Periapical innervation of the ferret canine one year after pulpectomy.

Previous studies have shown that, following removal of the dental pulp and its replacement with a filling material, the nerves in the periapical region proliferate within an area of chronic inflammation. This study examined these responses in the ferret in more detail, both quantitatively and in three dimensions, 12 months after pulpectomy which was followed by obturation with gutta percha and zinc oxide and eugenol sealer. The results were compared with the responses after three months. The basic patterns, in terms of both inflammation and neural proliferation, were similar at the two time periods. Both the sizes of the inflammatory lesions and the degree of neural proliferation were lower at 12 months than at three, although the differences were not significantly different in the small number of specimens examined. Bacterial stains failed to show bacteria either in the apical root canal delta or in the periapical area. It is possible that the persistent inflammation was due to the irritant nature of the obturating materials used but not due to the original tissue damage, since extraction sites, by comparison, healed very quickly. Apparently, following endodontic treatment, chronic periapical inflammation and concomitant neural proliferation can continue for long periods.     

Trends in prosthodontic treatment of cleft palate patients at one institution: a twenty-one year review.

This 21-year retrospective study evaluated the trends observed in the prosthodontic treatment of 269 patients. The patients were divided into three groups. The speech aid group consisted of 203 patients and showed a significant decrease in numbers over time. The maxillary obturator group consisted of 24 patients and did not show a significant change. The infant feeding prosthesis group consisted of 42 patients and showed a significant increase in numbers. Possible reasons for the trends observed are discussed.     

Plasmacytoid myoepithelioma of the palate. Report of one case and review of the literature

INTRODUCTION: Myoepithelioma is a benign neoplasm of salivary glands, represents 1.5 % of all salivary glands neoplasm. The plasmacytoid myoepithelioma from palate salivary glands is considered as a rare entity, at date it has been reported 14 cases. It is present one case of plasmacytoid myoepithelioma of palate. CASE REPORT: A Hispanic female of 28 years old presented a not-ulcerate, painless ovoid swelling at left side of hard palate with a one year and a half of evolution. An excisional biopsy was done. The sample was fixed at 10% buffer formalin, embedded in paraffin, cuts at 5 micron and stained with H-E. Microscopically, the lesion was composed by myoepithelial neoplastic cells characterized by a round ovoid silhouette, an eccentric nuclei of dense chromatin and eosinophilic cytoplasm. In some myoepithelial neoplastic cells were identifies intranuclear cytoplasmatic inclusions. The lesion was analysed with immunohistochemical technique using the follow antibodies: vimentin, citokeratin AE1/AE3, S100 protein and actin muscle specific. We observe positive immunoreactivity against vimentin, citokeratin, S100 protein and actin muscle specific. A diagnosis of plasmacytoid myoephitelioma of palate salivary glands was done. Our findings supports the suggestion about plasmacytoid myoepithelioma is an independent entity. The histological diagnostic parameters of plasmacytoid myoepithelioma versus pleomorphic adenoma are discussed.     

Percutaneous dilatational tracheostomy: haemorrhagic complications and the vascular anatomy of the anterior neck. A review based on 497 cases

In a series of 497 PDT procedures done in the intensive therapy unit at Morriston Hospital between 1992 and 1999, PDT was abandoned because of bleeding in 6 patients and was noted to be a problem in a further 18 cases (overall incidence 4.8%). In all cases, haemorrhage was successfully arrested. Surgical tracheostomy was necessary in 6 of these 24 cases. The source of bleeding in 4 of these patients was attributed to the inferior thyroid vein (2 cases), high brachiocephalic vein, and possibly an aberrant anterior jugular communicating vein, respectively. In one patient, the vessel presumed injured could not be identified and in another patient, bleeding was related to multi-system disease. We conclude that the risk of bleeding, although low, can be minimised if the operator maintains a high index of suspicion for aberrant vascular anatomy and investigates possible abnormalities with diagnostic ultrasound. Injury to vessels low in the neck can be reduced by not fully extending the neck and siting the stoma at the upper tracheal rings. The possibility of developing a tracheoarterial fistula is reduced if the stoma is situated above the 4th tracheal ring and fibreoptic endoscopy is used to confirm correct tracheostomy tube placement.     

