Odontogenic keratocyst in an infant.

Odontogenic keratocysts occur as solitary lesions or in association with the basal cell naevus syndrome (BCNS), and have been documented in the age range 5 to 83 years. A rare case of an odontogenic keratocyst in a one-year-old girl is presented. Its characteristic tendency to recur, and its association with BCNS present important clinical implications.     

Ultrastructure of an odontogenic myxoma.

The ultrastructural findings in a case of odontogenic myxoma are described. The main cell type was characterized by several cytoplasmic processes, intracytoplasmic fibrils, numerous glycogen particles, and salient Golgi complexes. A few mitochondria and a scarce endoplasmic reticulum was noted. The matrix consisted of numerous granules with fibrillar projections, collagen bundles, and smaller fibers. The over-all ultrastructural features of this tumor were similar to those described in the human cardiac myxoma and in Wharton's jelly and could be clearly differentiated from the fine structural characteristics of other connective tissue tumors.     

Clinical comparison of an adhesive precoated vs. an uncoated ceramic bracket system

Authors – Verstrynge A, Ghesquiere A, Willems G. Objectives – To clinically evaluate the bond characteristics of the adhesive precoated ceramic (APC) Clarity bracket and compare it with the uncoated Clarity bracket used with Transbond XT bonding system. Design – A randomized clinical trial. Settings and Sample Population – Department of Orthodontics, Katholieke Universiteit Leuven. Twenty patients requiring bonded fixed orthodontic appliance from central incisor to second bicuspid. Experimental Variable – APC Clarity brackets were bonded in the first and fourth quadrant of group 1 and in the second and third quadrant of group 2. Uncoated Clarity brackets were bonded with Transbond XT in the second and third quadrant of group 1 and in the first and fourth quadrant of group 2. Outcome Measure – During orthodontic treatment, bracket failures were registered. At debonding, the tooth surfaces were intraorally scored according to the Adhesive Remnant Index. Results – During treatment one tie wing fractured in the APC group and no bond failures occurred. At debonding, no significant differences between the APC and Transbond XT could be shown in any of the quadrants. Conclusion – The two groups performed identically.     

Syndromology: an updated conceptual overview. VIII. Deformations and disruptions

A deformation is an abnormal form or position of the body caused by nondisruptive mechanical forces. Clubfoot, congenital hip dislocation, and infantile mandibular asymmetry (not based on mandibular malformation) serve as examples. The musculoskeletal system is involved in almost all deformations. Various disturbances of intrauterine movement are the usual causes and commonly occur during the fetal period. Causes may be mechanical or malformational. The former includes first pregnancies, small maternal size, uterine malformations and tumors, and amnionic rupture leading to oligohydramnios. Malformational causes usually involve the urogenital system and the central nervous system. A disruption is a morphologic defect of an organ, part of an organ, or a larger region of the body resulting from a breakdown of, or interference with, an originally normal developmental process. Amnionic band disruptions with digital amputations serve as an example. The most recent studies of disruptions and their suggested mechanisms are discussed. Finally, the interrelationships between malformations, deformations, and disruptions are explained.     

Report of an audit into third molar exodontia.

A postal audit of the main surgical variables in third molar exodontia under general anaesthesia was undertaken on consultants holding a National Health contract within the British Isles. This first paper presents the results. A response rate of 175 returned questionnaires from the 247 consultants was obtained (70.9%). Analysis revealed that the majority of consultants use antibiotics, mouthwashes, sutures, analgesics and postoperative review and the minority steroids and peroperative local anaesthetic, routinely in the majority of cases. Approximately half routinely use a chisel as opposed to a bur for bone removal. The consultants who gave all their patients steroids were significantly (p less than 0.01) more likely to possess a medical qualification than the consultants who did not.     

Dens in dente: an unusual sequela. Abbreviated case report.

Dens in dente is the result of an invagination of the enamel organ into the developing dental papilla. The full pathologic potential of this lesion is often not fully appreciated. A case is reported in which a cyst resulting from a dens in dente obliterated the maxillary sinus and necessitated root canal therapy and apicoectomies in four adjacent teeth.     

