Surgically-assisted maxillary expansion

A combined surgical and orthodontic technique for management of transverse maxillary deficiencies in mature patients is described and discussed. Special references are made to the surgical release of several circummaxillary articulations to facilitate the use of a fixed expansion device, and to the authors' addition of an osteotomy below the nasal spine, to ensure that the nasal septum remains independent of the maxillary segments. Indications for the use of this surgically-assisted maxillary expansion technique, and its advantages when compared with segmented surgical expansion, are also presented.     

Histopathologic findings in a case of recurrent parotitis in adulthood

Most cases with recurrent parotitis in childhood (RPC) can be cured before puberty.^1–3 A few of them, however, may continue to adulthood.^1–4 To distinguish this condition from other types of chronic parotitis in adults, such as chronic obstructive parotitis,⁵ we suggest that the diagnosis of recurrent parotitis in adults (RPA) be reserved for the cases derived from RPC.⁶ The pathophysiology and development of RPA is still not well known. To our knowledge, there are few reports of RPA in the literature, especially concerning its histopathology. This report describes a cases of RPA studied with sialography and light and electron microscopy.     

Herpes zoster virus infection: A clinicopathologic review and case reports

Herpes zoster virus (HZV) infection, particularly of the trigeminal nerve, can be a disabling and disfiguring condition with variable clinical presentations. Acyclovir is a highly effective treatment modality during the acute clinical phase; however, pain control may be very difficult particularly with protracted and severe post herpetic neuralgia (PHN). The clinicopathologic features are reviewed and two cases in immunosuppressed patients with HZV infection of different divisions of the trigeminal nerve are presented.     

Limitations of rotational panoramic radiographs in the diagnosis of maxillary lesions. Case report

This case report clearly demonstrates that misdiagnosis may result from failure to recognize the limitations dictated by the width of the focal trough in rotational panoramic radiographs. The patient's clinical signs and symptoms were at variance with the findings from the rotational panoramic radiograph. A subsequent radiographic view by the occipito-mental (Water's) projection showed the extent and malignant features of the lesion.     

Bacterial Persistence in Dentoalveolar Bone Following Extraction: A Microbiological Study and Implications for Dental Implant Treatment

Background: The microbiological status of apparently healed alveolar bone implant sites is unknown. Implant success may be compromised by site‐specific persistence of bacterial biofilm co‐aggregations contaminating healed alveolar bone. Purpose: The purpose of the present study was to investigate whether extraradicular infection can persist in apparently healed alveolar bone and to develop a surgical debridement strategy that favors implant osseointegration. Materials and Methods: The study was conducted on 32 private practice patients. Seventy‐seven microbiological samples were taken from 16 pre‐implant extraction sockets, 56 healed post‐extraction osteotomies at fixture placement, and five failed fixtures. Two of the healed osteotomy samples were healed retreatment sites. Tissue fluid and bone samples were analyzed by either anaerobic/aerobic culturing or DNA molecular techniques. All patients were treated ad modum Brånemark, with a two‐stage sterile surgical procedure. A search of the medical and dental literature revealed no evidence‐based or best practice recommendations for the use of debridement in implant therapy. Thus, we developed a new technique for the debridement of alveolar bone found to be contaminated by persistent biofilm or planktonic bacteria. Results: The results of the microbiological analysis of 77 bone and effusion samples from 47 implant sites of the 32 patients showed that overall, 32% (n = 25) had bacteria present in the sample. In 16 pre‐implant extraction sockets, 69% of samples were positive for the presence of bacteria (n = 11). Of 56 osteotomies with a minimum 3‐month healing at fixture placement, 21% revealed a positive culture (n = 12). Two‐stage failed fixtures had 100% positive cultures (n = 5) and it was evident from radiographs that all of these failed fixtures had the apical ends close to the former tooth root end. Based on these findings, we have developed a microbiologically based surgical debridement strategy to successfully re‐treat early infective failures and to place successful two‐stage fixtures. Conclusion: Bacteria can persist as a contaminant in apparently healed alveolar bone following extraction of teeth with apical or radicular pathosis. A new technique for surgical debridement to reduce and limit this bacterial contamination has been described.