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Background: The analgesia after lower third molar alveolectomy is based on the use of non-steroidal anti-inflammatory drugs (NSAIDs) that have significant risks, and are contraindicated in the third trimester of pregnancy. Aiming to reduce NSAIDs use after this surgery, we quantified analgesic effects of ultrasound (US)-guided extraoral mandibular nerve block. Methods: Thirty-six patients were equally allocated to the experimental or control group, based on their willingness to receive experimental US-guided extraoral mandibular nerve block for postoperative analgesia. The experimental block applied prior to lower third molar alveolectomy, was followed by standard intraoral inferior alveolar nerve block. In the control group, patients received only intraoral block of inferior alveolar nerve. All patients reported pain level (visual analogue scale, VAS) right after the application of blocks. The next day, patients reported duration of pain-free time and the use of analgesic. Results: The US-guided extraoral mandibular nerve block prolonged the pain-free time to 8 h (vs. 4 in control group, P < 0.001) and reduced NSAIDs use (12 patients needed analgesic in experimental vs. 17 patients in control group, P = 0.038). The application of experimental block was less painful (VAS = 2) than the application of intraoral inferior alveolar nerve block (VAS = 4, P = 0.011). In 8/18 patients in the experimental group US-guided extraoral mandibular nerve block solely achieved adequate surgical anesthesia. Conclusion: US-guided extraoral mandibular nerve block prolonged pain-free period and reduced the use of NSAIDs after lower third molar alveolectomy, thus proving to be successful analgesia method for this dental surgery. Clinical trial registration: https://classic.clinicaltrials.gov/ct2/show/NCT06009302, identification number: NCT06009302, date of registration: 18/08/2023. [ABSTRACT FROM AUTHOR]

Endotracheal tube (ETT) cuff leaks can be encountered in the operating room with variable consequences ranging from a mere annoying bubbling sound to life-threatening respiratory compromise requiring immediate intervention. This scenario becomes more challenging if there is a difficult airway with limited mouth opening and oromaxillofacial surgery where nasal intubation is required with a north pole tube. ETT replacement can expose the patient to airway loss or life-threatening hypoxemia during the ETT exchange. There are no recommended guidelines on how to deal with an ETT cuff leak and no published step-by-step safe management strategy. With the lack of defined protocols and guidelines to manage intraoperative cuff leaks, the presence of mind and ability to make critical decisions by the anesthesiologist cannot be overemphasized. We present a case report of a 40-year-old patient weighing 70 kg diagnosed with carcinoma retromolar trigone posted for wide local excision and posterior segmental mandibulectomy. On airway examination, he had a limited mouth opening of <1 cm, with both nostrils of equal and adequate size. As mask ventilation was not difficult after induction of general anesthesia, we did fiberoptic-guided right nasal intubation with North Pole tube. We were unable to inflate the cuff of ETT and there was a significant leak. Here, we discuss how we exchanged the ETT in this difficult airway scenario. [ABSTRACT FROM AUTHOR]

An 8-year-old, 125 kg (275 lb) female miniature horse was evaluated for a persistently thickened left mandible and cutaneous fistula. Pulp horn defects were identified in pulp horns 1 and 3 of tooth 309 and occlusal pulp exposure was detected with a dental explorer. Radiography of the left mandibular dental quadrant revealed changes consistent with apical infection of tooth 309. Following the failure of oral extraction, a standing surgical approach was taken for transcutaneous lateral alveolar ostectomy and extraction. Roots were sectioned at the level of the furcation and elevated from the surgical site, and the remaining reserve crown was luxated and repulsed into the oral cavity. Healing of the surgical site and alveolus was uncomplicated. [ABSTRACT FROM AUTHOR]

Scientific literature describes autogenous bone as the gold standard among graft materials for alveolar reconstructive procedures. Alveolar ridge augmentation has been clinically achieved with different forms of autogenous bone, including autogenous cortical bone particulate (ACBP). However, few histologic studies demonstrating the biologic potential and healing dynamics following the use of ACBP are currently available. This case report presents 2 patients in whom atrophic edentulous alveolar crests were submitted to a vertical/lateral ridge augmentation prior to implant placement. The technique was performed through the use of a titanium-reinforced expanded polytetrafluoroethylene (e-PTFE) membrane with an ACBP graft obtained from the retromolar region with a specially designed bone scraper. Bone biopsy specimens were harvested at 9 months after graft placement. Analysis of the reconstructed bone revealed bone with a lamellar quality characterized by a mature osteonic structure. Sparse particles of grafted bone were evident in direct contact with the regenerated bone. Marrow spaces showed a normal stromal component with limited grafted particles. [ABSTRACT FROM AUTHOR]

In modern times, all procedures in oral surgery need to be painless and management of postoperative pain needs to be adequate. The surgical extraction of the third molar or alveolectomy of the wisdom tooth is one of the most common surgical procedures carried out in oral surgery and it includes rising a flap, bone removal and suturing. These surgical procedures usually cause swelling, trismus and moderate to severe pain. Third molar surgery is often used as a model in clinical trials that are directed toward reducing postoperative pain and improving its management. Tramadol is a well-known central acting opioid analgesic that produces analgesia against multiple pain conditions such as postsurgical pain, obstetric pain, terminal cancer pain, pain of coronary origin and neuropathic pain. Tramadol is an atypical opioid. When administered locally, it has both analgesic and anesthetic properties. The aim of this paper was to present new findings on local effects of tramadol in oral surgery.

