Learning from mistakes. Iatrogenic derangements of dentition and their rehabilitation.
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Mouth breathing induces a low rest posturing of the tongue and tongue thrusting in many cases. This disturbs the development of the oral functions. The first stage of the reeducation is nose breathing's rehabilitation in order to "liberate" the tongue. Nasal breathing cannot be taught exteriorly . It's a result of the physical well-being. It's important to observe the mouth breathers and understand their needs. The second stage of the reeducation concerns the tongue moving tonicity and suppleness. Every exercise relies on the proprioceptive control that makes the child aware of each motion of the tongue. The next stages will be the recovering of the different functions as the rest tongue posture, swallowing, chewing. The use of phonation (lingual alveolar speech sounds) will facilitate the automatism of the new functions, because the children feel the elevation of the tongue.
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It is discussed the importance of the diagnostic, prognostic and treatment design procedures in the oral rehabilitation where osseointegrated implants are used, doing a detail of the sequence to follow during this important treatment stage.
Tooth tissue loss from bruxism has been demonstrated to be associated with various dental problems such as tooth sensitivity, excessive reduction of clinical crown height, and possible changes of occlusal relationship. A literature search revealed a number of treatment modalities, with an emphasis on prevention and rehabilitation with adhesive techniques. Rehabilitating a patient with bruxism-associated tooth tissue loss to an acceptable standard of oral health is clinically demanding and requires careful diagnosis and proper treatment planning. This article describes the management of excessive tooth tissue loss in a 43-year-old woman with a history of bruxism. The occlusal vertical dimension of the patient was re-established with the use of an acrylic maxillary occlusal splint, followed by resin composite build-up. Full-mouth oral rehabilitation ultimately involved constructing multiple porcelain veneers, adhesive gold onlays, ceramo-metal crowns, and fixed partial dentures.
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This patient presented an interesting problem surgically from the standpoint of placement of implants immediately following removal of periodontally involved teeth at which time it was necessary to completely debride the alveoli. A 20-year history of smoking mitigated the prognosis in this particular case. Prophylactic antibiotics were used perioperatively, and his healing was uneventful. The prosthetic rehabilitation also details a specific technique to reproduce superior anterior esthetics to retain virtually the same appearance in the final implant retained fixed bridge. The case also demonstrates the efficacy of immediate implant placement and augmentation of the maxilla for adequate prosthetic management.
Dental arches, where almost all the teeth are missing, have been rehabilitated by prostheses leaving one or at most three contiguous teeth. Cases like this have been resolved with the use of a removable prosthesis with stress distribution by wires so as to obtain axial load on the abutment tooth and uniform distribution on the remaining tooth or teeth and on the alveolar mucosa. Examination 7 cases followed up for a period varying from 2 tp 13 years has shown that such prostheses are extremely functional.
The teeth should be conserved before radiotherapy: --in patients with good buccodental hygiene the teeth are conserved and fluoride treatment instituted,--when hygiene is only moderate, the mandibular teeth outside of the treated area are left in place and fluoride treatment is also attempted. The crowns are conserved, and an attempt is even made in some cases to apply them, as for example on the canines.--when hygiene is inexistant, all the teeth are extracted. Following radiotherapy, the authors will restore a prosthesis two months after irradiation in long-standing edentulons patients, and after 6 months for patients who have recently become edentulons. They sometimes recommend conservative treatment and a fixed prosthesis when the social context is favourable.
Dental management of persons with epidermolysis bullosa remains challenging because of the severe hard and soft tissue manifestations of these diseases. This study reviews the dental treatment of 14 cases requiring 24 general anesthetics. Twenty-three of the cases were managed with oral tracheal intubation to accomplish full-mouth dental rehabilitation. Dental therapy consisted of preventive, restorative, and surgical procedures, with extractions and stainless steel crowns being the most common treatment modalities. There were no serious postoperative complications, and no airway problems were experienced. Although extensive intraoral mucosal blistering did occur in several cases, postoperative healing progressed normally. Soft tissue trauma may be lessened through the use of small suction tips, flat tissue retractors, and extensive lubrication of all tissues requiring manipulation. This study provides further evidence that even the most severely affected patients with epidermolysis bullosa can receive comprehensive dental treatment directed at maintaining a functional dentition.