Craniofacial morphology in a patient with Simpson-Golabi-Behmel syndrome.

OBJECTIVE: We present the case of a 6-year-old boy with a coarse face, cleft palate, and malocclusion with anterior open bite who had been diagnosed with Simpson-Golabi-Behmel syndrome. Morphology of the craniofacial structures was examined on the basis of conventional radiographs, three-dimensional (3D) computed tomography (CT) and magnetic resonance (MR) scanning. PATIENT: This patient had 13 ribs on the right side, slight scoliosis, supernumerary nipples, a coarse face, hypertelorism, a short broad upturned nose, a wide mouth, a straight facial profile with incompetence of the lips, midline groove of tongue, and cleft palate. The patient also had severe anterior open bite, a distal step-type molar relationship, five congenitally missing teeth, and a supernumerary tooth. Lateral cephalometric analysis revealed a large anterior cranial base, a large maxilla and mandible, a large inferior face height, and skeletal Class I jaw relationship with a high mandibular plane angle and large gonial angle. The 3D CT image showed a large cranium, a long face height, and prominent skull sutures. The MR image showed a large tongue, midline groove of the tongue, and a small space between tongue and palate.     

血链球菌细菌素对伴放线聚集杆菌和白色念珠菌生物膜作用的研究

目的:研究血链球菌细菌素分别对单独培养及混合培养的伴放线聚集杆菌(A.a)和白色念珠菌(C.a)生物膜的最小抑菌浓度(MIC)。利用激光共聚焦显微镜研究血链球菌细菌素对A.a及混合培养的A.a和C.a生物膜活性的影响。方法:通过低温高速离心,细胞破碎,盐析等方法提取血链球细菌素—血链素。采用二倍稀释法,测定血链素对单独和混合培养的A.a及C.a的MIC;血链素作用于A.a及混合培养的A.a和C.a后,利用激光共聚焦显微镜分别在2 h、6 h、12 h、24 h、48 h、72 h观察生物膜活性的变化。结果:血链素对单独培养的A.a的MIC为0.25 g/L;血链素对单独培养的C.a的MIC为0.125 g/L;血链素对混合培养的A.a及C.a的MIC为0.5 g/L。通过激光共聚焦显微镜观察,血链素对A.a生物膜活性有较强的抑制作用,最显著的时间在72 h;血链素对混合培养的A.a及C.a生物膜活性同样具有较强的抑制作用,最显著的时间在48 h。结论:血链素对A.a及混合培养的A.a及C.a生物膜活性均有抑制作用。     

Peri-implantitis in the general oral and maxillofacial surgery practice. A pilot study

A peri-implant infection is a disorder with an annually increasing prevalence and incidence as a result of the increasing number of oral implants utilized. Based on existing literature, a patient-control study was carried out, as a pilot study, among patients who had been treated with oral implants at a department of oral and maxillofacial surgery in a general hospital. Significant relations were found between on the one hand the prevalence of peri-implantitis and on the other hand bone augmentation, a suprastructure of a fixed partial denture or a complete removable overdenture on a ball attachment mesostructure when compared to a crown, poor oral hygiene, poor periodontal condition, and the absence of keratinized mucosa surrounding the implant.     

Tensile stress in glass-ceramic crowns: effect of flaws and cement voids.

The objective of this study was to analyze the relative effect of loading site, occlusal thickness, ceramic flaws, elastic modulus of the cement, and voids in the cement layer on tensile stress that develops in molar glass-ceramic crowns under applied loads. Finite-element stress analyses were performed. Resin cement with a thickness of 0.05 mm was used. A central conical flaw (0.05 mm [diameter] x 0.05 mm) and a circular grooved flaw located under the cusp tips were included in all flaw cases. A void space confined within the occlusal region of the cement layer was also included in selected cases. For a ceramic thickness of 0.5 mm and a vertical distributed load applied at a distance of 1.3 mm from the vertical axis, the maximum tensile stresses were 100 MPa for a crown with flaws and a void, 87 MPa for a crown with no flaws and a void, and 75 MPa for a crown with flaws and no void. For a 1.5-mm-thick crown with flaws and a void, the tensile stress decreased to 22 MPa. When the load of 600 N was concentrated at the central point of the occlusal region, the peak tensile stress in a crown with flaws and no void was increased to 325 MPa. For the conditions analyzed in this study a large void in a flawed occlusal region of a thin molar crown (0.5 mm) is proposed as a mechanism of crown failure.     

