adverse impacts or effects during therapeutic processes to minimize the potential risks for patients.

References

1. Shajahan PA, Kumar PR, Hariprasad A, Mathew J, Shaji AP, Ahammed MF. Lasers: The Magic Wand in Esthetic Dentistry! J Int Oral Health 2015; 7:119-21.
2. Walsh LJ. Dental Lasers: Some Basic Principles. Postgrad Dent 1994; 4:26-9.
3. Walsh LJ. The Current Status of Laser Applications in Dentistry. Aust Dent J 2003; 48:146-55.
4. Martens LC. Laser Physics and a Review of Laser Applications in Dentistry for Children. Eur Arch Paediatr Dent 2011; 12:61-7.
5. Slavoljub Z, Larisa B, Mila K. Lasers in Dentistry. Serbian Dent J 2004; 51:146-52.
6. Green J, Weiss A, Stern A. Lasers and Radiofrequency Devices in Dentistry. Dent Clin North Am 2011; 55:585-97.
7. Gutknecht N, Kaiser F, Hassan A, Lampert F. Long-Term Clinical Evaluation of Endodontically Treated Teeth by Nd:YAG Lasers. J Clin Laser Med Surg 1996; 14:7-11.
8. Research, Science and Therapy Committee of the American Academy of Periodontology. Lasers in periodontics. J Periodontol 2002; 73:1231-9.
9. Stabholz A, Zeltser R, Sela M, Peretz B, Moshonov J, Ziskind D et al. The Use of Lasers in Dentistry: Principles of Operation and Clinical Applications. Compend Contin Educ Dent 2003; 24:935-48.
10. Strauss RA. Lasers in Oral and Maxillofacial Surgery. Dent Clin North Am 2000; 44:851-73.
11. Bornstein ES. Why Wavelength and Delivery Systems Are the Most Important Factors in Using a Dental Hard-Tissue Laser: A literature Review. Compend Contin Educ Dent 2003; 24:837-47.
12. Verma SK, Maheshwari S, Singh RK, Chaudhari PK. Laser in Dentistry: An Innovative Tool in Modern Dental Practice. Natl J Maxillofac Surg 2012; 3:124-32.
13. Steiner R. Laser Tissue – Interaction. In: Raulin C, Karsai S, Editors. Laser and IPL Technology in Dermatology and Aesthetic Medicine. Berlin Heidelberg, 2011, p. 23-36.
14. Launay Y, Mordon S, Cornil A, Brunetaud JM, Moschetto Y. Thermal Effects of Lasers on Dental Tissues. Lasers Surg Med 1987; 7:473-7.
15. Zach L, Cohen G. Pulp Response to Externally Applied Heat. Oral Surg Oral Med Oral Pathol 1965; 19:515-30.

Introduction:

The Renaissance period, spanning from the 14th to the 17th century, was a time of great intellectual and cultural advancement in Europe. It witnessed significant developments in various fields, including art, literature, and science. In this informative essay, we will explore the advancements and practices in surgery and dentistry during the Renaissance period.

Body:

Medical Knowledge and Education:

During the Renaissance, there was a renewed interest in studying human anatomy and understanding the human body. The publication of Andreas Vesalius’ groundbreaking work “De humani corporis fabrica” in 1543 revolutionized anatomical knowledge. Vesalius emphasized the importance of direct observation and dissection, leading to a more accurate understanding of human anatomy. This knowledge laid the foundation for advancements in surgery and dentistry.

Surgical Techniques:

Surgery during the Renaissance period was a challenging and risky endeavor. Surgeons primarily focused on treating wounds, fractures, and performing amputations. The use of anesthesia was limited, and patients often endured excruciating pain during surgical procedures. Surgeons employed various tools such as scalpels, forceps, and cauteries for surgeries, but the lack of aseptic techniques and understanding of infection control resulted in high mortality rates.

Contributions to Dental Care:

Dentistry during the Renaissance period experienced significant developments. The study of dental anatomy, tooth extraction techniques, and the understanding of oral diseases improved. Ambroise Paré, a renowned French surgeon, made notable contributions to dentistry by introducing new methods for tooth extraction and designing dental instruments. However, dental care was still relatively primitive compared to modern practices, and the emphasis was primarily on pain relief rather than preserving natural teeth.

