活髓保存治疗中生物材料的研究和应用

牙髓病治疗中最符合生物学观点的方法是活髓保存治疗，影响活髓保存成功的因而素很多，理想的盖髓剂至关重要。本文就活髓保存治疗中生物材料的研究应用情况作一综述。     

The classification of orofacial pains

This article highlights the process of making the proper orofacial pain diagnosis. A classification is presented based on the clinical characteristics of the pain complaint and the structure by which it emanates. It is meant to serve as a road map for the clinician, which will help him or her establish the correct diagnosis, thereby allowing the selection of the proper treatment.     

Clinical decision analysis in fixed prosthodontics.

Structured clinical decision analysis in dentistry in fixed prosthodontics, as in any branch of dentistry, allows the practitioner to think through more clearly the problems at hand based on the clinical data and extenuating factors presented by the patient. This discipline of decision making is intended to complement the experience level and educational background of the clinician in assisting him or her through the decision process. Additionally, CDA helps the clinician define not only the pre-existing condition of the patient prior to irreversible therapy, but also which treatment strategies may best be suited for that individual over an extended period. The systematic nature of decision analysis stimulates the focusing of one's attention on those factors considered to be germane to the overall complexity of the case and, at the same time, excluding those factors having little or no influence on its final outcome. With further implementation of computerized databases and procedural outcome probabilities based on clinical and laboratory studies as well as the clinical experience of those choosing to use it, the future for structured, formalized clinical decision analysis seems quite promising.     

Platelet-rich plasma and its derivatives as promising bioactive materials for regenerative medicine: basic principles and concepts underlying recent advances

Over the past decade, platelet-rich plasma (PRP), a platelet-concentrated plasma fraction, has been widely investigated and applied to regenerative medicine. The clinical utility of PRP is supported by evidence that PRP contains high concentrations of platelet-related growth factors and normal concentrations of plasma-derived fibrinogen, both of which contribute synergistically to the regenerative process. Additionally, its superior cost-efficacy versus conventional therapies is attractive to many clinicians. However, current disadvantages of PRP include a relatively complicated preparation procedure and variable operator-dependent efficacy. An additional disadvantage is the use of bovine thrombin, an animal-derived biological, as a coagulant. Many of these disadvantages are overcome by recent advances in preparation procedures and devices; for example, Joseph Choukroun simplified the platelet-rich fibrin preparation procedure and improved handling efficiency without the aid of animal-derived factors. With advancements in cell processing technology, there has been a general shift in cell therapy from autologous to allogeneic treatment; however, autologous PRP therapy will not easily be replaced by allogeneic treatment in the near future. Therefore, to provide more predictable regenerative therapy outcomes using autologous PRP, further investigations should address developing a standardized procedure for PRP preparation to augment its efficacy and potency, independent of donor variability. We would then propose that operators and clinicians prepare PRP according to the standardized protocol and to carefully evaluate the clinical scenario (i.e., recipient factors comprising skeletal defects) to determine which factor(s) should be added to PRP preparations. This careful approach will lead to improved clinical outcomes for patients.     

Treatment planning for implants versus root canal therapy: a contemporary dilemma

The predictability of implant fixtures as a long-term solution for edentulous areas has improved to the point where they have become the standard of care in many situations, in lieu of fixed prostheses. At the same time, the success rate of endodontically treated teeth, and those requiring retreatment, is very high as well. The dilemma presented to the clinician in treatment planning is when to retreat a tooth or extract and place an endosseous root-form implant. Risk assessment for prognostic evaluation plays an important role in the decision-making process. The clinical and systemic factors affecting the longevity of a tooth need be considered as well as location, bone quality and amount, and the condition of the patient's other teeth. This article attempts to provide a meaningful algorithm that will provide a basis for an appropriate choice of therapy.     

Dens invaginatus in first mandibular premolar

Abstract A case of dens invaginatus in a mandibular first premolar with periapical lesion is presented in which it was possible to perform non-surgical endodontic therapy. Dens invaginatus is a developmental malformation of teeth which results from abnormal morphodifferentation. Due to their abnormal anatomical configuration, invaginated teeth present technical difficulties in their clinical management. The treatment modalities available to the clinician include: endodontic therapy, endodontic surgery, combined treatment, or extraction. In this case the treatment of choice, selected according to clinical and radiographic considerations, was endodontic therapy of the main root canal.     

