The buccal bifurcation cyst: in non-surgical treatment an option?

The mandibular buccal bifurcation cyst (BBC) was first described by Stoneman and Worth in 1983. It is a lesion with a specific location, classically the buccal surface of the mandibular first molar and less frequently the mandibular second molar. There have been numerous reports in the literature describing the BBC and its treatment. Treatment advocated thus far includes extraction of the involved first molar, marsupialization and enucleation of the cyst. In their most recent article, Pompura, Sándor and Stoneman reported on the successful treatment of 44 cysts with enucleation without tooth extraction. This article will describe the diagnostic features of the BBC and present three cases with a total of five cysts, which were treated non-surgically and ultimately resolved. The authors, therefore, propose that a more conservative non-surgical approach to these lesions may be considered.     

Changes in chewing patterns after implantation in the edentulous mandible

Almost all edentulous patients with implant-supported prostheses in mandibles describe an improvement in their chewing function and quality of life. This was reason to believe that an implant prosthetic treatment actually influences mandibular border movements, as well as the chewing patterns. The present study compares border movements and chewing patterns in 15 patients recorded with the Sirognathograph. The first measurements were made with existing complete dentures. After implantation and rehabilitation with a Dolder-bar and clip-to-bar overdenture, the movements were recorded again. The measurements revealed an improved guidance of the mandibular movements and larger borderline patterns following stabilization of the complete denture with the bar. This leads to more harmonic shapes in the movements and better chewing efficiency.     

A morphometric analysis of the furcation region of mandibular molars

This study examined furcation dimensions and morphology in first and second mandibular molar teeth. One hundred thirty-four extracted human mandibular molars with divergent roots were selected. Teeth were viewed at 7X magnification on a dissecting microscope interfaced with a computer equipped with a state-of-the-art histomorphometry software program. Various aspects of furcation anatomy were measured and recorded. Data were examined by using analysis of variance for all paired comparisons. For nonparametric data, the Kruskal Wallis test was used. Results indicated that 61.94% of buccal and 50.75% of lingual molar surfaces presented with cervical enamel projections (CEPs), with the highest frequency noted in second molars. CEPs ranged from 0.98 mm to 1.33 mm, whereas root trunk heights varied between 2.23 mm and 2.93 mm. Generally, lingual molar surfaces had longer root trunks when compared to buccal surfaces. Root separation increased by approximately 0.5 mm at each 1-mm increment apical to the furcal roof. This study provides new information regarding the furcal anatomy of mandibular molar teeth and supplements previous reports that suggest the CEP is a common problem which must be addressed by clinicians when treating molar teeth.     

Follow up and maintenance of implant supported prostheses: a comparison of 20 complete mandibular overdentures and 20 complete mandibular fixed cantilever prostheses

Two independently selected groups of 20 patients who were edentulous in te mandible, were followed up on a regular basis over a 5-year period following restoration with a lower implant stabilised prosthesis and conventional upper denture. Significantly more treatment was required by those who received complete mandibular overdentures than those provided with complete fixed mandibular prostheses. In addition to adjustment for the relief of denture trauma to the mucosa, more mechanical problems arose with overdenture implant prostheses.     

A randomized clinical trial comparing the efficacy of mandibular implant-supported overdentures and conventional dentures in diabetic patients. Part I: Methodology and clinical outcomes

STATEMENT OF PROBLEM: Scientific evidence is lacking to support the general application of implant-supported mandibular overdentures. PURPOSE: This randomized clinical trial was undertaken to compare the efficacy of conventional mandibular and implant-supported overdentures in diabetic edentulous patients with clinically acceptable metabolic control. METHOD: A total of 102 diabetic patients, treated with or without insulin, were randomized to receive a new maxillary denture and either a conventional or an implant-supported removable mandibular overdenture. Treatment was completed for 89 patients, 37 with the conventional and 52 with implant-supported dentures. Detailed examinations, tests, and questionnaires were given before and at 6- and 24-months after treatment completion. Comparisons between the two treatment groups were made for treatment failures based on prespecifed criteria and the type and amount of maintenance care provided. RESULTS: The insulin and noninsulin treated groups were collapsed because of the lack of significant differences at entry. The conventional denture and implant-supported overdenture groups were similar in terms of general demographics, medical status, quality of their original dentures and denture support, several functional measures, and patient satisfaction. Treatment was judged to be successful in 56.9% of patients with conventional dentures and 72.1% with overdentures. This difference in success rate was not statistically significant (p > 0.05). Patients with treatment failures in both groups required excessive maintenance care. Those with conventional dentures needed frequent denture base adjustments and relines, whereas those with overdentures required frequent clip replacements and repairs. Although significant improvements were seen with both treatment modalities, a higher percentage of patients with implant-supported overdentures than those with conventional dentures reported improvements in chewing comfort and moderate-to-complete overall satisfaction.     