The restorative dentist treats patients with needs that often transcend dental disciplines. This dentist will be responsible for long-term dental maintenance and should logically oversee interdisciplinary reconstruction. This case report demonstrates an integrated treatment approach and 5-year retrospective study involving a patient with maxillary anterior excess, pronounced overjet, and advanced periodontitis. Extraction and radical alveolectomy with removable prosthesis is often considered in such cases; however, results are often less than optimum function, esthetics, and general oral health. In this case, a previously undescribed anterior maxillary rotating segmental ostectomy was integrated with restorative, periodontol and removable full and partial denture procedures. [ABSTRACT FROM AUTHOR]

Crown lengthening is one of the most common surgical procedures in periodontal practice. Its indications include subgingival caries, crown or root fractures, altered passive eruption, cervical root resorption and short clinical abutment, and its aim is to re-establish the biologic width in a more apical position. While the procedure in posterior areas of the dentition has been thoroughly investigated, crown lengthening performed for esthetic reasons in the anterior areas is still a matter of debate and an evidence-based technique is not available. This paper provides accurate descriptions of the surgical and restorative phases of the esthetic crown-lengthening procedure by answering the following questions: what is the ideal surgical flap design? how much supporting bone should be removed? how should the position of the flap margin relate to the alveolar bone at surgical closure? and how should the healing phase be managed in relation to the timing and the position of the provisional restoration with respect to the gingival margin? [ABSTRACT FROM AUTHOR]

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Aneurysmal bone cyst (ABC) is a nonneoplastic rare pathologic entity of the jaws. Its locally aggressive nature and high recurrence rate after curettage make surgical resection a better treatment option. Here, we present a case of ABC of maxillary alveolus and its management by alveolectomy followed by white head varnish pack application in the surgical defect.

In most mammals, compensatory lung growth occurs after the removal of one lung (pneumonectomy). Although the mechanism of alveolar growth is unknown, the patterning of complex alveolar geometry over organ-sized length scales is a central question in regenerative lung biology. Because shear forces appear capable of signaling the differentiation of important cells involved in neoalveolarization (fibroblasts and myofibroblasts), interstitial fluid mechanics provide a potential mechanism for the patterning of alveolar growth. The movement of interstitial fluid is created by two basic mechanisms: 1) the non-uniform motion of the boundary walls, and 2) parenchymal pressure gradients external to the interstitial fluid. In a previous study (Haber et al., Journal of Theoretical Biology 400: 118-128, 2016), we investigated the effects of non-uniform stretching of the primary septum (associated with its heterogeneous mechanical properties) during breathing on generating non-uniform Stokes flow in the interstitial space. In the present study, we analyzed the effect of parenchymal pressure gradients on interstitial flow. Dependent upon lung microarchitecture and physiologic conditions, parenchymal pressure gradients had a significant effect on the shear stress distribution in the interstitial space of primary septa. A dimensionless parameter δ described the ratio between the effects of a pressure gradient and the influence of non-uniform primary septal wall motion. Assuming that secondary septa are formed where shear stresses were the largest, it is shown that the geometry of the newly generated secondary septa was governed by the value of δ . For δ smaller than 0.26, the alveolus size was halved while for higher values its original size was unaltered. We conclude that the movement of interstitial fluid, governed by parenchymal pressure gradients and non-uniform primary septa wall motion, provides a plausible mechanism for the patterning of alveolar growth. [ABSTRACT FROM AUTHOR]

