Previously unappreciated carotid artery stenosis diagnosed by cone beam computerized tomography.

Stroke is the third leading cause of death in the western world. Calcification noted on cone beam computerized tomography, frequently used to evaluate the maxillofacial structures for extent of tumor, trauma, and implant placement, may indicate atherosclerotic disease in the carotid artery. Internal carotid artery stenosis is a recognized risk factor for stroke; multiple, large randomized controlled trials have demonstrated a decreased risk of stroke after repair of the stenotic artery. Recognition of calcified carotid artery plaque, on cone beam computerized tomography during the course of surgical care may offer the opportunity for stroke risk reduction.

The prevalence and significance of anatomic variance in the mandibular symphysis: a retrospective study.

As computerized tomography (CT) becomes more widespread in implant treatment planning, dentists are bound to encounter more uncharacteristic anatomical conditions in the jaws. This retrospective study examined the prevalence of one such anatomic variance on 78 CT scans of human mandibles. Irregular heterogeneous circular radiopacities with internal radiolucencies were present in a majority (97.4%) of the CT scans examined; however, the phenomenon only appeared pronounced in 28.9% of this group. Bone radiodensity was higher in the regions with the phenomenon as compared with adjacent bone without the phenomenon, which suggested no adverse indications for implant placement.

CT-based dental imaging for implant planning and surgical guidance.

CT-based dental imaging for implant planning and surgical guidance carries both clinical and radiographic information for implant positioning as far as trajectory, depth and distribution. The significance of accurate planning and surgical guidance as it pertains to critical anatomical landmarks, such as the mandibular canal, maxillary sinus and adjacent teeth, cannot be overstated. This case report describes a systematic approach to the planning and surgical placement of a single, implant-supported crown, using CT-based dental imaging for implant planning and surgical guidance. The simple steps result in the accurate transfer of critical radiographic information to the surgical site.

Maxillary and mandibular overlay removable partial dentures for restoration of worn teeth. A three-year follow-up.

This clinical report describes the fabrication and a three-year follow-up of maxillary and mandibular cast overlay removable partial dentures for the restoration of severely worn dentition with accompanying loss of vertical dimension of occlusion. The frameworks supported porcelain veneers for esthetics, and metal occlusal surfaces for strength and durability.

Cone beam computerized tomography-based dental imaging for implant planning and surgical guidance, Part 1: Single implant in the mandibular molar region.

Computerized tomography (CT)-based dental imaging for implant planning and surgical guidance carries both restorative information for implant positioning, as far as trajectory and distribution, and radiographic information, as far as depth and proximity to critical anatomic landmarks such as the mandibular canal, maxillary sinus, and adjacent teeth. This case report describes a systematic approach to the planning and surgical placement of a single implant-supported crown, utilizing CT-based dental imaging for implant planning and surgical guidance. The simple steps result in the accurate transfer of critical radiographic information to the surgical site.

Computerized tomography-based imaging and surgical guidance in oral implantology.

Computerized tomography (CT)-based imaging and surgical guidance carry both radiographic information such as height, density, and width of bone and clinical information such as axis of orientation for a successful prosthodontic result, thus determining the trajectory, depth, and distribution of the implants. The objective of this report is to review the associated literature and recent developments in CT-image-based information and surgical guidance systems. This report attempts to provide an argument for the development of evidence-based research on the utility of such systems and their effect on outcome in oral implantology.

Use of interdisciplinary team approach in establishing esthetic restorative dentistry.

Managing crown lengthening in cases of attrition (wear or loss of tooth substance) and achieving desired esthetic outcomes, especially in the esthetic zone, is challenging. This case report presents an interdisciplinary approach to case management. Concomitant use of digital imaging, along with model wax-ups and surgical guide, were used to enhance patient acceptance during treatment planning and to facilitate communication and treatment implementation among dental professionals and laboratory technicians. Resulting surgical template was used for crown lengthening to apically position the gingival zenith (margin) to a predetermined level, crown preps and final restorations, respectively, ultimately improving esthetics and patient satisfaction. Supplementing esthetic treatment planning with digital imaging, model wax-ups and a surgical template allows a dentist to carry information into the mouth and incorporate it into the surgical procedure, crown preps, temps and, ultimately, the final restoration.

