encouraged to eat healthy foods, brush twice a day, and visit

the dentist regularly. Patients may be experiencing xerostomia caused by medications they are taking, which may be
managed by Biotene to hydrate oral tissues and relieve
symptoms. High-risk adults with special care needs may
require prescription-strength fluoridated toothpastes. If
the individuals behavior makes it difficult or impossible
to brush the teeth regularly, chlorhexidine sprays may
help prevent root caries, as can chlorhexidine varnish
with thymol. Fluoride applications are indicated at each
dental visit. IRT methods are used for restorations. Noncavitated carious pit and fissure lesions should be sealed
rather than restored.
Older Adulthood (Age 65 and Older).Often older
adults with special needs live in institutions or long-term
care facilities and are assisted with meals and oral hygiene.
They may be given unhealthy snacks to help manage their
behavior. Some lose manual dexterity and cannot brush
their own teeth, nor can staff assist them in some cases.
Xerostomia caused by medications is worse at this age,
which can produce coronal and root caries. Swallowing
can be limited, so medications may be delivered in sugary
liquids. Mobility becomes an issue for many older adults,
making it difficult to make the trip to the dental office.
Medicare does not cover routine preventive and restorative care, and state Medicaid programs may or may not
extend coverage to adults. This raises financial barriers
to care.
The basics of care for older adults are the same as for
younger persons. For those living in group homes, the
dentist should provide written and verbal instructions for
care. Patients with diminished manual dexterity may benefit
from larger toothbrush handles and ultrasonic toothbrushes. Fluoride and sealants are applied regularly. Povidone iodine helps to promote oral health and prevent

adverse systemic health issues. Exposed root surfaces at

risk for root caries can be sealed using dentin bonding
agents. MI Paste may help remineralize carious lesions
and relieve symptoms of dry mouth. Dental offices must
accommodate nonambulatory adults in wheelchairs. The
dental office may help older adults access care when their
insurance does not cover dental procedures by identifying
community resources.
Prevention.Caries prevention and management may
be enhanced with the use of emerging chemotherapeutic
strategies. These include xylitol and other polyols and
diamine silver fluoride. In addition, dentists should implement caries risk assessment protocols to determine baseline caries risk, choose the best preventive strategies, and
arrange dental recall appointments. Risk assessments
should be done periodically as patients experience changes
in caries risk and treatment needs.

Clinical Significance.Dentists must address

various special needs situations in their patients
from birth onward. Intensive preventive and
nonsurgical strategies are part of this effort. Implementation of such strategies helps make
dental visits easier for patients and caregivers
and may lower the costs of restorations.

Chi DL, Ettinger RL. Prevention and nonsurgical management of

dental caries over the life course for individuals with special health
care needs. J Calif Dent Assoc 42:455-463, 2014
Reprints available from DL Chi; e-mail: dchi@uw.edu

Prosthodontics
Cantilevered zirconia ceramic fixed dental prostheses
Background.Zirconia ceramics are widely used in
dental practices worldwide because they offer high fracture
strength and fracture toughness. Based on this good performance, zirconia ceramic may offer benefits when used on
cantilevered all-ceramic resin-bonded fixed dental prostheses (RBFDPs). Because data are lacking on the clinical
outcome of zirconia ceramic RBFDPs, densely sintered zirconia ceramic single-retainer all-ceramic RBFDPs with a cantilevered design were evaluated.

Methods.A total of 42 anterior RBFDPs with a cantilevered single-retainer design were fabricated from yttrium
oxide
stabilized zirconium oxide ceramic, then inserted
using Panavia 21 TC as a luting agent after air-abrasion of
the ceramic bonding surface (Fig 1). The mean observation
time was 61.8 months (range 37.2 to 123.5 months).
Results.Two debondings and one biological complication occurred. The debondings occurred after approximately

Volume 59

Issue 6

2014

315

Fig 2.Oral view of a zirconia ceramic RBFDP after 2 years of clinical service. (Courtesy of Sasse M, Kern M: Survival of anterior cantilevered all-ceramic resin-bonded fixed dental prostheses made
from zirconia ceramic. J Dent 42:660-663, 2014.)

difference. Type of RBFDPsingle or splinteddid exert

a statistically significant effect favoring the single-type
design (failure-free rate of 93% versus 67%). However, few
splinted RBFDPs were included so this result should be regarded with caution.

Fig 1.A, Preparation of a lower lateral incisor for a single-retainer

RBFDP replacing the missing central incisor. B, Final try-in of the
veneered restoration before bonding. (Courtesy of Sasse M, Kern
M: Survival of anterior cantilevered all-ceramic resin-bonded fixed
dental prostheses made from zirconia ceramic. J Dent 42:660-663,
2014.)

11 months, with one in a splinted RBFDP and one as a result

of the patient being hit in the face with an elbow while playing with her preschool-age daughter. The first involved debonding of just one retainer wing. The RBFDP stayed in
place, and the framework was cut into two pieces to create
two separate RBFDPs that could be rebonded. The second
debonding was also successfully rebonded. One abutment
tooth had a carious lesion after 61.4 months that was
managed with a small composite filling. The overall 6-year
failure free rate was 91.1% (Fig 2). The success rate, which
considered debonding as a partial failure, was 95.2% after 6
years. Survival was 100%, with no catastrophic failures
occurring.
Comparing the rates of failure-free RBFDPs used for upper versus lower incisors yielded no statistically significant

316

Dental Abstracts

Discussion.Even though two debondings occurred,

the RBFDPs continued to function after rebonding.
Single-retainer all-ceramic RBFDPs performed better than
splinted RBFDPs in the anterior region. For molars, a cantilevered RBFDP is not recommended, although the use of a
modified inlay-retained zirconia FDP may offer an
alternative.

Clinical Significance.For a period of 4 to 6

years, it appears that single-retainer resinbonded fixed dental prostheses made from zirconia ceramic offer good rates of survival.
When single anterior teeth are missing, this
approach may be an appropriate alternative to
implant therapy.

Sasse M, Kern M: Survival of anterior cantilevered all-ceramic resinbonded fixed dental prostheses made from zirconia ceramic. J Dent
42:660-663, 2014
Reprints available from M Sasse, Dept of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, ChristianAlbrechts Univ, Arnold-Heller Str 16, 24105 Kiel, Germany; fax:
49 431 597 2860; e-mail: msasse@proth.uni-kiel.de