Systematic review and meta-analysis of tracheostomy outcomes in COVID-19 patients

A systematic review and meta-analysis of the entire COVID-19 Tracheostomy cohort was conducted to determine the cumulative incidence of complications, mortality, time to decannulation and ventilatory weaning. Outcomes of surgical versus percutaneous and outcomes relative to tracheostomy timing were also analysed. Studies reporting outcome data on patients with COVID-19 undergoing tracheostomy were identified and screened by 2 independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Outcome data were analysed using a random-effects model. From 1016 unique studies, 39 articles reporting outcomes for a total of 3929 patients were included for meta-analysis. Weighted mean follow-up time was 42.03 ± 26 days post-tracheostomy. Meta-analysis showed that 61.2% of patients were weaned from mechanical ventilation [95%CI 52.6%–69.5%], 44.2% of patients were decannulated [95%CI 33.96%–54.67%], and cumulative mortality was found to be 19.23% [95%CI 15.2%–23.6%] across the entire tracheostomy cohort. The cumulative incidence of complications was 14.24% [95%CI 9.6%–19.6%], with bleeding accounting for 52% of all complications. No difference was found in incidence of mortality (RR1.96; p = 0.34), decannulation (RR1.35, p = 0.27), complications (RR0.75, p = 0.09) and time to decannulation (SMD 0.46, p = 0.68) between percutaneous and surgical tracheostomy. Moreover, no difference was found in mortality (RR1.57, p = 0.43) between early and late tracheostomy, and timing of tracheostomy did not predict time to decannulation. Ten confirmed nosocomial staff infections were reported from 1398 tracheostomies. This study provides an overview of outcomes of tracheostomy in COVID-19 patients, and contributes to our understanding of tracheostomy decisions in this patient cohort.     

Cantilever resin-bonded bridges with one adhesive surface. A review of the literature

Conventional resin-bonded bridges are designed with adhesive surfaces on both sides of the dummy. As a consequence both abutment teeth are rigidly connected to each other. Loading of the abutment teeth or dummy will lead to wringing forces in the cement. Adhesive bridges with one adhesive surface are actually cantilever bridges. Theoretically this type of bridges will be less prone to wringing forces due to loading. However, long term research into the performance of cantilever resin-bonded bridges (RBBs) is hardly available. The results of research into the longevity of conventional RBBs differ remarkably between Europe, and the United States and Japan. These difference are discussed in this article. This article compares the fixed-fixed design RBBs with the cantilever RBBs. The differences are discussed based on eight articles, the earliest being published in 1991, which are dedicated, completely or partially, to the subject of cantilever adhesive bridges. One can conclude that in The Netherlands RBBs are wrongly considered to be unreliable. On the contrary, they appear to be reliable and predictable restorations provided their preparations meet the right standards. Although a number of authors conclude that cantilever RBBs are performing better than their fixed-fixed design counterparts in similar situations, further research is needed concerning the longevity of this type of adhesive bridges.     

Marginal bone loss one year after implantation: a systematic review of different loading protocols