Biologic Perspectives in Restorative Treatment

One of the primary goals of a long term successful restorative therapy is to establish a physiologic periodontal climate that facilitates the maintenance of periodontal health. The contemporary clinician has a host of alternatives for the restoration of teeth. It is now possible to mimic nature and provide restorations that defy detection but the most challenging procedure in clinical dentistry is fabricating a restoration in gingival harmony. Periodontal health is the basis of all restorative dentistry. Because periodontal disease is a major cause of tooth loss in adults, the clinician must be aware of the biological variables relevant to restorative therapy, basic concepts and clinical modes of therapy available, to be able to develop an appropriate diagnosis and treatment plan. A natural looking prosthesis within a healthy periodontium should represent the ultimate goal. This article addresses the interactions between periodontal tissues and restorative procedures. It reviews the essentials of soft tissue management inherent in restorative dentistry that will increase the probability of a successful restoration.     

Complications and treatment errors in root coverage procedures

Root coverage procedures have become very common in clinical dental practice. Even though these techniques are considered safe, the clinician may face several issues during the therapy due to their surgical nature. Some of these issues can be defined strictly as complications inherent to the procedure, whereas others are medical errors or treatment errors. This review will focus on describing treatment errors and complications that may arise during different phases of the root coverage therapeutic process and on how to prevent and manage them.     

Transcutaneous electrical nerve stimulation and myoneural injection therapy for management of chronic myofascial pain

The purpose of this article has been to discuss in detail both the rationale and techniques for TENS and myoneural injection therapy as modalities for the management of chronic myofascial pain. In a more subtle sense, we have also interjected some of our philosophy regarding the treatment of chronic myofascial pain. As was discussed earlier in the text of this article, very seldom, if ever, will any single technique stand alone as a "cure" for the patient with chronic pain, but, instead, each modality must be considered as an adjunctive form of multidisciplinary care. The multidisciplinary approach to pain management includes, as a minimum, pharmacotherapy, physical therapy, and behavioral medicine therapy. The concept of the team approach and goals of management, rather than cure, for chronic myofascial pain, cannot be overstated and is often as difficult to impart to the clinician as it is to the patient. To employ any individual form of therapy, the clinician must understand the indications and limitations of each modality in a total treatment program. Over the last several years TENS therapy has become extremely popular to a large extent because it is a noninvasive technique that most patients can be taught to use safely and effectively. An additional advantage to TENS therapy is that it provides many patients with some means of control over their pain, independent of medications and hands-on therapy by health care providers. Myoneural block therapy is often utilized to add a measure of control over the severe pain and dysfunction that may be present during the early phases of active treatment of chronic myofascial pain. It is used to enhance the effects of a conservative multidisciplinary pain management program when utilized on a short-term basis. Myoneural block therapy is often a useful adjunct to physical therapy to improve the patient's overall range of motion and facilitate either treatment by the physical therapist or a home exercise program. The clinician is reminded that myoneural injection therapy can be overutilized. It should be limited as to the number of injections per visit. Also, the total number of visits the patient receives injections should be kept low. After the initial myoneural injection treatment series of three to five sessions, it should be utilized only for severe pain exacerbation that has been unresponsive to conservative, noninvasive management.     

Bisphosphonate-related osteonecrosis of the jaws: a comprehensive review

BACKGROUND: Bisphosphonate-related osteonecrosis of the jaws (BRONJ) presents the clinician with significant management dilemmas. The purpose of this study was to distil information related to this disorder by comprehensively reviewing the literature. METHODS: The structure and function of bisphosphonates, and their role in the development of BRONJ will be discussed, as will the possible mechanisms through which this pathology develops. A review of cases presented in the literature will be undertaken, and suggestions offered as to the management of this pathology in terms of surgical and conservative approaches. RESULTS: Presentation of BRONJ is currently more common in patients taking intravenous forms of bisphosphonates, but there is a fear that the long-term cumulative effects of oral bisphosphonates may see BRONJ increasingly occurring in this patient group. CONCLUSIONS: Prevention is superior to treatment, and the establishment of meticulous oral hygiene and pre-emptive surgical treatment prior to commencement of bisphosphonate therapy is recommended.     

Salivary gland dysfunction: a review of systemic therapies

Xerostomia may result from salivary dysfunction secondary to a variety of conditions, including medications, autoimmune disease, and tumoricidal therapy. As the geriatric population increases, the incidence of xerostomia will increase and the oral manifestations will continue to be a challenge to the clinician. Common oral manifestations resulting from decreased salivary flow include increased dental caries, fungal infections, and dysphagia. Treatment for salivary gland dysfunction is currently limited because of a lack of controlled clinical trials. Medications that have been studied in clinical trials are emphasized in this article. The aim of this article is to briefly review salivary gland physiology and to summarize the suggested systemic treatment modalities for xerostomia that emphasize controlled clinical trials.     

