Recent advancements in ridge augmentation and bone regeneration have expanded the pool of patients that could benefit from dental implants. However, providing the patient with a temporary prosthesis during the wound heal...Recent advancements in ridge augmentation and bone regeneration have expanded the pool of patients that could benefit from dental implants. However, providing the patient with a temporary prosthesis during the wound healing phase without impairing the process is a challenging task. This article summarizes available information pertaining to provisional prostheses, both tooth-supported and soft tissue-supported, that may meet the patient needs. The advantages and disadvantages of each class of prosthesis, along with indications and contraindications, were taken into consideration to aid the restorative dentist in choosing the optimal provisional for their patients.
Tortorich J, Woods M, Shintaku W
… +1 more, Anderson KM
J Tenn Dent Assoc
· 2013 · PMID 24611215
Dentists are responsible for the diagnosis of abnormalities involving both hard and soft tissues in and around the oral cavity. In addition to a clinical examination, the radiographic evaluation will often highlight abno...Dentists are responsible for the diagnosis of abnormalities involving both hard and soft tissues in and around the oral cavity. In addition to a clinical examination, the radiographic evaluation will often highlight abnormalities within the radiographic field. A relatively uncommon radiographic abnormality is calcification of lymph nodes, which may be associated with a number of pathologic processes, both local and systemic. We present and discuss lymph node calcifications and the diagnostic considerations associated with them in order to assist practitioners in managing their patients appropriately.
Obtaining an accurate interocclusal record which relates the upper and lower jaws to one another is critical in the laboratory production of dental restorations. This may be particularly challenging when the configuratio...Obtaining an accurate interocclusal record which relates the upper and lower jaws to one another is critical in the laboratory production of dental restorations. This may be particularly challenging when the configuration of missing teeth dictate that such records are dependent on the remaining mucosal tissues for support. This article presents a practical and time saving method of using implant healing abutments, located within an edentulous distal extension space, to serve as vertical stops for an interocclusal record.
BACKGROUND: Maxillary defects are created following surgical treatment of patients with benign and malignant neoplasms, trauma or congenital defects. The size of these defects influences the degree of debilitation. CASE...BACKGROUND: Maxillary defects are created following surgical treatment of patients with benign and malignant neoplasms, trauma or congenital defects. The size of these defects influences the degree of debilitation. CASE DESCRIPTION: This patient lacks the conventional support, stability and retention when fabrication of the prosthesis is planned. The prosthesis that is used to close this palatal defect is called the hollow bulb obturator. CLINICAL OUTCOMES: It improves speech, deglutition, esthetics and function for the patient.
Communication skills have long been associated with practice success in dentistry. The Commission on Dental Accreditation's standards state that "Graduates must be competent in the application of the fundamental principl...Communication skills have long been associated with practice success in dentistry. The Commission on Dental Accreditation's standards state that "Graduates must be competent in the application of the fundamental principles of behavioral sciences" and that "Graduates must be competent in managing a diverse patient population and have...interpersonal and communications skills." A recent survey of U.S. dentists found an underutilization of communication skills by general dentists. The University of Tennessee College of Dentistry strives for continuous improvement and has implemented an innovative behavioral science curriculum to improve students' communication skills, consistent with the College's "patient-centered, comprehensive care" philosophy. We describe the design and implementation of our "Patient-Centered Dentistry" course, in which third-year dental students practice communication skills with simulated patients in the Kaplan Clinical Skills Center on the UTHSC campus. The clinical simulations involve the following scenarios: The Initial Interview with a Patient, Presenting a Treatment Plan, Treating Patients with Fear and Anxiety, Interviewing Considerations for Difficult Patients, Delivering Distressing News to Patients, and Coping with a Drug-Seeking Patient. Student simulations were videotaped and assessed by course instructors as well as clinical faculty, and students received immediate feedback by instructors and clinical faculty after their simulations. Students were provided with the opportunity to view their simulation performance and to reflect on their performance in order to recognize their communication strengths as well as areas for improvement. The use of simulation experiences is becoming a widespread and expected practice in health care education. The Patient-Centered Dentistry course provides students with the opportunity to experience the kinds of real-life situations that they would experience in dental practice, without risks to patients. It provides students with the opportunity to assess their communication skills, make mistakes and improve.
