Irrigation: beyond the smear layer

Traditionally, much of the attention placed on irrigation in endodontics has focused on smear layer removal. While the smear layer continues to be a relevant topic, other areas related to irrigation and irrigants have emerged that also require a more in‐depth analysis and understanding. This review starts with the smear layer, partially from a new angle, and expands into other topics such as uninstrumented root canal areas, and effect of irrigation in lateral canals and dentin canals. Advanced microbiological models for irrigation research will be presented and discussed. The effect of sodium hypochlorite and decalcifying solutions on dentin structure and dentin strength has become an important topic, which is related to the possible harmful effects of irrigation such as dentin erosion and even vertical root fracture. The impact of irrigant sequence and time of exposure will also be discussed, and recommendations for irrigation protocols will be made.     

Temporomandibular disorders. Part 3. Surgical treatment

Surgery of the temporomandibular joint has a small but nonetheless important role in the overall management of temporomandibular disorders. Appropriate case selection is the mandatory requirement for successful surgical intervention in order to achieve the desired outcome of treatment, such as relief of symptoms and improved function. In this, the third article in the series, a general overview of the current surgical treatment modalities for temporomandibular disorders will be presented.     

Considerations and treatment of direct and indirect pulp-capping

Depending on the clinical setting, vital pulp therapy can be managed with an indirect or direct pulp-capping procedure. The determination of which therapy to employ is a decision that must be made by the clinician at the time of treatment. It is hoped that the preceding discussion has informed the clinician as to both the indications and contraindications for each type of treatment and the rationale for selection. Because every possible clinical situation cannot be presented, it is anticipated that by understanding the principles presented in this article, the clinician will be able to correctly identify which therapeutic modality will most benefit the patient. Table 1 is presented as a quick reference to aid in selecting appropriate candidates for pulp-capping procedures.     

Corrections after facial trauma. Experiences with secondary periorbital corrections

Corrective surgery after primary treatment of periorbital trauma is indicated for functional as well as aesthetical reasons. These indications and the over-all results will be discussed, based on 56 cases. Surgical techniques such as osteotomy of the malar bone or correction of the nose will be presented. It is concluded that 60% of the cases achieve a good, final result. In another 30% considerable improvements have been realized.     

Unilateral masseter muscle hypertrophy: a case report.

Masseteric hypertrophy is a benign increase in the size of the masseter muscle, secondary to muscle hypertrophy. It produces facial asymmetry and is important in the differential diagnosis of other entities. The aim of this article is to report a case of unilateral masseteric muscle hypertrophy. The characteristics and diagnostic features of such alterations and options for treatment will be presented.     

Case report: Patient with acute dental pain has cardiac valve replacement--INR 3.8. What to do? What not to do?

Cardiovascular medicine treatments now include an increasing number of cardiac valve replacements; approximately 60,000 patients may undergo heart valve replacement per year. Dentists will be seeing an increasing number of patients who have undergone this surgical intervention. This paper will overview the types of valve replacements and suggested patient management in the dental setting. A case report of one such patient and the treatment provided is presented.     

Update of guidelines for surgical endodontics - the position after ten years

This is the first of a series of articles, which will summarise new or updated clinical guidelines produced by the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS). Important developments for the dental profession from a number of clinical guidelines will be presented, commencing with the Guidelines for surgical endodontics. The impact of recent evidence relating to the outcome of surgical endodontics and techniques such as cone beam computed tomography and microsurgical techniques are considered.     

Developing solutions for dental X-ray processors

Six developing solutions suitable for automatic X-ray processors with high developer temperature have been tested during a period of 14 days without replenishment of the chemicals. The results are presented as blackening of dental test films with an image of an aluminium step wedge (penetrometer). Both speed and contrast could be measured in this manner. Freshly mixed solutions showed marked differences in processing of films where the developers Dürr, Readymatic (Kodak) and Tetenal (Mediquipe) were best. After 14 days in the processor, the developing effect was poor for most of the tested liquids, due to atmospheric oxidation. The best images, with the least radiation, will be obtained with freshly mixed chemicals suitable for the films used. Besides a lower radiation dose to the patient, due to a short exposure time, blurring caused by the patient's moving will be reduced. Other factors such as the pack and prices must also be taken into consideration in the choice of radiographic solutions.     

