磨牙桩冠修复的临床效果分析

目的观察汞合金桩核与铸造金属桩核在磨牙桩冠修复中的临床疗效。方法选择我院2005～2010年经完善根管治疗后的69颗磨牙,进行桩冠修复。69颗磨牙分为两组:一组为牙体缺损不低于龈缘者,采用汞合金桩核,共39颗;另一组牙体缺损位于龈缘下方者,采用铸造金属桩核,共30颗。全部病例随访3年后进行疗效分析。结果桩冠修复3年后,汞合金桩核组成功37颗,失败2例(颗)均为冠脱落,铸造金属桩核组成功29颗,失败1例(颗),根折所致。结论用汞合金桩核和铸造金属桩核修复缺损磨牙,两者均能达到良好的临床疗效。     

Effect of prolonged water storage and repeated thermocycling on the reinforcing ability of refrigerated Amalgambond Plus/High Performance Additive in third molars with large mesio-occlusodistal amalgam restorations

OBJECTIVE: This in vitro investigation examined what effect prolonged water immersion and repeated thermocycling had on the fracture strength of extracted third molars restored with refrigerated Amalgambond Plus with High Performance Additive (AB+/HPA) and Tytin amalgam. MATERIALS AND METHODS: Mesio-occlusodistal (MOD) channels were prepared in one member from each of 19 contralateral pairs. After restoration, specimens were stored in water for 6 months, with thermocycling repeated every 2 months. Specimens were fractured in a universal testing machine, and the data were analyzed. Secondary effects of tooth location and tooth size were also examined. RESULTS: Fracture strengths of prepared/restored teeth were not statistically different from those of intact contralateral pairs (p > 0.05). Maxillary teeth had lower fracture strengths than mandibular teeth, and tooth size had no effect on fracture strength. CONCLUSIONS: Extracted molars with large MOD amalgam restorations bonded with refrigerated AB+/HPA had fracture strengths equivalent to those of intact contralateral pairs after 6 months of water storage and repeated thermocycling.     

Barodontalgia due to odontogenic inflammation in the jawbone

A case is presented of severe anterior mandibular pain, which first appeared during descent of a long commercial flight, and lasted 3 d for a 28-yr-old military helicopter pilot. Apical periodontitis due to pulpal necrosis of the #31 tooth was diagnosed as the causative pathology of the pain. This pain was not ever felt in his daily routine helicopter flights, up to 6000 ft, only in the pressurized chamber of a commercial flight to 7000-ft conditions. Although barodontalgia, dental pain evoked by barometric pressure change in an otherwise asymptomatic tooth, has relatively low prevalence nowadays, it seems that periodic dental vitality tests and panoramic imaging of the jaws are worthwhile for aircrew members.     

两种根管修复治疗后牙牙体缺损的疗效比较

 目的 对比两种方法修复根管(全冠修复根管、高嵌体修复根管)用于后牙牙体缺损患者临床治疗的效果及预后状况。方法 选取2017-05至2019-05医院口腔科收治的后牙牙体缺损患者80例,按治疗方法分为两组,每组40例;A组行高嵌体修复根管治疗,B组行全冠修复根管治疗,分析患者缺牙修复效果、满意度、口腔健康状况改善情况等。结果 两组修复效果优良率分别为92.50%、95.00%,差异无统计学意义;B组满意度评分为(96.82±4.37)分,明显高于A组的(80.62±5.35)分,差异有统计学意义(t=14.362,P<0.05); B组治疗后修复体完整、与邻牙吻合、牙齿美观、咀嚼功能恢复患者构成比,治疗后口腔健康影响程度量表(oralhealthim pactprofile,OHIP-14)中各项评分,均明显优于A组,差异有统计学意义(P<0.05)。结论 全冠、高嵌体修复根管均可获得良好修复效果,但高嵌体修复根管对改善口腔健康状况及预后效果更好。     

