The comparison of various oral hygiene strategies in neuromuscularly disabled individuals

BACKGROUND: This study aims to investigate the effect of various oral hygiene strategies on the symptoms of inflammation in neuromuscularly disabled patients and to define the optimum hygiene method. METHODS: Fifty-nine neuromuscularly disabled participants, suffering from cerebral palsy, were randomly divided into five groups as follows: Group M: manual toothbrush (n=14), Group E: electrically powered toothbrush (n=9), Group MC: manual toothbrush and chlorhexidine gluconate (CHX) spray (n=13), Group EC: electrically powered toothbrush and CHX spray (n=9), and Group C: CHX spray (n=14). The oral hygiene applications were provided by the parents and staff. At baseline and after 21 days the plaque index (PI), the gingival index (GI), and bleeding on probing (BOP) were recorded. RESULTS: In intra-group comparisons of the pre- and post-application scores, in all groups the PI and GI scores and BOP percentages, except in Group C, were found significantly different (p<0.05). There were significant differences among the post-application scores, between Group M and Group E and between Group C and Group E in PI scores; between Group C and Group E the difference in GI scores were found statistically significant (p<0.05). CONCLUSIONS: Although all oral hygiene strategies reduced plaque and gingival inflammation, the results of our study suggested the electrically powered toothbrush could be more recommendable to neuromuscularly disabled people in these strategies, while the combined procedures appeared to be neither beneficial nor favorable.     

Temporalis muscle flap for craniofacial reconstruction after tumor resection

Temporalis muscle flap provides a good solution for the reconstruction of craniofacial defects after tumor resection. Nine patients with complicated defects located at the upper two thirds of the face, anterior cranial base, or mastoid region are presented. Five patients had orbital exenteration, two with total maxillectomy and two with anterior craniofacial resection. Temporalis muscle flap provided profuse well-vascularized tissue for the obliteration of orbital exenteration and total maxillectomy cavities and coverage of surface defects. Cranial, oral, and nasal spaces were separated successfully in all patients. Temporalis muscle flap is a very reliable technique with low complication rates and few donor site problems. This safe and technically easy flap can be preferred for the reconstruction of craniofacial defects after ablative tumor surgery, especially in older and debilitated patients.     

A salvage procedure in cleft palate repair: suturing nasal mucosa directly to palatine process.

OBJECTIVE: Palatal fistulas are among the complications of cleft palate repair requiring additional surgery. Suturing the nasal mucosa and mucoperiosteal flaps together in a tension-free manner to create a double-layered closure in the hard palate is one of the most important points in prevention of dehiscence and fistula formation. In this report, we describe a salvage procedure to repair nasal mucosa that might be lacerated while being freed from the upper surface of the palatal process. METHOD: To restore the nasal lining, an ipsilateral vomer mucoperiosteal flap or the opposite nasal mucosa flap is advanced to the palatine bone and sutured directly to the palatal process in order to guarantee an intact cleft palate repair. RESULTS: This method is an easy, simple, and time-saving procedure. It should be a useful addition to the armamentarium of every plastic surgeon, especially those working as consultants in training units.     

Influence of grinding procedures on the flexural strength of zirconia ceramics

The surface of zirconia may be damaged during grinding, influencing the mechanical properties of the material. The purpose of this study was to compare the flexural strength of zirconia after different grinding procedures. Twenty bar-type zirconia specimens (21 x 5 x 2 mm) were divided into 4 groups and ground using a high-speed handpiece or a low-speed straight handpiece until the bars were reduced 1 mm using two different grinding times: continuous grinding and short-time grinding (n=5). Control specimens (n=5) were analyzed without grinding. The flexural strengths of the bars were determined by using 3-point bending test in a universal testing machine at a crosshead speed of 0.5 mm/min. The fracture load (N) was recorded, and the data were analyzed statistically by the Kruskal Wallis test at a significance level of 0.05. In the test groups, high-speed handpiece grinding for a short time had produced the highest mean flexural strength (878.5 ± 194.8 MPa), while micromotor continuous grinding produced the lowest mean flexural strength (733.8 ± 94.2 MPa). The control group was the strongest group (928.4 ± 186.5 MPa). However, there was no statistically significant differences among the groups (p>0.05). Within the limitations of the study, there was no difference in flexural strength of zirconia specimens ground with different procedures.     