Introducción: la prótesis Inmediata es una alternativa de tratamiento protésico que sustituye inmediatamente los dientes extraídos. Generalmente se confecciona para reponer dientes anteriores, evitando el deterioro psíquico del paciente; en ocasiones, se hace necesario realizar además de las exodoncias de los dientes afectados, técnicas de cirugía preprotésica, como la Tuberoplastia o la Alveolectomía. Objetivo: mostrar que es posible realizar el tratamiento de rehabilitación con prótesis inmediata luego de una amplia resección quirúrgica. Presentación del caso: se presentó el caso de una paciente femenina de 58 años de edad, trabajadora activa, con antecedentes de buena salud. Refiriendo rechazo al período de desdentamiento. Al examen intrabucal presentaba incisivos centrales superiores con fractura oblicua mesial y movilidad de grado III por trauma, protrusión dentoalveolar marcada del sector anterosuperior, con resalte aumentado y reducción del espacio interalveolar en el sector posterior. Fue diagnosticada como desdentada parcial superior clase I, subclase I de Kennedy, y desdentada parcial Inferior clase I de Kennedy. Se decidió rehabilitar a la paciente por prótesis inmediata total superior, realizando previa Alveolectomía correctora y Tuberoplastia bilateral en una misma intervención quirúrgica. Resultados: con el tratamiento quirúrgico-aparatológico elegido se lograron excelentes resultados, mostrando las bondades de este tratamiento. Conclusiones: se obtuvo en la paciente buen resultado estético, funcional y psíquico.Introduction: the Immediate Denture is a prosthetic treatment option. It substitutes the extracted teeth immediately. It is generally made to restore Front teeth, avoiding the patient's psychic trouble, sometimes becomes necessary to practice previous prosthetic surgery technics, such as reduction of hyperplastic tuberosities or Alveolectomy besides to make the exodontics of affected teeth. Objective: to show that it is possible to carry out the rehabilitation treatment with immediate prosthesis after a surgical wide resection. Case presentation: we presented a 58 year-old feminine patient, active worker with antecedents of good health. Besides she refereed she couldn't see herself without teeth. To the clinical exam it presents upper central incisors with mesial oblique fracture and III mobility grade, for trauma. Also shows marked dental and alveolar protrusion of the upper front sector, with increased overjet and overbite. And reduction of the interalveolar space in posterior area. Being diagnosed as upper partial toothless Kennedy's class I, subclass I, and inferior partial toothless Kennedy's class I.We decided to rehabilitate the patient for immediate complete upper denture carrying out previous Alveolectomy proofreader and bilateral reduction of hyperplastic tuberosities at the same surgical intervention. Results: with this prosthetic- surgical treatment excellent results were achieved showing the kindness of this treatment. Conclusions: an esthetic, functional and psychic good result was obtained for the patient.

Ameloblastic fibroodontoma (AFO) is a rare entity of mixed odontogenic tumors and frequently arises from posterior portion of the maxilla or mandible in first two decades of life. Herein, a 35-year-old woman with a noncontributory medical history who presented with a progressive left maxillary toothache, left maxillary first molar tooth mobility, and swelling in the left maxillary molar area for the last 2 months was reported. Radiologically, a tumor that originated from periapical area of the second mature molar teeth of maxilla was seen and additively unerupted tooth was not detected. The histopathologic examination revealed AFO. The patient is disease-free for five years after treated with limited segmental alveolectomy combining with Caldwell-Luc procedure. [ABSTRACT FROM AUTHOR]

Pre-prosthetic surgery is that part of oral and maxillofacial surgery which restores oral function and facial form. This is concerned with surgical modification of the alveolar process and its surrounding structures to enable the fabrication of a well-fitting, comfortable, and esthetic dental prosthesis. The ultimate goal of pre-prosthetic surgery is to prepare a mouth to receive a dental prosthesis by redesigning and smoothening bony edges.

Introduction: The bony lid technique, using a micro-saw and repositioned in situ, can be an alternative to decortication for impacted teeth, endodontic surgery, removal of foreign bodies cystic lesions or nonfunctional osteo-integrated implants. Using a micro-saw enables rapid movement velocity and could replace bur decortication or piezosurgery. Technique: A cortical block was established by four micro-saw osteotomies and cleaved facing the operating area. At the end of the surgery, the cortical component was reinserted and impacted at the initial position. In case of lack of stability, it was fixed using either screws and/or osteosynthesis plates or resorbable ligatures. Discussion: The emergence of this technique is partly linked to the progress of surgical instrumentation. The in situ repositioning of the flap at the end of the procedure encourages bone conservation, by preventing epithelial incarceration and promoting bone regeneration. However, fixing the bony lid at the end of the procedure is a delicate step that determines the success of the operation . The use of a micro-saw provides good operating visibility, reduced bone loss in the case of osteotomies, and a faster execution compared with decortication and piezosurgery. [ABSTRACT FROM AUTHOR]

This study aims to show that a mandibular bone graft is a predictable therapeutic approach for bone regeneration after surgical removal of a tooth. The study was performed in a middle sized dog (Canis Familiaris); alveolectomy was used for extraction of upper second premolar. Bone augmentation with an autogenous graft was performed. After four months the fixation screws were removed and a single stage implant was placed. The implant was loaded after three months. The immediate outcome was excellent. Long term success must be further evaluated. Final observation shows that autogenous bone grafts represent the gold standard of ridge deficiences correction. [ABSTRACT FROM AUTHOR]