Referral of patients with non-odontogenic oral diseases to an oral and maxillofacial surgeon

Patients with non-odontogenic oral diseases may be referred to an oral and maxillofacial surgeon by a dentist, a general medical practitioner or a medical specialist. At the department of Oral and Maxillofacial Surgery of a medical centre, a survey involving 96 referred patients with a non-odontogenic oral disease addressed the clinician who was responsible for the referral, the patient characteristics, and the nature and location of the oral disease. From the patients who regularly visited a dentist, 53% were referred by a dentist. From the patients who visited a dentist irregularly, 73% were referred by a general medical practitioner. No significant correlation was found between the nature and location of the non-odontogenic oral disease and the profession of the clinician who was responsible for the referral, with an exception for the tongue, for which a medical specialist was more often responsible for the referral.     

Achieving an even thickness in heat-polymerized permanent acrylic resin denture bases for complete dentures.

Permanent denture bases form the fitting surface of a denture and are constructed on a master cast, in heat-polymerized acrylic resin. These bases are strong and rigid and demonstrate both the fit and retention of the final prosthesis. General recommendations suggests a thickness of between 1.5 to 3 mm for these bases. The normal procedure for producing such a denture base is to manually adapt materials to the cast, in their plastic state, before processing. Such procedures are liable to distortion and variation in the thickness of the resultant denture base and may be unreliable. This article describes a method for achieving a consistent thickness in a heat-polymerized, permanent, acrylic resin denture base through the use of a vacuum-formed, thermoplastic blank as a template. The method is simple, and results in a denture base with a consistent even thickness.     

Face, palate, and craniofacial morphology in patients with a solitary median maxillary central incisor

The occurrence of a solitary median maxillary central incisor (SMMCI) is a very rare condition and might be a sign of a mild degree of holoprosencephaly. In this investigation, material from 10 patients, nine girls and one boy with a SMMCI (8-17 years of age) registered in orthodontic clinics was examined. The purpose was to evaluate the clinical characteristics and craniofacial morphology in this group of patients. Oral photographs, study casts, profile radiographs, and orthopantomograms were analysed. The study showed that this group of SMMCI patients were characterized by an indistinct philtrum, an arch-shaped upper lip, absence of the fraenulum of the upper lip, a complete or incomplete mid-palatal ridge, a SMMCI, and nasal obstruction or septum deviation. The craniofacial morphology of the nine girls, compared with normal standards for girls showed a short anterior cranial base, a short, retrognathic and posteriorly inclined maxilla, and a retrognathic and posteriorly inclined mandible. Furthermore, the sella turcica had a deviant morphology in five of the 10 subjects. The results indicate that the presence of a SMMCI should not be considered as a simple dental anomaly, since it may be associated with other clinical characteristics and more complex craniofacial malformations. It is therefore suggested that the SMMCI condition in future studies is classified according to clinical symptoms and craniofacial morphology.     

Calcium hydroxide barrier over the apical root-end of a type III dens invaginatus after endodontic and surgical treatment

AIM: To report the simultaneous endodontic and surgical treatment of a tooth associated with Oehlers type III dens invaginatus and a persistent periapical lesion, which comprised root-end resection, root-end filling and application of a calcium hydroxide barrier placed on the resected dentine surface. SUMMARY: Three root canals were identified in a tooth with a type III dens invaginatus, which presented with a necrotic pulp, wide foraminal opening and extensive periapical lesion, and with a previous history of acute abscess, intracanal exudate and fistula. After root canal preparation followed by intracanal application of calcium hydroxide pastes, the clinical-pathological status persisted. After periapical curettage and root-end resection, the root canals were filled, followed by root-end filling with Sealer 26 mixed with zinc oxide powder to a clay-like consistency. Calcium hydroxide paste was then applied over the exposed dentinal surface forming a covering over the root apex. At the 20-month follow-up examination the patient had no symptoms and no fistula; advanced periapical bone repair was obvious on the radiograph. KEY LEARNING POINTS: Because of the variable morphology and extent of invagination, type III dens invaginatus represents a challenge for conventional treatment, often leading to the need for a surgical approach. Sealer 26 thickened with zinc oxide powder provided satisfactory clinical properties for use as a root-end filling material. Application of a calcium hydroxide barrier over the resected root-end is a potential treatment option to encourage tissue repair.     

