Abstract Apicoectomy is a surgical procedure requiring precise planning and access to locate apices and avoid vital anatomic structures. Traditional methods limit treatment because they rely on ...two-dimensional radiography and corrective actions during surgery. Surgical guidance, which uses computed tomography and computer-aided design and computer-aided manufacturing processing, has been utilized in dentistry, but not in endodontics. Therefore, the aim of this study was to introduce periapical surgical guidance using computed tomography and computer-aided design and computer-aided manufacturing surgical guides and to compare apical access accuracy using guidance versus a conventional method. Results showed that distance from the apex was 0.79 mm (±0.33 SD) using guidance and 2.27 mm (±1.46 SD) using freehand drilling. An error greater than 3 mm occurred over 22% of the time freehand, yet never occurred with guidance. This in vitro study suggests that greater accuracy and consistency can be achieved during endodontic surgery with surgical guidance. Advantages also include presurgical visualization in three dimensions.
Periodontal-prosthesis guidelines have long been defined to specifically address dental reconstructions after moderate to advanced periodontal disease has occurred. More recently, specific dental ...techniques and materials have shown promise in addressing patients' increasing esthetic demands. However, treatment planning to achieve pleasing results for patients with advanced periodontitis requires a complex, multispecialty approach that is rarely discussed. A case report and literature review illustrate that the original periodontal-prosthesis guidelines not only remain useful today for obtaining esthetic results but also conform to recent understanding of maxillomandibular physiology.
Background: Studies have indicated an important role for host‐derived proteases in the pathogenesis of periodontal disease. The objectives of this study were: 1) to develop an assay measuring ...protease activity in situ and 2) to localize and characterize the enzymatic activity in intact inflamed and healthy gingiva.
Methods: Gingival specimens were prepared and overlaid with a quenched fluorescent substrate. Protease activity was visualized by fluorescence microscopy and correlated with histologic features.
Results: In inflamed tissues, enzymatic activity was detected mainly in the connective tissue (predominantly matrix metalloproteases) and, to some extent, in the epithelium (predominantly serine proteases). In contrast, clinically healthy tissues failed to exhibit significant amounts of protease activity. Quantitative and qualitative characteristics of protease activity in intact tissues were found to be pH dependent.
Conclusions: The method described here enabled assessment of active proteases in intact tissues where cell‐cell and cell‐matrix interactions had been maintained. Our results indicate that there are substantial differences in the distribution of specific proteases between clinically healthy and inflamed periodontal tissues. J Periodontol 1999;70:1303‐1312.
Consistency in clinical decision making may be necessary for reliable assessment of student performance and teaching effectiveness, yet little has been done to examine variation in periodontal ...diagnosis and treatment planning among dental school faculty. The purpose of this investigation was to examine variation among faculty in diagnosis and management of common periodontal diseases. Twenty‐seven clinical instructors (periodontists, general dentists, dental hygienists, and first‐ and second‐year periodontal graduate students) reviewed three web‐based cases and answered a brief questionnaire focusing on radiographic interpretation, periodontal diagnosis, and treatment planning. Response rates for the three cases ranged from 62 percent to 70 percent. Clinical instructors’ rating of percent bone loss in the majority of cases varied between three descriptive categories for the same tooth. Greater consistency in periodontal diagnosis was noted within the graduate student group as compared to periodontal and dental hygiene faculty groups. Diagnoses offered for one of the three patients varied between gingivitis and chronic and aggressive periodontitis. Six to nineteen different treatment plans (many with subtle differences) were submitted for each of the three cases. Inter‐rater variation was qualitatively more prevalent than intra‐rater variation. To our knowledge, this is the first study to document substantial variation among instructors in radiographic interpretation, diagnosis, and treatment planning for common periodontal diseases. Qualitative judgments speculating on the impact of variability among dental school faculty on student performance and patient care can be made but as yet remain unknown. Consistent use of accepted practice guidelines and greater consensus‐building opportunities may decrease variation among faculty and enhance dental education.
The purpose of this study was to evaluate identification of the mandibular canal on scans made with the cone-beam CT scanner I-CAT®. Five unembalmed cadaver heads were imaged with the clinical ...prototype of the I-CAT®, using default parameters (120 kVp, 90 mAs, 11 cm field of view, 0.4 mm voxel size, medium sharpness filter). Two observers independently evaluated the reconstructed cross-sectional images on both sides of the specimens. The mandibular canals were categorized as: (1) easily visible; (2) visible; (3) canal not identifiable without doubt. Images of the first three living humans scanned with the clinical prototype of the I-CAT were also evaluated. For the default image reconstruction algorithm, the mandibular canal was easily visible on two sides, visible on two sides, and not readily identifiable on six sides. The mandibular canal was easily visible on both sides of the three human scans. Since the mandibular canal could be seen easily in the scans of the humans but was not readily visible on scans of cadavers, factors other than image quality are most likely involved, such as the age of the specimens and the effect of the thawing process.
This is a case report of a patient presenting to our clinic with a chief complaint of occlusal changes, but no clear-cut diagnosis of local origin could be found. The patient later was diagnosed with ...acromegaly. This rare systemic disease, caused by a slow-developing tumor of the pituitary gland, induces changes in various vital organs. Among them is a change in occlusion that can bring the patient to the dentist first. Dental professionals may be the first health care providers to see the signs and symptoms of acromegaly, and thus have the first opportunity to correctly diagnose this serious disease. This case demonstrates the importance of taking a thorough medical history and making a careful diagnosis before any dental treatment is recommended or undertaken.
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