Aim To examine the types and frequencies of oral surgery diagnoses and ambulatory oral surgical treatments during one year period at the Department of Oral Surgery, University Hospital Dubrava in Zagreb, Croatia. Methods Sociodemographic and clinical data on 11 680 ambulatory patients, treated between January 1 and of December 31, 2011 were retrieved from the hospital database using a specific protocol. The obtained data were subsequently analyzed in order to assess the frequency of diagnoses and differences in sex and age. Results The most common ambulatory procedure was tooth extraction (37.67%) and the most common procedure in ambulatory operating room was alveolectomy (57.25%). The test of proportions showed that significantly more extractions (P < 0.001) and intraoral incisions (P < 0.001) were performed among male patients, whereas significantly more alveolectomies and apicoectomies were performed among female patients (P < 0.001). A greater prevalence of periodontal disease was found in patients residing in Zagreb than in patients residing in rural areas. Conclusion The data from this study may be useful for planning of ambulatory oral surgery services, budgeting, and sustaining quality improvement, enhancing oral surgical curricula, training and education of primary health care doctors and oral surgery specialists, and promoting patients' awareness of the importance of oral health. [ABSTRACT FROM AUTHOR]

Each tooth has its importance in the oral cavity and therefore its absence could cause an imbalance and have an impact on the health of surrounding oral structures. When dental impaction occurs, clinical and radiological examinations are necessary for both diagnosis and prognosis. Thus, several therapeutic options are possible ranging from abstention to surgical extractions using alveolectomy. However, the treatment most widely adopted and most desired is the establishment of orthodontico-surgical traction. Our work proposes to put the point on the means of failures forecasts which this therapeutic can meet. [ABSTRACT FROM AUTHOR]

Aneurysmal bone cyst (ABC) is a nonneoplastic rare pathologic entity of the jaws. Its locally aggressive nature and high recurrence rate after curettage make surgical resection a better treatment option. Here, we present a case of ABC of maxillary alveolus and its management by alveolectomy followed by white head varnish pack application in the surgical defect. [ABSTRACT FROM AUTHOR]

Aim: (1) To visually assess scarring of the gingiva and alveolar mucosa 1 year following apical surgery in the aesthetic zone; and (2) to evaluate whether scarring correlated with patient-related or surgical parameters. Material and methods: The material included 72 cases in the anterior maxilla. Three observers, who were blinded to the incision and flap design, independently assessed scar formation of the soft tissues. Each observer determined a pretreatment and a 1-year follow-up score of scarring, and mean changes were calculated. Results: With regard to the gingiva, the type of incision had a significant ( P = 0.0013) influence on scar formation; that is, submarginal incisions and papilla-saving incisions produced more scarring than intrasulcular and papilla-base incisions. Scarring of the alveolar mucosa was significantly ( P = 0.0108) influenced by the type of surgery (first-time vs. re-surgery) and by gender ( P = 0.0496); that is, less scar formation of the alveolar mucosa was observed in re-surgery than in first-time cases as well as in male compared with female patients. Conclusions: Scar formation of the gingiva appeared to be influenced by the incision technique and use of antibiotics, whereas scar formation of the alveolar mucosa was correlated with gender and type of surgery. Possible scar formation should be discussed with the patient before surgery. [ABSTRACT FROM AUTHOR]

This case report describes endodontic, restorative, and periodontal treatment of a complicated crown-root fracture of the right maxillary fourth premolar tooth in a dog. A buccal portion ('slab') had separated from the tooth, which extended subgingivally into root structure. Following completion of standard root canal therapy, a periodontal flap was elevated. Alveolectomy and alveoloplasty were performed, and inflamed soft tissues were debrided. The fracture site was prepared, restored, and shaped to receive a dental bulge contour. A gingival collar expansion technique was utilized to allow for apical positioning of gingiva at the distobuccal crown-root segment. Clinical and radiographic examination 15-months following treatment showed no evidence of endodontic failure. The restorations were intact, and periodontal probing depths were slightly increased probably due to gingival enlargement from concurrent cyclosporine therapy. The importance of biologic width maintenance in periodontal surgery and need for owner compliance with home oral hygiene are discussed. [ABSTRACT FROM AUTHOR]

Compared to non-invasive aspergillosis, invasive aspergillosis in the region of the mouth, jaw and face has rarely been reported. It occurs particularly often in the presence of haematological oncological illness. The case of a patient suffering from acute myeloid leukemia is described; he contracted invasive aspergillosis of the lungs and the alveolar processes in the course of chemotherapeutic treatment. All the alveolar processes in the region of the premolars and molars were demarcated and had to be removed by sequestrectomy. The therapy of invasive aspergillosis should be carried out within the framework of intensive interdisciplinary treatment. In addition to systemic and local antimycotic therapy, the debridement of necrotic hard and soft tissue was necessary. [ABSTRACT FROM AUTHOR]

