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Iatrogenic damage to approximal surfaces in contact with Class II restorations.

OBJECTIVES: This study investigated the frequency of iatrogenic damage to approximal surfaces in contact with Class II restorations. METHODS: Patients (n = 28) with a Class II restoration in contact with an unrestored surface had elastic separators fitted interproximally. Contralateral (unrestored) control surfaces were also separated. Impressions (light body polyvinylsiloxane) of the separated surfaces were taken 3-6 days later. Interproximal impressions (28 paired, seven unpaired) were examined by binocular microscope and scanning electron microscope (SEM) for iatrogenic damage, attrition and cavitation due to caries. RESULTS: 49-60% of surfaces adjacent to Class II restorations had been iatrogenically damaged. The most frequent types of damage were vertical grooves (26%), extensive damage (17%), indentations (6%) and scratches (6%). Damage was more frequent in maxillary teeth (61%) than mandibular teeth (25%), in permanent teeth (60%) more than deciduous teeth (20%). Qualified dentists produced more iatrogenic damage (64%) than undergraduate students (23%). CONCLUSION: The frequency of iatrogenic damage to approximal surfaces following Class II preparations was 49%, and possibly as much as 60% when questionably damaged surfaces were included. Protection of the adjacent enamel is of paramount importance during Class II cavity preparation.

Adolescent↗

Detection of white restorative dental materials using an alternative light source.

We assessed the value of an alternative light source for detecting white composite dental materials in burned and unburned teeth. Teeth filled with 18 different restorative materials (composite, glass ionomer or hybrid composite), were viewed with a Polilight. Between 415 nm and 555 nm, the glass ionomers showed distinctly different optical properties from the other materials: they either fluoresced or appeared darker. Wavelengths 415 nm to 530 nm gave a general enhancement in composite detection (17 of 18 materials). Light above 590 nm was of little value, enhancing detection in only 2 of 18 materials. After simulated burning of the teeth, there was enhanced visibility of 8 of 18 materials at wavelengths under 350 nm. Burning destroyed the previously distinct optical properties of the glass ionomers. Overall, this alternative light source aids the identification of white composite dental materials and could be used in routine forensic odontology practice.

Burns↗

Optimization of glottic exposure during intubation of a patient lying supine on the ground.

Two methods of endotracheal intubation of patients lying on the ground were compared for ease and speed of intubation and minimization of complications in a crossover study of prehospital-oriented emergency physicians. Intubation of a mannequin was attempted by the physicians in either a left lateral decubitus (LLD) position or a kneeling (K) position, followed by the alternate position. The LLD position afforded more rapid intubation, better glottic visualization, and less dental trauma. Eighty-seven percent of physicians completely visualized the glottis in the LLD position, versus 33% of the K position group. Intubation times were 10.5 versus 14.6 seconds in the LLD and K positions, respectively (P < .001). The LLD position is a more effective position (in a mannequin model) than the K position for intubation of patients found lying on the ground, a frequent situation in prehospital care.

Cross-Over Studies↗

[Dental accidents in relation to general anesthesia. Experience of mutual medical insurance group].

This article reviewed retrospectively 511 cases of dental damage reported to the French group for medical insurances from 1990 to 1995, and representing 40% of all accidents related to anaesthesia. The mean incidence rate was 9.5 accidents/100 anaesthetists/year and tended to decrease over time. The part of cases qualified as being linked to a fault was high and mainly due to the lack of dental examination and of informed consent during the preanaesthetic assessment. Although the mean cost of a dental accident is low compared with other anaesthetic accidents, the global cost is substantial considering their high incidence.

Anesthesia, General↗

Treatment of pulp floor and stripping perforation by mineral trioxide aggregate.

Mineral trioxide aggregate (MTA) has been widely used to repair various kinds of tooth perforations, but its use for obturation of the entire root canal has not been reported. We report two cases of tooth perforation successfully repaired with MTA. The first patient was a 78-year-old male with calcified canal and pulp floor perforation in the left maxillary first premolar. After bypass of the calcified palatal canal, both buccal and palatal canals were filled with gutta percha, and the pulp floor perforation was repaired with MTA. Clinical success with no evident radicular lesion was found at the 18-month follow-up. The second patient was a 51-year-old female with a stripping perforation in a C-shaped root canal of the right mandibular second molar detected after removal of a post. Following root canal debridement and calcium hydroxide therapy to control inflammation at the stripping perforation site, apical and furcation bone healing were observed by radiographic examination. The stripping perforation was repaired by obturation of the entire C-shaped root canal with MTA. Observation at the 9-month follow-up revealed bone healing without any clinical symptoms and signs. These cases suggest that MTA is an alternative root canal obturation material for treatment of stripping perforation in a C-shaped root canal and for repair of pulp floor perforation.

Aged↗

Hemophilic pseudotumor of the jaws: report of two cases.

Hemophilic pseudotumor of bone is a rare condition that occurs in patients with hemophilia. To date only 10 cases have been reported in the mandible, and none has been reported in the maxilla. The clinical, radiographic, and histologic features and treatment approaches of two cases of hemophilic pseudotumor occurring in the jaws are presented. One of them is probably the first one reported in the maxilla. Both patients had a history of trauma to the area.

Child↗

Bacteria of asymptomatic periradicular endodontic lesions identified by DNA-DNA hybridization.

