The evolution of a teledentistry system within the Department of Defense.

Total Dental Access (TDA) is the teledentistry project within the Department of Defense. This project enables referring dentists from the US Armed Forces to consult with specialists on the status of a patient. TDA focuses on three areas of dentistry: patient care, continuing education and dentist-laboratory communications. One of the goals of this project is to increase patient access to quality dental care. The other goal is to establish a cost effective telemedicine system. This paper describes the evolution of a teledentistry system, the main features of POTS-based, ISDN-based and Web-based systems used, advantages, disadvantages and cost-effectiveness of these systems. Data has been collected on the frequency of use, technical problems occurred, avoided patient or specialist travel and the total number of consults. A cost-effectiveness analysis has been conducted on the data collected. The results of this analysis will be presented.

Accuracy of orthognathic evaluation using telemedicine technology.

OBJECTIVE: Telemedicine technology has the ability to project highly specialized medical and dental expertise anywhere in the world. This is particularly important to many small, isolated communities that do not have access to medical and dental specialists. Telemedicine also has the potential to reduce unnecessary travel, time away from work, and unneeded hospital admissions. For this technology to be successful, however, clinicians need to have confidence in its capabilities. This study was conducted to determine the accuracy of an orthognathic evaluation using telemedicine. MATERIALS AND METHODS: Thirteen patients were randomly selected for review by two surgeons each using telemedicine and clinical examinations. Clinically acceptable differences were established, and the results of the two examination methods were compared. RESULTS: A main effect of the examination method was observed in 7 of the 18 continuous measurements taken. Examination of the absolute value of the within-subject difference between the two examination methods demonstrated that the mean absolute difference was statistically different from zero for 13 of 18 measurements taken. CONCLUSIONS: These data demonstrate that a relatively accurate orthognathic examination can be performed with this technology. With this in mind, clinicians may feel comfortable using this technology for other clinical applications.

Estrogenic hormones and dental implant therapy: the effects of estrogen and progesterone levels on osseointegration of dental implants.

Successful rehabilitation of female service members suffering traumatic injuries to the maxillofacial region is both a physiological and a psychological issue. A clinical evaluation to determine if an association exists between sex hormone levels and dental implant success was undertaken. Endosseous dental implants were placed in three patient groups: (1) male controls, (2) females with high estrogen, and (3) females with low estrogen. Female groupings were based on ovulation cycles. Serum estrogen (ng/dl), serum progesterone [ng/dl], and serum interleukin-6 (pg/ml) were determined at time of implant placement. Pre- and postsurgical photographs and vinyl-polysiloxane impressions were taken to evaluate crestal alveolar bone loss. Upon data analysis, the authors concluded that the balance of alveolar osseous wound healing was not influenced by temporal fluctuations in the ovulatory cycle.

Pyogenic granuloma associated with guided tissue regeneration: a case report.

A pyogenic granuloma is an exuberant growth of granulation tissue secondary to irritation. Intraorally, it can present with a wide array of clinical appearances, ranging from a sessile lesion to an elevated mass. Pyogenic granulomas generally are soft, painless, and deep red to reddish-purple in color. They are usually 0.5 to 1.0 cm in diameter, more common in females, and often found on the keratinized tissue. This case is interesting because the pyogenic granuloma was found associated with guided tissue regeneration and the lingual alveolar mucosa. The lesion arose after demineralized freeze dried bone allograft and an expanded polytetrafluoroethylene (ePTFE) membrane were utilized to repair osseous defects. Five weeks after surgery, the patient presented for routine follow-up where suppuration associated with the membrane was noted along with an exophytic growth of the lingual alveolar mucosa. The ePTFE membrane was removed alone with an excisional biopsy of one of the growths. By 10 days after the removal of ePTFE, the lesion spontaneously healed. Histologic evaluation of the tissue was consistent with a pyogenic granuloma. This is the first case in the literature of a pyogenic granuloma associated with a routine guided tissue regenerative surgery using a non-resorbable membrane and allograft.

