Dual wavelength spectrophotometry as a diagnostic test of the pulp chamber contents.

The purpose of this in vitro study was to determine the feasibility of using dual wavelength spectrophotometry to identify teeth with pulp chambers that are either empty, filled with fixed pulp tissue, or filled with oxygenated blood. In phase I of the experiment, a human third molar was prepared so that its pulp space could be filled with oxygenated blood and later emptied. In phase II, the lower jaw of a beagle dog was removed and placed in formalin, thereby fixing the pulps of the teeth. The pulp of the right canine was removed via an apical approach, and attachments were placed in a similar position to those on the human tooth, to allow filling and emptying of the pulp space. Cavit was placed over the exposed fixed pulp in the left canine. Ten readings, which were separated by light source and detector removal and replacement, were taken of the right canine pulp space when it was empty or filled with oxygenated blood, or the left canine pulp space when it was filled with fixed tissue. Distinct and reproducible changes were measured for pulp spaces filled with air, tissue, or oxygenated blood. In phase III, simulated pulp testing on a dog tooth model was performed. Blood was introduced into the root canal space, the chamber was rinsed with water and replaced with air, according to a predetermined code. Spectrophotometer readings were recorded. The identification of pulpal contents was correctly determined in all 20 of the predetermined conditions. The findings indicate that continuous wave spectrophotometry may become a useful pulp testing method.     

Pseudo and True Hirschsprung's Disease in One Family

A case of a 35-yr-old woman with the characteristics of pseudo-Hirschsprung's disease Is presented. The diagnosis was based on the following criteria: a history of chronic constipation since early infancy, a largely distended abdomen and an adynamic distal colon. The patient bad a normal anosphincteric relaxation reflex and normal rectal myenteric ganglion cells. Resection of the distended large bowel failed to relieve the symptoms and was followed by distention of the entire small bowel. Complete cure was achieved after a Duhamel procedure. This patient is an adult, unlike the previously reported cases. Of special interest is the occurrence of true Hirschsprung's disease in one of her children.     

Short vs. long-term calcium hydroxide treatment of established inflammatory root resorption in replanted dog teeth

Abstract This study examined, histologically, the healing of intentionally produced inflammatory root resorption of replanted teeth in beagle dogs, treated with short- or long-term placement of calcium hydroxide. Thirty beagle dog incisors were randomly divided into four groups. In group 1 (negative control), uninfected incisors were extracted, the roots were longitudinally grooved and the teeth were replanted within 2 min. In group 2 the root canals were artificially infected followed by extraction, longitudinal grooving, and replantation as in group 1. Radiographs were taken biweekly and at the first signs of inflammatory root resorption or at 4 weeks, the root canals were fully instrumented and medicated with calcium hydroxide. In group 2, the root canals were permanently obturated with gutta-percha and sealer after 1 week of calcium hydroxide. The teeth in group 3 were treated as described in group 2 but after 1 wk the calcium hydroxide dressing was repacked for the duration of the study. In group 4 (positive control) the teeth were treated as described in groups 2 and 3 but no endodontic treatment was performed. Twrelve weeks after the initiation of the endodontic treatment, sacrifice and histological preparation were carried out. In group 1, complete cemental repair was seen in all teeth. In group 2, five often teeth showed complete cemental repair whereas in group 3 complete cemental repair was seen in nine of ten teeth. None of the teeth in group 4 showed cemental repair. It was concluded that long-term may be more effective than short-term calcium hydroxide treatment of established inflammatory root resorption.     