Syndromes with cleft lip and cleft palate.

A series of tables is presented as a diagnostic aid for the clinician when he confronts a patient who has a cleft lip and/or palate, together with associated anomalies. The tables provide a rapid way of sorting through the recognized syndromes with orofacial clefting in search of a possible overall diagnosis. Today, 154 such syndromes are recognized. This is more than twice as many as were known in 1971. Undoubtedly, many new syndromes with orofacial clefting will be delineated in the future.     

Methotrexate and oral ulceration

Methotrexate is well established in the drug treatment of various neoplastic diseases. More recently it has become increasingly used as a once-weekly, low-dose treatment of disorders such as psoriasis and rheumatoid arthritis. Clinical trials have shown its effectiveness in these conditions and it is likely that dentists will encounter patients taking this drug in general dental practice. Oral ulceration can occur as a side effect of methotrexate therapy. This may be due to lack of folic acid supplementation or overdosage due to confusion regarding its once-weekly regime. Illustrations of these problems, which have initially presented in a dental setting, are given. Important drug interactions of methotrexate relevant to dentistry are discussed.     

Mental paraesthesia: An ominous symptom. Case reports

The sudden onset of paraesthesia in the distribution of the mental nerve should be regarded as an ominous symptom. It is usually related to events such as fractures or dentoalveolar surgery, but in the absence of such history this finding should be regarded with suspicion. Four case studies are presented in which the patient presented with unexplained mental paraesthesia, which were later related to metastatic malignant disease. Careful medical history is required to alert the clinician to appropriate diagnostic procedures and ensure correct management.     

Treatment options to optimize display of anterior dental esthetics in the patient with the aged lip.

PURPOSE: With aging a number of predictable changes occur in the upper and lower lips that act to mask otherwise esthetic dental procedures including dental implants, gingival esthetic surgery, and optimal dental restorations. The purpose of this article is to show how lip modification can be used to enhance the esthetic appearance of the patient, with specific attention to esthetic dental smile line characteristics. METHOD: Proper evaluation and diagnosis of senile lip changes, such as lip atrophy, loss of lip architecture, and lip lengthening lead to a reliable treatment plan that provides a more esthetic frame to view the oral aperture. Treatment options will be discussed that act to reverse these problems. Directed lip augmentation procedures are used to correct loss of lip volume and architecture. The subnasal lip lift technique is presented as a method to correct lip lengthening. Risks and limitations of these procedures are addressed. CONCLUSION: Safe and reliable methods are presented that can improve and rejuvenate the lip complex, thus allowing for optimal display of dental esthetics.     

Focal osteoporotic marrow defect: report of 100 new cases with ultrasonography scans

Focal osteoporotic marrow defect (FOMD) may be the earliest detectable form of the ischemic marrow disorders. The exact cause is unknown, but three theories have been proposed in the literature. A fourth is presented in this paper. In this study, 100 biopsies were examined histologically and were diagnosed as FOMD, based upon consistent histological characteristics. Until recently, the only diagnostic criteria were radiographic evaluation and incisional biopsy. In February 2002, a through-transmission alveolar ultrasonic test (Cavitat 4000, Cavitat Medical Technologies, Inc., Aurora, CO) was approved by the US Food and Drug Administration and by Health Canada for detection of low bone density and bone desiccation, both features of FOMD and chronic ischemic bone disease. Within this article, the diagnostic criteria and pathological findings of FOMD will be presented. The three current theories concerning its etiology will be briefly presented and a fourth theory will be proposed.     

Mandibular condyle fracture and dislocation into the middle cranial fossa

A case report is presented concerning a patient who sustained a condyle fracture with superior dislocation into the middle cranial fossa. Although relatively rare, other cases of central condylar dislocation have been presented and will be discussed and compared. Diagnosis has been a problem, and treatments have varied greatly for these cases. This is the first case on record, however, in which such a dislocation occurred in conjunction with a fracture of the condylar head. In the present case, the dura was covered with temporalis muscle and the glenoid fossa was covered using the fragments of the fractured condyle as an autogenous free bone graft.     

