Should second molars be extracted?

The effect of removal of the first premolar on the facial profile is controversial, and some orthodontists prefer to extract the second permanent molar as an alternative. However, this procedure is not widely practised in spite of the many advantages claimed for it. The arguments for and against the technique are described here. Practising orthodontists should take all these arguments into account when planning treatment.     

Ectopic eruption of maxillary first permanent molars in children with cleft lip

The main aims of therapy for inflammatory bowel disease (Crohn disease) in children and adolescents are (1) the induction and maintenance of remission, (2) the correction of nutrient deficits and (3) the restoration of growth and maturation. These goals are reached with the use of a combination of therapeutic methods, including pharmacologic agents, nutritional and psychological support, and surgical intervention. The commonly used drugs sulfasalazine, corticosteroids and metronidazole have all been shown to be safe and efficacious when given to children. Newer steroid preparations that are rapidly degraded either in the target tissue or elsewhere are being studied. Of these, budesonide currently shows promise as an efficacious drug with few side effects, but its use in children needs further study. Newer 5-amino-salicylate preparations such as Asacol have been shown to be effective in children, but the number of patients studied is small. Immunomodulatory drugs such as azathioprine and 6-mercaptopurine appear to be safe and efficacious for children; cyclosporine has been used infrequently to treat refractory Crohn disease in children. The use of other agents such as methotrexate, tacrolimus, monoclonal antibodies to cytokines, antibiotics and specific dietary products such as fish oils have not been intensively studied in children with Crohn disease. Nutritional therapy remains a mainstay of treatment because it corrects nutritional deficits, replaces losses and stimulates growth.     

Guided tissue regeneration in the treatment of degree III furcation defects in maxillary molars

11 subjects with generalized periodontitis and advanced lesions in the maxillary molar regions, including bilateral mesial-distal, but not buccal, degree III furcation defects in the 1st and/or 2nd molars, were recruited for the present clinical trial. The patients were given oral hygiene instruction and full-mouth scaling and root planing. A re-examination was performed after 3 months of healing, after which the furcation involved molars were randomly selected for a GTR or conservative treatment modality. An informed consent form was signed by each participating patient. The GTR procedure involved the elevation of mucoperiostal flaps, root surface debridement, and the placement of an e-PFTE membrane at the 2 entrances of the furcation defect. The flaps were repositioned and secured. The contralateral molar was treated in an identical manner but without the placement of the teflon membrane. The patients received amoxicillin (1g x 2/day for 8 days), were placed on chlorhexidine mouth rinsing and were recalled for prophylaxis 1x every 2 weeks. The teflon membranes were removed at a 2nd stage procedure after 6 weeks. All subjects were re-examined 6 months after the regenerative procedure, and in addition, all sites were evaluated following a reentry procedure. The final examination and measurements made during the reentry procedure documented that, although some reduction in probing pocket depth and some gain in probing attachment had occurred at both test and control sites, none of the furcation defects had closed, but retained the characteristics of a degree-III furcation involvement.     

Endodontic therapy in a maxillary second molar with three buccal roots

In this study, we report a case of a four-rooted maxillary second molar in which three well-separated buccal roots were located. This case demonstrated that even though it is not common, an extra root containing an independent root canal may occur.     

Root canal treatment of a mandibular first molar with three mesial root canals

A phlebotomist with nosocomially acquired human immunodeficiency virus infection developed tuberculosis 10 months after exposure to multidrug-resistant Mycobacterium tuberculosis during a nosocomial outbreak. Healthcare workers with immunosuppression are at increased risk of tuberculosis if infected and, if exposed, should be considered for preventive therapy regardless of tuberculin skin-test status.     