Pre-prosthetic surgery is that part of oral and maxillofacial surgery which restores oral function and facial form. This is concerned with surgical modification of the alveolar process and its surrounding structures to enable the fabrication of a well-fitting, comfortable, and esthetic dental prosthesis. The ultimate goal of pre-prosthetic surgery is to prepare a mouth to receive a dental prosthesis by redesigning and smoothening bony edges. [ABSTRACT FROM AUTHOR]

In modern times, all procedures in oral surgery need to be painless and management of postoperative pain needs to be adequate. The surgical extraction of the third molar or alveolectomy of the wisdom tooth is one of the most common surgical procedures carried out in oral surgery and it includes rising a flap, bone removal and suturing. These surgical procedures usually cause swelling, trismus and moderate to severe pain. Third molar surgery is often used as a model in clinical trials that are directed toward reducing postoperative pain and improving its management. Tramadol is a well-known central acting opioid analgesic that produces analgesia against multiple pain conditions such as postsurgical pain, obstetric pain, terminal cancer pain, pain of coronary origin and neuropathic pain. Tramadol is an atypical opioid. When administered locally, it has both analgesic and anesthetic properties. The aim of this paper was to present new findings on local effects of tramadol in oral surgery.

The article describes the surgical procedure for extracting the mandibular canine tooth in a dog through buccal or lingual approach. Photographic views and radiographs of the dog's teeth are provided. A scalpel blade and a periosteal elevator were used to incise a mucoperiosteal flap. According to the author, the incidence of rostal mandible fracture may be minimized by limiting alveolectomy to the lingual aspect.

Objective: To investigate the changes of the lateral cephelometric landmarks of soft tissue and hard tissue of patients with maxillary alveolar protrusion and advanced periodontitis treated with immediate implants and cross-arch fixed prostheses. Methods: From January 2013 to October 2016, consecutive patients with advanced periodontitis and maxillary alveolar protrusion in need of immediate implants and cross-arch fixed prostheses were included in this study. All the patients were treated with provisional cross-arch fixed prostheses supported with 4 to 6 immediate implants after extraction of all the residual teeth and reduction of excessive alveolar bone. After 6 months, a final cross-arch fixed prosthesis was delivered. The lateral cephalometric landmarks of soft tissue and hard tissue at the time of pre-operation and final prosthesis delivery were analyzed. The change of patients ' facial aesthetics was assessed using visual analogue scale (VAS). Results: Ten patients were included in the study. All the patients underwent full arch rehabilitation of both jaws supported by a total of 89 dental implants. In the maxillae, the average number of inserted implants were 4.5. The mean height of alveolar bone reduction was (6.3±1.8) mm. Both the distance of U1-NA (the upper incisor to nasion-A point line) and U1-PP (the upper incisor to palatal plane) were significantly reduced by (5.5±2.7) mm and (1.6±1.2) mm, respectively. The angle of U1-SN (between upper incisor to sella-nasion line) was reduced by 9.6°±8.1°palatally. The nasolabial angles were significantly increased by 10.5°±6.4°. Both the patients and dentists considered that the facial aesthetics was improved greatly after the treatment. Conclusions: With the reduction of excessive alveolar bone and the realignment of artificial teeth, the treatment of immediate implants and cross-arch fixed prostheses could improve the facial aesthetics of the patients with advanced periodontitis and maxillary alveolar protrusion.

A letter to the editor is presented in response to an article on external alveolectomy by William Lete Shearer which appeared in the June 1920 issue.

