Conventional radiographic and computed tomographic findings in cases of fracture of the mandibular condylar process

A total of 40 patients with 46 fractures of the mandibular condylar process were examined an average of 47 months after the injury. The conventional radiologic examination consisted of panoramic radiography and lateral transcranial view of the fracture in the mouth-open and mouth-closed positions. Sixteen patients with 21 fractures of the condylar process were examined additionally by computed tomography (CT) because of temporomandibular joint problems in the sagittal and coronal projection. Computed tomography revealed bony changes in the fractured mandibular condyle and its position in the mandibular fossa more exactly than conventional radiographic examinations. Furthermore, the results showed that disturbances in the position and function of the articular disc may be more common than was earlier anticipated, suggesting the more frequent use of CT examinations to evaluate temporomandibular joint changes after condylar process fractures.     

Fatal subarachnoid haemorrhage associated with dental local anaesthesia

A case is described of sudden death occurring after the use of a noradrenaline-containing local anaesthetic. Autopsy revealed a massive subarachnoid haemorrhage following a ruptured cerebral aneurysm. The noradrenaline in the local anaesthetic is thought to be an important factor in the cause of the rupture. It is recommended that preparations containing 1:25,000 noradrenaline not be used.     

Protaper--hybrid technique

Crown down preparation is the most known and described technique since the introduction of Nickel Titanium (NiTi) rotary instruments in endodontics. This technique gives good results but has limitations, such as not addressing the initial anatomy of oval or dumb-bell shaped canals. The specific design of the Protaper instruments allows use of them with a different technique and, specifically, with a brushing motion in the body of the canal. The recent introduction of hand Protaper files has expanded the range of application of this system, especially in curved canals. The 'hybrid technique', using rotary and hand files, and the advantages of the combination of both instruments, are clearly described in this article. Used with this technique, the Protaper is a very safe system to use, and more controllable, for both inexperienced and experienced practitioners alike, than other systems. Clinical Relevance: To understand the precautions needed with rotary files, and how to use them to preserve the anatomy of the canal and get a tapered shaping, even in severely curved canals.     

Restoration of irradiated patients using osseointegrated implants: Current perspectives

Statement of problem. The success rates of osseointegrated implants used to restore patients who were irradiated for head and neck tumors are influenced by radiation-induced changes in the hard and soft tissues.Purpose. This article examined, by review of the literature, current perspectives on the restoration of irradiated patients using osseointegrated implants.Results. In published reports that investigated both intraoral and extraoral applications, irradiation decreased implant success rates and the amount of reduction was dependent on the location within the craniofacial skeleton. The limited number of implants and patients in these studies precludes definitive conclusions regarding the efficacy of placing implants into irradiated tissues. The implants placed into the irradiated anterior mandible have demonstrated an acceptable implant success rate of 94% to 100% with a minimal risk of osteoradionecrosis. The efficacy of implants in the posterior mandible has not been examined. Implant success rates ranged from 69% to 95% in the irradiated maxilla for intraoral applications. Extraoral applications demonstrated excellent implant success rates in the temporal bone (91% to 100%). The rates in the anterior nasal floor have varied from 50% to 100%. The implant success rates in the frontal bone decreased as the length of the studies increased (96% to 33%). The long-term efficacy of implants in the irradiated frontal bone is poor. (J Prosthet Dent 1998;79:641-7.)     

False aneurysm of the facial artery

A case of an unusual traumatic aneurysm of the facial artery secondary to blunt trauma is reported. The lesion was typical in that it was pulsatile, had a systolic bruit, and had a filling defect that was evident on carotid angiography. Although a traumatic aneurysm is a rare occurrence in the facial region, the inclusion of this lesion in the differential diagnosis of soft tissue lesions is important if the serious consequences of hemorrhage are to be avoided.     

Surgical correction of mandibulofacial deformities secondary to large cervical cystic hygromas

The clinical features of cystic hygroma are presented. The effect on mandibular morphology is described, and surgical correction of the deformities is discussed.     

The Relationship Between Dental Utilization and Preventive Participation Among a Well-elderly Sample

Previous studies have shown that dental utilization by older people is lower than for the general population. This study hypothesizes that an elder's tendency toward participating in preventive health activities may be an important factor in explaining the likelihood of accessing the dentist. Subjects included 1,911 older individuals who enrolled in the UCLA Medicare Screening and Health Promotion Trial. All were interviewed about their utilization of preventive health services and participation in preventive behaviors. A recent dental visit was positively associated with all sociodemographic variables examined except age and sex. It was also related to health status questions and utilization of the preventive health services and health behaviors studied. Logistic regression analysis showed that both summary preventive health behavior and preventive service utilization variables were important factors in explaining a recent dental visit (model chi-square/221.4, P=.001) along with income, not having a removable prosthesis, and perceiving the need for dental care. This study showed that dental utilization is related to older people's participation in other preventive activities. When in contact with older people, health care professionals should consider current oral and general preventive health status and encourage appropriate referral for preventive activities.     

Adenomatoid odontogenic tumour of the jaws

The adenomatoid odontogenic tumour of the jaws is rare. It is important to differentiate it from other odontogenic tumours because of its benign behaviour and this can be reliably done by the histological features.