Edentulous area tissue graft correction of an esthetic defect. A case report.

A patient was left with a severe defect following the extraction of the right maxillary lateral and central incisors. A graft of epithelial and connective tissue was taken from the maxillary tuberosity and placed into the defect. This resulted in the filling of the defect and the correction of the esthetic problem.     

Replantation of an avulsed permanent maxillary incisor with an immature apex: report of a case.

A case is reported of the replantation of a maxillary incisor with an immature apex following a traumatic avulsion. A 14-month follow-up clinical examination revealed the patient to be asymptomatic, the tooth to be still functional, and a recall radiograph showed no evidence of renewed periradicular breakdown. The indications for, and limitations of, replantation of an avulsed permanent incisor with an immature apex are discussed.     

Reliability of an ear-bow arbitrary face-bow transfer instrument.

STATEMENT OF PROBLEM: Accuracy of techniques for recording the orientation of the maxillary arch to the articulation of the temporomandibular joints has been reported. The variability contributed by the dentist and the equipment within a technique may also contribute to technical error. PURPOSE: This study investigated the variability of a group of dentists who used an arbitrary ear-face-bow instrument to mount a maxillary cast. MATERIAL AND METHODS: The same maxillary cast on a single experimental subject was mounted on an articulator with a common arbitrary ear-face-bow instrument. This cast was equipped with 4 reference points for the measurement of changes of spatial orientation of the cast, which were determined through coordinate measurements with a machinist's microscope. A repeated measures analysis of variance was used to determine statistically significant changes in spatial orientation with a Wilks' Lambda test to compare mean values. RESULTS: A confidence interval of 95% demonstrated that any dentist might expect a range of +/-1.2 mm error in using this instrument/articulator combination. The 3 dentists did not demonstrate any significant differences in the spatial orientation of their mountings in the vertical or horizontal directions. However, there were significant differences in their mountings in linear distance changes of the patient's posterior right side. CONCLUSION: A range of inherent error attributable to the operator using this instrument was recorded.     

Oral health status in an institutionalised elderly Jewish population.

The oral health status and treatment needs of 95 institutionalised elderly Jewish persons were determined. The mean DMFT was 23.4, with the M component increasing with age. Untreated carious lesions were identified in men and women of all ages. A relatively small percentage (10.5%) of subjects were affected by root caries. In 75% of cases of identified periodontal disease, the condition presented as bleeding or calculus. All subjects were in need of oral hygiene instruction and 64 (67.3%) required scaling and root planing. Complex treatment formed only a small percentage of the overall treatment needs. A low prevalence of temporomandibular joint problems, denture stomatitis and angular cheilitis was noted. A relatively high prevalence of untreated oral disease of low severity was observed, indicating the need for a comprehensive form of preventive and basic oral care.     

Dentigerous cyst: report of an unusual case.

A case of dentigerous cyst in the maxillary sinus of a 16-year-old boy is reported due to its unusual presentation and extensive nature.     

Vital root retention in humans: an interim report.

A protocol based upon findings in laboratory animal studies was established for the retention of vital roots for overdenture support in humans. Ten patients with a mean age of 54.5 years and a postsurgical mean time of 11.1 months had 45 vital teeth buried submucosally under complete overdentures. Of the 45 teeth, 37 remained vital, seven were endodontically treated due to acute pulpal response following surgery, and one tooth has been extracted. A mean interproximal bone loss of 1.1 mm had occurred at the time the data were tabulated for this report. This project included a cross section of patient types, tooth selection, and surgical and prosthodontic management that varied slightly from the methods utilized in earlier patient treatment. The inclusion of maxillary teeth, the increased thoroughness of root surface roundings, and the utilization of root canal therapy with subsequent reburying of apulpally involved teeth expanded the scope of this research. A final report on this project will be forthcoming when all patients have been followed for a 24-month period.     

Ectopic movement of an unerupted mandibular canine.

