Purpose: This review article covers the diagnosis and treatment of obstructive sleep apnea (OSA) from a dental perspective. It addresses the issue of when and how to screen for and then, if indicated, refer the patient for a more comprehensive. Study selection: Our focus in this article was on identifying current unanswered questions that relevant to OSA problems that dental scientists have to pursue and on providing valuable information on that problems, consequently the previous studies which investi- gated or reviewed the diagnosis and treatment of OSA were included. In addition, we included studies on jaw movements during sleep and on the use of a lateral cephalometric film related to the diagnosis and treatment of OSA. Results: The role of portable sleep monitoring devices versus full laboratory polysomno- graphy is discussed. This review also describes what is known about the efficacy of mandibular advancement devices and when and how they fit in to a treatment program for a patient with obstructive sleep apnea. Finally some basic research is presented on jaw movements during sleep and how a lateral cephalometric film can be used to assess the changes of the airway with body posture and head posture. Conclusion: This article provides the valuable suggestions for the clinical questions in the diagnosis and treatment of OSA.

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Purpose: To evaluate the effect of three brands of resin cement on the final color of ceramic veneers. Methods: 50 disk-shaped ceramic specimens (IPS e.Max, 0.6 mm ? 8.0 mm diameter) and disk-shaped composite resin background specimens (4.0 mm ? 8.0 mm diameter) were prepared and divided into 10 groups (n = 5). These paired specimens were bonded using ten shades of resin cement (Variolink Veneer, shades LV-3, LV-2, MV, HV + 2, HV + 3; Panavia F, shades light and brown; and RelyX^TM Veneer, shades WO, TR, A3). A spectrophotometer (VITA Easyshade) was used to measure the color parameters (CIE L*a*b* values) of the paired disks before and after cementation. The color differences (DE values) after cementation were calculated and statistically analyzed by the One-way ANOVA (at the significant level p < 0.05). Results: The color parameters of the ceramic disks were measured in terms of the increase ^{in L* value, and the decrease in C?}ab ^{value after bonding with the resin cement. The DE values} of ceramic disks after cementation ranged from 1.38 to 7.16. The DE values were more than 3.3 when the ceramic disks were cemented with resin cements in shade HV + 3 (4.90) and shade WO (7.16). One-way ANOVA of DE values revealed significant differences in the resin cement shades. Conclusions: Resin cements can affect the final color of ceramic veneer restorations, and the extent of this effect varies according to the resin cement shades.

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Purpose: Many studies have identified risk factors for dental implant failure, although few have investigated the correlation among implant fixtures within single patients. A better analytical method may include repeated measures analysis including generalized estimating equations (GEE). This retrospective cohort study aimed to (1) identify the risk factors for failure of dental implantation and (2) evaluate an analytical method using GEE analysis. Methods: We analyzed data on early and late implant failures in 296 patients providing 721 rough surface dental implants (2.44 implants per patient). Potential predictors of implant failure included age, gender, smoking, location of implant, use of bone augmentation,number of remaining teeth, opposing tooth condition, fixture length, fixture diameter and type of suprastructure (fixed or removable partial denture). The likelihood of early and late implant failure was estimated by GEE. Results: The early failure rate was 1.5% (11/721 implants, 7/296 patients) and the 10-year cumulative survival rate was 94.0% (7/710 implants, 5/293 patients). The GEE analysis revealed that a significant risk factor for early implant failure was smoking ( p < 0.01), whereas significant risk factors for late failure were maxillary implant ( p = 0.02), posterior implant ( p < 0.01), number of remaining teeth (?20) ( p < 0.01), opposing unit being a removable partial denture or nothing ( p = 0.04) and having a removable type suprastructure ( p < 0.01). Conclusions: GEE analysis showed that smoking was a risk factor for early implant failure,

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Purpose: Occlusal plane inclination is important to maintain a normal opening closing/ biting function. However, there can be several causes that lead to alterations of the occlusal plane. The purpose of this study was to observe variations of occlusal plane inclination in adult patients, and to uncover the factors affecting changes in occlusal plane inclination with aging. Methods: Subjects were 143 patients. A cephalometric image was taken of these patients. In this study, our inquiry points were age, 3 variables on intra-oral findings, and 7 variables on cephalometric analysis. To evaluate the possible causes that affect occlusal plane inclina- tion, factor analysis was carried out, and each component was treated as factors, which were then statistically applied to a structural equation model. Statistical analysis was carried out through the SPSS 20.0 (SPSS Inc., Chicago, USA). Results: In all patients, Camper-occlusal plane angle (COA) ranged from ?25.7 to ?4.98 (Mean ? SD: ?6.4 ? 5.36). In the 60 patients who had no missing teeth, COA ranged from ?11.6 to ?4.98 (Mean ? SD: ?3.3 ? 3.31). From the results of the structural analysis, it was suggested that the occlusal plane changes to counter-clockwise (on the right lateral cephalograms) with aging. Conclusion: In this study, variations of occlusal plane inclination in adult patients were observed, and the factors affecting changes in occlusal plane inclination with aging were investigated via factor analysis. From our results, it was suggested that the mandibular morphology change and loss of teeth with aging influence occlusal plane inclination.