In-flight barodontalgia: analysis of 29 cases in military aircrew

OBJECTIVE: The purpose of this study was to assess the current in-flight incidence of barodontalgia, defined as dental pain caused by a change in barometric pressure in an otherwise asymptomatic tooth, and to identify the associated dental pathologies and etiologic factors. METHODS: A total of 450 questionnaires were e-mailed to permanent fighter, helicopter, and transport aircrews of the Israeli Air Force. They were asked to report whether they had ever suffered from a toothache during flight. If a positive answer was reported, the subject was interviewed and his dental file was reviewed to obtain details about the incidence. RESULTS: There were 331 (73.6%) aircrew members who responded. Of those, 27 (8.2%) reported at least 1 case of barodontalgia; their mean age +/- SD was 29.7 +/- 7.3 yr and the occurrence by aircraft platform were 9.0% of fighter, 8.0% of helicopter, and 7.0% of transport respondents. Many of the cases originated from vital and/or inflamed pulp (40.7%), whereas the other cases were due to pulp necrosis or peri-apical periodontitis (18.5%) and barosinusitis (18.5%). None of the patients reported premature mission termination due to dental pain. The incidence of barodontalgia was estimated as 1 case per 100 flight-years. CONCLUSIONS: Even with modern dental care, military aircrews from all the flight platforms may occasionally experience barodontalgia. Flight surgeons and dentists should be aware of this phenomenon and use preventive measures to minimize its incidence and severity.     

后路椎管减压固定治疗腰椎爆裂性骨折伴不全瘫疗效分析

目的探讨腰椎爆裂性骨折伴不全瘫行后路椎管减压固定的可行性及疗效。方法 2005年9月～2008年12月,采用后路固定达到椎管减压从而治疗腰椎骨折伴不全瘫22例。术前、术后及随访的胸腰椎正侧位X线片及SCT片测量cobb角,随访神经功能康复状况。结果术后脑脊液漏2例;腰神经根损伤0例;脊髓损伤加重0例;深静脉血栓形成1例;无断钉、退钉、内固定松动、假关节形成等并发症。22例均获得随访,时间18个月～3年,平均2.4年。复查X线及SCT示所有病例脊髓压迫均已减压,骨折块已复位,椎体高度基本恢复。其中双下肢肌力感觉恢复正常4例;阳痿2例;慢性腰背痛3例。结论对于腰椎爆裂性骨折伴不全瘫患者,可利用后路椎管减压操作来减压,减轻创伤,达到良好效果。     

Der Einsatz mobiler Röntgentechniken bei der odonto-stomatologischen Identifizierung von Katastrophenopfern

The use of dental radiology in cases of mass disaster is an absolute necessity. Radiographs usually permit identification of dental fragments containing as little as one tooth if a restoration or unique anatomical characteristic is present. Unfortunately the conditions at the scene are usually not adequate to use standard x-ray equipment. The paper presented here gives an overview of different types of mobile x-ray machines and digital radiographic techniques which are useful in disaster victim identification.     

椎体次全切除术加钛笼植入治疗陈旧性下颈椎骨折脱位

目的探讨椎体次全切除术加钛笼植入治疗陈旧性下颈椎骨折脱位的效果。方法回顾性分析2006年1月~2014年1月应用前路椎体次全切除术、椎体间钛笼植入(自体骨填充植骨)、钛板内固定术治疗的37例陈旧性下颈椎骨折脱位合并脊髓损伤患者的临床资料,男性25例,女性12例;年龄19~61岁,平均42岁。术前脊髓功能状况(JOA评分):完全性损伤8例,平均JOA评分1分;不完全性损伤29例,平均JOA评分5分。结果平均随访14个月,椎间高度和生理曲度获得良好重建,无钛板、螺钉松动断裂并发症。不完全性脊髓损伤患者的神经功能获明显改善(平均JOA评分从5分提高至13分),完全性脊髓损伤患者获得损伤平面神经根功能的改善。结论采用前路椎体次全切除术加钛笼植入治疗陈旧性下颈椎骨折脱位具有脊髓减压充分、有效恢复颈椎序列和生理曲度、获得即刻和永久的稳定性、促进神经功能恢复等特点。     

Is there a hazard to health by mercury exposure from amalgam due to MRI?

