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[Induction alveolectomies and root malformations].

In connection with 2 cases of dental retention due to radicular malformations, the authors draw attention to the following three points: 1. The diastema in which the retained tooth develops should exceed its mediodistal diameter. 2. The malformation of the root is not a counter-indication for induction alveolectomy: this triggers growth of the alveolar bone satellite of the tooth, following a process different from the usual mechanism of dental eruption. It could mean that the coronary portion, which is of epithelial origin, is rejected by its bony, connective tissue environment. 3. They would like diagnosis of dento-maxillary disharmony to be graded: --difficult to judge from X-rays alone; --dubious when abnormalities in the transverse diameter of the arches also contribute to crowding of the teeth.

Adolescent

Preprosthetic surgery.

Several of the abnormal conditions existing in the edentulous patient can be corrected surgically, prior to construction of dentures, to enable the patient to function more successfully following prosthetic restoration. The more common problems have been discussed which often require surgical correction. In some instances, articulated diagnostic models of the patient's mouth show that surgery can be avoided, or when surgery is necessary, these models help identify the exact locations of the tissue to be corrected. Alveolectomy has been presented with an eye toward conservatism since this procedure affects the quality of denture foundation and therefore denture stability. Alveolectomy should be performed only when there is a definite indication for the procedure. Correction of soft tissue abnormalities can substantially improve the patient's ability to function with dentures and solve many of the adjustment problems which confront the dentist. It is often better to correct the soft tissue abnormality rather than to circumvent the problem with an inferior prosthetic restoration. Since the introduction of resilient acrylics and tissue conditioning materials, the patient need no longer suffer the discomfort of denture withdrawal after surgery. Electrosurgery has emerged as a successful method of correcting many soft tissue abnormalities. Vestibuloplasty is receiving much emphasis as a possible treatment for atrophic ridges in which there is still enough alveolar bone from which to extend a sulcus. These sulcus extension procedures may offer some help in the future regarding the problem of resorbed ridges, but presently, more research is necessary before widespread use is recommended.

Alveoloplasty

Osseointegrated fixture placement with simultaneous tooth extraction.

Three cases are presented that illustrate the potential for accelerating the healing phase with fixture-based treatment. Depending on the clinical circumstances, techniques may include radical alveolectomy, the use of fresh extraction sockets, and fixture placement in inter-radicular bone.

Adult

The immediate implant: a treatment alternative.

The safety and efficacy of placing endosseous implants into the anterior mandible at the time of dental extractions with appropriate radical alveolectomies ("immediate implants") is reported. The results were compared to a control group of patients. The success of the immediate group was 92.7%; that of the control group was 98.1%. The difference in success rates was not significant at the P less than .05 level.

Adult

Osteoradionecrosis of the mandible. Treatment with hyperbaric oxygen.

Hyperbaric oxygen used in the treatment of 14 patients with intractable osteonecrosis of the mandible produced a favorable response in relief of pain, elimination of extraoral draining sinus tracts, the return of osseous union in areas of the abnormal fracture, and the rapid dissolution of sequestrum without suppuration, so that further loss of hard and soft tissue was minimized. This treatment is a more conservative approach in the management of osteoradionecrosis.

Adult

Results of surgical treatment for squamous carcinoma of the lower alveolus: segmental vs. marginal resection.

The records of 53 patients treated surgically for squamous cell carcinoma of the lower alveolar ridge were reviewed and the results of segmental and marginal resections of the mandible were compared. Analysis of these 2 treatment modalities disclosed that marginal resection was effective in controlling lower gingival cancers, with and without apparent bone involvement, if erosive bone defects that did not extend beyond the inferior alveolar canal, or invasive bone defects confined to a superficial area of the alveolar bone, were detected radiologically.

Adult

Cephalometric evaluation of surgical orthodontic treatment for the correction of anterior cross-bites.

Severe skeletal Class III malocclusion cases were treated by surgical orthodontic techniques. Surgical operations included alveolar osteotomy, horizontal osteotomy of the mandibular ramus, osteotomy of the mandibular body, and sagittal-split osteotomy of the mandibular ramus, according to the type of malocclusion. Comparisons between lateral cephalograms made before and after operation at the prognosis examination were made for the four surgical procedures.

Adolescent

Soft-tissue change as a result of maxillary surgery. A preliminary study.