The diagnostic value of serum lysozyme activity in inflammatory bowel disease

The inferior alveolar nerve was cut or the vessels entering the mandibular canal were damaged in 39 guinea pigs at 10 days of age. Possible changes in the incisors were recorded during a 100-day observation period whereafter the animals were killed and the skulls freed of soft tissues; at this time, 35 skulls were found suitable for further examination. The changes in the mandibular incisors on the operated side became observable 30-40 days post-operatively as discolourization, a 'trauma line' around the tooth, narrowing of the tooth or total loss of it's visible part. In the guinea pigs with the nerve cut (group A), such signs of maldevelopment were seen in 5 out of 19 animals, whereas the corresponding figure for the animals with the damaged vessels (group B) was 14/16. All incisors in group A and 13 out of 14 in group B recovered from the state of maldevelopment; one animal in group B showed complete loss of the incisor. The molar region was examined only from the cleaned skulls. In group A, the first molar was deformed in two animals; in group B, seven animals displayed either maldevelopment of the first molar or the first and second molar or complete loss of the first molar. No malformation of the third molar was observed. With two exceptions, the deformation or loss of molars occurred in combination with incisor maldevelopment. The malformations were considered to result from a disturbed blood supply. In group A, the dental changes may perhaps be ascribed to a short-term interference with the blood supply during the operation. The variable results in group B seem to imply that the mandibular teeth receive at least part of their blood supply from vessels besides those entering the mandibular canal. The innervation appears to have a subordinate role in the restoring of the morphology of continuously erupting teeth.     

A follow-up study on changes in mastication after insertion of mandibular bilateral free end saddle denture by EMG]

The purpose of this study was to investigate changes in the mandibular shortened arch, whose occlusal deficit had been reconstructed by removable partial denture, during mastication by using the EMG analyzing system. A total of 5 shortened dental arch patients was provided with RPDs, and observed by a sophisticated masticatory analyzing system using EMG, before and one day, about 2 weeks, 3 months, after denture insertion. The conclusions were as follows: i) The elements of the shortened arch during mastication, that is, the duration, interval, and cycletime, were prolonged at the time of insertion of RPD, but 3 months after denture insertion, they were shortened to almost the same state as before treatment. ii) Prosthetic treatment for shortened dental arch improved revitalization of functional musculatures, and their rhythmicity of functional procedure. iii) The functional tongue room for optimal bolus position in mastication was provided by insertion of mandibular bilateral free end saddle removable partial denture.     

The mandibular staple bone plate: a long-term retrospective evaluation

PURPOSE: Clinical and radiographic parameters and denture satisfaction were evaluated in a long-term retrospective study of patients treated with the mandibular staple bone plate. PATIENTS AND METHODS: Fifty-six edentulous patients were treated with the mandibular staple bone plate to stabilize their lower denture. The mean evaluation period was 103 months (range, 84 to 139 months). Peri-implant mucosa and bone height were scored, together with quality of the prosthesis and prosthodontic maintenance care. Denture satisfaction was assessed by using two questionnaires. RESULTS: Four staple bone plates were removed during the evaluation period, and one appeared to be fractured. The remaining 51 staple bone plates were functional without any signs of major complications (survival rate, 91%). No further alveolar resorption in the interforaminal region of the mandible took place during the evaluation period. Patients were very satisfied with the prosthetic construction. CONCLUSIONS: The mandibular staple bone plate is a good modality to stabilize the lower denture. However, endosseous implant systems are preferred because of comparable success rates with a more simple operative procedure.     

Practical implant dentistry--the mandibular removable overdenture prosthesis

The fully edentulous mandible presents functional, esthetic, and psychological challenges for the patient and the dentist. The mandibular overdenture supported by endosseous implants can provide a superior treatment modality, overcoming many of the difficulties inherent in the conventional denture. Advantages cited are increased denture retention, improved chewing efficiency, maintenance of bone height, replacement of lost anatomy, increased denture stability, reduction of soft tissue coverage and extension of the prosthesis, and easy access for hygiene maintenance. The major disadvantage rests with the patient's intolerance of a removable prosthetic design.     