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Purpose: The purpose of this study was to identify the related risk factors of dental implant accumulated postoperative pain and swelling by cellular phone-based assessment. Methods: Subjects were a consecutive series of patients who received oral implant surgery at Okayama University Hospital. Cellular phone-based questionnaire was sent at pre-set schedule to each subject every 2 h on the day of surgery, and every 24 h from the 2nd to 7th day post-surgery. Subjects replied in real-time the pain and swelling levels at the operated sites by an 11- and 4-grade rating-scale questionnaire. Overall intensity of individual pain and swelling was calculated by means of area under curve that drew by their time-dependent changes. Predictor variables were age, gender, presence of diabetes mellitus and/or hypertension (DM/HT), history of implant surgery, number of inserted implants, flap operation, surgical duration, pre-surgery anxiety, osteoplasty, bone quality,premedication, dosage of prescribed analgesics and local anesthesia and accumulated postoperative pain/swelling. Compliance rate and risk factors correlated with accumulated postoperative pain and swelling were calculated by multiple regression analysis. Results: Final subjects were 18 females and 7 male (mean age: 59.3 ? 7.32 yrs). Significant factors correlated with accumulated postoperative pain were DM/HT, surgical duration,premedication, bone quality, pre-surgery anxiety and postoperative swelling (R² = 0.769,p = 0.001, 0.013, 0.032, 0.007, 0.035 and 0.007, respectively). Meanwhile, significant factors associated with postoperative swelling were postoperative pain, DM/HT and bone quality (R² = 0.365, p = 0.002, 0.004, 0.008, respectively). Conclusion: These results suggested DM/HT and bone quality are correlated to overall intensity of postoperative pain and swelling.

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Patients: Singleton-Merten syndrome is an extremely rare autosomal dominant condition with less than 10 reported cases in the literature. It is characterized by abnormal aortic calcifications and dental abnormalities. The goal of this case report is to discuss the abnormal oral clinical features and the modified treatment protocol that was used in order to achieve osseointegration of dental implants in a patient having abnormal bone density and bone turnover associated with Singleton-Merten Syndrome. Discussion: Following extraction of the remaining teeth, titanium implants (Friadent GmbH, Mannheim, Germany and Straumann¹, Basel, Switzerland) were placed in the upper and lower jaw of the patient. The upper jaw which was treated with dental implants, received a bar supported implant retained prosthesis and the lower jaw an implant retained telescopic prosthesis.The patient was regularly followed up for the past13years during which, clinical and radiological evaluation of osseointegration was undertaken. All the loaded implants showed clinical and radiographic evidence of osseointegration. With a follow up of 13 years after insertion of the first implant, the patient reported functioning well with no complications. Conclusion: The treatment with dental implants in the extremely rare Singleton-Merten syndrome patients is a reasonable treatment option to rehabilitate maxillofacial aesthetics and establish normal function of the jaws.

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Patient: A patient of hemimaxillectomy with restricted mouth opening, wearing a hard acrylic bulb obturator encountered difficulty in insertion and removal of the prosthesis. The prosthesis was converted into a open hollow bulb obturator with flexible walls with permanent silicone soft liner for easy insertion and removal. Discussion: Patients having acquired maxillary defects due to surgical resection of the maxilla often suffer with difficulty in mastication, swallowing, nasal regurgitation, speech disturbances and poor esthetics. Different types of obturator with various bulb designs most commonly fabricated from acrylic resins together with ‘‘acrylic resin plate and/or'' metal framework are used to improve the quality of life of these patients by restoring the function. But restricted mouth opening in some of these patients makes it difficult to place and remove the prosthesis with hard acrylic bulb. Fabrication of flexible open hollow bulb and relining of remaining obturator with resilient permanent silicone soft liner makes easy insertion and removal of the prosthesis and also improve the retention by intimate contact of soft liner with the tissues. Conclusion: Permanent silicone soft liner open hollow bulb obturator is a novel way for the functional rehabilitation of a hemimaxillectomy patient suffering with restricted mouth opening.

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