The aim of this study was to analyse the influence of different loading protocols on marginal bone loss (MBL). The outcomes of different implant loading protocols were assessed at 1 year after implantation, with focus on MBL; protocols included immediate, immediate non-occlusal, early, and conventional loading. The search strategy resulted in 889 studies. Twenty-two of these studies fulfilled the inclusion criteria. Among the included studies, the lowest MBL was for immediately loaded implants (0.05 ± 0.67 mm) and the highest for immediate non-occlusally loaded implants (1.37 ± 0.5 mm). The results of the meta-analysis showed an estimated mean MBL of 0.457 mm (95% confidence interval (CI) 0.133–0.781) for immediate loading, 0.390 mm (95% CI 0.240–0.540) for immediate non-occlusal loading, 0.488 mm (95% CI 0.289–0.687) for early loading (>2 days to <3 months), and 0.852 mm (95% CI 0.429–1.275) for conventional loading (>3 months) implant protocols. The lowest decrease in 1-year implant survival per millimetre increase in MBL was observed for immediate loading and the highest for conventional loading. Conventional loading showed a significantly higher MBL than the other three loading protocols. This systematic review and meta-analysis indicates that the immediate loading protocol is a reasonable alternative to the conventional loading protocol.     

Immediate loading of single-tooth implants in the anterior maxilla. Preliminary results after one year

According to the standard protocol, a load-free healing period is one of the most emphasized requirements for implant integration. Recent studies have encouraged a progressive shortening of the healing period for single-tooth implants and immediate loading has been proposed for the aesthetic zone in the maxilla. The present study evaluated clinical outcomes of immediately loaded FRIALIT-2 Synchro implants 12 months after placement in the maxillary incisal region. In the course of our investigation, nine patients have been treated following an immediate loading protocol. The stepped-screw type implants were inserted with an increasing torque up to 45 Ncm, thus measuring the primary stability of the implants. All implants were immediately restored with unsplinted acrylic resin provisional crowns and the patients provided with occlusal splints. Regular controls were performed at monthly intervals, intraoral radiographs were taken directly after implant placement, 6 and 12 months post insertion. The survival rate, clinical stability (Periotest) and radiographic coronal bone defects (CBD) were evaluated at delivery of the definitive superstructures (CBD 6) and 6 months later (CBD 12). Twelve FRIALIT-2 Synchro stepped screws of 3.8, 4.5 and 5.5 mm diameter and 13 and 15 mm length were placed in the incisal maxillary region. The median Periotest value 6 months post insertion was -2 with a minimum of -5 and a maximum of +2. The mean coronal bone level changes (CBD) at 6 and 12 months were 0.45 and 0.75 mm. No implant failed up to 12 months after insertion, resulting in a 100% survival rate. The presented results showed promising data for immediately loaded single-tooth implants in the anterior maxilla. Periotest values were within the range published for submerged implants. The radiographic coronal bone resorption after 6 and 12 months was even less than evaluated for implants placed in a standard two-stage procedure. It is evident that successful immediate loading protocols require a careful and strict patient selection aimed at achieving the best primary stability and avoiding any excessive functional or non-functional loading. Additional research needs to be done to provide data in situations where problems of poor bone quality, multiple implants or augmentation procedures must be overcome.     

AEC综合征1例报告及文献复习

AEC综合征是一种罕见的以睑缘黏连、外胚层发育不全及面裂为主要临床表征的基因病。目前,国内尚未见该病的报道。本文报告1例AEC综合征病例,根据患者的临床表现,制订相应的治疗方案,手术修复左侧唇裂,术后患者外形有一定改善。通过文献复习,对AEC综合征的病因、临床表现、鉴别诊断及序列治疗进行了讨论。由于AEC综合征临床表现多样,严重影响患者面容及生长发育,因此,应增强对本病的认识,并进行系统序列治疗。     

Sturge-Weber综合征:1例报告及文献复习

Sturge—weber综合征是一种罕见的先天性神经皮肤综合征，以颜面部皮肤微静脉畸形、癫痫、青光眼和脑部异常钙化等为主要特征，其发病机制尚不清楚。本文报告1例典型病例，对其主要临床特点、发生率、诊断和治疗的相关文献进行回顾分析。     

Lemierre Syndrome associated with dental infections. Report of one case and review of the literature

