The lower third molar and antiphlogistics.
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Biomedical subjects
Publications and source records attributed to G Boering.
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In edentulous patients with a prognathic mandible, a pronounced chin and extensive resorption of the lower alveolar ridge, the commonly used techniques of ramus osteotomy and chin reduction will not give optimal results in the majority of cases. The solution of this problem can be obtained by mandibular body ostectomy and a sagittal rotation of the frontal part of the lower jaw. By this operation the originally horizontally orientated upper plane of the chin area is placed in a more vertical position. This operative technique gives a better predictable facial contour than the conventional methods. It causes no unfavorable displacement of the lower lip and, which is very important, it gives an absolute increase of height of the lower alveolar ridge and a more favorable inclination of the frontal part of the alveolar process from a prosthetic point of view. The problems encountered and the results obtained by this technique will be demonstrated by a short case presentation.
In a retrospective study of 63 patients, an attempt is made to determine in how many cases retained permanent upper incisors erupt after the removal of supernumerary teeth, and what predisposing and etiological factors are of importance. It proved that the eruption of a supernumerary tooth positively contributed to the chance of a spontaneous eruption of the permanent incisors. No relationship could be demonstrated between the age of a patient from whom supernumeraries were extracted, the number of supernumeraries, the extent of root formation, marked apical displacement and the chance of spontaneous eruption of the permanent incisors. It also proved that only in 1 out of 2 children did spontaneous eruption occur after removal of the supernumeraries. It therefore seems advisable to provide all impacted upper incisors with a cervical ligature of bracket with twined wire sling during the first operation in order to create the possibility for orthodontic traction if spontaneous eruption of the incisor does not occur, and thus to prevent a second operation for the child.
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The structure and function of the human temporomandibular joint has concerned several investigators but still fundamental questions exist and require further examination. A profound knowledge of the normal anatomy and histology of the temporomandibular joint is necessary to understand its function and functional disturbances. It is also necessary for a good understanding of clinical findings and the interpretation of radiographs. In this paper a clinically orientated description has been given of the anatomy and histology of the mandibular head, the articular fossa and eminence, the articular disc, the capsule and ligaments, the synovial membrane, the innervation of the joint and the normal relationship between the different components. About the physiology of the temporomandibular joint many controversial theories exist. A lot of research has still to be done, especially in the field of the co-ordination of the function of both joints, the muscles and the dentition.
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Quantitative data on postoperative complaints and complications after removal of the mandibular third molar, especially in relation to the different methods of treatment, are scarce. Mostly an objective approach is lacking. The present study attempts to provide such data and their clinical consequences. Within 1 year, 932 mandibular third molars were removed; 430 extractions served as a control group for 502 surgical removals. The procedure was fully standardized and all measurements objectively obtained. A computer was used for statistical evaluation. It appeared from this study that the possibility of postoperative complaints and complications will be smaller if the wound is not packed, if tight suturing is not done and if reflection of the mucoperiosteum is avoided. If reflection is inevitable the oblique vertical relaxing incision is preferred. Prophylactic administration of antibiotics is rejected.
Based on characteristic case-reports the mostly occurring patterns of maxillo-facial pain are discussed. A description is given of pain in case of pulpitis, dento-alveolar abcess, dry socket, deep local periodonitis, temporomandibular joint arthrosis, dehiscence of the mandibular canal, maxillary sinusitis, malignant neoplasm. Trigeminal neuralgia, atypical facial neuralgia and psychogenic pains are discussed. The article concludes with a survey of the most important symptoms of these pain-syndromes in order to facilitate a correct diagnosis.
No objective method for measuring postoperative swelling both simply and reliably is known from the literature. The method described in this article measures the degree of swelling indirectly by comparing tracings of pre- and postoperative photographs printed full-size. The photographs taken are standardized and full-face. The head is reproducibly fixed by means of a bite impression and two rings. One ring is mounted on a table on which the camera also is fixed. At the other, mobile, ring the bit impression is fixed. Three-point contact in the correct position between the two rings is signalled electrically, so that the head is in the correct position and the photograph can be taken. The advantage of this method over a rigis connection between bite fork and fixation stand on the table is that distortion or even bending of the fork and connecting bar is not possible. Experience with this method shows that in 95% of the patients photographed the picture was exactly reproducible. Measuring non-operated test persons revealed the reproducibility of the cheek contour to be better than 0.2 mm. The error made when tracing the photographs is of about the same magnitude.
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