Composite resin inlays: a single appointment technique

This article presents a time efficient technique for the fabrication and subsequent placement of a composite resin inlay. An inlay preparation is cut into a tooth and a polyvinylsiloxane impression is made. A polyether impression of the polyvinylsiloxane impression forms a die, then a composite resin inlay is fabricated on the die. The inlay is contoured and polished on the die and occlusion is evaluated clinically. The inlay has a final polymerization under intense light and vacuum pressure, then is cemented with a mixture of unfilled resin and hybrid composite. The technique allows an esthetic restoration to be placed in one appointment. The die provides easy access and rapid inlay fabrication. There is no need to place a separator on the prepared tooth, no chance of premature tooth bonding, and interproximal contact is easily achieved.     

Total quality management in orthodontic practice

Quality is the buzz word for the new Millennium. Patients demand it, and we must serve it. Yet one must identify it. Quality is not imaging or public relations; it is a business process. This short article presents quality as a balance of three critical notions: core clinical competence, perceived values that our patients seek and want, and the cost of quality. Customer satisfaction is a variable that must be identified for each practice. In my practice, patients perceive quality as communication and time, be it treatment or waiting time. Time is a value and cost that must be managed effectively. Total quality management is a business function; it involves diagnosis, design, implementation, and measurement of the process, the people, and the service. Kazien is a function that reduces value services, eliminates waste, and manages time and cost in the process. Total quality management is a total commitment for continuous improvement.     

A removable appliance for the three-dimensional movement of ectopic maxillary canines

A removable appliance design has been described which is useful in the traction of ectopic canine teeth and is capable of exerting forces in all planes of space, thus optimizing the potential to achieve a stable and aesthetically pleasing result. It does not substitute for the finesse of a fixed appliance, but is a useful tool for when a fixed appliance is not acceptable to the patient. The appliance is cheap to construct, easy to adjust and keep clean, and is well tolerated by patients.     

Multiple autoextractions: oral self-mutilation reviewed

Oral self-mutilation occurs in a variety of clinical settings. The etiology of oral self-mutilation can be divided into organic and functional categories. Organic etiologic factors include metabolic and genetic disorders. Functional self-mutilation is performed knowingly, as a response to certain stimuli, and may or may not serve a cognitive purpose. The occurrence of oral self-mutilation with a functional cause represents a diagnostic challenge to practitioners. In this article, a case of autoextraction of multiple posterior teeth in a psychotic 27-year-old white man is presented. Though a wide range of self-mutilation in a person in a psychotic state is well documented, oral self-mutilation, particularly autoextraction, is rare. Although the case reported is extreme in nature, incidence of oral self-mutilation is not uncommon and should be considered in the differential diagnosis of lesions of unknown cause.     

Repair of the trigeminal nerve: a review

Nerve surgery in the maxillofacial region is confined to the trigeminal and facial nerves and their branches. The trigeminal nerve can be damaged as a result of trauma, local anaesthesia, tumour removal and implant placement but the most common cause relates to the removal of teeth, particularly the inferior alveolar and lingual nerves following third molar surgery. The timing of nerve repair is controversial but it is generally accepted that primary repair at the time of injury is the best time to repair the nerve but it is often a closed injury and the operator does not know the nerve is injured until after the operation. Early secondary repair at about three months after injury is the most accepted time frame for repair. However, it is also thought that a reasonable result can be obtained at a later time. It is also generally accepted that the best results will be obtained with a direct anastamosis of the two ends of the nerve to be repaired. However, if there is a gap between the two ends, a nerve graft will be required to bridge the gap as the two ends of the nerve will not be approximated without tension and a passive repair is important for the regenerating axons to grow down the appropriate perineural tubes. Various materials have been used for grafting and include autologous grafts, such as the sural and greater auricular nerves, vein grafts, which act as a conduit for the axons to grow down, and allografts such as Neurotube, which is made of polyglycolic acid (PGA) and will resorb over a period of time.     

HIV-associated Kaposi sarcoma: pathogenic mechanisms

Kaposi sarcoma (KS) is a multicentric angioproliferative disorder characterized by spindle cell proliferation, neo-angiogenesis, inflammation, and edema. Human herpesvirus (HHV)-8, a gamma-herpesvirus, is a critical factor, but is not alone sufficient for the initiation of KS. Other cofactors such as human immunodeficiency virus (HIV), host-derived cytokines, chemokines, and growth factors are required for the development of KS. Whether HIV-associated KS is a reactive hyperplastic inflammatory lesion or a true neoplasm is still controversial. It is likely that HIV-associated KS begins as a reactive disorder that in some cases progresses to a monoclonal, an oligoclonal, and a polyclonal neoplasm.     

