Anterior Segmental Osteotomy to Save Implants for Prosthetic Restoration: A Multidisciplinary Case Report.

Titanium root form dental implants are among the major advances modern dentistry can offer patients. Occasionally, in spite of all precautions and best operator intentions, implants are inadvertently placed in positions that do not permit their use for high-quality esthetic dental restorations. Salvaging these implants to permit their use is a challenge for practitioners. Such a situation came to our attention in 2012 after two anterior implants placed in 2009 were found to be in unusable positions. A plan to remove the implants, regraft the area and-after a considerable waiting period-replace the implants in a more "proper" position was considered. Instead, by combining oral/maxillofacial surgical techniques developed for reconstruction of severe dentofacial deformities with newer clinical and laboratory techniques for crown fabrication, the problem was corrected for the patient with a minimum of lost time. And an esthetically pleasing result that more than satisfied our patient was achieved.

Treatment of a recurrent ameloblastic fibroma.

Ameloblastic fibroma (AF), a slow-growing, benign tumor of odontogenic origin, represents 2% of all odontogenic tumors. Jaw expansion is among the most common symptoms, with diagnosis often made through routine radiographs. AFs have a recurrence rate of 18% to 43.5% after conservative enucleation. Long-term follow-up by both the surgeon and referring dentist is recommended, since recurrence may be due to regrowth of residual tumor undergoing malignant transformation. Aggressive management is recommended for local tumor recurrence. En bloc excision with bone grafting, followed by implant reconstruction, can be curative and preservative of function. Treatment of a recurrent AF is described.

Residents' perception of the impact of the Bell Commission in oral surgery training: an initial study.

PURPOSE: In 1989, the New York State Legislature enacted New York State Code 405 (Bell Commission) in response to the death of Libby Zion at Lincoln Medical and Mental Health Center (Bronx, NY). The resultant limitations imposed on resident work hours have been the focus of much debate in medical literature, but their impact on the training of oral and maxillofacial surgery (OMFS) residents has remained relatively unexplored. The purpose of this study was to evaluate the opinion of OMFS residents toward the benefits of work hour restrictions. We asked residents how work hour restrictions affected their ability to provide care safely and efficiently and the quality of their surgical training. We also aimed to estimate the amount of their scheduled off-time that residents used for sleep. MATERIALS AND METHODS: A 12-item questionnaire was forwarded to all available residents and interns in the 17 OMFS training programs in New York State. A total of 36 surveys were returned. RESULTS: The majority of respondents felt that their program adhered fairly well to the guidelines of the Bell Commission and that it had a positive effect on the quality and efficiency in which they provided patient care. Most also felt that the Bell Commission guidelines had a positive effect on the quality of their residency. However, senior residents felt that the Bell Commission did not have as positive of an impact on their ability to provide care safely or efficiently as junior residents. Similarly, senior residents felt that the quality of their residency had not been as greatly improved by the Bell Commission as did junior residents, and used a lower percentage of their time off duty on actual sleep. CONCLUSION: This preliminary study indicates that most OMFS residents perceive that the Bell Commission guidelines have a positive impact on their residency training and on patient care. We recommend further studies to evaluate the effects of the Bell Commission on OMFS training. Additionally, the perception of OMFS faculty can be appraised in future studies. However, the limitations of this study include recall bias of the surveyed residents and responder bias (including fear of reprisal in reporting details that might otherwise be considered by training programs to be confidential).

Modern concepts in understanding and management of the "dry socket" syndrome: comprehensive review of the literature.

OBJECTIVES: This paper provides a comprehensive review of the etiology, pathophysiology and current treatment of dry socket. STUDY DESIGN: The Medline database (Ovid version) from 1966 to 2007 was searched for the term "dry socket" published in the English language, and 317 results were obtained. The articles were screened by abstract for relevance to etiology, pathophysiology, or treatment of dry socket. Treatment papers were ranked on the quality of evidence presented as assessed using the evidence-based systematic review worksheet of the University of Alberta. A total of 62 publications were included in the final review. RESULTS: Prevention methods remain the key to avoiding this complication. Prophylactic placement of topical antibiotics can be considered, whereas systemic antibiotics should be reserved for patients who are immunocompromised. CONCLUSION: This paper provided a comprehensive review of the etiology, pathophysiology, and current treatment of dry socket in dental practice.