Supplementary role of panoramic radiographs in the medical surveillance of a patient at risk for stroke.

Panoramic radiography is commonly used by dentists as a diagnostic tool. The known prevalence range of positive incidental carotid artery calcifications in the general dental population is 2% to 5%, with a population older than 55 representing the higher end of the range. Dentists are expected to identify medical conditions while providing dental care and to refer patients for follow-up medical care. In this case report, incidental carotid artery calcifications were identified on routine panoramic radiographs obtained for oral health reasons. A 69-year-old white man who was under surveillance for carotid stenosis and risk for stroke had a routine panoramic radiograph made for oral health reasons. Positive carotid calcification findings on a panoramic radiograph were found to be in accord with a subsequent duplex ultrasound examination.

Drug industry in "depression".

The productivity crisis in pharmaceuticals is an important problem that should be seriously addressed by academic scientists and NIH administrators. It is true that most academic scientists avidly practice the reductionist approach and tend to neglect the big picture. However, in light of the crisis, that should change. To stimulate such a change, scientists should see publications addressing big picture issues, and specifically publications which present analyses of the productivity crisis in pharmaceuticals. Although the public media recently published a series of articles reporting the crisis, so far, the peer-reviewed professionaljournals tended to avoid the issue. There seems to be a consensus that there is no successful drug discovery without reasonable biology. The Drug industry in "Depression" paper provides an opportunity to balance the picture and entice discussions on the relationships between academic research practices, NIH policies, and success in drug discovery. Academia and the drug industry must adopt a unified biomedical research approach rather than a multitude of what appears to be unrelated reduction methodologies, especially the basic science/biology end of it.

Diagnosis of non-dental conditions. Carotid artery calcifications on panoramic radiographs identify patients at risk for stroke.

BACKGROUND: The oral and maxillofacial manifestations of some occult systemic disorders may be identified during the provision of dental care. Medical conditions so identified should be referred to a physician for confirmation by appropriate test and indicated therapy. Atherosclerosis at the bifurcation of the carotid artery is a common cause of stroke, and, when such lesions are calcified, they may easily be identified on a panoramic radiograph since the carotid bifurcation lies within the field of a properly performed X-ray. LITERATURE REVIEWED: To examine the degree to which this finding is recognized by the dental community, the authors conducted a PubMed review to find publications that detailed the identification of carotid artery calcifications on panoramic radiographs. RESULTS: Between 1981-2003, there were 39 peer-reviewed dental manuscripts and 29 pertinent abstracts reporting the observation of incidental carotid calcifications visible on routine panoramic radiographs. These studies documented a 3% to 5% prevalence of carotid artery calcifications in the general dental population, with higher percentages occurring in patients having medical illnesses associated with advanced atherosclerosis. PRACTICE IMPLICATIONS: The widespread recognition that calcifications seen in the region of the carotid bifurcation can identify a population at increased risk of stroke supports the practice of routinely examining this area during review of panoramic radiographs. Since a panoramic radiograph is often obtained for dental reasons, in many instances, further examination of the area of the carotid bifurcation is essentially cost-free, and can serve to prolong lives and bring significant savings in overall health care costs by assisting in the prevention of critical events such as strokes.

The effect of esthetic consultation methods on acceptance of diastema-closure treatment plan: a pilot study.

