Persistent endodontic lesion due to complex cementodentinal tears in a maxillary central incisor--a case report

The cementodentinal tear is rarely detected by noninvasive procedures owing to its clinical picture simulating a root fracture or a periodontal or endodontic lesion. We present a case of complex cementodentinal tears in a 79-year-old woman who presented a repeated swelling at the labial mucosa of the left maxillary central incisor for 6 months. Periapical radiographs demonstrated a vertical radiolucent fracture line extending from the root apex along the mesial aspect of the root to near the middle portion of the root of the left maxillary central incisor. Because endodontic re-treatment failed to cure the disease, periapical surgery was performed, and 2 fractured U-shaped root fragments around the apical root surface were removed. Histologic examination showed that the 2 fractured root fragments were composed mainly of the dentin covered by a thin layer of the cementum and overlying periodontal ligament tissue, suggesting cementodentinal tears. A swelling recurred 8 months after the initial operation. Therefore, a second periapical surgery was performed. Although no obvious fracture line was observed around the root surface, the second surgery did not cure the disease, either. A persistent small swelling was noted at the alveolar mucosa of the affected tooth during the follow-up. We conclude that although a cementodentinal tear can be detected by a careful radiographic examination, its clinical outcome is not predictable by surgical removal only.     

Analysis of postoperative symptoms following surgical endodontic treatment.

OBJECTIVE: The purpose of this prospective study was to analyze postoperative pain and swelling of patients undergoing surgical endodontic treatment using a strict protocol incorporating measures to control postoperative symptoms. METHOD AND MATERIALS: The study consisted of 82 patients referred for surgical endodontic treatment. All surgical procedures were performed using a microsurgical technique employing strict protocol. All patients were premedicated with a single dose of oral dexamethasone (8 mg) preoperatively and two single doses (4 mg) 1 and 2 days postoperatively. Antibiotics were prescribed selectively only when severe symptoms were present due to infection. Patients were administered chlorhexidine mouthwash twice daily starting 3 days before the operation and an additional 7 days postoperatively starting the day after surgery. Cold compresses were applied on the skin at the site of surgery intermittently every 15 minutes during the operative day. Pain and swelling were recorded pre- and postoperatively, and the influence of different variables on postoperative sequelae were analyzed. RESULTS: One day postoperatively, 76.4% of the patients were completely pain free, less than 4% had moderate pain, and 64.7% did not report any swelling. The preoperative symptoms significantly influenced the pain experience post-surgery. CONCLUSION: There was a low incidence of postoperative pain and swelling following endodontic surgical treatment according to protocol with measures to control postoperative signs and symptoms. Patients with preoperative pain were more likely to have postoperative pain.     

Management of interdental papillae loss with forced eruption, immediate implantation, and root-form pontic

BACKGROUND: A 25-year-old Asian woman complained of an unesthetic black triangle between her upper right front teeth. Defective interdental papillae may result from external root resorption, which makes esthetic restoration more difficult. A combined use of forced eruption, immediate implant placement, and a root-form pontic made a successful esthetic and functional restoration. METHODS: The treatment sequences of this patient included short-term forced eruption, subsequent immediate implant placement after tooth extraction, and a provisional root-form pontic restoration. A final prosthesis was completed 6 months later, followed by clinical maintenance. RESULTS: Papillae were augmented by forced eruption. After immediate implantation and root-form pontic placement had been performed, the peri-implant soft and hard tissues were manipulated and maintained in a stable state. CONCLUSIONS: We successfully reconstructed the interdental papillae and replaced the deficient tooth with an immediate implantation. During 2 years of follow-up, the implant and peri-implant structures remained stable and healthy.     

A newly designed resonance frequency analysis device for dental implant stability detection

Resonance frequency (RF) analysis technology was used to design a new dental implant stability detector. To calibrate and test the performance of this novel apparatus, in vitro and in vivo models, respectively, were used. The RF values of the test implants detected using our new device and a commercially available analogous device (Osstell) were compared. Further, implant stability status was also detected clinically using our device at 2, 4, 8, and 12 weeks after surgery. A high correlation was demonstrated between the values measured with the two devices (y = 0.31x-12.45; R2 = 0.98, p < 0.05). In our clinical tests, an initial RF value above 10.0 kHz indicated that the implant was ready to accept functional loading, while values in the 4.0-10.0 kHz range reflected the need for further osseointegration. In conclusion, these results indicated that our new device might be useful in a clinical setting for evaluating the healing status of a placed implant.     