Clinical and radiographic features of chronic monostotic fibrous dysplasia of the mandible

Chronic untreated fibrous dysplasia of the mandible in a 40-year-old man is described, with emphasis on the radiographic findings. To the authors' knowledge, this is the first such case to be reported in the literature. Within this mature mandibular lesion, a large radiolucency was noticed, with the appearance of a simple bone cyst. The patient did not have any symptoms directly related to the mandibular lesion. Various aspects of the diagnosis, radiographic appearance and differential diagnosis are discussed. The information presented here will be useful for all dentists, oral and maxillofacial surgeons, physicians and other health care providers in identifying the appearance of chronic fibro-osseous lesions.     

Appreciating the art of custom surgical orthodontic care

Orthodontics has changed a lot since its humble beginnings. Today orthodontics is not considered a luxury, but more likely a proactive attempt to create better oral health through improving facial harmony and esthetics. Occlusion and functional issues such as mastication, breathing, speech, and self esteem are now issues that patients understand and want to improve. Educational mechanisms such as the internet combined with a multidisciplinary team approach drive patients to ask for very specific treatment objectives. However, there is a huge disparity in the variety of treatment mechanisms that a patient may utilize. The choices presented to the patient are often limited not by what the patient wants, but rather to mechanics that the doctor uses daily. It is not reasonable to think that an adult will want to have mechanics similar to what a growing 12 year old uses. Older patients desire to hide their orthodontic mechanics, and thus the need for a more cosmetic solutions was born. Isn't it ironic that the most advanced and accurate custom orthodontic appliance happens to be on the lingual of the teeth?! This article will discuss and review how the Incognito appliance system may be used to prepare cases for orthognathic surgery. The benefits to this system are numerous. It's effectiveness at setting cases up for orthognathic surgery is real. Multiple multidisciplinary cases will be demonstrated with issues in transverse, sagittal, and vertical planes. Cases will be shown from treatment planning through retention. Historically, lingual orthodontics has been perceived as a challenging concept to master. The Incognito appliance system is uniquely different compared to labial mechanics as the arch wire is a ribbon arch and as such it displays torque moves much more effectively when it is planned and deployed. Properly utilized, the Incognito appliance system can be the difference when teeth need to be decompensated for surgery. It's strength is delivering an accurate, predictable tooth position while achieving esthetic excellence. Regardless of the dimension(s) to correct (transverse, vertical or antero-posterior dimension) via a combination of comprehensive orthodontics and orthognathic surgery, lingual appliances simply represent the best option when a patient demands esthetic appliances to correct their malocclusion.     

Intraspinal anomalies: presentation,assessment, treatment and association with the development of scoliosis

The most common congenital intraspinal abnormalities presenting to medical attention is either a Chiari malformation with or without associated syringomyelia or caudal anomalies, such as tethered cord and fatty filum terminale. These intraspinal defects are usually diagnosed at birth or in early childhood, but they may also be identified in adult life due to newly presented neurological symptoms. Availability and use of appropriate imaging modalities, such as MRI and regular fetal screening has reduced the incidence of delayed diagnosis of spinal dysraphism and other accompanying congenital systemic anomalies. In view of the risk for neurological complications, prophylactic surgery is often recommended in spinal dysraphism; hence knowledge of various intraspinal abnormalities, their clinical presentation and natural history will allow early diagnosis and treatment in order to prevent neurological deterioration and irreversible morbidity. This review summarizes the embryological aspects and clinical manifestations of intraspinal abnormalities and provides a rational approach for evaluation and management in this group of patients.     

The impact of tissue engineering on dentistry

BACKGROUND: Tissue engineering is a novel and highly exciting field of research that aims to repair damaged tissues as well as create replacement (bioartificial) organs. OVERVIEW: The authors provide a general review of the principles underlying key tissue engineering strategies, as well as the typical components used. Several examples of preclinical and clinical progress are presented. These include passive approaches, such as dental implants, and inductive approaches that activate cells with specific molecular signals. PRACTICE IMPLICATIONS: Tissue engineering will have a considerable effect on dental practice during the next 25 years. The greatest effects will likely be related to the repair and replacement of mineralized tissues, the promotion of oral wound healing and the use of gene transfer adjunctively.