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Tissue preservation and maintenance of optimum esthetics: a clinical report.

Today, most tooth replacement in the esthetic zone is done using implants placed in a delayed surgical protocol. Unfortunately, this delay can result in loss of both hard and soft tissue during the healing period, necessitating guided tissue regeneration techniques at the time of implant placement. Recent developments with tapered implants have facilitated predictable immediate implant placement, preserving the osseous structure surrounding the socket. Further developments with custom healing abutments can preserve the crestal soft tissues, including the papillae. This article reviews techniques that provide for the preservation of both bone and soft tissue while enhancing the esthetic results around implants.

Bicuspid↗

Treatment of trauma to the primary and young permanent dentitions.

An overview of the various possibilities for trauma to the primary and young permanent dentition has been presented. Appropriate treatment procedures have been described. Advances in dental science have been great, and dental materials have become superior to what they were just a few years ago. The dentist must never forget the variabilities of human responses to any of the treatment techniques, however, and the dentist must never be dogmatic in approach. The dentist should be able to diagnose, interpret, and alter any of the treatment techniques as more scientific evidence is obtained.

Child↗

A multidisciplinary approach to the treatment of an intruded maxillary permanent incisor complicated by the presence of two mesiodentes.

Treatment of a traumatically intruded maxillary incisor with an immature apex remains controversial. Treatment options include observation, surgical repositioning, or orthodontic forced eruption. Likewise, the ideal timing of surgical removal of a mesiodens is highly controversial: immediate versus delayed intervention. The complications associated with untreated supernumerary teeth include: overretention of primary teeth, delayed eruption of permanent incisors, rotations, impaction, diastema, pulp necrosis and root resorption. Less common sequelae include enlarged follicular sacs, cystic degeneration and nasal eruption. This paper describes another risk factor associated with delayed removal of a mesiodens previously not mentioned in the dental literature, namely potential complications arising from a traumatic injury, in particular intrusion, of the maxillary permanent incisors.

Child↗

Restoration of endodontically treated tooth containing wide or flared canal.

There has been much anecdotal information and misinformation disseminated regarding the restoration of endodontically treated teeth, which has comprised the foundation for our restorative protocol. In the past, it was considered appropriate to place a cast post and core in every pulpless tooth without regard to the amount of remaining supportive tooth structure present. Recent developments in available ceramics, greater cosmetic demands by patients, and the advent of adhesive bonding techniques have caused clinicians to reevaluate their restorative protocol. This article reviews the current literature with regard to restoration of the endodontically treated tooth and presents a method for restoration and reinforcement using a combination of polyethylene ribbon and a prefabricated fiber post to create a post and core that is retentive, supportive, cosmetic and able to impart reinforcement to a structurally compromised root.

Composite Resins↗

Endodontic radiographs: realities and illusions.

Several case reports show how, on occasion, radiographs fail to disclose important realities. The illusions that are presented radiographically have the potential to misdirect diagnosis and treatment as well.

Adult↗

Biomechanically-induced dental disease.

Malocclusion, as an etiological agent in dental disease, is among the most controversial subjects in dentistry. Bruxism has been blamed on stress and many other nondental factors. A biomechanical mechanism that serves as a contributing factor to stimulate tooth clenching and grinding is defined and used to identify the 12 common dental symptoms caused by tooth clenching and grinding. A method is proposed through which the practitioner can link the observable dental signs with the biomechanical factors for accurate diagnosis and appropriate treatment, preferably at an early stage before the damage becomes severe.

Adult↗

Ridge preservation of dentition with severe periodontitis.

Severe loss of alveolar bone height and width can occur following the removal of teeth with advanced periodontitis. This compromise of the alveolar bone can limit the options available for achieving an acceptable dental restoration. Two case reports are presented of alveolar ridge augmentation after tooth removal and before implant placement using bone grafting and a biodegradable membrane. The resultant alveolar ridges in both patients were adequate for the placement of dental implants.

Adult↗

Treatment of a cracked tooth with a resin-ionomer restoration and a connective tissue graft: a case report.

Treatment of a cracked tooth can be difficult and unpredictable. Quite often, the most predictable treatment possible is simply extraction. This is a case report of the treatment of a cracked tooth with a resin-ionomer restoration and a connective tissue with partial-thickness double pedicle graft. The crack was detected during a routine root coverage procedure using this type of graft. A resin-ionomer was used to repair the crack. Then, the root coverage procedure was completed. Complete root coverage was obtained, including the portion of the root that was repaired. The results remained stable and the tooth treated remained asymptomatic. Clinically, the treatment was a success.

Bicuspid↗

Trauma to the primary and young permanent dentitions.

It is the responsibility of the dentist to stay current on the latest techniques available to treat traumatic injuries. The charts included provide most of the potential emergency treatment possibilities, recommended follow-up treatment, and final treatment outcomes essential to providing the best care for our child patients. It is also the responsibility of the dentist to use evidence-based research when adopting treatment protocols. It is not appropriate to use anecdotal or single case studies as a basis for adopting treatment protocols. It is very difficult in this area of trauma to come up with good scientific research with adequate sample sizes and long-term data. Dr. J.O. Andreasen has excellent compiled long-term research on trauma. His books, Essentials of Traumatic Injuries to the Teeth and An Atlas of Replantation and Transplantation of Teeth are two very good books for any clinical practice.

Child↗

Intraoral camera helps predict and prevent tooth loss.

The video exam has proven to be a most effective means of re-establishing trust between patient and dentist by making the patient a co-diagnostician. In fact, it is not uncommon for patients to stop the diagnosis and ask specific questions about what they see. They can begin to diagnose pathology even before the dentist mentions it. A major benefit to the dentist is that invariably the exam reveals conditions not seen with typical clinical exams even using magnification loops. Although the intraoral camera has been around for more than a decade, its benefit during the video exam is more important now than ever before (8, 9). Every new patient and all patients of record should have the benefit of a video exam, as well as the dentist.

Dental Caries↗

Dental abnormalities in rats after a single large dose of cyclophosphamide.

Delayed drug-related mortality in rats treated with a single high dose (75 mg/kg) of cyclophosphamide complicated experiments using this drug treatment. We observed that this delayed mortality was due to dental abnormalities including broken teeth, absent teeth, extra long teeth, and/or supernumerary teeth. These dental abnormalities developed about 140 days after treatment and, if left untreated, interfered with eating. Eventually, the untreated rats starved. Clipping their long teeth and feeding the rats powdered chow eliminated the deaths. Researchers should be aware that high doses of cyclophosphamide may result in dental abnormalities several months after the treatment.

Animals↗