Root canal morphology of maxillary permanent first molar teeth at various ages

The root canal anatomy and pulp chamber morphology of 216 maxillary permanent first molar teeth of known age was examined using a radiographic technique after infusion of the root canal system with a radiopaque sodium iothalomate gel. This technique proved to be a rapid and effective method for the examination of root canal morphology and is recommended when root canal anatomy needs to be examined before further investigations are carried out. Over 95% of palatal and disto-buccal roots contained a single root canal. The mesio-buccal root was more complex. All types of configurations were seen. Only 26% of mesio-buccal roots showed a single canal. The pulp canal in all roots appeared to narrow at an early age. In the mesio-buccal root, a definite two-directional calcification pattern was apparent in most teeth by the age of 10. The rate of progress of root formation was very variable. There was no apparent relationship between the type of canal system in the mesio-buccal root and the type of canal orifice present. The transverse cross-sectional shape of the pulp chamber was trapezoidal in 81% of teeth.     

Guided tissue regeneration in Class II furcation involved maxillary molars: a controlled study of 8 split-mouth cases

The purpose of this study was to clinically evaluate the effectiveness of polytetrafluoroethylene membranes in the healing of interproximal Class II furcation defects in maxillary molars using a surgical treatment technique based on the principles of guided tissue regeneration. Eight subjects with similar bilateral Class II furcation lesions on the mesial aspect of maxillary first molars participated in this study. Patients received initial therapy consisting of oral hygiene instructions, scaling and root planing, and occlusal adjustment if necessary. Clinical parameters evaluated included plaque index, sulcular bleeding index, probing depth, attachment level, gingival recession, and open horizontal and vertical furcation fill. An acrylic occlusal stent was used to assure reproducibility of measurements. Experimental sites received a polytetrafluoroethylene membrane following surgical exposure of the furcation. Control sites were treated in the exact same manner but without a membrane. Membranes were removed at 6 weeks after the first surgery. Reentry surgeries were performed at 9 months. Postsurgical results showed a significant improvement in probing depth, attachment level, and open horizontal furcation fill for both groups when compared to baseline values, with experimental sites performing significantly better than controls. Control sites showed a slight loss in open vertical furcation fill while experimental sites remained unchanged. This study suggests that guided tissue regeneration using polytetrafluoroethylene membranes is of some but limited value in the treatment of maxillary molar interpoximal Class II furcation lesions.     

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.     

Angiographic anatomy of the first and second segments of the maxillary artery

The problem of distinguishing rare polymorphism from deleterious mutations is an important question in molecular medicine. In order to estimate the frequency of a sequence variation, unrelated normal individuals are usually screened for the mutation concerned. A sequence variation that is not found in non-affected individuals becomes more likely to be the cause of the disease. The aim of this paper is to provide a practical estimation of the fortuitous occurrence of a private polymorphism in one or several patients. The frequency of a sequence variation is not difficult to estimate in a population. The 95% upper frequency limit of a gene variant not observed in n chromosomes is 1-n+1 square root of 0.05. This can conveniently be approximated as 3/n. While the likelihood for finding a sequence variation only in patients is easily calculated, it is practically impossible to compute the exact probability that this variation is indeed the cause of the disease.     

Crown structure of the maxillary molars in the Japanese shrew mole, Urotrichus talpoides (Insectivora, Talpidae)

The maxillary first and second molars (M1 and M2) in the Japanese shrew mole, Urotrichus talpoides, were investigated using an odontometrical approach. The mesiodistal crown diameter was larger in M1 than in M2, while the buccolingual diameter of M1 was nearly equal to that of M2. M2 was more compressed mesiodistally than M1. M1 had a large distal triangle on the stylar shelf. The mesial triangle of M2 was slightly larger than the distal triangle. Despite being smaller than M1, M2 was less variable than M1 in terms of size. The distal triangle of M1 and the mesial triangle of M2 were well developed, and thus this area, which corresponds to the inflection point of the maxillary dental arch, was most likely the center of an occlusal function.     

Sexual dimorphism in the tooth crown dimensions of the second deciduous and first permanent molars of Taiwan Chinese

Corticosteroids such as prednisone are commonly prescribed for a variety of illnesses mediated by the immune system. This paper reviews the available literature on mood symptoms during corticosteroid treatment. Few studies have used well-recognized measures of symptoms or clearly defined diagnostic criteria to characterize such mood changes. The limited data available suggest that symptoms of hypomania, mania, depression, and psychosis are common during therapy. Symptoms appear to be dose dependent and generally begin during the first few weeks of treatment. Risk factors for the development of mood instability or psychosis are not known. The similarities of the psychiatric symptoms resulting from corticosteroid treatment to the symptoms of bipolar disorder are discussed.     