Maxillary complete arch fixed implant-supported prostheses are a popular treatment option for edentulous patients. Excessive gingival display or gummy smile in edentulous patients is relatively uncommon. However, many partially edentulous patients or completely dentate patients with compromised dentition and excessive gingival display may seek a fixed implant-supported prosthesis. Some of these patients may be candidates for immediate implant placement and insertion of the prosthesis, while others may carry over their preexisting excessive gingival display to the edentulous state for a variable period of time. Both types of patients require meticulous treatment planning and often require additional preprosthetic interventions before the placement of dental implants. This report provides an overview of the etiology, diagnosis, treatment planning, and options for management of patients with excessive gingival display who seek a maxillary complete arch fixed implant-supported prosthesis., (Copyright © 2012 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Introduction: The evaluation of alveolar bone healing may have a role in dental implantology, in prosthodontics in the post-extraction phase and in monitoring fracture repair. There are several radiological techniques described to evaluate alveolar bone regeneration. However, most are expensive and time consuming., Objectives: To develop and evaluate a radiological method utilising readily available equipment to measure alveolar bone regeneration., Materials and Methods: An apparatus was designed to enable the acquisition of standardized x-ray images, consisting of a disposable impression tray, digital positioning system, aluminum step wedge, digital x-ray sensor, Rinn apparatus and laboratory putty. Bone biopsies were collected from each oral quadrant in each of five Chacma baboons (Papio ursinus). Accurately standardised x-ray images of the biopsy sites were taken pre-operatively, directly post-operatively and again after three and six week intervals. These images were analysed using a graded histogram provided in a computer software program., Results: The average gray-scale value on the histogram of the selected biopsy area was determined on the series of standardised images. The average values for the three biopsied sites per quadrant were expressed as percentages of pre-operative density. The results ndicated a mean ncrease of 6.3% (+/- 1.4%) (mean +/- 1 SEM) in bone density after three weeks and 12.6% (+/- 1.7%) six weeks post-operatively., Conclusion: A standardised radiologica examination method was developed which, together with a computer ised evaluation technique, could be applied to accurately determine relative bone density. This method was shown to provide comparative bone density values during the regeneration process of alveolar bone over a six week period.

Background: The biologic width provides a tight seal around the tooth, protecting the periodontium from microbial injury and promoting periodontal health. However, clinical situations such as subgingival caries and crown-root fracture may compromise the biologic width dimension. Crown lengthening is a surgical technique that can be used to re-establish this important landmark in order to maintain periodontal health and long-term stability of the restorations., Method: A full-thickness mucoperiosteal flap is elevated to expose the bone and root surfaces. Debridement of the bone and root surfaces is completed and the crown preparation finalized, ensuring that at least 3 mm is between the restorative margin and alveolar bone crest. This guarantees preservation of the biologic width. The crown preparation is subsequently provisionalized to protect the tooth structure and promote soft-tissue healing., Results: Using the immediate temporization crown-lengthening (ITCL) technique, the crown preparation is finalized and impressions can be obtained during the surgical phase. This not only shortens the patient visits but also allows for the fabrication of a restoration of a good fit. The patient also receives a provisional restoration, which provides protection of the tooth structure and restores function and esthetics during healing., Conclusion: ITCL is a simple, straightforward, and predictable approach that can be easily incorporated into the daily practice of many dentists.

Patients with impacted ectopic canines often present to Orthodontic and Oral and Maxillofacial units, with 85% being displaced palatally. Current orthodontic opinion suggests that the creation of adequate space ultimately allows the spontaneous eruption of most impacted canines, but we are often requested to operate to facilitate their eruption. There are several approaches, techniques that vary depending on whether orthodontically assisted or spontaneous eruption is expected. There are few publications that describe either the techniques or their merits. We have used a gingival-sparing technique for more than 10 years in this unit. To determine current practice, we carried out a national postal survey of consultant oral and maxillofacial surgeons and staff grade/associate specialists. A total of 564 questionnaires were sent, and 353 replies were received (63%). There was considerable variation in the design of mucosal flaps used for exposure of the canines. Only 9% of clinicians avoided the gingival margin of the adjacent erupted teeth during operation. We describe this unit's practice of sparing the gingival margins, and highlight the merits of this technique., (Copyright © 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The tissue-based phenomena and the tissue interactions responsible for tooth displacement can be modulated by varying the intensity of the applied forces or by means of medicated molecules absorbed by the patient or prescribed by the orthodontist. However, harmful side-effects such as inflammatory root resorption or replacement resorption (ankylosis) can occur requiring appropriate management on the part of the practitioner., (Copyright 2010 CEO. Published by Elsevier Masson SAS. All rights reserved.)

The aim of this article was to present the treatment of an unesthetic smile in a 27-year-old woman showing gingival recession, gingival asymmetry, and an altered passive eruption in the natural dentition. First, an apically positioned flap with osseous resective surgery was applied to correct the gingival asymmetry at the maxillary right incisors. The amount of bone resection was determined by means of bone sounding at the maxillary left incisors. Six weeks later, a coronally advanced flap procedure was performed to cover the gingival recession at the maxillary right canine, along with an enamelplasty and a direct composite resin restoration. The patient was satisfied with the final treatment outcome.

