A clinical comparison of glass ionomer, resin-modified glass ionomer and resin composite restorations in the treatment of cervical caries in xerostomic head and neck radiation patients.

Controversy exists as to whether there is less secondary caries at the margins of glass ionomer restorations compared with other materials that do not release fluoride. This study examined the incidence of secondary caries for three types of restorative materials in Class V restorations in xerostomic patients. The study group consisted of 45 high caries-risk adult patients who had undergone head and neck irradiation for the treatment of cancer. All were substantially xerostomic and in need of at least three restorations in the same arch. Every patient received a restoration with each of the test materials, a conventional glass ionomer (GI), a resin modified glass ionomer (RMGI) and a resin composite (C). Patients were instructed in the daily use of a neutral pH sodium fluoride gel in custom trays. Recall appointments were made at 6, 12, 18 and 24 months, and the restorations were examined for material loss, marginal integrity and recurrent caries at the restoration margin. Fluoride compliance was determined at each recall period and recorded as the percentage of recommended use during that interval. Patients were categorized at the end of the study as fluoride non-users if their average compliance was 50% or less. Those with greater than 50% compliance were categorized as fluoride users. In the latter group, no recurrent caries was found for any of the restorations, whereas a material-dependent incidence of recurrent caries was found in the fluoride non-user group. None of the GI, one RMGI and eight C restorations failed due to recurrent caries. For the fluoride non-user patients, Fishers exact test (p=0.05) showed no statistical difference between GI and RMGI but statistical differences were found among those materials and resin composite at each recall period. Recurrent caries reductions for GI and RMGI relative to C were greater than 80% in xerostomic patients not using topical fluoride supplementation.

Extranodal non-Hodgkin's lymphoma of the maxillofacial region: analysis of 88 consecutive cases.

Examination of the records of 88 consecutive patients with extranodal maxillofacial non-Hodgkin's lymphoma (ENHL) was undertaken. Each patient's complete record was reviewed. Males outnumbered females by 1.7:1. Age at diagnosis ranged from 22 to 94 years (median 60.0). Affected anatomic sites included: maxillary sinus (22), nasal cavity (8), maxilla (13), mandible (8), salivary glands (14), and other (23). The most common presenting symptom was a non-painful mass. Associated dental symptoms were present in 72 patients and included intraoral swelling, pain, and loose teeth. Treatment included chemotherapy and radiation with a follow-up of 1-25 years. Treatment trends indicate a shift towards multimodal therapy. Non-Hodgkin's lymphoma of the head and neck, if discovered early, has an excellent prognosis.

The effects of antitumor irradiation on mandibular opening and mobility: a prospective study of 58 patients.

OBJECTIVE: The purpose of this study was to analyze the effects of head and neck radiation therapy on jaw opening and mobility. STUDY DESIGN: Maximum jaw opening and mandibular mobility were measured before and after radiation treatment in 58 patients presenting for angle down wedge, homolateral wedge pair, and parallel pair head and neck radiation treatment. RESULTS: As dose to the temporomandibular joint and pterygoid muscles increased, maximal jaw opening decreased linearly. Mandibular dysfunction appeared to increase as radiation dose to the pterygoid muscles increased. Similar effects were not observed with temporomandibular joint irradiation. Irradiation of the pterygoid muscles appeared critical in the development of trismus. Angle down wedge treatment irradiated the temporomandibular joint and pterygoid muscles with clinical effects similar to those seen in homolateral wedge pair and parallel pair patients. Doses as low as 1493 cGy resulted in functional impairment. CONCLUSIONS: Future investigations into radiotherapy delivery and appropriate postradiation trismus treatment may reduce head and neck radiation morbidity.

Hinged mandibular removable complete denture for post-mandibulectomy patients.

The presence of excessive lingual undercuts after mandibulectomy and surgical reconstruction is a rare clinical condition and presents unique prosthodontic challenges. The goals of prosthodontic treatment include: providing lip support, improving articulation, reducing drooling, and regaining favorable esthetics. This article describes the fabrication of a hinged removable mandibular complete denture prosthesis using a sectional impression tray technique and a custom-made hinge mechanism. Clinical and laboratory procedures of the prosthetic treatment are described, and the advantages and disadvantages are reviewed.

Optimum dental radiography in bone marrow transplant patients.

OBJECTIVE: The purpose of this study was to establish an optimum radiographic examination regimen for patients undergoing bone marrow transplantation. Two radiographic examinations were compared: the panoramic radiograph and the full mouth series of radiographs. STUDY DESIGN: A prospective analysis of 65 consecutive patients undergoing bone marrow transplantation was undertaken. All patients were examined through use of both panoramic and full mouth series intraoral radiographs, including bitewings. Significant findings were recorded and compared by means of paired t test analysis for parametric data, such as caries, periapical inflammation and subgingival calculus, and by means of McNemar's test for nonparametric data, such as the presence or absence of severe periodontal disease. RESULTS: Acquired findings, such as caries, periodontal disease, and clinically significant faulty restorations, were detected more frequently from the full mouth series (P < .05). There was no significant difference in the detection of periapical pathosis. In 8 of 65 patients, clinically significant information, such as evidence of impacted wisdom teeth, neoplasms, and multiple myeloma, was better detected from the panoramic radiographs. CONCLUSIONS: The results suggest a combination of both modalities as the optimum means of radiologic survey in this "high-risk" patient population.

