Palatal neurofibroma associated with localized periodontitis

BACKGROUND: Neurofibromatosis type 1 (NF1) is the most common form of neurofibromatosis. While typically considered a dermatologic disorder, intraoral signs of neurofibromatosis occur quite commonly. This clinical entity can be confused with periodontitis because of the presence of periodontal pockets. In this report, we present the case of a palatal neurofibroma with radiographic involvement in a patient with NF1. METHODS: A 40-year-old female patient was referred from her general dentist to evaluate advanced periodontitis in the maxillary left quadrant. The patient's medical history was significant for a soft tissue lesion excised from her back 11 years previously and diagnosed as a neurofibroma. Subsequent medical examination at that time confirmed a systemic diagnosis of NF1. A comprehensive periodontal evaluation was performed, and panoramic and periapical radiographs were taken. Teeth were tested for vitality. An incisional biopsy was completed for histopathologic examination. RESULTS: The periodontal evaluation revealed the presence of 6 to 9 mm probing depths adjacent to teeth #14 and #15. Panoramic and periapical radiographs showed a circumscribed 0.8x0.9-cm unilocular radiolucency superimposed over the root of tooth #13 and extensive horizontal bone loss on the distal side of #15. Incisional biopsy confirmed the presence of a neurofibroma, and because of the extent of the lesion, the patient was referred to the Oral and Maxillofacial Surgery service for complete excision. CONCLUSIONS: Neurofibromas can cause extensive destruction of alveolar bone, mimicking periodontitis. Due to the potential systemic and genetic implications, the diagnosis of neurofibroma requires appropriate medical referral.     

Comparison of methods for measurement of hypoplastic lesions

Enamel hypoplasia is a quantitative defect of enamel thickness. Methods previously used for its measurement have limitations in clinical studies. The aim of this study was to investigate new methods of measurement using image analysis. Lesions on 8 teeth affected by enamel hypoplasia were quantified from study models and impression surfaces using an image-analysis system. The measurements made included lesion area and tooth surface area; from these the proportion of tooth surface area affected was calculated. For comparison, manual measurement was performed on impression surfaces and study models, using digital callipers. Images were also acquired of lesions on 12 exfoliated teeth, and the lesion area and total tooth area were calculated. For assessment of intra-operator reliability, the +/– repeatability coefficient was calculated. Measurement of the surface of lesions direct from the exfoliated teeth gave the best results overall, followed by direct image analysis of the silicone impression.     

An evaluation of a technique to remove stains from teeth using microabrasion

BACKGROUND: Microabrasion using a paste made of acid and pumice is a technique that has been used to remove white, yellow and brown stains from enamel. The authors evaluated the technique by studying the effectiveness of a proprietary microabrasion product. METHODS: One author used microabrasion to remove white, yellow and brown stains from within the outermost layer of the tooth enamel of 32 subjects. Standardized slides of the teeth were taken before and one week after treatment. Four prosthodontists evaluated the paired images, using a standardized questionnaire and visual analog scales ranging from 1 (no improvement in appearance or stain not removed at all) to 7 (exceptional improvement in appearance or stain totally removed). The evaluators were calibrated and blinded. RESULTS: The evaluators always identified a difference between the pretreatment slides and posttreatment slides; they found no difference between the control slides. In all cases but one (97 percent), the treated teeth had improved in appearance with more uniformity in color. Analysis of variance revealed no differences between evaluator ratings (P = .146). The intraclass correlation coefficient for ratings of individual cases by different evaluators was 0.72, representing a "good" level of correlation of the ratings for improvement of appearance and for stain removal. Mean (+/- standard deviation) ratings were 5.38 (+/- 1.26) for improvement of appearance and 5.06 (+/- 1.26) for stain removal. CONCLUSIONS: This study showed that enamel microabrasion could remove stains from within the outermost layer of tooth enamel, thereby improving the appearance of the teeth. CLINICAL IMPLICATIONS: This study supports recommendations that enamel microabrasion is an effective, atraumatic method of improving the appearance of teeth with stains in the outermost layer of enamel.     

The use of arthrography in management of temporomandibular joint problems

A bstract — Arthrography is useful in selecting those patients with severe dysfunction of the temporomandibular joint who would benefit from surgery. Plain films are usually unrewarding in the diagnosis of soft tissue abnormalities of the joint. Three cases are presented, illustrating the most common problems encountered and diagnosed by arthrography.     

Intravenous procedural sedation: an alternative to general anesthesia in the treatment of early childhood caries

Providing comprehensive dental treatment for preschool children with early childhood caries (ECC) is probably the greatest challenge facing most dentists; many elect to hospitalize a child with ECC and provide treatment under general anesthesia. However, as waiting lists for hospital admission are long, ECC continues to progress and can cause pain or acute infection. Hospital treatment also results in substantial costs beyond those for dental treatment. This paper describes a cost-effective intravenous sedation program being used in a pediatric dental practice in Kelowna, British Columbia. The program offers an alternative to general anesthesia that allows qualified dentists to provide comprehensive dental treatment to children with ECC safely and efficiently in the private practice setting.     

Adhesive analysis of voids in Class II composite resin restorations at the axial and gingival cavity walls restored under in vivo versus in vitro conditions.