UNLABELLED: Establishing the sagittal jaw relationship is a key component to developing a diagnosis when treating an orthodontic patient. Several measurements, including the Wits Appraisal, ANB angle and nasion perpendic...UNLABELLED: Establishing the sagittal jaw relationship is a key component to developing a diagnosis when treating an orthodontic patient. Several measurements, including the Wits Appraisal, ANB angle and nasion perpendicular have been and are currently used by practitioners to diagnose the sagittal jaw relationship. Unfortunately, all of these measurements have their limitations. The Cannon Analysis was created in an attempt to help overcome these limitations. METHODS: One hundred untreated patients from the Vanderbilt University Medical Center database were selected, and their initial lateral cephalometric radiographs were digitally traced utilizing the Cannon Cephalometric Analysis. All of these patients had an orthognathic profile, a Class I occlusion and a good skeletal balance as judged by the authors. Normative values were established for the Cannon Analysis and then broken down by sex and age (8-11, 12-18, 19 and over). An example case was analyzed using the Cannon Analysis and several diagnostic scenarios were reviewed. RESULTS: The variance or difference between Porion to A Point (Po-A) and Porion to B Point (Po-B) was found to be 12.6 mm. This value remained relatively constant throughout life, with only slightly higher values for males versus females. CONCLUSION: The Cannon Analysis is an effective way to accurately establish the sagittal jaw relationship since it is not affected by the anterior / posterior position of nasion, the steepness of the mandibular plane angle, nor an improperly drawn occlusal plane.
The theory of non-carious cervical lesions (NCCLs) suggests that tooth flexure arising from cyclic, eccentric occlusal forces causes their formation and progression in vulnerable cervical regions of teeth. The etiology i...The theory of non-carious cervical lesions (NCCLs) suggests that tooth flexure arising from cyclic, eccentric occlusal forces causes their formation and progression in vulnerable cervical regions of teeth. The etiology is still controversial. Attrition, corrosion, abrasion and stress-corrosion might act alone or in combination to initiate and perpetuate lesions. This review of the literature provides the basis for the diagnosis that can be used in consideration of treatment options.
The odontogenic keratocyst (OKC) is distinctive among jaw cysts given its tendency toward recurrence and aggressive clinical behavior. This paper presents a well-documented case of OKC and a review of the diagnostic feat...The odontogenic keratocyst (OKC) is distinctive among jaw cysts given its tendency toward recurrence and aggressive clinical behavior. This paper presents a well-documented case of OKC and a review of the diagnostic features, treatment modalities and new evidence supporting the reclassification and renaming of this unique pathologic process.
UNLABELLED: Marijuana, prepared from the plant Cannabis sativa, is the most widely used illicit drug in the United States. Marijuana use has been associated with adverse psychosocial and health effects, including effects...UNLABELLED: Marijuana, prepared from the plant Cannabis sativa, is the most widely used illicit drug in the United States. Marijuana use has been associated with adverse psychosocial and health effects, including effects on oral tissues. Periodontal literature has limited references to the periodontal effects of cannabis use. In this report, we present two cases of marijuana-associated gingival enlargement and review the literature on oral complications of marijuana use. METHODS: Two asymptomatic males, aged 23 and 42 years, presented independently for oral prophylaxis. Both had an unremarkable medical history and related a history of significant marijuana use of 2-16 years duration. Common findings following oral and periodontal examination were nicotinic stomatitis-like lesions, uvulitis and gingival enlargement. Marginal and papillary gingiva of the anterior dentition were the areas primarily affected by gingival enlargement, while some of these areas exhibited a nodular or "pebbly" appearance. RESULTS: Marijuana-associated gingival enlargement was diagnosed in the reported cases. A review of the literature revealed two other reports of marijuana-associated gingival enlargement, all in young adult males with chronic (2 or more years) cannabis use. These authors reported a resemblance to phenytoin-induced enlargement. Biochemical similarities between phenytoin and cannabis active compounds suggest possible common pathogenetic mechanisms. Uvulitis and nicotinic stomatitis appear to be the two most common of the several oral manifestations of marijuana use. CONCLUSIONS: Chronic marijuana use may result in gingival enlargement with clinical characteristics similar to phenytoin-induced enlargement.
Census Bureau data indicate a continuing national increase in the number and size of dental establishments. These developments are reviewed for the State of Tennessee during the past decade, including the number of estab...Census Bureau data indicate a continuing national increase in the number and size of dental establishments. These developments are reviewed for the State of Tennessee during the past decade, including the number of establishments, employees, population per establishment and related factors.
Melanin is an endogenous pigment responsible for human tissue coloration of the skin, mucosa, hair, eyes and parts of the brain. In the skin, its function is protection from the harmful effects of UV radiation. Its purpo...Melanin is an endogenous pigment responsible for human tissue coloration of the skin, mucosa, hair, eyes and parts of the brain. In the skin, its function is protection from the harmful effects of UV radiation. Its purpose in oral tissues has not yet been determined. Oral pigmentation could be an esthetic issue for some patients, particularly when it is located on the anterior labial gingiva in individuals with a high smile line. This article presents and describes several different approaches for the management of oral melanin pigmentation.