The Role of Barber-Surgeons:

Barber-surgeons played a crucial role in providing medical care during the Renaissance. They were skilled in minor surgical procedures, bloodletting, and tooth extractions. However, their training and knowledge were limited compared to university-educated physicians. Barber-surgeons often performed a range of medical tasks, including haircuts, bloodletting, wound dressing, and dental treatments, reflecting the blurred lines between medicine and grooming during that era.

The Influence of Islamic Medicine:

The Renaissance period also witnessed the influence of Islamic medicine on European medical practices. Arab scholars had preserved and expanded upon the medical knowledge of ancient civilizations. Their translations of Greek and Roman texts, as well as their own medical contributions, had a profound impact on European medical practices. Islamic scholars’ emphasis on observation, experimentation, and the use of medicinal plants influenced Renaissance surgeons and physicians.

Advances in Medical Illustration:

The Renaissance period was marked by significant advancements in medical illustration. Detailed anatomical drawings became more prevalent, aiding in the understanding and documentation of surgical procedures. Artists such as Leonardo da Vinci and Vesalius produced intricate anatomical illustrations, which not only served as educational tools but also contributed to the development of surgical techniques and knowledge.

Conclusion:

The Renaissance period was a transformative era in the fields of surgery and dentistry. Advancements in anatomical knowledge, the emergence of medical illustrations, and the influence of Islamic medicine all contributed to the progression of medical practices. However, it is important to note that surgical and dental care during this period were still rudimentary compared to modern standards. The lack of anesthesia, limited understanding of infection control, and the prevalence of barbaric practices highlight the challenges faced by medical professionals.

The Renaissance period laid the groundwork for future advancements in surgery and dentistry by fostering curiosity, expanding knowledge, and promoting the importance of anatomical understanding. The developments and practices of this era provide valuable insights into the evolution of medical science and the continuous pursuit of improving healthcare for humanity.

Vietnam, capitol Hanoi, is a Southeast Asian country bordered by Cambodia, China, Laos and Malaysia with the Vietnamese dong as the national currency. The national language is Vietnamese with few confident English speakers despite learning it in school, but due to the history of one thousand years of Chinese occupation and French colonization in the late 19th to the early 20th century, minority languages spoken include both French and Chinese (Lonely planet, 2019).

Japanese invasion and control of Hanoi in 1940 caused resistance and saw the formation of the communism – anti-colonialists established under Ho Chi Minh, who resisted and destabilized the French and Japanese forces. In 1945, Ho Chi Minh declared the independence of Vietnam, however this was soon followed by strife between the Communist North and Anti-communist South, resulting in the taking over of the South in 1975. The reunification of Vietnam occurred in 1976, with Saigon being changed to Ho Chi Minh City, and it is currently governed as a communist state through a one-party system (Cultural Atlas, 2019).

Vietnam is officially declared an atheist state with tight control being kept over the organization of religious groups by the Vietnamese government, therefore it is illegal for foreigners to perform religious services without government approval. Around 20 percent of the population identify with registered religions including Buddhist, Catholic and Christian. It is estimated that many people practice folk religions such as Buddhism, Confucianism and Taoism, and may consider their traditional worship as a ‘philosophy’ or way of life rather than a religion (Cultural Atlas, 2019).

Modesty is considered a key part of the culture (Cultural Atlas, 2019) as well as the custom of ‘saving face’. These indicate a person’s reputation, influence, dignity and honor. Thus, while travelling in Vietnam, one should avoid public displays that could compromise reputation and avoid loud arguments, making a scene, berating others for mistakes or pointing out anything that would cause locals to feel shamed (Vietnam National Administration of Tourism, 2019).

Greetings and respect for the elders is considered important in Vietnam. When greeting, one should address them by their title and first name, shaking hands (sometimes using 2 hands) and bowing their heads or lowering the gaze of the younger person to indicate respect. It is important to note that it is uncommon for women to shake hands with men (or each other), so one should wait for the woman to extend her hand first (Cultural Atlas, 2019).

I believe good oral health is reflected by a healthy and pain free mouth, that does not limit an individual’s capacity to bite, chew, smile and speak (Naseem et al., 2017). Oral health entails more than just having healthy teeth; it is vital for good general health and well-being of both the biological and psychosocial sides, and does not diminish our quality of life. This implies being free of chronic orofacial pain, oral and pharyngeal cancer, oral tissue lesions, birth defects and other diseases or disorders that affect the craniofacial complex (WHO, 2019) and may affect our psychological and social well-being.