1997 Judson C. Hickey Scientific Writing Awards. Lip prosthesis retained with resin-bonded retentive elements as an option for the restoration of labial defects: a clinical report.

Surgical resection of the lips is a relatively uncommon procedure, and it usually presents surgical and prosthodontic rehabilitation challenges. The goals of prosthetic treatment include regaining favorable speech and restoration of esthetics. This clinical report described a method for fabricating a lip prosthesis that uses resin-bonded retentive elements bonded to the patient's teeth for retention. Clinical and laboratory procedures of the prosthetic treatment were described, and the advantages and disadvantages were reviewed.

Intraoral pyogenic granuloma after allogeneic bone marrow transplant. Report of three cases.

Allogeneic bone marrow transplant patients commonly have oral complications related to their disease or its treatment. Those reported include: xerostomia, mucositis, caries, infection, gingival hyperplasia, periodontitis, and graft-versus-host disease. These complications may be responsible for significant morbidity. This article reviews commonly reported oral complications of bone marrow transplantation and presents three cases in which intraoral pyogenic granuloma occurred. The cause of these lesions in post-bone marrow transplant patients is discussed.

Reduction in the incidence of postradiation dental complications in cancer patients by continuous quality improvement techniques.

The major dental consequences of radiation treatment to the head and neck are reviewed, and the role of the dentist in the management of these patients outlined. By using a concurrent patient data base and integrating quality assurance (clinical indicators) and quality improvement, a clinical department demonstrates how the risk of dental morbidity can be identified and reduced.

The utilization of a multi-layer prosthesis to treat recurrent antral carcinoma: a case report and review of the literature.

This paper reviews the use of an intracavitary mold in the radiotherapeutic management of recurrent sub-orbital carcinoma of the maxillary sinus. An overview of the clinical features of antral carcinomas and the concept of brachytherapy in the management of these lesions is presented. Brachytherapy is usually reserved for relatively accessible lesions. Post-surgical and radiation-induced trismus can be a complicating factor, as in the case presented, where the inter-incisal distance was less than three millimeters. To circumvent the problem, a multi-layer antral plug was utilized as a carrier for the radioactive sources, and its construction is described.

A clinical comparison of glass ionomer (polyalkenoate) and silver amalgam restorations in the treatment of Class 5 caries in xerostomic head and neck cancer patients.

Fifty-four pairs of restorations (one glass ionomer and the other amalgam) were placed in the mouths of 36 xerostomic head and neck cancer patients. Patients were either fluoride users or fluoride nonusers. In patients who used a daily application of a mildly acidic (pH 5.8) sodium fluoride gel, glass-ionomer cements failed and amalgam restorations did not (P < 0.0001). In patients who neglected to use their topical fluoride as directed, glass-ionomer cement restorations did not fail, but amalgam restorations did (P < 0.001). The mean time to restoration loss for both restorative materials was 8.5 months. In severely xerostomic patients these findings were exaggerated.

B-cell lymphoma presenting as a midfacial necrotizing lesion.

A case of midfacial necrotizing lesion (midline nonhealing granuloma) is reported. Paraffin- and frozen-section immunocytochemistry suggested a tumor of B-cell lineage and was confirmed by Southern blot analysis that disclosed an immunoglobulin heavy chain gene rearrangement with no evidence of T-cell receptor genetic aberration. The tumor was of B-cell lineage despite the tumor site and the angiocentric pattern, which are typically seen with peripheral T cell lymphoma with this presentation.

Postradiation dental extractions without hyperbaric oxygen.

This study examined the incidence of osteoradionecrosis after tooth extraction with low-epinephrine or epinephrine-free, nonlidocaine local anesthetics and conservative surgical techniques. Estimates of the absorbed radiation dose on irradiated alveolar bone were made by reviewing radiotherapy records. This investigation included 72 patients ranging in age from 22 to 80 years (median 57.4 years). We removed 449 teeth. Analysis of radiotherapy check films revealed that only 196 teeth (44%) were included within the treatment volume. The median prescribed tumor dose was 50 Gy (range 25 to 84 Gy) in 20 fractions (range 10 to 37), with a median dose per fraction of 2.5 Gy (range 1.88 to 3.14 Gy). Follow-up time ranged from 68 days to 19.3 years (median 4.8 years). No instances of osteoradionecrosis occurred as a result of dental extraction with this conservative method.

Primary, multi-focal, non-Hodgkin's lymphoma of the jaws presenting as periodontal disease in a renal transplant patient.

An unusual presentation of non-Hodgkins lymphoma is presented in an immunocompromised patient. The importance of having a high index of suspicion for malignancy in transplant patients is stressed.