BACKGROUND: The authors conducted a study to determine which of four consultation methods helped patients best understand a proposed treatment plan for maxillary anterior diastema closure. METHODS: The authors presented 24 subjects with four types of consultation in random order: before-and-after photographs of other patients, diagnostic models with wax setups, resin-based composite/esthetic preview/mock-ups and computer-imaging simulations. After viewing each method, the authors asked the subjects about treatment acceptability. At the end of the demonstrations of all four methods, the authors asked the subjects which consultation method helped them best understand the proposed treatment plan. RESULTS: A total of 87.5 percent of the subjects indicated that they would accept the proposed treatment plan after they were shown the computer-imaging simulation, 50 percent said they would after they were shown the resin-based composite/esthetic preview/mock-up, 41.7 percent said they would after they were shown photographs of other patients, and 25 percent said they would after they were shown diagnostic models with wax setups. When asked which method helped them best understand the proposed treatment, 54.2 percent of the subjects selected computer-imaging simulation, 33.3 percent selected resin-based composite/esthetic preview/mock-ups, and 12.5 percent selected before-and-after photographs of other patients. None of the subjects selected diagnostic models with wax setups. A chi2 test for goodness of fit indicated that these differences were statistically significant. CONCLUSION: Subjects preferred computer-imaging simulation to the other three consultation methods, and they indicated that computer-imaging simulation provided a better understanding of the proposed treatment plan for diastema closure. CLINICAL IMPLICATIONS: The use of computer-imaging simulation enhances the patient's understanding of a proposed treatment plan concerning maxillary anterior diastema closure.

The supplementary role of panoramic radiographs in diagnosis and prevention of life-threatening systemic health condition. Case report.

A 71-year-old white male had a routine panoramic radiograph taken for oral health reasons. Positive carotid calcifications findings on the radiograph were in agreement with significant carotid stenosis as determined by duplex ultrasonic examination. If the occasion arises, the authors advocate that a routine panoramic radiograph examination include an assessment of the region of the carotid system for presence of carotid calcifications in all adult patients.

Maxillary and mandibular overlay removable partial dentures for the restoration of worn teeth.

This clinical report describes the fabrication of maxillary and mandibular cast overlay removable partial dentures for the restoration of severely worn teeth with accompanying loss of vertical dimension of occlusion. The frameworks supported porcelain veneers for esthetics and metal occlusal surfaces for strength and durability.

The role of panoramic radiographs in the medical surveillance of a patient at risk for stroke: case report.

Positive carotid calcifications on a panoramic radiograph were found to be in agreement with significant carotid stenosis as determined by duplex ultrasound examination. As dentists are expected to be aware of systemic health conditions that they identify while providing dental care and to refer patients for follow-up medical care, this case report may help dentists to detect incidental carotid artery calcifications on panoramic radiographs.

The reduction of broken appointment rates through an automated appointment confirmation system.

Broken appointments continue to be an important productivity, quality assurance, and access gauge for private dental practices and academic dental centers. In November 2001, the University of Rochester Eastman Dental Center, an urban academic dental center, installed an automated confirmation system to address a high incidence of broken appointments. Following the installation of the system, the Eastman Dental Center experienced a marked decrease in the broken appointment rate. Over a twelve-month period, the center's overall broken rate declined from 23.42 percent to 19.17 percent. The general dentistry rate declined from 23.67 percent to 19.77 percent, and the pediatric dentistry rate declined from 29.42 percent to 25.25 percent.

Oral health disparities between ranks in a military environment: Israel Defense Force as a model.

UNLABELLED: Some studies have demonstrated a relationship between occupational status and position in the workplace to use of dental services and oral health status. Ranks symbolize social status in the military hierarchy, which is different from that accepted in civilian workplace. OBJECTIVE: This study was aimed at analyzing differences between officers and noncommissioned personnel in regard to dental treatment needs and use of dental services. METHODS: One-thousand, one-hundred thirty-nine personnel of the Israel Defense Force were examined, using DMFT (decayed, missing, filled permanent teeth and CPITN (community periodontal index of treatment needs indices to define oral health status. A questionnaire was used to calculate utilization rates. RESULTS: Noncommissioned personnel had on average 50% more unmet caries treatment needs, and 19.1% of them suffered from deep periodontal pockets. No differences were demonstrated in utilization rates CONCLUSIONS: Military rank influences oral treatment needs the way civilian organizational structure does with the exception of utilization rates of dental services.