Background: The authors conducted a literature review regarding the rationale, basic surgical principles, contraindications and wound healing associated with periodontal crown-lengthening surgery. They present a report of a clinical case illustrating crown lengthening with osseous resection., Types of Studies Reviewed: The authors evaluated clinical and radiographic studies, as well as literature reviews. They selected only publications that pertained to the surgical exposure of the natural dentition to facilitate restorative therapy, esthetic concerns or both., Results: Periodontal crown lengthening can be used for esthetic enhancement in the presence of delayed passive eruption. Moreover, for teeth with subgingival caries, fractures or both, this treatment can establish a biological width and, if needed, a ferrule length facilitating prosthetic management. Crown-lengthening surgery involves various techniques, including gingivectomy or gingivoplasty or apically positioned flaps, which may include osseous resection. Authors of wound-healing investigations have reported that an average of 3 millimeters of supragingival soft tissue will rebound coronal to the alveolar crest and can take a minimum of three months to complete vertical growth., Clinical Implications: Initiation of final prosthetic treatment should wait at least three months and possibly up to six months for esthetically important areas, as the free gingival margin requires a minimum of three months to establish its final vertical position. Dentists must be aware that osseous resection could affect periodontal stability and may pose a contraindication to crown-lengthening therapy.

Purpose: Calcium sulfate (CaS) is a simple, biocompatible material with a very long, safe clinical history in several different fields of medicine. CaS is a rapidly resorbing material that leaves behind a calcium phosphate lattice, which promotes bone regeneration and hemostasis. The aim of this study was to perform a clinical evaluation of a possible hemostatic effect of calcium sulfate hemihydrate (CaSO(4)), commonly known as plaster of Paris, in the surgical and orthodontic treatment of impacted teeth., Materials and Methods: Forty-three patients with 66 impacted cuspids and premolars were enrolled in this study. The gap between teeth and bone was filled with several layers of CaS cement. Each layer was put in place and was compressed with a dry gauze. The outer layer was then hardened with a potassium sulfate solution. After hardening, the CaS excess was removed, and a bracket was applied to the surface of the tooth., Results: In no case was a separation of the bracket by the surface of the tooth observed., Conclusions: These results seem to confirm the usefulness of the hemostatic effect of CaS in this procedure., (Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Unlabelled: The treatment planning, clinical stages and construction of immediate dentures pose challenges to both dentist, dental technician and patient. In this two-part series, the various principles for successfully providing patients with immediate dentures will be discussed. This first paper examines the advantages and disadvantages, as well as the treatment planning involved in providing immediate dentures., Clinical Relevance: Although the provision of immediate dentures is common in dental practice, it is a treatment option which is not without problems. This article will show how careful planning, prior to treatment starting, can prevent unforeseen complications occurring.

Extensive exposure of the gingiva during a smile, called excessive gingival display, may be a point of concern for both patients and clinicians. Patients often present to the dental clinic seeking a solution to their "gummy" appearance. A clinician must fully understand the various factors involved in this situation, to provide patients with an appropriate answer. Thorough examination followed by the right diagnosis is imperative for achieving an esthetic and predictable result in the treatment of such situations. The aim of this article is to discuss the various aspects of excessive gingival display and its etiology and to present the current solutions that exist in the literature.

Introduction: This article illustrates a new treatment system combining accelerated osteogenic orthodontics and osseointegrated mini-implants for minor tooth movement in severely compromised conditions. The procedures, advantages, efficacy, and indications of this method are discussed., Methods: Three patients who needed minor tooth movement and orthodontic mini-implant treatment were recruited to use this combined technique; 1 required molar intrusion, and 2 required molar uprighting. C-Implant (diameter, 1.8 mm; length, 8.5 mm) were placed, and, after 5 weeks of healing, decortication of bone was performed near the malpositioned teeth by using a low-speed round bur. Bleeding was controlled, and the bone graft material was placed into the decorticated area. After the flap was secured, an immediate strong orthodontic force from the C-implant was applied to the teeth to start rapid tooth movement., Results: Only a few orthodontic attachments were necessary, and the teeth moved rapidly to a good occlusal relationship without root resorption., Conclusions: The combination of accelerated osteogenic orthodontics and a partially osteointegrated mini-implant (C-Implant) was a safe and effective treatment choice. The C-implant's surface allows partial osseointegration, so it can resist a force moment without loosening and withstand the heavy forces associated with the accelerated osteogenic orthodontics protocol.

Cervical external root resorption can be present in natural teeth, involving one or more teeth in the same patient. The incidence of these lesions appears random and the etiology remains unclear. Cervical external root resorption has been considered a difficult clinical situation, and its diagnosis and treatment of the defect challenging. The present report describes a case of multiple external cervical resorption lesions involving four teeth, including the history, and the clinical and radiographic findings. The treatment included surgical intervention and restoration of the defect without sacrificing the pulp. A 3-year re-evaluation of the case confirmed a stable, uneventful clinical recovery.

