Attachment of a splint to enamel of lower anterior teeth.
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A full upper stabilization splint divided into three pairs of occlusal bilateral blocks was made for eight healthy young adult subjects. The three pairs of blocks allowed the location of the centric occlusal contacts to vary and to be distributed over equivalent periodontal surfaces. The electromyographic activity of the masseter and temporal muscles was recorded with surface electrodes during maximum voluntary clenching over the centric occlusal blocks. The electromyographic activity from the elevator muscles with the anterior blocks was significantly less than with the intermediate and posterior occlusal blocks. With use of the intermediate blocks, the activity from the elevator muscles was significantly less than with the posterior blocks. The elevator activity with the posterior blocks was similar to that with the full coverage splint.
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Osseointegrated implants are now an accepted part of the prosthetic treatment of edentulous patients. More recently, osseointegrated implants have been advocated in the treatment of partially dentate patients. The implants can be used in conjunction with natural teeth for the support of rigid prostheses. The natural tooth is supported in bone by a periodontal ligament, whereas the implant may be described as having a more intimate or ankylotic connection with the supporting bone. Different attachment mechanisms may lead to differential rates of destruction in both situations, particularly if teeth and implants are splinted together by a rigid prosthetic appliance. Also noteworthy are the possible differential rates of marginal tissue breakdown as a result of the influence of bacteria. Results of a pilot study in which marginal breakdown was induced around implants and natural teeth in beagle dogs suggest that the process of destruction proceeds more slowly in the case of implants. However, the disease process around implants may be more difficult to arrest due to conjectural problems in treating the surface of the implant using conventional techniques of periodontal treatment. From the limited data available so far, it would appear that osseointegrated implants can be used as predictably in partially dentate as in totally edentulous mouths. More research should be initiated on the potential for tissue-breakdown, and long-term maintenance of the marginal tissues around implants.
In view of the relationship between supragingival and subgingival plaque, chemical agents which alter supragingival plaque may also alter subgingival plaque. As a result, a beneficial effect on gingival health may be anticipated. This article reviews the use of chemotherapeutic agents which reduce plaque and gingivitis. Indications for the use of these agents include patients with problems with mechanical plaque control, extensive splinting or fixed prostheses, intraoral fixation, orthodontic appliances, overdenture abutments and implants, and for patients in the immediate post-surgical period. Improvement of wound healing following periodontal surgery may represent one of the most valuable aspects of use of these agents. As mouthrinses, these agents cannot be expected to significantly alter subgingival plaque. However, for this purpose, their use in irrigation devices deserves further study. Since recent reports have suggested benefits of various mouthrinses when used as irrigants as compared to rinses may also reduce the bacterial back-spray associated with ultrasonic devices and high-speed handpieces, and thus provide a protective effect for dental personnel. The practitioner in the United States is encouraged to recommend products accepted by the American Dental Association's Council on Dental Therapeutics in order to insure both safety and efficacy.
Dental pain and disfigurements cause patients to seek care from the Emergency Department of hospitals. It is important for physicians to understand dental disease and trauma in order to diagnose, treat, and refer patients with dental emergencies efficiently. Many common dental problems have been discussed in clinical terms. Treatment and referral options were offered. Techniques for local dental anesthesia and avulsed tooth splinting were described.
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A total of 211 consecutive patients of a restorative dentist who received full-mouth radiographs between October 1988 and March 1989 were screened for teeth treated endodontically at least 10 years earlier. In all, 51 patients had 138 teeth treated and restored by the authors. All involved teeth were restored with tapered smooth posts, cores with complete or 7/8 cast ferrules, and an onlay or cast precious metal crown (with or without veneering). No posts, splints, or bridges were loose, and only one crown was loose. There were nine failures in 138 teeth (6.5%)--three restorative, two endodontic, two root fractures, and two periodontal. When tapered smooth posts are used properly, retentive problems do not occur.