Possible inclusion of contaminant bacteria during surgery has been problematic in studies of periradicular lesions of endodontic origin. Therefore, in this study, two different surgical techniques were compared. A second problem is that some difficult to cultivate species may not be detected using bacteriological methods. Molecular techniques may resolve this problem. DNA-DNA hybridization technology has the additional advantage that DNA is not amplified. The purpose of this investigation was to determine if bacteria from periradicular endodontic lesions could be identified using DNA-DNA hybridization. A full thickness intrasulcular mucoperiosteal (IS) flap (n = 20) or a submarginal (SM) flap (n = 16) was reflected in patients with asymptomatic apical periodontitis. DNA was extracted and incubated with 40 digoxigenin-labeled whole genomic probes. Bacterial DNA was detected in all 36 lesions. Seven probes were negative for all lesions. In patients with sinus tract communication, in teeth lacking intact full coverage crowns, and in patients with a history of trauma 4-13 probes provided positive signals. Seven probes were positive in lesions obtained by the IS, but not the SM technique. Two probes were in samples obtained with the SM technique, but not the IS. Only Bacteroides forsythus and Actinomyces naeslundii genospecies 2 were present in large numbers using either the IS or the SM technique. The SM flap technique, in combination with DNA-DNA hybridization, appeared to provide excellent data pertaining to periradicular bacteria. These results supported other studies that provide evidence of a bacterial presence and persistence in periradicular lesions.

Actinomyces↗

Tongue piercing and associated oral and dental complications.

The insertion of metal objects into intraoral and perioral sites is growing in popularity. However, there are numerous oral and dental complications associated with tongue piercing. Fifteen patients with tongue piercings (pierced in the body of the tongue, anterior to the lingual frenum) attending the dental office of the authors, with and without complaints, were clinically and radiographically examined. The most common dental problem registered was chipping of teeth. Furthermore, two cracked teeth and four teeth with cusp fractures were also seen. One case of selective dental abrasion was registered. Trauma to the lingual anterior gingiva was the most common gingival problem. A salivary flow stimulating effect was only reported by 2 of the 15 individuals. None of the patients complained of interference with speech, mastication and swallowing. One case of galvanic currents produced by the appliance was registered. On the basis of the registered data, we concluded that patients need to be better informed of the potential complications associated with tongue and oral piercings, and that the dental profession can serve this role.

Adult↗

Comfort and discomfort of dental trauma splints - a comparison of a new device (TTS) with three commonly used splinting techniques.

The present experimental study compared four dental trauma splints in 10 volunteers. The evaluated splints included a wire-composite splint (WCS), a button-bracket splint (BS), a resin splint (RS), and the newly developed titanium trauma splint (TTS). All splints were bonded to the labial surfaces of the maxillary lateral and central incisors and left in place for 1 week. After splint removal, the next splint was placed after a 1-week rest period. The sequence of splint application was randomized for each individual. The following subjective parameters were assessed using a visual analogue scale: sensitiveness of splinted teeth, irritation of the gingival margin, irritation of the lips, impairment of speech, eating and oral hygiene. The results show that the application of BS leads to a significantly higher irritation of the lips and greater impairment of speech compared to other splints (P < 0.05). The RS leads to an increased and significantly higher irritation of the gingiva (P < 0.05) owing to a significant increase in cleaning difficulties (P < 0.05). In conclusion, WCS and TTS appear to be more accepted splints according to a subjective assessment by 10 volunteers.

Acrylic Resins↗

Periodontal mechano-sensory responses following trauma to permanent incisor teeth in children.

The aim of this study was to investigate mechano-sensory responses of injured and uninjured incisor teeth. Twenty-five children who had experienced dental trauma, together with age- and gender-matched controls, were studied prospectively. Touch thresholds of incisor teeth from both groups were determined using calibrated sets of von Frey hairs (force range 0.5-10.0 g in 0.5 g increments) using a forced choice staircase method. Forces were applied perpendicular to the buccal enamel surfaces along the midline, 2 mm from the incisal edge. Touch threshold was defined as the lowest force detected in three out of the five occasions. Following statistical analysis, P < 0.05 was considered significant. At initial examination, the touch threshold values of 25 traumatised teeth were significantly greater than the untraumatised controls (P < 0.001), and these values approached those of the control teeth over 3-12 months (P > 0.05). Dental trauma was associated with increased touch thresholds in permanent incisor teeth, with recovery toward healthy control values usually occurring between 3-12 months.

Adolescent↗

The immediate or delayed replacement of teeth by permucosal intra-osseous implants: the Tübingen implant system. Part 1. Implant design, rationale for use and pre-operative assessment.

No single implant system is applicable to all clinical problems which may be treated with implants. Clinicians who wish to develop expertise in the field of dental implantology should decide which clinical situations they wish to treat with implants and then receive an appropriate level of instruction in the use of systems which have been shown, in refereed literature, to be successful in the treatment of such problems. The Tübingen implant system has been in clinical use for more than 13 years, following preliminary basic research and animal studies, and is supported by an extensive literature. It is applicable primarily to the immediate or delayed replacement of individual teeth which are subsequently to be restored with a post crown. It may also be used in other situations, such as in combination with bridge restorations. This is the first of two papers which describe in detail the range of applications, patient selection and assessment, and the surgical and restorative techniques involved in its use.

Adult↗