The local magnetic fields from computer monitors are well known. Recently a hypothesis was published that these magnetic fields may lead to a 400% increase of mercury dissolution from dental amalgam fillings. In MRI the exposure to the magnetic field exceeds by far the exposure from computer monitors. Therefore, this study examined the amalgam-related mercury release for typical MRI conditions, separated for both the static and the variable magnetic fields in a 1.5 T MR-unit. First, 20 dental cavities were filled with a non-gamma-2 amalgam, and the mercury release was measured for 14 days in a non-magnetic environment. Second, one half of the specimens were exposed to a static magnetic field for 24 hours (group A), while the other specimens were exposed to a repetitive gradient echo sequence for 60 minutes (group B). In both experiments there was no significant increase in mercury release due to MRI. This in vitro study demonstrated no evidence of an elevated mercury dissolution from a nongamma-2 amalgam during magnetic field exposure by MRI; therefore, there is no increased risk to health.     

Primary flight training performance of student naval aviators with vision waivers

Performance was studied for student naval aviators with waivers for defective uncorrected distance visual acuity who underwent primary flight training at NAS Whiting Field, FL, for fiscal year 1987 (cases = 45). Outcome variables were completion rate, primary flight training grades and flight hours. Controls for completion rate were all other students during that period (N = 1443). For training grades and hours, controls were selected who completed the same training squadron within 1 month of the case. Two controls were selected who progressed to the jet pipeline, with two additional controls selected who progressed to the same pipeline as the cases, either maritime/patrol or helicopter (controls = 180). Results demonstrated the cases were significantly more likely to complete training (p = 0.029), but not significantly different in primary flight grades or hours. These results suggest student naval aviators on vision waivers were competitive with their contemporaries.     

Epidemic decompression sickness: case report,literature review,and clinical commentary

BACKGROUND: Decompression sickness (DCS) is a syndrome of symptoms caused by bubbles of inert gas. These bubbles are produced by a significant ambient pressure drop. Although cases are usually solitary there have been several episodes of DCS clusters. This paper reports an episode of epidemic decompression sickness and reviews the literature. METHODS: The case reported describes six aircrewmen with DCS following an unpressurized AC-130 flight (maximum altitude 17,000 ft). Two obvious concerns-the low altitude at which DCS was encountered and the potential for epidemic hysteria-are discussed and discounted. In addition, factors contributing to this case are recounted in depth. Moreover, the literature was examined for similar cases of epidemic decompression sickness. Four other instances were discovered. Detailed qualitative analysis of these five reports was performed. RESULTS: With this information epidemic decompression sickness is defined and classified. Two types are described-individual-based (Epi-I) and population-based (Epi-P). Epi-I is a cluster of DCS following a solitary exposure; whereas, Epi-P is a cluster of DCS following multiple exposures over time. Investigation of Epi-P follows the classical rules of outbreak investigation (time, place, person, and environment); whereas, Epi-I does not. In fact, the focus in Epi-I is almost entirely the environment. Following this outline should produce an etiology that control measures can be directed against. However, it is prudent to look beyond the etiology. Enter the Haddon Matrix, a classic public health tool that considers counter-measures before, during, and after the event. CONCLUSION: These many concepts are illustrated with the presented case. Following this template, both the expert and the novice flight surgeon have a systematic and reproducible approach to these difficult puzzles.     

Management of a laterally luxated upper incisor caused by the hit of a rifle stock

Lateral luxation is the displacement of the tooth in a direction other than axial, which is accompanied by comminution or fracture of the alveolar socket. Lateral luxation is one of the most prevalent dental injuries among the general population, resulting in up to 27% of all dental wounds. All physical activities have an associated risk of orofacial injuries due to falls, collisions, and contact with hard surfaces. Just like any other training activities, military training exercises present a significant risk of dental traumas, which comprise 2% to 8% of all military dental emergencies. The aim of this report was to present a case of a dental lateral luxation caused by the hit of a rifle stock during close combat training. The tooth was extruded from its bony lock, temporarily filled with a calcium hydroxide-based paste, replaced into its original anatomic position, and secured with Ivy loop wirings. The permanent endodontic treatment was performed 4 weeks after repositioning. At the end of the 8-months follow-up, the tooth was asymptomatic and any pathological alterations were absent.     

Die Zuordungswahrscheinlichkeit eines numerisch-topographischen Zahnstatus bei der Identifikation unbekannter Leichen

The numerical topographical dental findings of 29,862 adult patients from several German dental practices were evaluated. Taking into account the age-dependent loos of teeth the various decades were investigated separately for increased incidences of identical findings. The total number of teeth comprising the dental findings in the form of tooth number classes was a first-line criterion aiding classification. In accordance with an underlying binominal distribution, a raised incidence of identical dental findings was found both in patients edentulous jaws or few residual teeth and in patients with largly complete dentition. The raised incidence was confined to a few standard findings in each of these high or low tooth number classes. However, more than 50% of all cases were either in the intermediate tooth number classes, in which raised incidences of ≥ 0.2% generally do not occur, or showed correspondingly rare constellations of findings in the high or low tooth number classes. In more than half of all cases, there was therefore a numerical topographical dental status which can be used in identification with a matching probability of ≥ 99.8%. Dental findings which occur less frequently can be arranged clearly according to tooth number classes.     

Two autopsy cases with injuries to the stomach following cardiopulmonary resuscitation

We herein report two autopsy cases with gastric injury associated with cardiopulmonary resuscitation (CPR). Case 1 was a 36–year–old woman who was found in cardiopulmonary arrest possibly caused by a fall from a height of 8 m. She received continuous manual chest compression with artificial ventilation while being transferred to the hospital. Autopsy revealed bruises on her left upper arm with a fracture to the left humerus and advanced pneumohemothorax that was associated with laceration of the left lung due to fracture of the dorsal left costa. Furthermore, complete rupture of the gastric wall (25 cm) was found without hemorrhage. Case 2 was an 85–year–old man found unconscious on the road. He had a history of oral anticoagulant administration, cognitive impairment, and gait disorder. He also received cardiac massage and manual artificial ventilation during CPR. Autopsy revealed severe head injury, possibly caused by a backward fall. His stomach was markedly dilated by air and a fresh intramural hematoma had extended into all layers of the stomach and adjacent omentum; however, injury of the abdominal wall was not evident. Histopathological investigation of the brain revealed advanced Alzheimer’s disease and Lewy pathology, and the damaged neural tissue, which was positive for the amyloid precursor protein. We determined that the gastric injuries in both cases had been caused by CPR. We conclude that careful investigation is required for gastric injury cases to determine the etiology and correlation between gastric injury and cause of death when the victims receive CPR.     

Backscattering from dental restorations and splint materials during therapeutic radiation

Models were constructed to simulate as closely as possible the human oral cavity. Radiation absorbed doses were determined for controls and various test situations involving the presence of dental restorative and splint materials during cobalt-60 irradiation of the models. Adjacent gold full crowns and adjacent solid dental silver amalgam cores both increased the dose to the interproximal gingivae by 20%. Use of orthodontic full bands for splinting the jaws increased the dose to the buccal tissues by an average of 10%. Augmentation of dose through backscatter radiation was determined to be only slight for intracoronal amalgam fillings and stainless steel or plastic bracket splints.     

Horizontally root fractured teeth with pulpal vitality - two case reports

This case study reports the successful outcome of horizontal root fractures of two different patients, which took place in permanent incisors. Report 1 describes a case of a 29-year-old patient who suffered a mandibular trauma affecting mainly the lower central incisors, caused by a car accident. A panoramic radiograph was taken right after the accident and showed a horizontal root fracture in the middle third of tooth 42, which went untreated. Report 2 illustrates a case of a 17-year-old male patient who searched for orthodontic therapy and the periapical radiograph showed horizontal root fracture in tooth 11 caused by a previous trauma, which went untreated as well. There was healing through the reestablishment of pulp activity and dental coloration without professional intervention.     

