Quintessence International, 10/1993

Many studies have shown that deep and wide gingival recessions can be predictably covered by free gingival autografts. Most of the autografts in these studies were performed on single-rooted teeth. This article presents a rationale for a new technique that repairs this type of defect in maxillary molar areas by means of thick masticatory mucosa autografts that intentionally include not only the lamina propria, but also portions of the submucosa. In addition, a new suturing approach that allows adequate adaptation of the donor tissue to the recipient site and permits relocation of the graft is proposed. This new approach has been shown to be a significant advantage in the anatomically problematic maxillary molar area.

The etched cast restoration was introduced as the Maryland bridge in 1980. The technique has continued to evolve with modifications in tooth structure and framework design as well as improvements in luting resins, including some that chemically bond to the alloy. The conservation of tooth structure and the avoidance of involving the gingival crevice remain the major advantages of the technique. Research has shown that the etched cast restoration, when designed with a retentive framework, exhibits bond strengths comparable with those of traditional complete coverage restorations. The main purpose for this retentive framework is to limit the stresses placed on the resin, thus preventing the phenomenon of stress fatigue in the resin. Clinical observations and an 11-year clinical study involving 127 restorations confirm this research. The long-term success rate in this study was 92.9%.

Tunnel restorations have been advocated as a conservative treatment modality for early carious lesions. However, the question arises as to quantity of dentin that remains within the marginal ridge above the tunnel path. In this experiment, extracted maxillary premolars with early carious lesions were sectioned and photographed. Measurements taken from tracings of the projected slides revealed that no dentin remained within the marginal ridge, irrespective of the direction of the tunnel path. These measurements indicate that the tunnel restoration is not a satisfactory treatment for proximal caries. The position of caries percludes the cutting of a tunnel preparation that leaves sufficient dentin under the marginal ridge, unless the bulk of enamel caries is left untouched.

Glass-ionomer-resin cements carry the advantages of both traditional glass-ionomer cements (such as esthetics and fluoride ion leaching) and light-curing resins (such as adhesive bonding to tooth structure and rapid material hardening by visible light exposure). In addition, their physical properties are improved over those of self-hardening glass-ionomer cements. The glass-ionomer-resin cements can be used to restore primary teeth quickly and successfully. The technique for simultaneously restoring adjacent Class II lesions in primary teeth is presented.

Cutaneous sinus tract of dental origin is the most common among the many types of sinus tracts that are formed on the face and neck. Because these lesions are often diagnosed incorrectly, they are also treated ineffectively. Cases of cutaneous sinus tract on the chin and cheek are presented, and a simple way to diagnose this lesion is described. In both patients, the lesion was completely resolved following nonsurgical endodontic therapy

The aim of this study was to examine the clinical performance of the Gluma enamel dentinal bonding system and Pekalux microfilled composite resin. Sixty esthetic restorations wre placed by three different operators. After 5 years of clinical performance, 40 restorations were evaluated. Alpha scores were given to 25 restorations for marginal integrity, 21 for color stability, and 27 for anatomic form. Bravo scores wre given to 11 restorations for marginal integrity, 13 for color stability, and 10 for anatomic form. Six restorations had to be replaced. The results of this study reveal the importance of the periodoic maintenance of restorations; every patient was reexamined, underwent conservative restoration polishing, and attended an oral ghygiene session every 6 months.

Palatal perforation with granulomatous pansinusitis caused by deep mycotic infection is a rare complication of acquired immunodeficiency syndrome. Two cases of palatal uleration with osseous destruction, one caused by Histoplasma capsulatum the other by Cryptococcus neoformans, are discussed. Treatment with a palatal obturator restored function and speech in both patients during the remainder of their lives.

Twelve patients with heart transplants and who needed dental operations were studied. At the same time, a group of normal subjects was enrolled as control. Blood perssure and heart rate were recorded in all subjects when they sat in the chair, after 5 minutes of relaxation, 5 minutes after administration of local anesthetic, and immediately after each dental extraction or curettage. No statistically significant difference was found between the values recorded during the different situations and the basal values in transplanted patients. Conversely, in the normal subjects, the values recorded when they sat in the chair, at the end of curettage, and at the end of dental extractions were significantly different from the basal values. The slight and dulled cardiovascular reaction to stress in patients with heart transplants suggests that the management of these patients is relatively uncomplicated and certainly easier than treatment of subjects with heart disease.

Preprosthetic surgery is often indicated to obtain a firm, resilient covering that is uninterrupted by frena, scars, or redundant tissue. However, surgical intervention is contraindicated for some patients, especially the medically compromised. This paper presents a viable alternative to surgical intervention of atypical tissue attachments-the use of beading on the master cast. This procedure requires minimal time and is easily accomplished.