Temporomandibular joint involvement caused by Borrelia Burgdorferi

BACKGROUND: Lyme borreliosis is an endemic disease in Slovenia with an incidence of around 150 patients per 100,000 inhabitants. Although the large joints are most typically affected in Lyme borreliosis, there are also periods of disease activity with arthritis or arthralgias involving smaller joints, including the temporo-mandibular joint. PATIENTS: During the years between 2000 and 2003, two patients with Lyme borreliosis affecting the temporo-mandibular joints were treated. The patients presented with fatigue and pain in diverse muscle groups accompanied by arthralgia, which was most pronounced in the temporomandibular joint area. None of the patients were febrile or had joint effusions. METHODS: Both patients were examined by means of biochemical and serological examinations for Borrelia burgdorferi using ELISA assay and Western blot test (both for IgM and IgG), plain radiographs, MR and CT scans, and scinti-scan of the temporo-mandibular joints They both had positive serum markers for an acute B. burgdorferi infection and were treated with intravenous ceftriaxone. RESULTS: None of the patients had clinical or laboratory signs of chronic Lyme disease activity two and four years following therapy, respectively. Roentgenographic and nuclear magnetic resonance imaging of the temporo-mandibular joints had not shown any persistent sign of acute inflammation. CONCLUSION: There are only few reports of patients with manifest temporo-mandibular joint involvement of Lyme borreliosis in the literature. This report emphasizes the importance of differential diagnosis of acute temporo-mandibular joint arthralgia, of early diagnosis of Lyme borreliosis, and of the necessity for prompt antibiotic treatment.     

Alveolar cleft closure by distraction osteogenesis with skeletal anchorage during consolidation

Intraoral distraction osteogenesis (DO) has been widely used for the reconstruction of various dentoalveolar defects. However, its use in the management of alveolar clefts is relatively new. This method allows the closure of the cleft via the regeneration of new alveolar bone and attached gingiva through the distraction of a dento-osseous segment. It eliminates the need for a donor site for autogenous bone grafting and possible graft failure. However, the relatively long consolidation period required for the use of intraoral DO devices may result in soft tissue irritation that would compromise patient cooperation, especially in children. In the case presented, the intraoral DO technique was used for the treatment of a unilateral residual alveolar cleft and an implant was subsequently placed in the regenerated bone. A miniplate was also placed to serve as a skeletal anchor to enable the early removal of the distractor device. The distractor was removed before the beginning of the consolidation phase.     

Emdogain in regenerative periodontal therapy. A review of the literature

The goal of regenerative periodontal therapy is the reconstitution of the lost periodontal structures (i.e. the new formation of root cementum, periodontal ligament and alveolar bone). Results from basic research have pointed to the important role of the enamel matrix protein derivative (EMD) in the periodontal wound healing. Histological results from animal and human studies have shown that treatment with EMD promotes periodontal regeneration. Moreover, clinical studies have indicated that treatment with EMD positively influences periodontal wound healing in humans. The goal of the current overview is to present, based on the existing evidence, the clinical indications for regenerative therapy with EMD. Surgical periodontal treatment of deep intrabony defects with EMD promotes periodontal regeneration. The application of EMD in the context of non-surgical periodontal therapy has failed to result in periodontal regeneration. Surgical periodontal therapy of deep intrabony defects with EMD may lead to significantly higher improvements of the clinical parameters than open flap debridement alone. The results obtained following treatment with EMD are comparable to those following treatment with GTR and can be maintained over a longer period. Treatment of intrabony defects with a combination of EMD + GTR does not seem to additionally improve the results compared to treatment with EMD alone or GTR alone. The combination of EMD and some types of bone grafts/bone substitutes may result in certain improvements in the soft and hard tissue parameters compared to treatment with EMD alone. Treatment of recession-type defects with coronally repositioned flaps and EMD may promote formation of cementum, periodontal ligament and bone, and may significantly increase the width of the keratinized tissue. Application of EMD seems to provide better long-term results than coronally repositioned flaps alone. Application of EMD may enhance periodontal regeneration in mandibular Class II furcations. The clinical results are comparable to those obtained following GTR.