Objectives: Effective carrier technologies and dosing appear critical for the successful use of bone morphogenetic proteins (BMPs). This study evaluated radiographically the potential of a purpose-designed titanium porous-oxide implant surface combined with recombinant human BMP-2 (rhBMP-2) to stimulate alveolar ridge augmentation., Material and Methods: Twelve young-adult Labrador dogs were used. Three 10-mm titanium implants per jaw quadrant were placed 5 mm into the alveolar ridge following extraction of the premolar teeth and reduction of alveolar ridge. Six animals received implants coated with rhBMP-2 at 0.75 or 1.5 mg/ml randomized to contralateral jaw quadrants. Another six animals received implants coated with rhBMP-2 at 3 mg/ml or uncoated control using the same split-mouth design. The mucoperiosteal flaps were advanced, adapted, and sutured to submerge the implants. Radiographic registrations were made immediately postsurgery (baseline), and at weeks 4 and 8 (end of study)., Results: rhBMP-2-coated implants exhibited robust radiographic bone formation extending to and above the implant platform from week 4 (P<0.01). Some rhBMP-2-coated implants showed voids within the newly formed bone that gradually resolved and/or implant displacement, being severe in two animals receiving implants coated with rhBMP-2 at 3 mg/ml. Controls showed limited, if any, new bone formation at weeks 4 and 8 postsurgery. There were no significant differences among the rhBMP-2 groups in bone gain., Conclusions: The titanium porous-oxide surface serves as an effective carrier for rhBMP-2, showing a clinically significant potential to stimulate local bone formation. With the carrier technology used, therapeutic dosage appears to be in the range of 0.75-1.5 mg/ml.

Purpose: In recent years, the concept of prosthodontic-driven implantology has received more attention. The precise placement of implants in accordance with greater safety and confidence allow the practitioner to offer a safer, more secure and predictable treatment than could previously be provided. In this report, this novel approach is illustrated through description of 1 difficult case., Materials and Methods: Using principles of computer-assisted design and rapid manufacturing, the data acquisitioned from computerized tomography was used to plan implant rehabilitation and to transfer this information to the surgery as well., Results: The procedure of implant planning in this sophisticated technique has potential to yield substantial public health benefits., Conclusions: It was demonstrated that the versatility of the technique allows not only precise translation of the treatment plan to the patient's mouth, but also offers many additional significant benefits including use of special guides during surgery which would be difficult to achieve with traditional procedures.

Objective: To present a modified option to surgical crown lengthening for repair of biologic width loss., Methods: The alternative to the traditional method involves reshaping the fractured root surface in combination with conservative removal of the supporting alveolar bone to rebuild the biological width. Although these teeth were considered as not suitable for the traditional methods, 7 teeth from 7 patients with fracture surface located lower than alveolar bone crest were treated by this modified method of surgical crown lengthening. Restoration was accomplished on these teeth two month later. Periodontal index such as tooth mobility, plaque index, probing depth and bleeding index were recorded and followed up., Results: The mean follow-up period was 17 months (ranged from 10 to 31 months). Result of surgery and restoration of these 7 teeth was satisfactory. The gingival tissue remained healthy and esthetic with good function., Conclusion: This modified surgical crown lengthening can be used as an alternative to the traditional method to save more fractured teeth.

Periodontal surgical procedures consisting of gingival flaps and osseous recontouring are indicated for crown lengthening of several contiguous teeth in the esthetic zone; both in cases where restorations are required and in cases where no restorations are planned, such as in patients with excessive gingival display due to altered passive eruption. Forced tooth eruption via orthodontic extrusion is the technique of choice when clinical crown lengthening is necessary on isolated teeth in the esthetic zone.

Selective reduction of bone without collateral damage (nerves, teeth) is essential in apicectomy. To test whether skills acquired on a virtual apicectomy simulator (VOXEL-MAN system with integrated force-feedback) are transferable from virtual to physical reality, two groups of trainees were compared. Group 1 received computer-based virtual surgical training before performing an apicectomy in a pig cadaver model. The probability of preserving vital neighboring structures was improved significantly, i.e. six-fold, after virtual surgical training (P<0.001). The average volume of the bony defects created by the trainees of Group 2 (mean: 0.47 ml) was significantly (P<0.001) larger than by the trainees of Group 1 (mean: 0.25 ml). Most importantly, the ability to objectively self-assess performance was significantly improved after virtual training. Training with a virtual apicectomy simulator appears to be effective, and the skills acquired are transferable to physical reality.

In esthetic dentistry, expanding the evaluation beyond the teeth is necessary to achieve a truly desirable result. The lips, attached and unattached mucosa, free gingival margin, and osseous position and contours must be considered and changed if necessary. Although many treatment modalities are available to accomplish these modifications, the use of lasers of varying wavelengths provides advantages not possible by other means. Lasers are often thought of as generic instruments, but different laser wavelengths function differently, and each has its place in the esthetic continuum. Diode, neodymium:YAG, CO(2) and erbium lasers each have advantages that can be exploited to maximum effect and disadvantages that must be taken into consideration. A thorough understanding of their mechanism of action, their tissue effects, and laser safety is vital to obtaining excellent results.