OBJECTIVES: Adhesive analysis, under the scanning electron microscope of microtensile specimens that failed through the adhesive interface, was conducted to evaluate the amount of voids present at the axial versus gingival cavity walls of class II composite restorations restored under in vivo and in vitro conditions. METHODS: Five patients received class II resin composite restorations, under in vivo and in vitro conditions. A total of 14 premolar teeth yielded 59 (n=59) microtensile adhesive specimens that fractured through the adhesive interface. The fractured surfaces of all specimens were examined and the % area of voids was measured. RESULTS: Voids at the adhesive joint were highly predictive of bond strengths. An increase in the number of voids resulted in a decrease in the microtensile bond strength. The area of voids at the adhesive interface was as follows: in vivo axial 13.6+/-25.6% (n=12); in vivo gingival 48.8+/-29.2% (n=12); in vitro axial 0.0+/-0.0% (n=19) and in vitro gingival 11.7+/-17.6% (n=16). SIGNIFICANCE: Composite resin may bond differently to dentin depending upon the amount of voids and the cavity wall involved. The bond to the gingival wall was not as reliable as the bond to the axial wall. An increase in the amount of surface voids was a major factor for reducing microtensile bond strengths of adhesive to dentin.     

Effect of soaking in Hank's balanced salt solution or milk on PDL cell viability of dry stored human teeth

Abstract— This study was designed to evaluate the effect of soaking in either Hank's balanced salt solution (HBSS) or milk on peri⁻odontal ligament (PDL) cell viability in avulsed teeth. Dry storage times of 30, 60, and 90 min were evaluated. PDL cell viability was determined after removal of the cells from the root surfaces of extracted teeth using a modification of the procedure described by Nakashima (Arch Oral Biol 1991;36:655–63). After trypsinization and subsequent treatment in collagenase, the cells were stained with trypan blue, and viable and non-viable cells were counted using a hemocytometer and converted to percentages for statistical comparison. The results of this study demonstrated no significant difference in the number of viable cells with or without soaking in HBSS or milk at any of the dry storage times. In addition, there was no significant difference in PDL cell viability between the 30-and the 60-min dry periods. Although the soaking procedure had no obvious negative consequence, no simcant improvement in PDL cell viability by the addition of this step was demonstrated under the conditions of this study.     

The Accuracy of Implant Verification Casts Compared With Casts Produced From A Rigid Transfer Coping Technique

Purpose Prosthodontic techniques for implant-supported prostheses continue to evolve in an effort to facilitate treatment and minimize costs. Because research has shown no impression transfer technique to be without error, some clinicians have attempted to control the fit of prosthetic frameworks by reorienting sections of patterns or frameworks intraorally, fabricating a verification cast, and completing the prosthesis to fit such a cast. One manufacturer has attempted to meet both impression-making and verification-cast objectives by providing metallic impression copings (MICS) with extensions that allow contact between the copings for rigid fixation with acrylic resin before impression making. The purpose of this study was to determine the accuracy of casts produced from the MICS transfer process compared with casts produced from sectioned frameworks, where both techniques used a low-polymerization-shrinkage acrylic resin polymer to rigidly join the sections. Materials and Methods Using stainless steel measurement spheres as a reference point on each implant analog, the distances between analogs on the experimental casts were compared with the distances measured on the master cast. Seven casts were produced for each group and measured with a machinist's microscope at a 4-μm level of precision. Results The results revealed that the MICS transfer exhibited a mean error of 41 μm, which was significantly less than the verification-cast group mean error of 57 μm (p < .01, Student's t test). Conclusions Given these results, clinicians can consider the rigid transfer technique as provided in the MICS transfer to be more accurate than the verification technique as outlined in this study.     

Bone resorption and serum levels of vitamin D metabolites in the hypophosphataemic rat

The supplementation of a low phosphate diet with vitamin D has been shown to result in an increase in bone resorption in the hypophosphataemic rat. The aim of the present study was to determine if administration of vitamin D to rats fed a vitamin D and phosphate-depleted diet would result in an increase in the circulatory levels of the active vitamin D metabolite 1,25(OH)₂D₃ and an associated increase in bone resorption. Three groups of weanling Sprague-Dawley rats were used. The first group consisted of control animals on a normal laboratory stock diet and the second and third groups were experimental animals receiving a vitamin D-and phosphate-deficient diet with the third group receiving vitamin D supplementation. All animals were housed in the dark. After 30 days on the diet the experimental animals received 0.1 mmol NaH₂PO₄ by intraperitoneal injection. Blood was sampled at zero, 3, 6, 18 and 48 h post-injection and analysed for the vitamin D metabolites 25(OH)D₃ and 1,25(OH)₂D₃, calcium and inorganic phosphate (Pi). The serum analyses revealed that the level of 25(OH)D₃ in the hypophosphataemic animals was significantly lower than that of the control animals. However the 1,25(OH)₃D₃ level was initially significantly higher, then dropped to the control level at 18 h post-intraperitoneal injection of phosphate. Further, the serum levels of 25(OH)D₃ and 1,25(OH)₂D₃, calcium and Pi in the hypophosphataemic animals supplemented with vitamin D were significantly higher than those of the vitamin D-deficient animals. Also the vitamin D-supplemented animals exhibited significantly greater levels of bone resorption. These results therefore, are consistent with a role of 1,25(OH)₂D₃ in bone resorption in hypophosphataemic rats.