1/3. Failure of resin ionomers in the retention of multi-rooted teeth with Class III furcation involvement: a rebuttal case report.BACKGROUND: Severe periodontal furcation invasion has long been a treatment dilemma for the clinician. Many techniques have been advocated in the treatment of multi-rooted posterior teeth ranging from conventional scaling and root planing (SRP), apically positioned flaps, root amputations, root resections, tunnel procedures, guided tissue regeneration, and restorations. The keys to success depend on the clinician's ability to access the furcation to remove local factors and create an environment that enhances the patient's own hygiene efforts. Long-term success in treating teeth with furcation invasion depends upon tooth retention and arresting the destructive processes within the furcation area. methods: A Class III furcation invasion in a mandibular molar was treated by surgical access for SRP along with obliterating the furcation utilizing a resin ionomer restoration. RESULTS: Initially, the patient was asymptomatic. Within 3 months of treatment, the patient presented with suppuration that was refractory to local efforts. Radiographs taken only 5 months postsurgery demonstrated advanced bone loss apical to the restoration. The tooth ultimately was extracted because mobility increased and the tooth became symptomatic. CONCLUSIONS: The clinician must consider the multi-factorial etiology of periodontal breakdown within a furcation. For this patient, the technique of sealing off the exposed furcation with restorative material appeared to have resulted in progressive bone loss and accelerate tooth loss. This single case report is presented as a rebuttal to recently published articles, which have demonstrated excellent results when treating furcations with ionomer restorations.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/3. Utilization of third molars in the orthodontic treatment of skeletal class III subjects with severe lateral deviation: case report.AIM: This clinical report discusses the importance and use of third molars in the adult patient by presenting a case in which their use during orthodontic treatment allowed occlusal improvement. SUBJECT AND TREATMENT PLAN: The patient was a Japanese adolescent boy who had a skeletal Class III malocclusion with severe lateral deviation of the mandible, significant loss of posterior occlusal vertical dimension, due to premature loss of the maxillary and mandibular left first molars, and furthermore, both first molars had advanced carious lesions that had resulted in reduced crown heights and bilateral chewing surfaces. The mandible had shifted to the left, with a bilateral chewing pattern and a lack of posterior vertical alveolar height, which in turn had produced an abnormal occlusal plane and curve of Spee. The maxillary arch was expanded, the maxilla was moved downward and forward, and the mandible was moved slightly backward and rotated open to increase posterior vertical alveolar and crown height. The reconstruction of a functional occlusal plane was achieved by uprighting the posterior teeth to correct asymmetric posterior vertical alveolar and crown height, using a full multibracket system incorporating four third molars and closing the space from the missing first molars and extraction of the questionable first molars. RESULTS: A normal overbite and overjet and adequate posterior support and anterior guidance were established, achieving a better intercuspation of the posterior teeth. A favorable perioral environment was created, with widened tongue space to produce an adequate airway. A well-balanced lip profile and almost symmetric face were achieved using the four wisdom teeth without extraction of the four premolars. Subsequent mandibular growth, with development of posterior vertical alveolar height and temporomandibular joint adaptation, has resulted in an almost symmetric posterior vertical height and joint structure between right and left sides. These factors have contributed to the occlusal stability maintained for more than 5 years. CONCLUSION: In the growing patient, with missing and/or early advanced caries of the first molars, it may be more beneficial to plan occlusal improvement through extraction of the questionable first molar rather than premolar extraction. This method of treatment can equalize posterior vertical dimension and does not restrict tongue space. In addition, this treatment method addresses the clinician's concern about postorthopedic relapse due to tongue habits and eruption of the third molars.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/3. Oral diseases in older adults.In the case presented, a 65-year-old man with multiple dental, medical, and social problems benefited from interdisciplinary assessment and treatment. Despite his poor oral-health status and oral-health behaviors upon admission, patient education and dental therapy resulted in improved daily oral hygiene, elimination of oral diseases, and improved oral function. The overall quality of life of any individual, particularly an older one, can be enhanced through oral-disease prevention, health promotion, and, when indicated, dental therapy. This patient was treated in a hospital environment with a well-established team approach to geriatric care. However, regardless of the care setting, the physician can play a key role in improving the oral health status and quality of life of older adults by including an oral screening examination as part of the periodic comprehensive geriatric assessment, recognizing oral pathology, requesting dental consultations and encouraging appropriate dental service utilization.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |