Combination of real-time needle-tip pressure sensing and minimal intensity stimulation limits unintentional intraneural injection during an ultrasound-guided peripheral nerve block procedure: A randomized, parallel group, controlled trial.

Study Objective: Ultrasound guidance does not eliminate the risk of intraneural injection, which must be avoided during PNB. Combining ultrasound guidance (USG), nerve stimulation (NS), and injection pressure monitoring is advocated to prevent nerve injury during PNB. We hypothesized that combining patient-tailored dynamic NS and real-time pressure sensing (RTPS) could reduce the incidence of intraneural injection and nerve puncture during USG PNB compared with a traditional fixed thresholds (Control) procedure.

A New Definition of Attached Gingiva Around Teeth and Implants in Healthy and Diseased Sites.

There is a need to modify the definition of attached gingiva (AG) as it applies to healthy and diseased teeth and implants. There are two parts to this new definition: Part A is when the biologic width is supracrestal (epithelial attachment and gingival fibers) and is attached to a healthy tooth or tissue-level implant, and the zone of AG is measured from the base of the sulcus to the mucogingival junction (MGJ); Part B is when the biologic width is subcrestal-as with infrabony defects on periodontally involved teeth, periodontally involved tissue-level implants, and bone-level implants placed at or below the bone crest-and the zone of AG is measured from the bone crest (not the base of the sulcus) to the MGJ. Further, what the AG is actually attached to around teeth and different types of implants, and the clinical significance of these differences, are thoroughly discussed.

Objective Epidural Space Identification Using Continuous Real-Time Pressure Sensing Technology: A Randomized Controlled Comparison With Fluoroscopy and Traditional Loss of Resistance.

Background: Performance of epidural anesthesia and analgesia depends on successful identification of the epidural space (ES). While multiple investigations have described objective and alternative methodologies to identify the ES, traditional loss of resistance (LOR) and fluoroscopy (FC) are currently standard of care in labor and delivery (L&D) and chronic pain (CP) management, respectively. While FC is associated with high success, it exposes patients to radiation and requires appropriate radiological equipment.

Layperson's Esthetic Preference to the Presence or Absence of the Interdental Papillae in the Low Smile Line: A Web-based Study.

Purpose: To determine the layperson's esthetic preference to the visual display (presence) or lack thereof (absence) of the interdental papillae during minimum smiling or the low smile line patient type.

Materials And Methods: Two hundred lay-people were shown three-paired smile images indicative of a low gingival smile line patient type in which the vermillion border of the maxillary lip covered the mid-facial gingiva of the anterior teeth. The three images differed only with respect to [1] presence of interdental papillae, [2] absence of the interdental papilla ("black triangle"), or [3] absence of the interdental papillae (replaced with a long restorative contact area).

Flapless Postextraction Socket Implant Placement: The Effects of a Platform Switch-Designed Implant on Peri-implant Soft Tissue Thickness-A Prospective Study.

This paper presents the results of a prospective study on the clinical effect of grafting the buccal gap with platform switching, following flapless tooth extraction and immediate implant placement and provisional restoration, on (1) alterations in buccolingual ridge dimension and (2) midfacial peri-implant soft tissue thickness. Fifty-six patients were placed in one of four treatment groups: (1) a non-platform-switching implant (Non-PS, n = 14); (2) a non-platform-switching implant and bone graft (BG/Non-PS, n = 14); (3) a platform-switching implant (PS, n = 15); and (4) a platform-switching implant and bone graft (BG/PS, n = 13). Buccolingual ridge dimensional change and peri-implant soft tissue thickness at 2 mm below the free gingival margin were measured.

Subclassification and Clinical Management of Extraction Sockets with Labial Dentoalveolar Dehiscence Defects.

Immediate implant therapy involving implants placed into intact Type 1 extraction sockets has become a consistent clinical technique. The classification of Type 2 extraction sockets, where the mucosal tissues are present but there is a midfacial osseous dehiscence defect, has been described according to the extent of the buccal bone plate absence. The literature has offered different techniques in the treatment of Type 2 sockets; however, the extent of the defect has never been defined or delineated.

A novel prosthetic device and method for guided tissue preservation of immediate postextraction socket implants.

Preservation of the surrounding hard and soft tissues associated with an immediate postextraction socket implant to replace a nonrestorable tooth in the esthetic zone is one of the greatest challenges facing the dental team. Several studies have documented the biologic and esthetic benefits of bone graft containment with either a custom healing abutment or provisional restoration. Use of a prefabricated shell that replicates the extracted tooth at the cervical region can help achieve guided tissue preservation and sustainable esthetic outcomes in an easy, simple, consistent, and less time consuming way.

Maxillary anterior papilla display during smiling: a clinical study of the interdental smile line.

The purpose of this research was to quantify the visual display (presence) or lack of display (absence) of interdental papillae during maximum smiling in a patient population aged 10 to 89 years. Four hundred twenty digital single-lens reflex photographs of patients were taken and examined for the visual display of interdental papillae between the maxillary anterior teeth during maximum smiling. Three digital photographs were taken per patient from the frontal, right frontal-lateral, and left frontal-lateral views.

A biometric approach to aesthetic crown lengthening: part II--interdental considerations.

Optimizing the aesthetic outcome for patients requiring periodontal aesthetic restorative treatment has become a primary objective in contemporary dentistry. Techniques that simplify and enhance quality of treatment provide substantial benefits to patients and clinicians. This article describes new concepts associated with interdental changes due to alterations in tooth and contact area position, and addresses the need for treatment of the interdental papillae.

A biometric approach to aesthetic crown lengthening: part I--midfacial considerations.

Although human dental anatomy is taught in university curricula, clinicians often witness restorations that are not proportional to one another. Dental restorations should also be proportional to periodontal supporting tissues as an essential aspect of dental anatomy. Measurements can be performed directly on a patient's teeth with aesthetic gauges used to confirm the correct position of the supporting osseous topography.

A prospective clinical patient study evaluating the effect of increasing anesthetic volume on inferior alveolar nerve block success rate.

Objective: The purpose of this study was to clinically evaluate an anesthetic technique in which a second cartridge was reloaded in a traditional dental syringe and reinjected at the same site in regard to success rate of the attempted inferior alveolar nerve block. During the same appointment, a computer-controlled delivery system was used on the opposite side of the same patient to administer 2 cartridges as well. Successful anesthesia and time efficiency of the traditional syringe and computer-controlled technique were then evaluated and compared.

Single-tooth anesthesia: pressure-sensing technology provides innovative advancement in the field of dental local anesthesia.

This article will review standard techniques for intraligamentary injection and describe the technology and technique behind a new single-tooth anesthesia system. This system and technique represents a technological advancement and a greater understanding of intraligamentary anesthesia.

Interstitial tissue pressure associated with dental injections: a clinical study.

Objectives: The purpose was to measure the interstitial fluid pressure generated from tissue resistance during administration of local anesthetic solution at 4 anatomic locations within the oral cavity and to determine whether differences in soft tissue density affect interstitial fluid pressure when anesthetic solution is administered at a fixed flow rate.

Method And Materials: A computer-controlled local anesthetic delivery device (CompuFlo, Milestone Scientific) that records and stores pressure data during a subcutaneous injection was used. Subjects consisted of adult patients seeking routine dental care that required local anesthesia.