The 1993 General Social Survey I: alcohol use in Canada

Natural dentitions of elderly people are often reduced and the remaining teeth are heavily restored. It is unknown whether they are satisfied or dissatisfied with this situation. To get more insight into this phenomenon 320 dentate non-institutionalized elderly subjects were clinically examined and interviewed by means of a questionnaire. Analysis of the data showed that only 13% of the subjects had at least a complete dentition from the right first molar to the left first molar; 50% had less than four occlusal units, 39% of the subjects were wearing a removable partial denture. Ninety per cent of the subjects was satisfied with the dental state and nearly all subjects mentioned they could chew well (97%), despite the fact that 91% of the subjects mentioned they had to deal with one or more dental discomforts. Satisfaction decreased significantly when the number of the occlusal units was reduced or a removable partial denture was present. The conclusion is drawn that although the dentitions of the elderly are often reduced they are, in general, satisfied with their dental state.     

Heterotopia of the mandibular third molar: a case report

A rare finding of unilateral heterotopia of a mandibular third molar was most probably caused by primary and total dislocation of the tooth base. Other possible causative factors, such as a lack of space between the mandibular second molar and the mandibular ramus or a disproportion between the base and the direction of growth of the third molar, have been considered in similar cases reported in the literature.     

Mandibular infected buccal cyst or a paradental cyst?: Report of a case

The mandibular infected buccal cyst occurs on the buccal and distal aspects of the roots of the partially or newly erupted first permanent molar. It typically affects children between the ages of 6 to 10 years and the associated first permanent molar is vital. The cyst is lined with a non-keratinised squamous epithelium with inflammatory cell infiltrate in the connective tissue. Most clinical and histological features are similar to those reported for paradental cysts.     

Exodontics

Exodontic therapy may be challenging and difficult especially if the involved tooth has minimal or no periodontal disease. Surgical methods aid the clinician's ability to perform exodontic therapy for the maxillary fourth premolar, mandibular first molar, maxillary canine, and mandibular canine. Complications of exodontic therapy may include fracture, ocular trauma, and infection.     

The study of molar furcation involvements in adult periodontitis. II. Age, sex, location and prevalence

The purposes of the study were as follows: (1) to evaluate the molar furcation involvement and number of molar correlated with age and sex; and (2) to study the relationship between the means of alveolar bone loss and associated factors of molar furcation involvements (FIs). 1102 molars (703 males and 399 females) were measured in 219 individuals (136 males and 83 females) for the alveolar bone loss and associated factors of molar furcation involvements. Based on the results, we conclude the following: (1) the higher prevalence of FI was in the mandibular first molar (94.6%), whereas the lowest prevalence of FI was in maxillary second molar; (2) except for the mandibular first molar, the prevalence of molar FI markedly increased with an increased age group (16 & 26, r = 0.335, p < 0.01; 17 & 27, r = 0.345, p < 0.01; 37 & 47, r = 0.239, p < 0.01); (3) the prevalence of molar FI was significantly higher in males than in females (p < 0.05); (4) the mean number of molar FI was significant greater in males (mean = 3.45) than in females (mean = 2.69); (5) factors such as age (r = 0.222, p < 0.01), sex, (r = 0.145, p < 0.05), number of remaining teeth (r = -0.330, p < 0.01) and molar FI (r = 0.471, p < 0.01) are strongly associated with the mean alveolar bone loss of molars.     

Infection-related mental and inferior alveolar nerve paresthesia: literature review and presentation of two cases

A review of the literature on infection-related mental and inferior alveolar nerve paresthesia is given. This is followed by 2 case reports. The first case is of a mandibular left second molar in which a chloropercha overfill puff occurred in the vicinity of the inferior alveolar canal. The tooth remained asymptomatic until 2 and 1/2 yr later, when the periapical lesion enlarged and swelling, pain, and paresthesia developed. The paresthesia resolved 2 weeks following periapical surgery. The second case is of a mandibular right first premolar in which paresthesia began 1 day after the initial endodontic treatment. The intracanal medication was formocresol on a cotton pellet that was squeezed dry. The paresthesia was treated by irrigation, antibiotics, and dexamethasone. The paresthesia lasted 7 weeks, and when it resolved the root canal was filled with gutta-percha/eucapercha. Almost 9 months later, the tooth remained asymptomatic.     