The effect of A Triclosan/copolymer/fluoride dentifrice on plaque formation and gingivitis: a six-month clinical study

A total of 108 adult male and female subjects completed a six-month, double-blind clinical study designed to compare the effect of a dentifrice containing 0.3% triclosan and 2.0% of a copolymer of methoxyethylene and maleic acid (Gantrez copolymer) in a 0.243% sodium fluoride/silica base to a 0.243% sodium fluoride/silica placebo dentifrice on supragingival plaque formation and gingivitis. Subjects were stratified into two balanced groups by their baseline plaque and gingivitis scores. They received an oral prophylaxis and were assigned to use either the triclosan/copolymer dentifrice or the placebo dentifrice for the next six months. After six months, the dentifrice containing triclosan/copolymer provided a 24.93% statistically significant (99% level of confidence) reduction in supragingival plaque, and a 19.72% statistically significant (99% level of confidence) reduction in gingivitis compared to the placebo dentifrice. Twice daily use of a dentifrice containing 0.3% triclosan, 2.0% of a copolymer, and 0.243% sodium fluoride in a silica base, over a six-month period, reduces supragingival plaque formation and gingivitis to a significant degree compared to a sodium fluoride/silica base placebo dentifrice.     

Prosthetic assessment in cleft lip and palate patients: a case report with oronasal communication

The cleft lip and palate patient is mainly characterized by the presence of an oronasal communication, malformation or agenesis of the teeth close to the cleft, and deficient sagittal and transverse growth of the maxilla. These patients require various treatments involving a multidisciplinary team, which may include a maxillofacial surgeon, an orthodontist, a speech therapist, a paediatrician, a general dentist, a prosthodontist, an ENT specialist, a psychologist and all those professionals who can help provide functional, aesthetic and psychological improvement. This report describes a case of prosthetic rehabilitation in a patient with cleft lip and palate and an oronasal fistula (communication) following surgery. Different prosthetic treatments are described, with emphasis being placed on the approach chosen after to discuss the various limitations which arose.     

Pseudoaneurysm of the facial artery after the injection of local anesthetics

Generally, a true aneurysm is a dilatation of the vessel wall, whereas a pseudoaneurysm (PA) is a weakening or rent in a vessel wall, with contained rupture into the surrounding tissues. In the face, PAs of the facial artery are an extremely rare development after penetrating or blunt trauma. A 31-year-old woman presented with nontender, palpable, and firm lump that had been steadily increasing in size over a 4-week period. Examination confirmed a firm and spherical swelling in the left mandibular area, which was nonpulsatile. The patient presented with a mass on the upper part of her left chin 6 months after the injection of local anesthetics for dental treatment. After the procedure, a hematoma developed over the injection site, and it was treated with local ice. This case is unique in that the lesion seen using computed tomography and ultrasonography scanning had an unusual presentation. Ultrasonography revealed thrombi within the tumor, and color Doppler examination showed blood moving in the perivascular mass. During the operation via intraoral incision, a lesion was found as a dilation of the muscular branch of the facial artery. The facial artery was exposed, isolated, and tied off with a 2-0 white silk ligature. Histopathologic analysis determined that the content of the fragile cystic lesion was an organized thrombus and hematoma. As with any penetrating facial injury, local anesthetics can damage vessels and produce a PA. Therefore, we present a rare case of false facial artery aneurysm with no associated risk factors, which was nonpulsatile on presentation.     

Does dysfunctional swallowing influence posture?