Oral health care system in Chinese Mainland

The purpose of this review is to describe the training of dental professionals and to give an overview of the oral health care system in Mainland China. It may be of interest and importance for American readers to become aware that there are alternative practice structures and the world is getting smaller.     

Transient loss of power of accommodation in 1 eye following inferior alveolar nerve block: report of 2 cases

Unintended intravascular injection from inferior alveolar nerve blocks can result in frustrating distant complications affecting such structures as the middle ear and eyes. Possible complications affecting the eyes include blurring of vision, diplopia, mydriasis, palpebral ptosis and amaurosis (temporary or permanent). In this article, we present a complication that has been reported only rarely. Two patients developed transient loss of power of accommodation of the eye resulting in blurred vision after routine inferior alveolar nerve blocks on the ipsilateral side. Clear vision returned within 10-15 minutes after completion of the blocks. The possible explanation for this phenomenon is accidental injection into the neurovascular bundle of local anesthetic agents, which were carried via the blood to the orbital region. This resulted in paralysis of a branch of cranial nerve III, the short ciliary nerves that innervate the ciliary muscle, which controls accommodation.     

后牙复合树脂磨耗的临床评价

为探索评价复合树脂磨耗的最佳方法，本研究采用直接临床评价法和间接模型比较法，对以４种复合树脂修复的９３例磨牙面洞修复体进行了３年的评估。结果表明，直接法对修复体早期磨耗的评估不敏感，但对修复体其它方面的评价目前仍为首选；间接法评估修复体的磨耗更准确、敏感，量化的磨耗值便于统计学分析；直接法与间接法相结合可更客观，更全面地评价复合树脂修复体的临床效果。     

Clinical evaluation of different treatment methods for oral submucous fibrosis. A 10-year experience with 150 cases

Over a 10-year period (1982–1991), a total of 150 patients divided into two groups with varying degrees of oral submucous fibrosis (OSF) were treated by either medical or surgical therapies. Medical treatment involved (a) conservative oral administration of vitamin B-complex, buflomedial hydrochloride and topical triamcinolone acetonide 0.1%, or (b) conventional submucosal injections of a combination of dexamethasone and hyaluronidase, or (c) a combination of both (a) and (b). The surgical group was treated by the excision of fibrotic tissues and covering the defect with split-thickness skin, fresh human amnion, or buccal fat pad (BFP) grafts. Treatment was chosen according to the stage of clinical progression to gain maximal interincisal distance (ID). The cases were followed up by monthly examinations for at least two years, or when possible even longer. A combination of (a) and (b) medical treatment was satisfactory in cases of mild impairment (ID > 20 mm) but in the long term it led to symptomatic relief only. Surgical therapy, on the other hand, when accepted by the patients, led to a significant improvement of trismus in cases of severe limitation (ID < 20 mm). Following this strategy, an additional ID increase was observed in all patients. BFP grafting was particularly successful in diminishing scarring after two years as compared with the other two grafts. Together with a cessation of the betel quid chewing habit before and after therapy, these treatment regimens combined with daily mouth opening exercises were found to be necessary to manage OSF cases in early and advanced stages of progression.     

应用植入控释系统进行一次法根管治疗术的动物实验研究

目的：利用自制含氯霉素、甲硝唑等药物的控释系统，对实验家兔的血药浓度、药物抗菌活性和家兔根管、尖周组织的病理观察，为今后临床应用提供理论和实验依据。方法：应用组织病理观察和液相色谱分析技术。结果：用ＨＰＬＣ法得出实验用家兔血药浓度和抗菌活性均为阴性，根管及尖周组织病理切片无特殊表现。结论：自制控释系统是一种无毒、无副作用、有效的根管治疗药物剂型，可进行临床应用。