Although there are several epidemiological studies on dental trauma internationally, there are not many studies that record, analyse and follow different kinds of dental trauma treated in a private office, and that evaluate how parameters such as type of dental trauma, as well as time lapse until treatment might influence the final outcome and the prognosis of the teeth. The sample consisted of 242 patients, 6-17 years of age, with 369 injured teeth treated within a period of 5 years. All the case were treated by the first author and were followed for at least 3 years. The treatment modalities used were based upon the clinical examination and the history of the case and included direct and indirect pulp capping, partial pulpotomy, pulpotomy, pulpectomy and splinting. The type of trauma was classified based on WHO classification partially modified. Seventy six percent of the teeth suffered only hard tissue injuries and 22% had only periodontal ligament PDL) trauma. Of the total number of teeth class I represented 3%, class II 59%, class III 20% and class IV 2%. Of the PDL injuries 14% of the teeth suffered concussion, 69% luxation and 17% exarticulation. The highest incidence of dental trauma was observed at the age of 10. Sixty eight percent of the patients sought treatment 3 days or more after the trauma had occurred delayed treatment), while only 32% within the first 3 days (immediate treatment). The main reasons for delayed treatment were neglect (50%) and unawareness 37%). Of the teeth with delayed treatment 43% became necrotic, while only 28% of the teeth that were treated on time needed pulpectomy. Luxations caused more pulp necrosis (46%) than Class I (0%) Class II (7%) or Class III (34%) type of trauma. The data from this study suggested that a most of the dental injuries on permanent teeth were class II or III type, b) a high percentage (68%) of the patients sought treatment more than 3 days after the injury (delayed treatment), c) delayed treatment caused more necrotic teeth, d) the public should be informed of the importance of immediate treatment in an effort to improve the prognosis of the pulp, e) dentists should be informed of the appropriate treatment of dental injuries since 10.3% of the cases were mistreated.
The present report describes a case of a mid-root fracture in a maxillary central incisor of a 19-year-old patient. The fractured tooth was splinted with composite that was removed only 3 years later, as the patient did not appear for follow-up examinations. At this time, the radiographs revealed a normal periodontal ligament, rounding of the borders of the fragments and pulp obliteration of both fragments. Eight years later, the tooth was clinically normal and blurred calcification of the root canal was disclosed radiographically. After 13.5 years the patient complained of tooth mobility and radiographic examination revealed an advanced cervical root resorption. As no conservative approach was possible at this stage, the patient was referred to a prosthodontist for esthetic rehabilitation.
Pain is a major public health problem. The management of orofacial pain may be a difficult challenge to the medical and dental professions. Ideally, severe cases of this type of pain should be treated by a team drawn from several disciplines such as neurology, otolaryngology, dentistry and psychiatry. Trigeminal neuralgia patients develop brief, very severe unilateral pain, usually radiating from the upper or lower jaw toward the ear, and confined to the distribution of the trigeminal nerve. The pain may be triggered by chewing, shaving or exposure to cold wind. Most patients respond to carbamazepine, with phenytoin or baclofen as an alternative. Intractable pain may require surgical treatment. Horton's syndrome (cluster headache) is always unilateral and is often associated with unilateral lacrimation and rhinorrhoea. The pain is extreme, and its typical localisation the eye, forehead, temple, jaws, or teeth. Treatment with ergotamine and sumatriptan has been used with some success, calcium blockers (e.g., verapamil) being used as prophylaxis. Atypical facial pain is a continuous ache with intermittent episodes, localised to non-muscular, non-joint facial areas. The pain may be unilateral or bilateral, and may persist for many years. Typically, these patients consult a variety of specialists, such as dentists and otolaryngologists. Surgical procedures such as tooth extraction or sinus surgery, even if skillfully executed, exacerbate the condition, are are thus contraindicated. If the patient does not respond to reassurance, antidepressants may be tried. In sinusitis, the pain location is dependent upon which paranasal sinus is affected. Routine diagnostic nasal endoscopy and coronal plane computed tomography enable subtle pathological changes that are related to chronic pain to be identified. If medical treatment fails to afford relief, surgery should be considered. Pain, limited range of jaw motion, and joint noises are the common characteristics of temporomandibular disorders. Treatment usually consists of non-surgical means such as splints, occlusal equilibration, and non-steroidal anti-inflammatory drugs. Surgical treatment is indicated in a few carefully selected cases. Most dental pain is attributable to caries or periodontal disease. When pus is present, drainage affords excellent pain relief. Acute pericoronitis involving mandibular third molars responds to irrigation, removal of maxillary third molar trauma, and--in cases of serious infection--antimicrobial therapy. Early recognition of a case of chronic pain improves the chances of successful management, and avoids frustration and disillusion both to patient and doctor.