Swallowing is one of the first functions to be set up in utero for vital reasons. Physiological and psychic maturation then occur to lead from a dysfunctional to a functional state. Nevertheless, for certain individuals, maturation is incomplete, and swallowing remains dysfunctional. The clinical literature has already proven the incidence of a dental change of occlusion and the consequences of a lingual dysfunction upon posture. This work proposes to show that the posture can be affected by dysfunctional deglutition because of the lack of dental contacts during this function and because of the lingual dysfunction which characterizes it. We studied a population of 20 young adults, divided into two groups: a group of subjects presenting with a functional swallowing, and a group of subjects presenting with a dysfunctional swallowing. The experimental protocol includes four conditions: mandibular rest, cognitive task of articulation, functional swallowing, dysfunctional swallowing. Their effect on the posture is evaluated by means of a standardized stabilometric platform, and is supplemented by an electromyographic study of a manducator muscle (the masseter) and of a muscle of the cephalic posture (the sternocleidomastoid). The results show that swallowing would have the same postural effects as the cognitive task by increasing the postural oscillations and the energy spent by the postural system. Furthermore, the deglutition would have increased effects when it corresponds to a forced deglutition for the subject.     

Three-body wear of a hand-consolidated silver alternative to amalgam.

Recent studies have investigated a mercury-free silver alternative to amalgam, but the silver powders required a relatively high compaction pressure to consolidate. The aim of the present study was to consolidate a precipitated silver powder into a cohesive solid using an air-driven pneumatic condenser fitted with an amalgam plugger at a clinically realistic load, and to study the mechanisms and rates of three-body wear of the consolidated silver in comparison with that of an amalgam. The silver powder was annealed, rinsed with a dilute acid, and consolidated either in a prepared tooth cavity or in a specimen mold at a load of 15 N. A four-station wear machine was used where each specimen was immersed in a slurry containing polymethyl methacrylate beads, then a steel pin was loaded and rotated against the specimen at a maximum load of 76 N. The flexural strength in MPa (mean +/- SD; n = 10) was 86 +/- 20 for amalgam, 181 +/- 45 for silver with a polished surface, and 202 +/- 21 for silver with a burnished surface. After 4 x 10(5) wear cycles, the wear scar depth in microm was 134 +/- 54 for amalgam, 143 +/- 8 for polished silver, and 131 +/- 9 for burnished silver, which were not significantly different (Tukey's multiple comparison test; family confidence coefficient = 0.95). SEM examination revealed cracks and fracture pits in the worn surface of amalgam, in contrast to a smooth surface in silver. Wear and material removal in amalgam occurred by microfracture and dislodgement of cracked segments, while wear in the silver occurred by ductile deformation and flow of materials. To conclude, the consolidated silver possesses a three-body wear resistance similar to that of amalgam, and a higher resistance to wear-induced damage and cracking than amalgam. The mechanism of wear in amalgam is microfracture and material dislodgement, while that in consolidated silver is ductile deformation and flow of material.     

Secondary craniofacial reconstruction of huge frontoethmoidal encephalomeningocele after primary neurosurgical repair

Frontoethmoidal encephalomeningocele is a congenital herniation of intracranial contents, including meninges, brain and part of the ventricle, through a bony defect in the skull at the junction of the frontal and ethmoid bones. Management involves meticulous preoperative assessment using computed tomography scans and magnetic resonance imaging, and surgical repair of the central nervous system, skeletal deformities of the orbit, downward displacement of the medial canthi, upward displacement of the eyebrows, and nasal deformities. Frontoethmoidal encephaloceles are best operated on via a craniofacial approach which enables repair of the central nervous system and skeletal deformities in one stage. However, a two-stage reconstruction must be considered when a prolonged operative time is expected or the patient's general condition increases the risks. There have only been a few reports of two-stage reconstructions. We performed a two-stage reconstruction of a huge frontoethmoidal encephalomeningocele, with neurosurgical repair during the first procedure and craniofacial reconstruction during the second procedure. We report on the surgical procedures and the problems encountered.     

Rehabilitation with removable dentures among the dentate population in Finland

The information available on the rehabilitation with removable dentures among dentate subjects is contradictory. In the present study, the most common type of rehabilitation was a complete maxillary denture with or without a partial one. Nineteen per cent of men and 27% of women belonged to this category. Partial denture(s) without a complete one were worn by 11% of men and 15% of women. The odds ratio of having partial denture(s) was significantly higher among women, among people with a medium level of income, with a regular dental attendance pattern, and with a shorter distance to the nearest dental clinic. The presence of a complete denture significantly decreased the odds ratio of having a partial denture. The effect of age was non-significant in the two youngest age categories. The odds ratio of having a single complete denture was significantly higher among women, among people with a medium level of income and with a shorter distance to the nearest dental clinic. The presence of a partial denture and belonging to the oldest age bracket decreased the odds ratio significantly. Regularity of use of dental services had a non-significant effect.     