A case history has been given with the radiographic evidence of the migration, during development of an unerupted mandibular canine from its normal position. In a 30-month period the canine assumed a horizontal position and moved to a site that was apical to the mandibular incisors, still in the confines of the cortical plates. Because erratic movements of unerupted teeth cannot be anticipated, it would seem wise to defer the elective removal of permanent teeth during the mixed dentition stage until the clinician is assured of a normal eruption pattern of the succedaneous teeth.     

Radiolucent lesion of an unerupted mandibular molar.

A coronal radiolucent lesion of an unerupted and partially developed mandibular second molar was coincidentally found during a routine radiographic orthodontic examination of a generally healthy 9-year old girl. The size of the lesion increased continuously during a 2-year observation period. Histologic examination after extracting the tooth proved the lesion to be an idiopathic external coronal resorption. In a review of the literature, we found no original research on the subject. However, the number of case reports suggests that idiopathic external coronal resorptions are quite common in young patients. Their etiology, however, remains unclear. The case history, histologic findings, differential diagnoses, and possible treatment approaches suggested in the literature are described.     

Treatment of mandibular prognathism in an acromegalic patient.

A 41-year-old man with acromegaly underwent cryosurgery for a pituitary adenoma. Although soft tissue regression is possible after pituitary ablation, bony changes are permanent. Thus, bilateral vertical osteotomies and bilateral coronoidotomies were performed for correction of the mandibular prognathism. The postoperative occlusion and facial profile were very acceptable. Unfortunately, the patient died of a myocardial infarction eight days postoperatively.     

Aspiration of an avulsed primary incisor. A case report

A 7-year-old girl had injured her maxillary primary incisors in a playground. One of the already-mobile incisors had been avulsed. The child who had a cough and breathing difficulties during sleep was diagnosed as suffering from upper respiratory infection and was treated with antibiotics. A few days later because her body temperature was elevated a chest radiograph was taken. The radiograph revealed an aspirated tooth in her right bronchus with atelectasis of the lower lobe. The tooth was removed by bronchoscopy. Dentists should suspect any tooth that has been avulsed and not found as possibly aspirated.     

Delayed tooth eruption associated with an ameloblastic fibro-odontoma.

Delayed eruption of a single primary tooth is an uncommon event. Excluding a previous traumatic insult, the presence of a pericoronal odontogenic cyst or neoplasm is the primary cause for this abnormality. This case report describes the clinical and radiographic features of an ameloblastic fibro-odontoma in a young child, who presented with delayed eruption of the primary mandibular canine and prominent buccal expansion. A differential diagnosis for mixed, radiolucent and radiopaque lesions of the jaws will be discussed.     

Technique for an immediate temporary fixed tooth replacement.

A clinical technique for the immediate replacement of an extracted anterior tooth was presented. The clinical crown of the patient's extracted tooth was used as a pontic by attaching it to the adjacent teeth with acid-etch bonded resin. This technique provides a practical and esthetic immediate fixed tooth replacement that requires minimum materials and time.     

Actinobacillus actinomycetemcomitans-associated peri-implantitis in an edentulous patient. A case report

BACKGROUND: Peri-implantitis is a risk factor for implant loss. Late bacterial infection of the peri-implant tissues and loss of alveolar bone in edentulous patients is caused by commensal oral anaerobic bacteria. In partially edentulous patients, Porphyromonas gingivalis and occasionally Actinobacillus actinomycetemcomitans are associated with peri-implantitis lesions. AIMS: To investigate the microbiology of a peri-implantitis case in an edentulous patient. METHODS: Anaerobic culture techniques and selective culture techniques for A. actinomycetemcomitans were used to study the peri-implant microflora at sites with and without bone loss. RESULTS: An anaerobic peri-implant microflora with several putative periodontal pathogens was found at sites with bone loss. Furthermore, a metronidazole-resistant A. actinomycetemcomitans was isolated. The A. actinomycetemcomitans infection did not respond to systemic doxycycline therapy, despite good susceptibility in vitro. CONCLUSIONS: The present case of severe A. actinomycetemcomitans-associated peri-implantitis shows the importance of pre-operative infection control. The findings in this case show that remaining teeth affected by periodontitis can be a serious risk factor for peri-implantitis.