Reviewing nonsurgical periodontal therapy

Selection of the appropriate case and clinical competency in treatment modalities results in success in nonsurgical periodontal therapy. The patient with early periodontitis with significant local factors in the form of professionally accessible plaque and calculus is the most receptive to nonsurgical periodontal treatment. The clinician must make decisions centering around the important question, "Can the patient, or moreover, can the therapist delivering the debridement, gain access to the microbial subgingival plaque on a frequent basis below the host defense threshold of the respective patient?" If the answer is "yes," nonsurgical periodontal therapy will be rewarding. If the answer is "no," other modalities such as periodontal surgery must be instituted.     

The microscopic diagnosis and treatment of a mandibular second premolar with four canals

AIM: The purpose of this article is to report the case of a mandibular second premolar with four distinct canals. SUMMARY: It is generally recognized that incomplete instrumentation and cleaning of root canals will lead to failure in root-treated teeth. Before root canal treatment is performed, the clinician should be aware of the configuration of the pulp space of the tooth that is to be treated. Frequently, root canals are left untreated because the clinician fails to identify their presence, particularly in teeth that have anatomical variations or additional root canals. Traditionally, additional canals have been detected by clinical examination of the floor of the pulp chamber, and sometimes found radiographically. More recently microscopic examination of the pulp chamber using endodontic microscopy has assisted the identification of extra canals. A case report is presented that deals with the successful treatment of a mandibular second premolar with four canals. KEY LEARNING POINTS: Even in teeth with a low frequency of abnormal root canal anatomy, the possibility of additional root canals has to be considered in the clinical and radiographic examination of the patient. The ability to recognize and locate unsuspected canals is enhanced by microscopic investigation of the pulp chamber.     

Clinical considerations in the treatment of dens invaginatus

Abstract Dens invaginatus is a developmental malformation of teeth which results from abnormal morphodiflerentiation. Such a condition is often associated with pulpal and periapical pathosis, which require treatment. Due to their abnormal anatomical configurations, invaginated teeth present technical difficulties in their clinical management. The treatment modalities available to the clinician include: endodontic therapy, endodontic surgery, combined treatment, or extraction. The treatment of choice should be selected according to specific clinical considerations. This article discusses these clinical considerations and establishes criteria for case selection and treatment planning.     

Preserving the socket dimensions with bone grafting in single sites: an esthetic surgical approach when planning delayed implant placement

Recent advancements in barrier membranes, bone grafting substitutes, and surgical techniques have led to a predictable arsenal of treatment methods for clinicians who practice implant dentistry. The contemporary clinician is supplied with proven knowledge, substantiated materials, and instrument inventory that allows implant placement in cases that used to be reserved for the specialist in the past because of their complexity. Nowadays, postextraction alveolar ridge maintenance can be a predictable procedure and can certainly aid the clinician in preventing ridge collapse, thereby allowing for implant placement in a position that satisfies esthetics and function. Extraction socket maintenance for future implant therapy does not rule out immediate implant placement but rather provides an additional option when treatment planning implant patients. This article will focus on the concept of extraction socket preservation using regenerative materials. It will describe a technique suggested by the authors to resist bone resorption and soft tissue shrinkage following tooth extraction.     

Subgingival application of chlorhexidine in the treatment of periodontitis

The clinician is frequently faced with poor treatment outcome of scaling and root planing predominantly in deep pockets and furcations. In an attempt to optimize clinical effects at these weakly responding sites chemo-mechanical treatment strategies have been developed and studied, among those using chlorhexidine as an antimicrobial agent. In this overview the clinical effects of subgingival chlorhexidine irrigation, gel, chip and varnish administration as an adjunct to scaling and root planing in the treatment of periodontitis are discussed. There is little to no evidence indicating treatment outcome will benefit from subgingival irrigation using chlorhexidine solutions. Furthermore, the use of a chlorhexidine solution as a coolant during (ultra)sonic scaling does not result in a clinically superior response when compared to water cooling. Despite the high viscosity of a gel, its use cannot be justified in the treatment of periodontitis as clinical effects are also negligible. Multi-center studies have indicated significantly higher pocket reductions and clinical attachment gains following a combination of scaling and root planing and the administration of a chlorhexidine chip. As some studies failed to confirm this finding, more research is needed to elucidate the additional value of the chip. The subgingival administration of a supersaturated chlorhexidine varnish seems promising as additive clinical effects have been reported. Large-scale studies are however lacking on this treatment concept. The clinician should continue treating periodontitis primarily by mechanical means. Supplemental chemical therapy based on subgingival chlorhexidine administration can be considered; yet, solutions and gels are not suitable as compensatory aids when scaling and root planing becomes less effective.     

