Cervical vertebrae: Mandibular growth dynamism indicators?

A study of mandibular growth maturation was performed on a population of 103 patients during orthodontic treatment (69 girls and 34 boys) from 11 to 16 years, having initially a Class II skeletal discrepancy. The relationship between wrist maturation indices and the cervical vertebrae maturation was studied by Lamparski classification. Significant correlations were found between Bj?rk stages, MP3=, MP3 cap and MP3 U and respectively Lamparski stages as CVS 2, CVS 3-4 and CVS 5-6. This retrospective longitudinal study identified three mandibular variables at three different maturation stages according to Bj?rk classification and to the six stages of Lamparski classification. The relationships between these different maturation stages and a quantitative mandibular response permit to estimate optimal time for our orthodontic therapy. The results indicate a significant increase in mandibular length between CVS 4 and CVS 5, suggesting the persistence of a condylar response to a stimulation therapy after CVS3 or CVS 4 stages (MP3 cap). Mandibular growth seems to continue after MP3 U stage or CVS 5 stage.     

Autogenous tooth transplantation: an alternative to dental implant placement?

Autogenous tooth transplantation, or autotransplantation, is the surgical movement of a tooth from one location in the mouth to another in the same individual. Once thought to be experimental, autotransplantation has achieved high success rates and is an excellent option for tooth replacement. Although the indications for autotransplantation are narrow, careful patient selection coupled with an appropriate technique can lead to exceptional esthetic and functional results. One advantage of this procedure is that placement of an implant-supported prosthesis or other form of prosthetic tooth replacement is not needed. This article highlights the indications for autogenous tooth transplantation using 3 case reports as examples. A review of the recommended surgical technique as well as success rates are also discussed.     

Results of immediate loading for implant restoration in partially edentulous patients: a 6-month preliminary prospective study using SinusQuick? EB implant system

STATEMENT OF PROBLEM

Many dental clinicians are concerned about immediate loading of inserted implants. However, there have been few clinical studies surveying the success rates of immediate loading, based on Korean implant systems.

PURPOSE

The aim of this study was to evaluate the outcome of immediate functional loading of the implant (SinusQuick™ EB, Neobiotech Co., Seoul, Korea) in partially edentulous maxilla or mandible.

MATERIAL AND METHODS

Total 15 implants were placed. Within 2 weeks after implant insertion, provisional implant-supported fixed partial dentures were delivered to the patients. Quantitatively, marginal bone loss was measured at the time of immediate loading, after 3-months of continued loading and at the last follow-up. The mean follow-up period was 4.8 months.

RESULTS

Mean marginal bone loss from implant surgery to early loading, 3-months follow-up and last follow-up was 0.03 ± 0.07 mm, 0.16 ± 0.17 mm and 0.29 ± 0.19 mm. No implant failed up to 6 months after insertion, resulting in a 100% survival rate.

CONCLUSION

Immediate loading exhibited high success rate in partial edentulism for up to 6 months. Well-controlled long term clinical studies with large sample size are necessary to confirm this finding.     

Intraoperative imaging in orbital reconstruction: how does it affect the position of the implant?

Intraoperative imaging enables the surgeon to control the position of the implant during orbital reconstruction. Although it might improve surgical outcome and avoid the need for revision surgery, it may also increase the duration of the operation and the exposure to radiation. The goal of this study was to find out whether intraoperative imaging improves the position of the implant in reconstructions of the orbital floor and medial wall. Two surgeons reconstructed complex orbital fractures in 10 cadavers. After the reconstruction a computed tomographic scan was made to confirm the position of the implant and, if required, to make any adjustments. Scans were repeated until the surgeon was satisfied. The ideal position was ascertained by scans that were obtained before and after creation of the fractures. The position of the implant achieved was compared with that of the ideal position of the implant, and improved significantly for yaw (p = 0.04) and roll (p = 0.03). A mean of 1.6 scans was required for each reconstruction (maximum n = 3). The main reason for alteration was the rotation roll. Intraoperative imaging significantly improves the position of the implant in fractures of the orbital floor and medial wall. The surgeon has quality control of its position during the reconstruction to restore the anatomical boundaries.     

Evaluation of a predoctoral implant curriculum: does such a program influence graduates' practice patterns?