The first publication on Lemierre Syndrome appears in 1936 by Lemierre. It is defined as an "oropharynx bacterial infection characterized by the thrombophlebitis in the internal jugular vein, derived in a systemic septic embolism". In 81% of the cases, the Fusobacterium necrophorum is the most frequent etiologic agent. Fever is the most common symptom, but it can depending on the primary infection, tonsillitis, mastoiditis or odontogenic infection. According to the literature the mortality is very low, but with a significant morbidity, that is why the diagnosis and early treatment is very important. The diagnosis it's clinical, even though the CT scan and other diagnosis methods (echography, MRI) help to determine the extent of the infection. It's necessary to administer the antibiotics endovenous at high dose, (keeping in mind that the most frequent micro organism is anaerobic), and vital support measures if necessary. We present a case report of Lemierre Syndrome associated to an odonthogenic infection caused by the 4.8 molar.     

软腭骨瘤1例报告及文献复习

骨瘤是常见的由分化成熟的骨组织构成的良性肿瘤,多来源于邻近骨质,发生于骨膜内层骨母细胞,由成骨性纤维组织、成骨细胞及所产生的新生骨组成。发生于口腔软组织的骨瘤极为罕见,作者报道1例软腭骨瘤病例,结合有关文献对其组织来源、病理分型、鉴别诊断和治疗等进行了讨论。     

下颌骨溶骨症1例报告及文献复习

溶骨症又称Gorham综合征，临床罕见，其病因及发病机制尚不清楚，以自发性进行性骨溶解吸收为主要临床表现。溶骨症可发生于任何年龄，特别好发于5-25岁，无明显性别差异，可发生于单一骨骼，也可跨过关节，侵犯多个骨骼。目前认为，早期彻底切除可有效阻止病变进展。作者报告1例，并结合相关文献，对该病的临床特点，好发部位，诊断与鉴别诊断及治疗方法进行讨论。     

Evaluation for the training and behavior of dental treatment in our special patients center

With a view to modifying the respective behaviors of patient, protector and operator so that a relationship of reliability can be established among them, we have adopted the training for dental treatment in the medical care system for handicapped children. We took this opportunity to classify the present handling methods at the practice of medical care into 4 groups (A, B-1, B-2, C) and to examine the training effect in each group and its features. [Method] On 145 patients having received treatment in the Dental Center for the Handicapped Children in our Hospital, number of patients by group, average age at the first examination, average training frequencies before and after treatment, average treating frequency, behavior in the training and relationship between each group and the disorder were examined for the card. [Results] 1) About 40% of the subjects for examination became capable of receiving treatment without any controlling appliance before the final treatment. 2) Average training frequency and average treating frequency had higher values of B-1 group than for other groups. 3) Behavioral estimation during the training revealed that A and B-1 groups showed better performance in mouth washing, brushing and cleaning by brushing than B-2 group, but the case was the contrary with oral use of three-way syringe and the vacuum. [Conclusion] Application of various behavior-modifying techniques to the training for dental treatment in children with psychosomatic disorder made its effect and features.     

Surgical techniques in the treatment of pleomorphic adenoma of the parotid gland: our experience and review of literature.

This paper presents a retrospective study carried out on a sample of 100 patients affected by pleomorphic adenoma of the parotid gland and treated at the Department of Maxillofacial Surgery at the University of Rome "La Sapienza" between January 1, 1989 and December 31, 1997. For the diagnosis of this neoformation, cytological tests were performed on material taken from the neoformation using fine needle aspiration and ultrasound scan. In some selected cases, a CT examination of the head and neck with medium contrast or Nuclear Magnetic Resonance (NMR) was carried out. This study sets out to examine the most suitable treatment to be followed for the removal of the pleomorphic adenoma of the parotid gland. In 56 cases the patients underwent a superficial, conservative parotidectomy. Forty one patients had a total parotidectomy with the facial nerve left intact and one patient had a total parotidectomy where the marginal mandibular nerve of the facial nerve was damaged. The remaining two patients involved in the study were suffering from a recurrent pleomorphic adenoma and in these two cases a total parotidectomy was performed where the facial nerve was killed. The removal of the cranial nerve VII in these patients proved necessary because the nerve fibers had adhered to the surrounding scar tissue of the tumor, either after previous surgery or due to repeated chronic phlogosis of the gland.     