Dental considerations for a Glanzmann's thrombasthenia patient: case report.

Glanzmann's thrombasthenia is a qualitative platelet disorder characterized by a deficiency in the platelet membrane glycoproteins (GP) IIb-IIIa. It belongs to a group of hereditary platelet disorders typified by normal platelet numbers and a prolonged bleeding time. The bleeding seen in Glanzmann's thrombasthenia usually includes bruising, epistaxis, gingival hemorrhage, and menorrhagia. Spontaneous, unprovoked bleeding is unusual. The severity of bleeding is unpredictable in thrombasthenia and does not correlate with the severity of the platelet GP IIb-IIIa abnormality. The present case report describes the dental treatment of a patient with Glanzmann's thrombasthenia. A 39-year-old female with a history of Glanzmann's thrombasthenia presented for periodontal therapy for spontaneous gingival hemorrhage. The patient had been sporadically seen in the past and had a record of only returning for appointments on an "emergency" basis. The periodontal findings revealed a diagnosis of moderate to advanced adult periodontitis in all quadrants. After all dental options had been discussed, the treatment of choice was determined to be extraction of the remaining dentition and fabrication of immediate dentures. The patient received a loading dose of 5 grams of aminocaproic acid (EACA) intravenously 3 hours prior to the surgery. At the beginning of the extractions 1 gram of EACA per hour continuous infusion and a 6 pack of platelets was administered. The patient tolerated the extractions well. All sites healed normally. The patient has had no difficulty in adjusting to the dentures. The case report discusses a possible treatment option in a noncompliant patient having Glanzmann's thrombasthenia and briefly discusses other hereditary bleeding disorders with similar presentations.

The effects of intracanal medicaments, fillers, and sealers on the attachment of human gingival fibroblasts to an exposed dentin surface free of a smear layer.

To date there has been very little research into the possible effects of endodontic therapy on regeneration of the lost periodontal attachment. The objective of this study was to examine the effects of endodontic medicaments on fibroblast attachment to dentin surfaces free of a smear layer. Pulp chambers of extracted third molars were filled with one of the following medicaments: gutta-percha with Roth's zinc oxide and eugenol-based sealer, warm gutta-percha with sealer, warm gutta-percha without sealer, calcium hydroxide, formocresol, cotton pellet, or left empty. A predetermined dentin surface area was then inoculated with human gingival fibroblasts at a concentration of 2 x 10(4) cells per ml. The cells were allowed to adhere to the dentin surface for either 4 or 24 hours, then cell attachment was quantified using a methyl-tetrazolium assay. The data were analyzed using a Kruskal-Wallis one-way analysis of variance and Dunn's multiple comparison test. It was determined that fibroblast attachment was significantly reduced when exposed to formocresol or warm gutta-percha without sealer at both the 4 and 24 hour interval (P < or = 0.05). This suggests that the use of formocresol or warm gutta-percha without sealer in a root canal may impede periodontal wound healing and regeneration.

Toxic effect of ethylene-oxide-sterilized freeze-dried bone allograft on human gingival fibroblasts.

Freeze-dried bone allograft (FDBA) which either had or had not been sterilized by exposure to ethylene oxide (EtO) prior to lyophilization was obtained from two commercial sources. EtO-sterilized FDBA was reexposed to EtO as a positive control. Gas chromatograph assays revealed that three out of four commercially obtained EtO sterilized FDBA had no detectable EtO, with one sample having 0.21 parts per million (PPM). Surprisingly, 0.24 PPM was detected in one sample which had not been sterilized with EtO gas. This was presumed due to contamination from a gas-sterilized rubber stopper. In the cell toxicity study, FDBA and human gingival fibroblasts (HGF) were added simultaneously, incubated for 72 h, and fixed and stained. Samples of FDBA sterilized with EtO which were free of EtO did not alter HGF growth. However, the positive control FDBA which contained 0.72 PPM EtO had a deleterious effect on HGF. FDBA with EtO residuals caused morphologic change in HGF.