Clinical,radiographic, and histologic analysis of the effects of acemannan used in direct pulp capping of human primary teeth: short-term outcomes

Acemannan has been previously reported as a direct pulp-capping agent in animal study. This natural material demonstrated its biocompatibility and enhanced reparative dentin formation. The objective of this study was to investigate the action of acemannan as a direct pulp-capping material in human primary teeth with deep caries. Forty-two deeply carious mandibular primary molars from 37 children, aged 7–11 years old diagnosed with reversible pulpitis were studied. After completely removing the infected dentine, teeth with a pinpoint pulpal exposure were randomly divided into two treatment groups: acemannan or calcium hydroxide. A glass-ionomer cement base was applied to all teeth prior to restoration with stainless steel crowns. Clinical and radiographic evaluation was performed 6 months post-treatment. The teeth due to exfoliate were extracted and histopathologically evaluated for inflammation, dentine bridge formation, and soft tissue organization. At 6 months, the overall clinical and radiographic success rates of direct pulp capping with acemannan and calcium hydroxide at 6 months were 72.73 and 70.0 %, respectively. The histopathological results indicated that the acemannan-treated group had significantly better histopathological responses compared with the calcium hydroxide-treated group (p < 0.05). These data suggest acemannan offers a valuable alternative biomaterial for vital pulp therapy in primary teeth.     

Compliance with maintenance therapy after periodontal treatment.

The aim of this study was to investigate the degree of compliance with a post treatment maintenance programme and to establish whether compliance could be related to the clinical assessment parameters before treatment or at the end of the initial phase of treatment. The study was carried out on 231 individuals who had been referred for periodontal therapy. Initial and post treatment plaque and gingivitis levels and pocket depth measurements were evaluated, in order to establish if postoperative compliance could be related to any of the pretreatment clinical parameters, or the changes which took place in these parameters as a result of treatment. It was found that more females tended to comply with the prescribed maintenance programme. Highly significant differences in the clinical parameters were noted for the compliant and non-compliant groups before treatment and at the end of the initial phase of treatment. 42% of individuals did not comply with the prescribed maintenance treatment. It is concluded that the degree of postoperative compliance with maintenance therapy is unrelated to the clinical parameters evaluated. The clinician must therefore recognise that a large percentage of individuals may not comply with the postoperative maintenance programme, although it is not possible to anticipate which individuals are less likely to be compliant from assessment of the clinical assessment parameters routinely used in clinical practice.     

MTA用于犬牙直接盖髓术的组织学观察

目的 通过组织学观察，比较MTA（Mineral Trioxide Aggregate)和氢氧化钙制剂(Dycal)在直接盖髓时对牙髓的影响。方法 3条健康杂种犬尖牙12颗，随机分为2组：MTA，Dycal。用裂钻在尖牙唇侧颈部穿髓后以MTA和Dycal盖髓，GIC修复牙体缺损。4个月后将犬处死取下尖牙，常规制作组织切片，观察牙髓炎症反应和牙本质桥形成情况。结果 MTA盖髓的实验组中，5／6无炎症或仅有轻度炎症反应，该组所有标本均有牙本质桥形成。Dycal盖髓的对照组牙髓均有轻度或中度的炎症反应，只有2例出现了牙本质桥。结论 MTA具有良好的生物相容性，适用于直接盖髓术，有望替代现有的盖髓材料。     

Clinical, radiographic, and histologic perspectives on success and failure in endodontics.

There is a tremendous impact of multiple variables on the decision-making process in determining success or failure. The best approach to quality outcomes is to minimize the variables that can affect case adversity. Therefore, it behooves the clinician, who chooses to do endodontic therapy, to fully understand the level of treatment that is necessary to achieve success and to attain that level on a consistent basis. Additionally, the wise and prudent clinician should be able to assess completed treatment, with the proper integration of clinical and radiographic factors, in an environment that minimizes the shackles of bias and the dictates of cognitive dissonance.