Good oral hygiene practices involve using a combination of effective home care and dental visiting habits to attain good oral health. This includes:

• Brushing for two minutes twice a day, using either a manual or electric tooth brush and a fluoride toothpaste, and making sure to use the correct technique (modified bass);
• Spitting out the toothpaste and not rinsing afterwards to allow the fluoride to take effect;
• Replacing the toothbrush every 3 months;
• Flossing at least once a day after brushing or using other interdental cleaning products;
• Rinsing with a fluoride mouthwash or chewing sugar free gum with xylitol after meals and snacks;
• Wearing a mouth guard when engaging in contact sports;
• Having regular check-ups to detect and treat early signs of oral disease (FDI World Dental Federation, 2019).

It is both the dentist’s and the patient’s responsibility to ensure that good oral hygiene habits are being practiced and used effectively. Thus, what I value the most about patients is how rewarding it is to see them walk away with better oral health and often more confidence. Every day we meet different people from all walks of life and are given different situations to work with, but the appreciation for the work we do for the patient never changes and so does the sense that you’ve made a positive change for someone’s health. This not only makes being a dentist a really rewarding career, but also makes it very interesting and dynamic as you’re always discovering new things and you never stop learning throughout your career.

Health beliefs in Vietnam are often based on the balance of yin and yang (opposing forces), where an imbalance of these forces is believed to lead to disease (Duong Nguyen, 1985). Vietnamese people may also view good oral health to be of a lower standard and is often given lower priority than what has been discussed above. Studies have shown that the prevalence of caries amongst adults is high and overall, patients were more likely to have a reduced dentition, with low number of filled teeth but relatively high numbers of decayed or missing teeth (impacting mainly molars). At age 20, subjects had an average of 14 sound teeth, decreasing gradually until 6 at the age of 80 (Nguyen et al., 2010).

However, despite the large number of oral diseases reported in Vietnam, more than half of these patients do not use health faculties, with most patients choosing to self-medicate or have no treatment. Thus, delay or no treatment is highly prevalent despite the significant social and psychological impact the oral diseases may be causing the patients. Some of the barriers that may have contributes to this include education level, perceived importance of oral health, perceived benefits of visits and availability of care (Dao et al., 2015).

Where dental care is pursued, it is usually for symptomatic reasons instead of preventative purposes (Dao et al., 2015) with many patients not believing in the need for surgical and invasive techniques, except for as a last resort (Duong Nguyen, 1985). Therefore, for the vast majority of patients, relief from pain is what they value most about visiting the dental clinic, with extraction being the most common treatment for caries (Nguyen et al., 2010).

The current oral health status of the population in Vietnam was explored in a recent study. Findings state that the DMFT scores in subjects over 45 ranged from 6.09 to 11.66 and there were higher numbers of missing teeth compared to filled teeth with the mean number of missing teeth increased from 1 in each jaw at age 20, to 8 at age 80. Absent anterior teeth are considered to impact more on oral function than absent molar teeth, thus, using the concept of a shortened dental arch, the focus of most practices is to preserve anteriors and premolars to preserve adequate oral function (Nguyen et al., 2010).

Analyzing the statistics above, I believe the majority of patients we’ll see in Vietnam, regardless of the setting, will be for symptomatic reasons, including caries and periodontal issues, and rarely for preventative purposes. The focus of dental hospital will be on emergency procedures, whereas the primary school and private practices may be more concentrated towards preventative and aesthetic measures such as placement of fissure sealants and orthodontics.

However, currently in Vietnam there are insufficient dental resources and active dentist with nearly half of the nation’s rural districts having no dentists at all. The majority of the nation’s wealth and clinics tend to be concentrated in urban centers and even then, the ratio of dentists to the total population can range from 1:178 500 to 1:13 400. Incentives such as scholarships and stipends have been given to the number of practitioners in rural areas, but conditions make rural areas unappealing (Vu, 2013). Nationwide water fluoridation has been proven effective in preventing dental caries however 70% of the rural population do not benefit from it (Peterson et al., 2012).

In conclusion, the lack of oral health policies precludes not only proper intervention, but also the designing and implementation of health promotion and disease prevention activities (Kandelman et al., 2012). The World Health Organization has stated that a major reason for the lack of success of many oral health programs is that they operate in isolation, separate from the general health care structure. It is therefore important that any oral health promotion strategy is integrated into a national health promotion strategy. For future programs to be executed effectively, more effort needs to be spent from all areas (i.e., the government, communities, health centers, families) to make oral health a higher priority. Regional or district level programs can be created to better suit local needs, and each population should be investigated separately prior to program creation, with a trial period included before implementation on a larger scale.