Failures in fabrication and treatment using ceramic crowns

Dental ceramics is a constituent prosthodontic material with excellent aesthetic properties. It is stable, does not change shape, color or size, and is biotolerant. Treatment with ceramic restorations is a standard procedure in modern fixed prosthodontics. Because of its multiphase structure and the thermal processes it undergoes during the making of a fixed prosthodontic replacement, ceramics is highly sensitive to small failures in fabrication. These failures can develop into cracks that can ultimately cause fracture of restorations in use. This is why each phase of restoration in a dental practice and a dental laboratory requires professional skill. Selection of a definite ceramic system for a specific clinical case is more important than with other constituent materials. Patient selection, oral hygiene, masticatory force, as well as proper maintenance of instruments and devices for the fabrication of ceramic replacements are all important.     

Clinical procedures for improving veneered metal crowns

Satisfactory design and preparation of the veneer window presuppose that a perfect or a near-perfect preparation of the tooth has been made. The window is not just a cutout and is not the responsibility of the laboratory technician.Whenever optimum gingival health, a satisfactory esthetic result, and a longlasting restoration are desired, it is worthwhile to carefully check and, if necessary, adjust the veneer window directly in the mouth before the veneer is added. This is especially important in restorations that extend below the gingival margin.     

Ameloblastic fibro-odontoma in children: report of 2 cases

Ameloblastic fibro-odontoma is a rare, mixed, benign, odontogenic tumor of significant prevalence in the mandible, with epithelial and mesenchymal components. It usually affects pediatric patients and is associated with teeth, causing a delay in eruption chronology or an alteration in the dental eruption pathway. It is occasionally diagnosed during radiographic evaluations of these patients. The literature is unclear whether it is a distinct pathological entity or a stage of odontoma. As it is benign and has a low recurrence rate, conservative treatment is recommended. The purpose of this paper was to present 2 cases of ameloblastic fibro-odontoma in the mandibles of children.     

An Innovative and Simple Approach to Functional Salivary Reservoir Fabrication

Saliva is a valuable oral fluid that is often taken for granted. Impaired salivary function is a major and a debilitating sequela of radiation treatment for patients with head and neck cancer. It can persist for years and thereby increases the risk of oral infection significantly. Moreover, it has a notably negative impact on the quality of life of such patients. To help overcome this problem, a number of techniques have been proposed for incorporating a reservoir containing salivary substitute into a removable prosthesis. A new design for a functional salivary reservoir is presented here. This design is simple to construct and easily maintained by the wearer. Details of its design, construction, and other potential advantages are presented.     

Biological determinants in implant design

This paper considers whether fibro-osseous integration is a feasible outcome for dental implants and whether the mucosal-implant junction is a crucial factor for implant success. It is argued that the periodontal ligament is a connective tissue with specific origin determined early in development. Further, it is argued that fibroblasts of the ligament exhibit unique functional characteristics associated with tooth support and that these characteristics cannot, as yet, be duplicated in other fibroblasts. These specific attributes argue against the feasibility of fibro-osseous integration unless cells of the periodontal ligament are available to develop a fibrous attachment. With respect to the dentogingival junction, it is argued that this structure does not provide a functional seal around the normally functioning tooth and therefore a minor degree of inflammation in the connective tissue adjacent to an implant is acceptable. It is also argued that inflammation associated with fibro-osseous integrated implants is not the result of a deficiency in the epithelial attachment but rather is due to the inability of the connective tissue to withstand the forces applied to it.     

Fabrication of removable stone dies using cemented dowel pins.

Proper dowel pin placement in the working cast is important in the fabrication of a cast restoration. A technique is suggested whereby the dowel pin is orientated and cemented after the working cast has been separated from the impression. This procedure produces a working die that has a correctly positioned dowel pin, is stable, and can be repeatedly returned to its original relationship. A technique is suggested whereby the dowel pin is orientated and cemented after the working cast has been separated from the impression. This procedure produces a working die that has a correctly positioned dowel pin, is stable, and can be repeatedly returned to its original relationship.     

Excellence in orthodontics. Interview by M. G. Choukroun and O. Sorel

"Excellence is not an act, it is a daily exercise", is a sentence quoted by B. Zachrisson and is the cornerstone of his approach. He explains how, by a careful inspection and an analysis of the facial bone structure, using the patient's movement, he can establish a diagnosis and set the treatment's objectives. He defines the key points of a balanced smile, the rules and guidelines for enamel reproximation, the methods of bonding and the rules governing the stability of orthodontic treatments.     