A retrospective investigation of soft-tissue changes following two types of maxillary surgical procedure (anterior alveolar segmental, LeForte I) in nineteen adult patients was undertaken. Several hard-tissue coordinates were correlated to each coordinate of eleven soft-tissue points by multivariate regression analysis. This new method was compared to a previously derived nonsurgical prediction method (Ricketts). The following results were observed: 1. For eight horizontal and vertical coordinates (Glh, Glv, Nah, Av, Nch, Ncv, Pnh, and Pnv), neither method was accurate. 2. For ten horizontal and vertical coordinates (Snh, Snv, Ah, Av, ULh, ULv, Stv, LLh, Bv, and Pogv), the mean prediction residuals for the multivariate method were significantly smaller than those for the modified nonsurgical method. 3. For three horizontal and vertical coordinates (LLv, Bh, and Pogh), there were no significant differences between the mean prediction residuals of both methods. Two additional cases were used to test the new method for general applicability. Visual examination reveals that the predictions for these cases are clinicallly acceptable. Only further testing can establish the true validity of the new method.

Adolescent

Anterior mandibular subapical osteotomy: a useful treatment for patients with severely worn mandibular anterior teeth.

Rehabilitation of patients with severe dental wear is a complex diagnostic and restorative problem. As wear occurs, space for restorative materials is lost, and unique treatment techniques are needed to provide good esthetics and function. Use of orthognathic surgery to reposition mandibular anterior teeth and supporting alveolar bone can create a more ideal environment for restorative procedures.

Alveolectomy

Proplast in dental facial reconstruction.

Successful clinical applications since early 1970 have occurred with the use of temporomandibular condylar prosthesis and endosseous blade-vent implants coated with porous proplast. Proplast as a bulk material has also been used to augment atropic mandibular alveolar ridges and deficient facial contours in the mental, mandibular border, and zygomatic areas.

Alveolectomy

The healing of surgical defects in alveolar bone produced with ultrasonic instrumentation, chisel, and rotary bur.

A histologic comparison of the effects of an ultrasonic instrument, a low-speed rotary cutting bur, and a surgical chisel, all used with water coolant, on the rate of healing of dog alveolar bone was made. After reflection of a mucoperiosteal flap, each instrument was used to produce a 3 by 3 by 2 mm. defect in buccal alveolar bone, 3 mm. apical to the alveolar crest and directly overlying the root structure of the right premolar teeth. Dogs were killed immediately following flap replacement with sutures and 3, 7, 14, 28, 56, and 90 days later. Histologic examination of the surgical areas revealed that the bur produced the smoothest surface. At day 3, specimens prepared with the chisel and the ultrasonic instrument exhibited areas of cellular organization along surfaces with the defect and the formation of osteoid in adjacent marrow spaces. At day 7, osteoblastic activity was most pronounced in specimens prepared with the chisel and least in those prepared with the bur. The subsequent rate of healing in later periods appeared histologically to be the best with the use of the chisel, followed closely by the use of the ultrasonic instrument, and the slowest with the bur, the order of which is consistent with the over-all microscopic evaluation of the effect of the three instruments.

Alveolar Process

Primary malignant melanoma of the oral cavity.

The natural history of malignant melanoma of the oral cavity is discussed with reference to the findings of previous writers, and six additional cases are reported. These demonstrate the considerable variations in detail of the course of the disease while confiriming the difficulty of treatment and the inexorable nature of the condition.

Aged

Incidence of nerve damage following third molar removal: a West of Scotland Oral Surgery Research Group study.

A survey was carried out to record both initial and longterm effects on the lingual and inferior alveolar nerves following third molar removal. Eight hundred and twenty five patients were included from eight West of Scotland Oral Surgery Units, and had 1339 third molars removed. Changes in sensation were recorded by direct questioning at 6 to 24 h and 7 to 10 days, and by postal questionnaire at 12-18 months. The incidence of lingual nerve damage was found to be 15% of operated sides at 6 to 24 hours, 10.7% at 7 to 10 days, and 0.6% after 1 year. The incidence of inferior alveolar nerve damage was 5.5% of operated sides at 6 to 24 h, 3.9% at 7 to 10 days, and 0.9% after 1 year. These results are proposed as an indication of the likely incidence of nerve damage complicating third molar removal in the general circumstances of current United Kingdom practice and are presented as a basis for discussion of patient information and current prudent practice. Since one in four patients suffered at least temporary sensory deficit, we believe the case for effective warning of all patients undergoing impacted third molar removal is overwhelming.

Adolescent

Report of an audit into third molar exodontia.

A postal audit of the main surgical variables in third molar exodontia under general anaesthesia was undertaken on consultants holding a National Health contract within the British Isles. This first paper presents the results. A response rate of 175 returned questionnaires from the 247 consultants was obtained (70.9%). Analysis revealed that the majority of consultants use antibiotics, mouthwashes, sutures, analgesics and postoperative review and the minority steroids and peroperative local anaesthetic, routinely in the majority of cases. Approximately half routinely use a chisel as opposed to a bur for bone removal. The consultants who gave all their patients steroids were significantly (p less than 0.01) more likely to possess a medical qualification than the consultants who did not.

Adolescent