The nasal frame osteotomy: technical note

In the practice of orthognathic surgery, a patient presenting with a gummy smile and lip incompetence is readily diagnosed as having vertical maxillary excess, and a maxillary impaction osteotomy is usually the proposed treatment. If a short nose, an arched and upwardly displaced upper lip, and a broad face accompany these 2 features, nasal lengthening and caudal repositioning of the central portion of the upper lip by a nasal frame osteotomy should be considered instead. The technique of the nasal "frame" osteotomy, which was used in 1 patient with a 4-year follow-up, is described.     

Cephalometric characteristics of Korean Class III surgical patients and their relationship to plans for surgical treatment

In comparison to gender-matched normal Koreans, Korean patients selected for surgical correction of skeletal Class III problems have, on average, a shorter anterior and posterior cranial base, a shorter maxilla, a longer mandible, increased lower facial height, and a retrusive upper lip. In both males and females, about 40% of a group of Class III patients scheduled for surgery had a maxilla within one standard deviation of the normal position and a prognathic mandible, as compared with a group of normal Korean adults. Almost as many males (37%) in the surgical group had both a retrognathic maxilla and a prognathic mandible, while 18% had a retrognathic maxilla and normal mandible. In females, 25% had only a retrognathic maxilla and 25% had both jaws outside the normal range. The percentage of the Korean patients whose Class III relationship was primarily a result of mandibular prognathism (48%) is more than twice as high as the corresponding number for American Class III surgical patients (19%), somewhat higher than in Chinese patients (39%), and similar to the percentage of Japanese (50%). Maxillary surgery, alone or in conjunction with mandibular setback, is currently used in the treatment of most Class III patients. Both the esthetic consideration of widening the already broad Asian nose and the relative proportions of maxillary versus mandibular abnormalities suggest that mandibular setback alone can be considered for a higher number of Asian than Caucasian Class III patients.     

Merkel cell carcinoma

Merkel cell carcinoma (Mcc) is a very rare, malignant, neuroendocrine tumour. Mcc has an aggressive behavior, local recurrence, and regional or distant metastasis generally develop within a short period of time. At the Oral Medicine Department 158,056 patients were treated between 1970 and 2004. A single case of Mcc was diagnosed, in a 79-year-old woman. The tumour was localized to the upper lip. After successful cryosurgery and a 7-year tumour-free period, a new tumour developed in her palatine tonsil. It was an anaplastic carcinoma with neuroendocrine features, raising the possibility of a late haematogenous metastasis, a second field tumour, or a second primary tumour. The clinical, histological, immunohistochemical and genetic findings suggested that the tumour of the palatine tonsil is a second field tumour.     

Three-dimensional analysis of tooth movement after intrusion of a supraerupted molar using a mini-implant with partial-fixed orthodontic appliances

Objective:To evaluate three-dimensional (3D) positional changes of an intruded tooth, a neighboring tooth, and a tooth connected to a mini-implant following intrusion of a single supraerupted molar, using a mini-implant with partial-fixed orthodontic appliances.Materials and Methods:The study consisted of 14 adult patients (two males and 12 females, mean age 41.9 years) with a supraerupted molar due to loss of an antagonist. Intrusion was performed using a mini-implant with a partial strap-up. The mean treatment time was 11.9 months, and the mean retention time was 23.3 months. To quantify the positional changes of the teeth, 3D models using a laser-based, dental scanning system and 3D software at pretreatment, posttreatment, and retention were oriented in a coordinate system and superimposed using nonmoved teeth as references. The changes on the x-, y-, and z-axes were measured at the tip of each cusp in the involved teeth.Results:A supraerupted molar was intruded by a mean amount of 1.35 ± 0.48 mm and was well maintained during the retention period. The overall change in the neighboring tooth was insignificant, although it showed opposite movement compared to the intruded tooth during the intrusion. The tooth connected to a mini-implant exhibited a secure anchorage.Conclusion:3D analysis showed the detailed positional changes of each tooth, and the involved molars were well maintained after intrusion.