An Innovative Approach to Chairside Provisional Replacement of an Extracted Anterior Tooth: Use of Fiber-Reinforced Ribbon-Composites and a Natural Tooth

Immediate chairside replacement of an extracted anterior tooth may contribute to a patient's comfort, treatment acceptance, and expectations of treatment; however, fabrication of a custom restoration in the anterior region of the mouth may result in an esthetic compromise for patients during the fabrication period. Chairside tooth replacement is an excellent application of fiber-reinforced composite resin technology. This article presents an innovative, affordable chairside procedure in which Ribbond Multi-Purpose Bondable Reinforcement Ribbon is used to replace a single extracted anterior tooth using the patient's own tooth.     

Predictors of oral health quality of life in older adults

There is limited information regarding oral health status and other predictors of oral health‐related quality of life. An association between oral health status and perceived oral health‐related quality of life (OHQOL) might help clinicians motivate patients to prevent oral diseases and improve the outcome of some dental public health programs. This study evaluated the relationship between older persons' OHQOL and their functional dentition, caries, periodontal status, chronic diseases, and some demographic characteristics. A group of 733 low‐income elders (mean age 72.7 ISD=4.71, 55.6% women, 55.1% members of ethnic minority groups in the U.S. and Canada) enrolled in the TEETH clinical trial were interviewed and examined as part of their fifth annual visit for the trial. OHQOL was measured by the Geriatric Oral Health Assessment Index (GOHAI); oral health and occlusal status by clinical exams and the Eichner Index; and demographics via interviews. Elders who completed the four‐year assessment had an average of 21.5 teeth (SD=6.9). with 8.5 occluding pairs (SD=4.6), and 32% with occlusal contacts in all four occluding zones. Stepwise multiple regressions were conducted to predict total GOHAI and its subscores (Physical, Social, and Worry). Functional dentition was a less significant predictor than ethnicity and being foreign‐bom. These variables, together with gender, years since immigrating, number of carious roots, and periodontal status, could predict 32% of the variance in total GOHAI, 24% in Physical, 27% in Social, and 21 % in the Worry subscales. These findings suggest that functional dentition and caries influence older adults' OHQOL, but that ethnicity and immigrant status play a larger role.     

Palatogram Assessment of Maxillary Complete Dentures

Phonetics, esthetics, function, and comfort form the foundation of a successful dental prosthesis. A review of the mechanics of speech as well as common speech problems encountered with a removable maxillary prosthesis are presented. The use of a palatogram to aid the clinician in the assessment and resolution of speech problems associated with a maxillary denture is demonstrated.     

Primary management of maxillofacial hard and soft tissue gunshot and shrapnel injuries

PURPOSE: A 10-year retrospective study was undertaken of all patients treated for facial gunshot and shrapnel wounds at our medical center to evaluate the outcomes and assess the results of simultaneous management to treat the hard and soft tissue injuries primarily. PATIENTS AND METHODS: A total of 44 patients were treated. Medical documentation of the patients was compiled. All maxillofacial gunshot, shrapnel, and warfare injuries were treated by the oral and maxillofacial surgeon. Other concomitant bodily injuries were treated by pertinent consultant specialists. Patients ranged in age from 8 to 53 years, with a mean age of 24.7 years. Maxillofacial hard and soft tissue injuries were treated definitively in the first operation except when gross contamination, infection, extensive comminution, or general condition precluded this. RESULTS: There were 2 shotgun, 28 bullet, 10 shrapnel, 3 land mine, and 1 breech block injuries. Overall postadmission mortality in this series was 2.2%. Of the 97.7% of the patients who had an injury to the underlying craniofacial skeleton, all required surgical intervention. The soft tissue and underlying bony injuries were addressed concomitantly (in a single stage at the time of primary surgical debridement) in 86.3% of the patients. Nine percent of the patients had a tracheostomy emergently for management of the airway, 6.8% had an intracranial injury, and 2.2% of them required neurosurgery. In the series, 4.5% of the patients had neck wounds that required exploration. Comprehensive treatment was rendered in 1 to 3 major operations (average, 1.5). CONCLUSION: All patients in this series required surgical intervention for treatment of their facial gunshot wounds. Primary treatment of hard and soft tissue injuries of the face at the time of surgical debridement was possible in the majority of our patients. This minimized the number of admissions and did not bear a higher complication rate than other reported series that advocate multiple staged operations to treat such injuries despite the fact that, in our series, flaps were also mobilized for wound closure in the primary phase.     

Mandibular displacement in Angle Class II, Division 2 malocclusion

The effect of the treatment of Angle Class II, Division 2 malocclusion was studied in 22 children by x-ray cephalometry and by recording the relation between the retruded and the intercuspal mandibular positions. The treatment was performed in three phases. In the first phase the upper incisors were proclined, and the deep bite was corrected with an upper removable plate. In the second phase the distal occlusion was corrected with an activator. The result was retained in the third phase with a second activator designed for retention. The relation between the retruded (RCP) and the intercuspal (ICP) mandibular positions was recorded with wax bites and dental casts mounted in a modified gnathothesiometer. The anteroposterior distance between RCP and ICP was large before the start of the treatment. The distance was unchanged after proclination of the upper incisors and correction of the deep bite but decreased after correction of the distal occlusion and increased again somewhat during the retention phase. The proclination of the upper incisors and the correction of the deep bite (phase one of the treatment) did not result in mandibular anterior positioning. This fact and the results of the recordings of the relation between RCP and ICP were interpreted as evidence that the mandible is not posteriorly displaced in Class II, Division 2 malocclusion.