Xeroradiography and its application to dentistry

Xeroradiography is a highly accurate electrostatic imaging technique. In this technique a conventional single-phase dental x-ray unit is used as an x-ray source, but instead of a silver-halide film image, a uniformly charged selenium alloy plate housed in a light-proof cassette is used. In this article the equipment, procedure, properties and artifacts related to the xeroradiographic technique are described. An evaluation of the xeroradiographic images is also presented. Xeroradiography, which requires only about one-third of the dose required for conventional radiographs, is a valuable alternative to conventional radiography for detecting carious lesions, calculus deposits and periodontal disease. It is also of value in interpreting periapical structures.     

Facial tuberculoid leprosy: case report

Leprosy is a chronic, infectious, systemic disease caused by Mycobacterium leprae and is classified as paucibacillary and multibacillary types. It is contagious and has an insidious onset. Clinical presentation is characterised by hypopigmented skin lesions with reduced sensation. Presence of acid-fast bacilli in tissue specimens is regarded as a gold standard for diagnosis. Treatment is based on multi-drug regimens. We report a case of borderline tuberculoid leprosy in a 31-year-old woman.     

Xeroradiography and its application to dentistry

Abstract Xeroradiography is a highly accurate electrostatic imaging technique. In this technique a conventional single-phase dental x-ray unit is used as an x-ray source, but instead of a silver-halide film image, a uniformly charged selenium alloy plate housed in a light-proof cassette is used. In this article the equipment, procedure, properties and artifacts related to the xeroradiographic technique are described. An evaluation of the xeroradiographic images is also presented. Xeroradiography, which requires only about one-third of the dose required for conventional radiographs, is a valuable alternative to conventional radiography for detecting carious lesions, calculus deposits and periodontal disease. It is also of value in interpreting periapical structures.     

Osteomyelitis of the Mandible in a Patient with Osteopetrosis. Case Report and Review of the Literature

Osteopetrosis is a rare hereditary bone disorder presenting with variable clinical features and is characterized by an increase in bone density and reduction of marrow spaces that result from a defect in the function of osteoclasts and, consequently, a decrease in bone turnover. This disease is generally divided into three types: severe infantile malignant autosomal recessive, intermediate mild autosomal recessive, and benign autosomal dominant. The prognosis of the first two types is very poor and is characterized by an early onset, usually within the first decade of life, and early death. The benign-type is characterized by a later onset and a longer life span. Ten percent of osteopetrosis cases develop osteomyelitis that usually involves the mandible. The osteomyelitis is generally caused by tooth extraction or pulpal necrosis. The leading cause of the increased rate of infection is thought to be a lack of adequate bone vasculature. Treatment of osteomyelitis secondary to osteopetrosis is controversial. Treatment regimens include high-dose systemic antibiotics coupled with thorough debridement of necrotic bone and primary closure of soft tissues, if possible. Hyperbaric oxygen has been used for the treatment of chronic osteomyelitis.     

Elastomeric impression materials

Elastomeric impression materials are in common use. The impression taken should be highly precise, thus, requiring specific care when manipulatingthese materials. There are 4 groups of elastomers; polysulfide, condensation silicone, addition silicone and polyether; each differ in their setting mechanism and their physical and chemical properties. This review elaborates the major properties of elastomers and its implications on their use. The impression material is inserted into the patient's mouth in a viscous state and transforms into viscoelastic state, upon withdrawal, influencing the residual deformation. The requirements are minimal residual deformation or maximal elastic recovery. As the mouth is a wet environment a major consideration is hydrophilicity. The wettability which is estimated by measuring either the contact angle of a droplet of water and the substrate post setting or the contact angle of a droplet of impression material and the wet tooth pre setting, determines the interaction of the material with both mouth fluids and gypsum. As the primary end target is to obtain a model depicting accurately the oral details, an attention to the impressions' compatibility with gypsum should also be given. Many studies were conducted to get a thorough understanding of the hydrophilic properties of each material, and the mechanism utilized, such as surfactants in hydrophilic PVS. Polyether is the only material that is truly hydrophilic; it exhibits the lowest contact angle, during and after setting. Recent studies show that during setting the Polyether hydrophilicity is increased compared to the condition after setting. Dimensional stability, a crucial property of the impression, is affected by the physical and chemical attributes of the material, such as its tear strength. Polysulfide has the highest tear strength. Tear Strength is affected by two major parameters, viscosity, a built-in property, and how fast the impression is pulled out of the mouth, the faster the impression is loaded and pulled out, the higher the tear strength is. The clinical use is dictated from the properties of each impression material, and the understanding of those enables the practitioner to minimize failures.