Replacement of Maxillary Permanent Central Incisors Lost Due to Trauma in the Mixed-Dentition.

Traumatic injuries to anterior teeth in children range from minor chipping to total tooth loss and occur more often in boys than in girls. The treatment of permanent tooth loss in younger patients is complicated by the difficulty of doing restorative procedures which may be influenced by pulpal size, clinical crown height, and a dental profile that is constantly changing. This case report presented a situation involving a 9-year-old boy who had experienced traumatic loss of the maxillary central incisors. Innovative materials coupled with sound principles of removable partial denture design were utilized to fabricate a cast metal removable denture prosthesis to satisfy the esthetic, functional and psychological dental needs of the patient and his parents.

Management of a Dental Implant with Internal Thread Damage. A Patient Treatment Report.

When a patient presents with an implant with the internal threads damaged (or cross-threaded), a definitive restorative challenge may be faced. By having a difference in hardness between an abutment screw and the implant to which it is to be attached, there is potential for internal thread damage to the implant if the opposing threads do not interface properly. As such, the operator must use care when positioning the abutment and engaging the threads to prevent possible misalignment and damage to the internal aspect of the implant body. This article describes such a situation and the action taken to overcome the problem.

Replacement of maxillary permanent central incisors lost due to trauma in the mixed-dentition.

Traumatic injuries to anterior teeth in children range from minor chipping to total tooth loss and occur more often in boys than in girls. The treatment of permanent tooth loss in younger patients is complicated by the difficulty of doing restorative procedures which may be influenced by pulpal size, clinical crown height, and a dental profile which is constantly changing. This case report presented a situation involving a 9-year-old boy who had experienced traumatic loss of the maxillary central incisors. Innovative materials coupled with sound principles of removable partial denture design were utilized to fabricate a cast metal removable denture prosthesis to satisfy the esthetic, functional and psychological dental needs of the patient and his parents.

Flexible removable partial dentures: a basic overview.

For many years, flexible resin materials have been available for fabricating removable partial denture (RPD) prostheses. Using a nonrigid material for the major connector or other components of an RPD may be a consideration for certain patients. Except for the promotional literature that has been written for flexible resin dentures, there is very little information available in the dental literature concerning nonrigid RPDs. As a result, the decision to use this treatment option depends on the judgment and experience of the dentist and fabricating laboratory. This article summarizes clinically pertinent information about flexible, nonrigid partial dentures.

Intraoral gothic arch tracing.

In order to create optimum esthetics, function and phonetics in complete denture fabrication, it is necessary to record accurate maxillo-mandibular determinants of occlusion. This requires clinical skill to establish an accurate, verifiable and reproducible vertical dimension of occlusion (VDO) and centric relation (CR). Correct vertical relation depends upon a consideration of several factors, including muscle tone, inter-dental arch space and parallelism of the ridges. Any errors made while taking maxillo-mandibular jaw relation records will result in dentures that are uncomfortable and, possibly, unwearable. The application of a tracing mechanism such as the Gothic arch tracer (a central bearing device) is a demonstrable method of determining centric relation. Intraoral Gothic arch tracers provide the advantage of capturing VDO and CR in an easy-to-use technique for practitioners. Intraoral tracing (Gothic arch tracing) is a preferred method of obtaining consistent positions of the mandible in motion (retrusive, protrusive and lateral) at a comfortable VDO.

Direct chairside hard reline at delivery of a newly fabricated distal extension removable partial denture: considerations and techniques.

The stability of a dental prosthesis is its resistance to displacement when it is subjected to functional, horizontal and rotational stresses. For a removable partial denture (RPD), stability depends greatly on overall quality of fit to the supporting teeth and tissues. There are numerous reasons why the fit of a newly fabricated RPD might be compromised, but it is easy for the dentist to determine visually whether vertical movement is excessive. If finger pressure applied to the distal-most tooth on a distal extension denture base results in lifting of the anterior-most indirect retainer, then the RPD is not stable and either an indirect (laboratory processed) or direct (chairside) hard reline should be carried out. In this paper, we discuss factors that might influence the need to do a direct, chairside hard reline at delivery of a newly fabricated distal extension RPD and we recommend techniques.

Vital tooth cleaning for cementation of indirect restorations: a review.

This article reviews factors that must be considered to select the best technique for cleaning a vital tooth prior to cementation of a definitive restoration. The dental literature offers many suggestions with supporting rationales. In cases where provisional cement has been present or contrast powder has been used, some mechanical cleaning (with fine pumice or prophy paste) appears to be justified. The value of soaps or other chemicals is questionable except perhaps as topical disinfectants. Dentists should be aware that a cleansing agent may have a negative or positive effect on bond strength, depending on the adhesive system chosen. It may be necessary to tailor the particular method of tooth cleaning to the cement that is to be used.