Utilization of tracheostomy in craniomaxillofacial trauma at a level-1 trauma center.

PURPOSE: The decision to perform a tracheostomy on patients with maxillofacial trauma is complex. There is little data exploring the role of tracheostomy in facial fracture management. We sought to profile the utilization of tracheostomy in the context of maxillofacial trauma at our institution by comparing patients who required tracheostomy with and without facial fractures versus those with facial fractures not requiring tracheostomy. MATERIALS AND METHODS: All patients admitted to the Trauma Service at Legacy Emanuel Hospital and Health Center (LEHHC), Portland, OR, from 1993 to 2003 that sustained facial fractures or underwent tracheostomy were identified and data were retrospectively reviewed using patient charts and the trauma registry. Variables such as age, gender, death, injury severity score (ISS), facial injury severity score (FISS), Glasgow coma score (GCS), intensive care days (ICU), hospital length of stay (LOS), facial fracture profile, and oral and maxillofacial surgery (OMFS) operative intervention were tabulated and analyzed. Data were divided into 3 groups for comparison: group 1 (ffxT) consisted of patients who underwent a tracheostomy procedure and repair of their facial fracture during the SAME operation by the OMFS department (N = 125); group 2 (ffxNT) were those patients who had repair of their facial fractures by OMFS and did not require a tracheostomy (N = 224); and group 3 (NffxT) were patients who did not have facial fractures but received a tracheostomy during their hospitalization (N = 259). Ten-year data were used to analyze the ffxT and 5-year data were used to analyze the ffxNT and NffxT. Analysis of variance and chi2 testing was used for statistical analysis. RESULTS: A total of 18,187 patients were admitted to the trauma LEHHC Trauma Service during the study period, of which 1,079 (5.9%) patients sustained facial fractures and 788 (4.3%) required a tracheostomy. One hundred twenty-five patients (0.69% of total; 11.6% of facial fracture) received a tracheostomy at the same time as the facial fracture repair. All patients had their facial fractures successfully managed, regardless of the type of method used to stabilize the airway. There were no known cases of tracheal stenosis, severe bleeding requiring a return to the operating room, airway obstruction, or loss of secured airway. Males were the predominate gender in all 3 groups. The NffxT group (mean, 44.9 years) was much older compared with the ffxT (mean, 36.2 years) and ffxNT (mean, 30.9 years) groups. The incidence of death was higher in the tracheostomy groups compared with 0% with the non-tracheostomy group. The ffxNT group had a statistically significant higher GCS with an average of 12.4 when compared with the tracheostomy groups (ffxT = 6.8; NffxT = 6.7). ISS was nearly the same in the tracheostomy group (ffxT = 28.45; NffxT = 30.04), but higher when compared with the ffxNT (ISS = 17.33). All 3 groups were much different in terms of LOS and ICU days, in which the NffxT group had an average hospital LOS and ICU days of 34.4 and 16.56, respectively. This was higher when compared with the ffxT (LOS = 19.71 days; ICU = 7.21 days) and ffxNT (LOS = 6.82 days; ICU = 1.33 days) groups. The FISS averaged 6.22 in the ffxT group and was higher compared with an FISS of 3.16 in the ffxNT group. Overall, the fracture profile was different between the tracheostomy and non-tracheostomy groups. There was a higher prevalence of mandibular fractures, multiple mandibular fractures, and Le Fort III fractures in the ffxT group compared with the ffxNT group. CONCLUSION: Tracheostomy is commonly performed in the context of multisystem trauma and is a safe method for airway stabilization in patients with craniomaxillofacial trauma. Multi-institutional collaboration and a prospective, randomized trial measuring outcome, resource utilization, and length of ICU stay is necessary to determine if tracheostomy is indeed of measurable benefit to patients with complex injuries.