Quintessence International, 04/1997

The early loss of permanent teeth following trauma or congenital aplasia may be corrected by orhtodntic or prosthetic means, sometimes combined with implant therapy. The orthodontic soluion results usually in different anatomic, functional, and esthetic problems. Prosthetic and implant procedures, on the other hand, are very demanding and require long-term maintenance. Considering these limitations, a comprehensive diagnostic and treatment plan is mandatory to achieve the most satisfactory clinical result. Modern restorative modalities, such as recontouring, bleaching, and resin composite bonding, may improve the final clinical result after orthodontic space closure. In more difficult situations, veneers and crowns may also be indicated.

This article describes the iatrogenic 3exfoliation of maxillary central incisors following the improper use of orthodontic elastic bands. The unsecured rubber band had migrated apically and caused an almost bloodless extraction of both maxillary central incisors. A combined orthodontic-prosthetic solution was used to replace the lost incisors.

This article reports the findings of a study on reasons for the placement and replacement of direct restorations in general dental practice in the United Kingdom. Twenty-two selected practitioners recorded information pertaining to up to 250 consecutive direct restorations placed by themselves during a 6-week period. From data derived from 2,379 restorations, it was found that about 60% of restorative practice in the United Kingdom may be found to comprise the replacement of existing restorations. For restorations of amalgam and glass-ionomer cement, the principal reason for replacement was secondary caries. For restorations of resin composite, secondary caries and poor appearance accounted for equal proportions of failures. Apart from the need for more extensive surveys of the type reported, the data emphasize the need to monitor treatment treands in contemporary clinical practice.

Traditionally, crown-lengthening procedures to expose subgingival caries for oeprative restorative work are carried out in a two-stage approach. A disadvantage of this procedure is that the gingival margin associated with the treated tooth moves apically; this may create an esthetic problem. Resin-modified glass-ionomer cement has been demonstrated to have good biocompatibility with dental hard and soft tissues. Surgical and restorative procedures were combined at the same appointment in an effort to achieve a restoration with minimal change in the gingival margin. Four patients have been treated with this one-stage team approach and followed for 8 to 13 months. The clinical results demonstrated this team approach procedure is excellent for the dentition when esthetics is a consideration.

Eighty Class V abrasion cavities were selected, and 20 cavities were restored with one of three resin-modified glass-ionomer materials (Fuji II LC, Photac-Fil, and Vitremer) or a polyacid-modified resin composite (Dyract). The restorations were clinically evaluated after 1 and 2 years with the US Public Health Service criteria. The results revealed a statistically significant difference in the percentage of restorations rated Alfa for color match at 2 years. No statistically significant difference was found in the percentage of alfa rating for anatomic form. Restorations of all materials showed some marginal discrepancies that were not statistically significant.

Fixed partial dentures should be designed for function, esthetics, and easy maintenance. The gingivolingual embrasures between multiple adjacent pontics are unnecessary f or function and esthetics and create crevices where food, plaque, and calculus can accumulate. These spaces make oral hygiene procedures more difficult for the patient and the dentist to accomplish. A hygienic design for multiple pontics is suggested that eliminates these unnecessary embrasures and still displays an anatomically realistic, cosmetically acceptable facade.

An endodontic file carrier is fabricated from disposable foam fluoride trays glued to a mixing pad. The carrier allows convenient retention and transfer of root canal instrum ents and is particularly useful when the clinician is utilizing a rotary handpiece canal-shaping technique with hand files and reamers.

Melkersson-Rosenthal syndrome is classically described as a triad of orofacial swelling, facial palsy, and fissured tongue. More often this syndrome presents in its oligosymptomatic forms. Melkersson-Rosenthal syndrome may not be as rare as suspected but rather a syndrome that often goes undiagnosed. Presented is the case of a mentally challenged man who was eventually diagnosed with Melkersson-Rosenthal syndrome only after being misdiagnosed and incorrectly treated for an odontogenic infection for more than a decade.

There is a well-known correlation between surgical dental procedures and the risk of bacterial endocarditis in patients with prosthetic cardiac valves. A 43-year-old patient with prosthetic aortic and mitral valves, which already have been removed twice because of endocarditis, suffered from a prosthetic valve-related endocarditis following dental scaling, which was performed without any antibiotic prophylaxis. Invasive medical procedures in patients with prosthetic heart valves may lead to endocarditis. Antibiotic prophylaxis is recommended even for dental procedures considered to be harmless, such as dental scaling.

Gangrenous stomatitis (cancrum oris) is a lesion involving the orofacial structures that is primarily seen in areas where the socioeconomic standards are low and there is poor hygiene. The general clinical features, associated etiologic factors, and ensuing complications in eight consecutive cases diagnosed between 1991 and 1995 are presented and discussed.

Marsupialization of a dentigerous cyst allowed eruption of a tooth related to the cyst cavity.