Tourniquets exposed to the Afghanistan combat environment have decreased efficacy and increased breakage compared to unexposed tourniquets

We hypothesize that an anecdotally observed increase in tourniquet breakage and decrease in efficacy may be secondary to environmental exposure during military deployment. This was a study comparing efficacy and breakage of 166 Afghanistan-exposed tourniquets to 166 unexposed tourniquets. Afghanistan exposure was defined as tourniquet carriage by field staff in the operational environment for approximately 6 months. In a controlled environment in the United States, a previously exposed tourniquet was tested on one thigh of each subject, while an unexposed tourniquet was tested on the opposite thigh. We recorded tourniquet efficacy (absence of distal pedal pulse for at least 30 seconds), breakage, and the number of turns required to stop the distal pedal pulse. A Wilcoxon sign-rank test was used to test differences between exposed and unexposed tourniquets. Tourniquets exposed to the environment broke more often (14/166 versus 0/166) and had decreased efficacy (63% versus 91%; p < 0.001). Three turns were required for most tourniquets to be efficacious. Environmental exposure of military tourniquets is associated with decreased efficacy and increased breakage. In most cases, tourniquets require three turns to stop the distal lower extremity pulse.     

胸腰椎骨折伴截瘫前路减压固定术并发症分析

目的探讨胸腰椎骨折前路减压固定术并发症产生原因和处理对策。方法1998年2月-2004年8月，收治胸腰椎骨折伴截瘫采用前路减压固定术者204例，近期并发症34例51例次，发生率为25．0％。测量术前、术后及随访时的胸腰椎正侧位X线片，随访神经功能康复状况。结果术后发生感染1例；脑脊液漏7例；气胸8例；血气胸2例；肋间神经损伤5例；腰神经根损伤2例；脊髓损伤加重2例；生殖股神经损伤3例；股外侧皮神经损伤2例；术侧肢体皮温升高8例；深静脉血栓形成3例。术后半个月内复查X线片示：脊柱侧凸畸形3例，后凸畸形5例。占4．0％。84例获得随访，时间3个月～6年，平均2．5年。其中慢性腰背痛7例，脊柱后凸畸形6例，侧凸畸形5例。无断钉、断棒、内固定松动、假关节形成等并发症。结论熟练掌握胸腰椎前路减压操作技术、减轻术中创伤、恰当合理的康复指导，可避免大多数并发症。     

Extended CT scale overcomes restoration caused streak artifacts for dental identification in CT--3D color encoded automatic discrimination of dental restorations

OBJECTIVE: Besides DNA, dental radiographs play a major role in the identification of victims in mass casualties or in corpses with major postmortem alterations. Computed tomography (CT) is increasingly applied in forensic investigations and is used to scan the dentition of deceased persons within minutes. We investigated different restoration materials concerning their radiopacity in CT for dental identification purposes. METHODS: Extracted teeth with different filling materials (composite, amalgam, ceramic, temporary fillings) were CT scanned. Radiopacities of the filling materials were analyzed in extended CT scale images. RESULTS: Radiopacity values ranged from 6000-8500HU (temporary fillings), 4500-17000HU (composite fillings) and >30710HU (Amalgam and Gold). The values were used to define presets for a 3D colored volume rendering software. CONCLUSIONS: The effects of filling material caused streak artifacts could be distinctively reduced for the assessment of the dental status and a postprocessing algorithm was introduced that allows for 3D color encoded visualization and discrimination of different dental restorations based on postmortem CT data.     

Spatial disorientation and dysfunction of orientation/equilibrium reflexes: aeromedical evaluation and considerations.

Loss of spatial awareness has been implicated as a direct causal factor in 4-10% of serious aircraft mishaps and 10-20% of fatal aircraft mishaps (7). Spatial disorientation in flight usually results from misperception of visual, vestibular, or proprioceptive cues. Pathologic causes have rarely been implicated. A student naval aviator with recurrent loss of spatial awareness due to a defective vestibulo-ocular reflex (VOR), presumably from vestibular neuronitis in adolescence, is reported. His chief complaint, an inability to focus on the instrument panel during turbulent instrument meteorological conditions (IMC), resulted in spatial disorientation and adverse flight attitude. A simple test of visual-vestibular interaction, the dynamic visual acuity test, could identify a defective vestibulo-ocular reflex in aviation personnel. An absent or defective vestibulo-ocular reflex has potential for disorientation in instrument flight. A comprehensive vestibular function test battery is indicated in individuals with recurrent or overwhelming spatial disorientation who fail a screening dynamic visual acuity test. The aeromedical disposition of vertigo and dysequilibrium is discussed.