The differences in the chronology and calcification of second molars between angle Class III and Class II occlusions in Japanese children

OBJECTIVE: To examine dietary selenium intake and indices of selenium status (plasma and red blood cell selenium and glutathione peroxidase activities) in apparently healthy Scottish individuals. DESIGN AND SUBJECTS: One hundred subjects, aged between 40 and 60 y, completed a seven day weighed food intake and provided blood samples for selenium status analysis. SETTING: Inverurie, Aberdeenshire, Scotland. RESULTS: Average reported selenium intake was low (43 micrograms/d). A significant number of subjects had reported intakes below the RNI. Low levels of plasma selenium were also found but no subject had values below 40 micrograms/1. Red blood cell selenium was within the reference range established for a healthy UK population. Smoking status had no consistent effect on selenium status. CONCLUSIONS: The results of the present study suggest that selenium status of certain Scottish individuals may be compromised and that further studies are warranted. SPONSORSHIP: BASF, Germany; The Tobacco Products Research Trust, UK; Scottish Office Agriculture Environment and Fisheries Department.     

In vivo fluoride profiles at different sites of buccal and lingual enamel surfaces obtained by enamel biopsy of human maxillary first permanent molars in young adults

Twenty male volunteers, average age 24 years, participated in this study. Specimens were obtained by enamel biopsy using 5 microliters of 0.5 M HClO4 for 30 s. Using a regression curve, comparisons of fluoride concentrations were made at different depths. The fluoride concentrations (mean +/- SE) at a depth of 5 microns were highest in the distobuccal (1698 +/- 136), high in the mesiobuccal (1343 +/- 122), low in the distolingual (1119 +/- 107), and lowest in the mesiolingual sites (819 +/- 78). Of the interior enamels (> or = 10 microns in depth), the distobuccal site (1330 +/- 88 parts/10(6) F at 10 microns) had a higher-concentration than all other sites. The fluoride profiles were steepest to shallowest in the order: distobuccal, mesiobuccal, distolingual and mesiolingual. There were no correlations between the enamel fluoride concentrations and the fluoride concentration in parotid saliva. It was concluded that in vivo fluoride profiles of maxillary first molars reflect the wear of the tooth surface with age and the condition of dental plaque deposition, and, to some extent, the site-specific distribution of saliva between buccal and lingual surfaces.     

Nickel-titanium versus stainless-steel finger spreaders in curved canals

Fibro-osseous lesions of the sinonasal region are relatively frequent, but those strictly confined to the nasal cavity are rare. We report an atypical fibro-osseous lesion in the nasal cavity and describe its radiological features. The differential diagnosis is discussed.     

Orthognathic surgery effects on maxillary growth in patients with vertical maxillary excess

Patients with acute renal failure in the intensive care unit have high in-hospital mortality. In this setting, decision making with regard to the initiation or discontinuation of dialysis by physicians, patients, and families is challenging because of the desire of all for the patient to recover while sparing unnecessary suffering. Decision making can be facilitated by knowledge of outcomes of the treatment of such patients in the medical literature. This knowledge assists nephrologists to distinguish those patients whose clinical situation indicates a more favorable prognosis from those whose prognosis is uncertain or definitely poor even with dialysis. This information, combined with consideration of relevant ethical guidelines, provides a framework for nephrologists to make decisions that are evidence based and ethically sound. We present and discuss two cases to show the application of evidence-based medicine and ethical considerations to decision making for patients with acute renal failure in the intensive care unit.     

Gallium-67 scanning in the differentiation of maxillary sinus carcinoma from chronic maxillary sinusitis

Gallium-67 scans of 25 patients in whom the clinical symptoms and radiographic findings were suggestive of either maxillary sinus carcinoma or chronic sinusitis proved to be valuable in the differentiation between the two disease processes. Those patients with carcinoma had positive scans, while those with sinusitis had either negative or only weakly positive scans.