Brandt R, Hollis S, Ahuja S
… +2 more, Adatrow P, Balanoff W
J Tenn Dent Assoc
· 2012 · PMID 22870551
BACKGROUND: The introduction of small-diameter implants has provided dentists the means of providing edentulous and partially edentulous patients with immediate functioning transitional prostheses while definitive restor...BACKGROUND: The introduction of small-diameter implants has provided dentists the means of providing edentulous and partially edentulous patients with immediate functioning transitional prostheses while definitive restorations are being fabricated. The successful use of these small-diameter implants for temporary stabilization of prostheses has led many clinicians to explore the option of using them as a definitive alternative, especially as the technique requires minimal time and also is economical for the patients. To date, there has been no study with multiple patients looking at both the subjective and objective outcomes of these small-diameter implants. MATERIALS AND METHODS: Twenty-seven edentulous patients were enrolled in this study, seven of them were smokers. One-hundred and eight small-diameter (2.0 mm, MDL) implants were surgically placed in 24 edentulous mandibles. All implants were immediately loaded. The patients filled out a screening questionnaire and four subsequent questionnaires to test their satisfaction with the altered prosthesis at 6, 12, 18 and 24 months. The survival of the implants was also noted. RESULTS: Smokers had an implant survival of 79%. Non-smokers had an implant survival of 100%. The results of the questionnaire indicated an overall satisfaction with the implant-supported prosthesis.
Rawal YB, Rosebush MS, Rawal SY
… +1 more, Anderson KM
J Tenn Dent Assoc
· 2012 · PMID 22870550
Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterized by the presence of cutaneous neurofibromas, multiple cafd-au-lait spots and pigmented nodules of the iris known as Lisch nodules. In some cas...Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterized by the presence of cutaneous neurofibromas, multiple cafd-au-lait spots and pigmented nodules of the iris known as Lisch nodules. In some cases, the diagnosis can be made at birth while in others the diagnosis is made later in life based on the appearance of additional criteria. We describe radiographic abnormalities of the mandible in a young adult male with NF1.
Gingival enlargement is common among patients and can be caused by a variety of etiological factors. The most common reason is poor oral hygiene and high bacterial load that leads to gingival inflammation and enlargement...Gingival enlargement is common among patients and can be caused by a variety of etiological factors. The most common reason is poor oral hygiene and high bacterial load that leads to gingival inflammation and enlargement. Other implicated factors include systemic drugs, such as phenytoin (Dilantin) taken by epileptic patients, calcium channel blockers such as nifedipine (Procardia) and verapamil (Calan) for the treatment of hypertension, arrhythmia and angina. Another class of medication associated with gingival enlargement is immunosuppressive agents given to organ-transplant patients to prevent rejection of the new element such as cyclosporine. Some enlargements could be associated with other conditions such as puberty, pregnancy or diabetes or be a symptom of a systemic disease (leukemia, Wegener's granulomatosis or sarcoidosis). In rare cases the cause for the enlargement is genetic and termed hereditary gingival fibromatosis (HGF). HGF is a genetic disorder characterized by a progressive enlargement of the gingiva. Histologically, the gingiva is characterized by an accumulation of dense fibrous connective tissue. This is believed to be due to an imbalance between synthesis and degradation of extracellular matrix composed mainly of collagen molecules or due to an alteration in fibroblast proliferation. Different pathogenic mechanisms have been proposed and examined over the years but no precise process has been identified. The main objective of this paper is to discuss this genetic anomaly and support it with clinical cases of a mother and her two children. It will focus on the clinical and histologic characteristics of HGF as well as known biologic and genetic features and treatment modalities.
The computer-aided design/computer-aided manufacturing (CAD/CAM) has evolved during the past 25 years, and this evolution has improved the speed and precision in which dentists can deliver high quality esthetic restorati...The computer-aided design/computer-aided manufacturing (CAD/CAM) has evolved during the past 25 years, and this evolution has improved the speed and precision in which dentists can deliver high quality esthetic restorations. CEREC is an acronym for "ceramic reconstruction" and is one of the CAD/CAM systems available to dentists in private practice. The University of Tennessee College of Dentistry was one of the first dental schools in the United States to embrace this technology and integrate it into the four-year curriculum. In a dental school setting, this technology can prove to be an educational tool for the dental students, cost effective for the University and provide exceptional service for the patients.
One of the most significant challenges in contemporary dental implant therapy involves managing the transition of the restoration from the implant through the soft tissues by means of an abutment. This article presents a...One of the most significant challenges in contemporary dental implant therapy involves managing the transition of the restoration from the implant through the soft tissues by means of an abutment. This article presents a practical technique to visualize if the selection of a custom-made abutment would be favored over the use of a manufactured standard abutment to receive crown restoration supported by a dental implant.