Unilateral semi-precision removable partial denture utilizing Bredent VKS-SG attachment system.

There are various options for removable partial dentures. A removable partial denture fills in the space created by missing teeth and restores the smile. The semi-precision attachment is a way to clasp a removable partial denture (RPD) to existing abutment teeth in order to provide greater stability and retention without having a visible clasp assembly. In this report, we show how the Bredent VKS-SG ball attachment provides balanced support to a Kennedy Class III edentulous area, maximizing esthetics, stability and retention with low maintenance and exceptional patient comfort.

A practical review of prevention and management of ingested/aspirated dental items.

Most dental procedures are accomplished while the patient is partially or totally supine; as a result, all restorative patients have the potential to ingest or aspirate a dental item. The principle of nonmaleficence dictates the use of preventive practices (rubber dam, ligatures, throat pack) when possible; even so, accidents happen and one has to assume the worst when a dental item disappears. Knowing what to do can be extremely important, both medically and legally. The first order of business is ensuring that the airway is not compromised and advising the patient of the problem. Immediate referral (with escort) to a medical facility for appropriate radiographs and determination of required medical action is mandatory, regardless of how well the patient looks. According to the literature, all aspirated foreign objects and approximately one-third of ingested items require the patient to be hospitalized. Proper documentation also is important to reduce liability in the event of litigation.

Do dental educators need to improve their approach to teaching rubber dam use?

Most dentists are educated in rubber dam use in dental school, but there is often disparity between what is taught for various restorative procedures and what is practiced in the private sector. It is a common, although undocumented, belief that few practicing dentists routinely use rubber dam isolation. This study repeated a survey conducted in 1985 evaluating U.S. general dentists' attitudes toward rubber dam usage to see if improvement is needed in current dental educators' approach to this topic. Four hundred dentists were selected randomly from ten major geographically diverse cities using the website YellowPages.com. Each was mailed a letter requesting survey participation, which included a pre-stamped, pre-addressed postcard with the survey printed on the back. The target population, general dentists, returned 164 surveys (41 percent). Their responses can be summarized as follows: 71 percent do amalgams-of those, 53 percent never use a rubber dam whereas 12 percent always use a rubber dam; 100 percent do anterior direct resin composites-of those, 45 percent never use a rubber dam whereas 17 percent always use a rubber dam; 98 percent do posterior direct resin composites-of those, 39 percent never use a rubber dam and 18 percent always use a rubber dam; and 78 percent do endodontic procedures-of those, 11 percent never use a rubber dam whereas 58 percent always use a rubber dam. Most (74 percent) felt that their dental school rubber dam training was adequate; 42 percent felt that its use has an effect on the quality of restorative dentistry. Their most common reasons for not using a dam were the following: inconvenience (40 percent); unnecessary (28 percent); other (12 percent); patient refusal (11 percent); and time (9 percent). No respondent indicated that "cost" was a reason for not using rubber dams. This study indicates that many general dentists in this country continue to ignore the rubber dam for many restorative and some endodontic procedures. It indicates that predoctoral dental educators need to look for opportunities for improvement to reduce the discrepancy between what is taught and the general practice of dentistry.

Impression materials: a comparative review of impression materials most commonly used in restorative dentistry.

Impression materials are used to record intraoral structures for the fabrication of definitive restorations. Accurate impressions are necessary for construction of any dental prosthesis. The relationship between static and mobile oral structures must be reproduced accurately for an optimum cast. The more common types of impressions are used for fabricating diagnostic and master casts. Accurate impressions depend on identifying the applications that do or do not fit each material's characteristics. Materials used without adequate knowledge of their characteristics can impair a successful outcome. Often, the choice of impression materials depends on the subjective choice of the operator based on personal preferences and past experience with particular materials.

A case of Rocky Mountain spotted fever.

Rocky Mountain spotted fever is a serious, generalized infection that is spread to humans through the bite of infected ticks. It can be lethal but it is curable. The disease gets its name from the Rocky Mountain region where it was first identified in 1896. The fever is caused by the bacterium Rickettsia rickettsii and is maintained in nature in a complex life cycle involving ticks and mammals. Humans are considered to be accidental hosts and are not involved in the natural transmission cycle of this pathogen. The author examined a 47-year-old woman during a periodic recall appointment. The patient had no dental problems other than the need for routine prophylaxis but mentioned a recent problem with swelling of her extremities with an accompanying rash and general malaise and soreness in her neck region. Tests were conducted and a diagnosis of Rocky Mountain spotted fever was made.