PURPOSE: Didactic predoctoral dental implant education is part of the curriculum in most US dental schools. However, fewer than half offer laboratory instruction, and only a few allow dental students to place and restore dental implants. The additional time necessary for laboratory and clinical experience encroaches on an already crowded curriculum. Is the additional time necessary in the curriculum for laboratory and clinical experience by dental students reflected by the practice patterns of graduates who have completed such a program over the past 10 years? MATERIALS AND METHODS: A survey was designed to determine the implant practice patterns of graduates of the Creighton School of Dentistry, Omaha, Nebraska, for the 10-year period 1988 to 1997. These graduates had all participated in a formal undergraduate didactic and laboratory curriculum in implant dentistry. Approximately half also had the opportunity to place and/or restore dental implants while students. The survey was also sent to graduates (also 1988 to 1997) from a midwestern dental school without a formal laboratory or clinical component (used as a control group). The data were analyzed statistically. RESULTS: In comparison to the control group (56% versus 23%), more than twice as many Creighton graduates restore dental implants as a part of their general practice, surgically place more dental implants, refer more implant patients to surgical specialists, and seek more continuing education hours related to implant dentistry. These conclusions were all supported by statistical analysis of the data. DISCUSSION: Student clinical experience with implant dentistry appears to significantly increase the incorporation of implant dentistry into future dental practices. Even if clinical experience was not an option, a school curriculum which included both didactic and laboratory participation still significantly increased the number of graduates who included implant dentistry in their practices. CONCLUSION: The inclusion of laboratory and clinical experience in implant dentistry in the CUSD undergraduate curriculum resulted in significantly greater participation in implant dentistry at the general practice level.     

Temporomandibular joint surgery: what does it mean to the dental practitioner?

A poor appreciation of the role of surgery in the management of temporomandibular disorders (TMD) may result in some patients being denied access to appropriate care. While surgery is often considered as an option of last resort, there are instances where surgery is the definitive and sometimes the only treatment option. The aim of this paper was to review the role of temporomandibular joint (TMJ) surgery and its place in the treatment armamentarium of temporomandibular disorders. Indications, rationale for surgery, risks vs. benefits are discussed and complemented with examples of clinical cases treated by the author. All dental practitioners should be aware of the benefits of TMJ surgery so that patients do not suffer unnecessarily from ongoing non-surgical treatments that ultimately prove to be ineffective in the management of their condition.     

Changes in growth and morphology of the condyle following mandibular distraction in minipigs: overloading or underloading?

OBJECTIVE: Loading of temporomandibular tissues during mandibular distraction may cause changes in condylar growth and cartilage thickness. This study examines the effects of distraction on the condyle in a large animal model by explicitly measuring growth and in vivo loading. DESIGN: Unilateral mandibular distraction was carried out on 20 growing minipigs divided into three groups. One group underwent distraction but not consolidation, whereas the other two groups were allowed a period of consolidation of either 1 or 2 weeks. Animals received fluorochrome and 5-bromo-2'-deoxyuridine (BrdU) labelling and masticatory strain was measured from the condylar neck. Condylar strain was also recorded in an age-matched sample of eight animals that received no distraction surgery. Immunohistochemical procedures were used to identify dividing prechondroblasts and histological analysis was used to measure mineral apposition rate, count dividing cells, and measure the thickness of condylar cartilage. RESULTS: Strain magnitude, particularly compressive strain, was much larger on the non-distraction side compared to the distraction side condyle. Compared to normal loading levels, the distraction side condyle was underloaded whereas the condyle on the intact side was overloaded. Mineral apposition and cartilage thickness were greater on the distraction side condyle compared to the opposite side. Differences between the sides were most pronounced in the group with no consolidation and became progressively reduced with consolidation time. CONCLUSIONS: Increased mineralisation and cartilage thickness on the distraction side condyle are associated with reduced, not increased loading, perhaps because of disruption of the distraction side masseter muscle.     

An interdisciplinary approach to case-based teaching: does it create patient-centered and culturally sensitive providers?

This investigation explored whether teaching a case-based seminar influenced dental students' perceptions of the importance of various factors for diagnosis and treatment planning. In addition, the effects of an interdisciplinary approach to case-based teaching were analyzed. During the winter semesters 2004 and 2005, 204 second-year dental students participated in a case-based comprehensive care seminar. The students were randomly assigned either to a section with a behavioral science instructor present or to a section without a behavioral science instructor. At the beginning and end of each semester, the students evaluated the importance of various factors for diagnosis and treatment planning in self-administered questionnaires. This seminar increased students' importance ratings of subjective oral health-related factors (such as dental fear) and diversity-related factors (such as the patient's ethnicity/race) from the beginning to the end of the semester. Students in the section with a behavioral science instructor rated the importance of behavioral and diversity-related factors higher than students in the section without the behavioral science instructor. These findings suggest that interdisciplinary, case-based teaching increased students' appreciation of the complexity of patient care and of a patient-centered, culturally sensitive approach to diagnosis and treatment planning.     

Supraclavicular lymphadenopathy following COVID-19 vaccination: an increasing presentation to the two-week wait neck lump clinic?

The first COVID-19 vaccination was given in December 2020 and there is an effort to vaccinate the international population on a massive scale. Common side effects from the vaccine include headache and tiredness. Regional lymphadenopathy has been described in relation to other vaccines. We describe two cases of supraclavicular reactive lymphadenopathy presenting in patients who had the COVID vaccination in the ipsilateral arm. Awareness of this diagnosis is important for patients presenting to the neck lump clinic.