Occupational medicine on the turn of the 21st century--analysis of changes and their determinants

Cross-sectional and longitudinal studies have identified that persons wearing overdentures require regular care and maintenance of their dentures and their remaining dentition. This paper reports on a longitudinal study of the denture treatment needs of 284 dentures placed in 254 patients seen over a period of 12 years. At placement of the overdentures, baseline measurements and photographs were made by a single examiner. These measurements included evaluation of the restorations, abutment height above the gingival margin, periodontal probing depths, and oral hygiene. Denture status was evaluated by examining stability, retention, the integrity of the denture bases, and the relationship of the teeth in centric occlusion. Denture hygiene was also assessed. Based upon this examination, the subjects' denture treatment needs were determined. The majority of overdentures were well tolerated, and in general the patients were satisfied with their dentures. The most common denture treatment need was cleaning, followed by adjustment of the denture bases. Relining was a more common problem in the mandibular arch than in the maxillae. The need for occlusal adjustment did not seem to be a problem after the fifth year, but this might have been because of replacement of worn teeth or dentures. The majority of denture repairs were necessitated before the sixth year. Patients who received immediate dentures did not have greater treatment needs. Looseness of the dentures was the primary complaint, followed by sore teeth and denture-bearing tissues. In spite of their complaints, the great majority of the patients were satisfied with their overdentures.     

Mandibular soft tissue mass as the initial presentation of Burkitt's lymphoma

A six-year-old girl was evaluated for an intraoral mass of 5 months duration, which had been treated with antibiotics in a district hospital. Extraoral examination showed a firm, non-tender swelling at the angular region of the left mandible with regional lymphadenopathy. Intraoral examination revealed a mass extending from the left mandibular primary first molar to the retromolar region, interfering normal occlusion. The mass was painful and firm, peduculated and reddish in appearance. The remainder of the oral examination was unremarkable. Panoramic radiograph and CT scan showed a large multilocular radiolucency beginning from the bud of second premolar, extending to the mandibular ramus that displaced the bud of second molar. Incisional biopsy of the intraoral mass was performed and the result was reported as Burkitt's lymphoma. The child was treated with chemotherapy and radiation, with recurrence.     

A genetic study of dentin growth in the mandibular second and third molars of male mice

Although the influence of genetic and environmental factors on the completed crown size of mandibular molars in mice is well known, such influence on the growth process of the mandibular second and third molars of mice has not yet been clarified. The purpose of the present study is to examine the growth pattern of the dentinal formation and evaluate the relative contributions of both genetic and environmental factors to longitudinal dentin formation by the use of the partial diallel cross-genetic approach, the time-marking method and a computerized image measurement system. The following results were obtained: 1) the onset of dentinal formation in the second molar was on the 6-9th day after birth, while that of the third molar was on the 9-12th day after birth; 2) the best fitted growth curve of the dentinal formation for the first molar was the fifth order polynomial equation, while for the second molar the fourth order polynomial equation was best, and for the third molar the third order polynomial equation was best; 3) maternal effect strongly influenced the second and the third molar dentin growth at an early stage of postnatal growth. Thus, it could be concluded that the dentinal formation growth pattern differed among the three kinds of mouse molars while maternal environmental factors, in addition to genetic factors, played an important role in the mouse second and third molar dentin growth during the early stage of postnatal growth.     

Midazolam-fentanyl-isoflurane anaesthesia is suitable for haemodynamic and fluid balance studies in pigs

The effects of various directed forces applied by combined headgear were evaluated in this study. The study material consisted of 30 patients with Class II dental relationships and steep mandibular plane angles. Three groups of 10 patients each were formed. In the first treatment group, forces of 150 gm per side were used for the high-pull component and the cervical component. In the second treatment group, forces of 200 gm per side for the high-pull component and 100 gm per side for the cervical component were applied. In the third treatment group, forces of 100 gm per side were applied for the high-pull component and 200 gm per side for the cervical component. Distal tipping of upper molar was greatest in the third treatment group. Intrusion of the upper molar in the second treatment group and extrusion of the upper molar in the third treatment group were statistically significant. Changes in occlusal and mandibular plane angles showed significant differences between the groups.     

Guidelines for prescribing dental radiographs. United States Food and Drug Administration

Conventional endodontic therapy, necessitated by the development of a carious lesion coronal to the furcation area of a mandibular first molar tooth, and management by gingivoplasty of a resultant Grade II furcation lesion are described. In addition, the significance of radiographic changes associated with the periapical region of an undercondensed mesial root is addressed.