Quintessence International, 09/2003

Treatment concepts that are "ideal" from a medical perspective, representing an excellent simulation of missing tissues (alveolar ridge, teeth), are not automatically tantamount to high treatment cost and difficult clinical procedures. An analysis of different treatment concepts has shown that relatively simple implant-borne solutions are made possible by preserving and integrating elements of the residual dentition; by not including complicated and technically elaborate constructions (such as screw fixation, attachments, splints); and by using prefabricated components (abutments shaped extraorally; conical crowns). In this context, there cannot be a single clear-cut answer to the question, "Implant prosthodontics: What next?"; it can be answered only in terms of probabilities. There is one certainty: implant prosthodontics is here to stay, whatever its path and whatever its destination, and it will become established as an essential-a constituent part of current-day dental practice. As so often happens with medical progress, what once was a very specialized treatment modality is becoming a standard procedure. The concomitant cost reduction will allow us to apply treatment concepts that include implant procedures in a much larger number of cases than today.

Radiotherapy for the nasopharyngeal cancer patient with poor oral care may lead to severe deterioration of the dentition and may require multiple extractions. Although the use of an implant-retained overdenture can successfully restore the function and esthetics of edentulous patients, its use can be complicated by the tissue changes subsequent to head and neck irradiation. The difficulties in implant treatment planning for an edentulous patient with macroglossia and soft tissue changes following radiotherapy are discussed.

A case of crestal root perforation and periapical lesion in a maxillary left lateral incisor is reported. Teeth with root perforation present technical difficulties in their clinical management because of their complex defects. In the present case, surgical endodontic treatment was chosen. The apical and lateral pathology was curetted, the tooth root was resected, and a retrograde root restoration of amalgam was placed in a root-end cavity and perforation site. A 10-year follow-up clinical and radiographic examination showed an asymptomatic tooth with osseous healing proceeding.

Objectives: To develop prototype rotary selective dentin caries excavators and to demonstrate their ability to remove only carious dentin in extracted teeth. Method and materials: Milled polymer prototype and formed wire loop prototype burs were made. They were tested on normal dentin with standardized force application and compared to carbide burs for ability to cut by weighing three extracted teeth at pre- and postcutting for each prototype version. They were tested on carious dentin of three teeth for each prototype version. The resulting excavated surfaces were analyzed with dentin caries dye, the teeth were decalcified and examined histologically, and the used prototypes were examined in light and scanning electron microscopes. Results: For both prototypes, noncarious teeth did not lose weight from prototype instrumentation, but each lost 9 or 10 mg after instrumentation with the control carbide bur. Both prototypes quickly removed carious dentin in each of the carious teeth until a definitive cutting endpoint was reached. The excavated surfaces from the milled polymer prototypes did not stain with caries dye, but those from the wire loop prototypes stained lightly in some areas. In the light microscope, all sections of excavated carious teeth were bacteria-free. Light and scanning electron microscope images of the prototypes revealed scratch patterns on the wire loop prototypes and deformation of blades on the polymer prototypes. Conclusion: Both prototypes removed carious dentin but did not remove normal dentin in the extracted teeth used in this study. Further development is indicated.

Adenomatoid odontogenic tumor is an odontogenic tumor that appears in the anterior portion of the jaws and more frequently, in the anterior maxilla usually in association with the crowns of inclused teeth. A case report of adenomatoid odontogenic tumor with an associated impacted right maxillary first premolar is presented. Under general anesthesia the lesion and the impacted tooth were removed. There was no recurrence at the 1-year follow-up.

Rieger syndrome is a rare, autosomal dominant disorder due to developmental arrest of tissues derived from neural crest ectoderm in the third trimester. It is characterized by abnormalities of the anterior chamber of the eye coincident with dental and craniofacial anomalies. Early recognition of dental anomalies aids in detection of the syndrome and prevents progressive loss of vision. This case report discusses the ocular, dental, and craniofacial findings and the overall management of the patient.

Radiotherapy may be either an effective alternative to surgery or a valuable adjunct to surgery and/or chemotherapy in the locoregional treatment of malignant head and neck tumors. The care of patients with head and neck cancer undergoing radiotherapy or who have completed treatment is a multidisciplinary effort. Oral health care providers can expect to be called upon to care for patients with head and neck cancer undergoing radiotherapy. Early, active participation in developing preventive and therapeutic strategies, in implementing the plan, and in the education and rehabilitation of the patients is paramount in addressing quality of life issues. To provide timely and competent care, oral health care providers must understand the disease, its treatment, and the impact the disease and/or its treatment may have on these patients. Oral health care providers should develop and implement preventive and therapeutic strategies with the same ethical, moral, and professional standards of care as may be appropriate in the management of any other patient.