The surgical management of children with familial dysautonomia

Familial dysautonomia (FD) is a rare incurable genetic disorder with multisystem involvement. Most of its clinical manifestations are related to disorders of the autonomic nervous system. The disease is associated with specific disturbances of the upper gastrointestinal tract: pharyngoesophageal dyskinesia, gastroesophageal reflux, and prolonged gastric emptying. About 40% of the dysautonomic children manifest repeat vomiting crises. In view of the extensive gastrointestinal symptomatology, children with FD are prone to repeated aspiration pneumonia and chronic respiratory failure, while inadequate calory and fluid intake may lead to a chronic state of hypovolemia and severe failure to thrive. Control of vomiting, prevention of aspiration due to abnormal swallowing, and the assurance of adequate calory intake are three major objectives in the treatment of the dysautonomic child. Medical treatment of the gastrointestinal disorders using different drugs has had limited success. This study reviews the surgical experience in ten children with FD. The type of the procedure used was determined by the severity of the upper GI disturbances. Nine children underwent gastroesophageal Nissen fundoplication and gastrostomy. In seven of them, a pyloroplasty was added. Gastrostomy alone was done in one patient only. Postoperative complications included transient dysphagia in four patients, gastric dilatation in four patients, and dumping syndrome in one. There has been no incidence of immediate postoperative death. One child died 6 months after operation from severe and irreversible respiratory failure. Following operation, the patients still suffered from dysautonomic crises but these were not associated with vomiting.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cancellous Bone Block Allografts for the Augmentation of the Anterior Atrophic Maxilla

Background: Pre‐implant augmentative surgery is a prerequisite in many cases in the anterior maxilla to achieve a stable, long‐term esthetic final result. Purpose: The aim of the present study was to evaluate the outcome of ridge augmentation with cancellous freeze‐dried block bone allografts in the anterior atrophic maxilla followed by placement of dental implants. Materials and Methods: Thirty‐one consecutive patients were included in the study. A bony deficiency of at least 3 mm horizontally and up to 3 mm vertically according to computerized tomography (CT) served as inclusion criteria. Sixty‐three implants were inserted after a healing period of 6 months. Nineteen of sixty‐three implants were immediately restored. Bone measurements were taken prior to bone augmentation, during implant placement, and at second‐stage surgery. Results: Forty‐six cancellous allogeneic bone blocks were used. The mean follow‐up was 34 ± 16 months. Mean bone gain was 5 ± 0.5 mm horizontally, and 2 ± 0.5 mm vertically. Mean buccal bone resorption was 0.5 ± 0.5 mm at implant placement, and 0.2 ± 0.2 mm at second‐stage surgery. Mean bone thickness buccal to the implant neck was 2.5 ± 0.5 mm at implant placement, and 2.3 ± 0.2 mm at second‐stage surgery. There was no evidence of vertical bone loss between implant placement and second‐stage surgery. Block and implant survival rates were 95.6 and 98%, respectively. All patients received a fixed implant‐supported prosthesis. Conclusion: Cancellous block allografts appear to hold promise for grafting the anterior atrophic maxilla.     

Efficacy of Cancellous Block Allograft Augmentation Prior to Implant Placement in the Posterior Atrophic Mandible

Background: The present study evaluated the outcome of ridge augmentation with cancellous freeze‐dried block bone allografts in the posterior atrophic mandible followed by placement of dental implants. Materials and Methods: A bony deficiency of at least 3 mm, horizontally, vertically, or both, according to computerized tomography (CT) para‐axial reconstruction served as inclusion criteria. Implants were inserted after a healing period of 6 months. Bone measurements were taken prior to bone augmentation, during implant placement, and at second‐stage surgery. Marginal bone loss and crown‐to‐implant ratio were also measured. Results: Twenty‐nine cancellous allogeneic bone blocks were placed in 21 patients. The mean follow‐up was 37 months. Bone block survival rate was 79.3%. Mean horizontal and vertical bone gains were 5.6 and 4.3 mm, respectively. Mean buccal bone resorption was 0.5 mm at implant placement and 0.2 mm at second‐stage surgery. A total of 85 implants were placed. Mean bone thickness buccal to the implant neck was 2.5 mm at implant placement and 2.3 mm at second‐stage surgery. There was no evidence of vertical bone loss between implant placement and second‐stage surgery. Implant survival rate was 95.3%. All patients received a fixed implant‐supported prosthesis. At the last follow‐up, the mean marginal bone loss was 0.5 mm. The mean crown‐to‐implant ratio was 0.96. Conclusion: Implant placement in the posterior atrophic mandible following augmentation with cancellous freeze‐dried bone block allografts may be regarded as a viable treatment alternative.