Failures in implant dentistry.

This article describes the many failures and complications that can occur when using implants to support restorations. Most of these failures can be prevented with proper patient selection and treatment planning. Implant failures can be largely classified into four main categories: 1) loss of integration, 2) positional failures 3) soft tissue defects, and 4) biomechanical failures.

Local anesthetics: dentistry's most important drugs, clinical update 2006.

Local anesthetics are the safest most effective drugs in medicine for the control and management of pain. They also represent the most important drugs in dentistry. Today, dentistry has a spectrum of local anesthetics that permit pain control to be tailored to the specific needs of the patient: short-, intermediate-, and long-acting drugs.

An interdisciplinary approach to treatment planning in implant dentistry.

The practice of implant dentistry requires an interdisciplinary approach that integrates the knowledge, skills and experience of all the disciplines of dentistry into a comprehensive treatment plan. This article outlines a comprehensive interdisciplinary treatment philosophy designed for developing the foundation of optimal aesthetics in implant dentistry. Cases are presented to illustrate the utility of interdisciplinary treatment in which specialists are recruited to enhance and improve a patient's dental function and aesthetics.

Cellular uptake of amelogenin, and its localization to CD63, and Lamp1-positive vesicles.

Proteins of the developing enamel matrix include amelogenin, ameloblastin and enamelin. Of these three proteins amelogenin predominates. Protein-protein interactions are likely to occur at the ameloblast Tomes' processes between membrane-bound proteins and secreted enamel matrix proteins.

Four oral motor disorders: bruxism, dystonia, dyskinesia and drug-induced dystonic extrapyramidal reactions.

This article reviews four of the involuntary hyperkinetic motor disorders that affect the orofacial region: bruxism, orofacial dystonia, oromandibular dyskinesia, and medication-induced extrapyramidal syndrome-dystonic reactions. It discusses and contrasts the clinical features and management strategies for spontaneous, primary, and drug-induced motor disorders in the orofacial region. The article provides a list of medications that have been reported to cause drug-related extrapyramidal motor activity, and discusses briefly the genetic and traumatic events that are associated with spontaneous dystonia.

Mesenchymal stem cell-mediated functional tooth regeneration in swine.

Mesenchymal stem cell-mediated tissue regeneration is a promising approach for regenerative medicine for a wide range of applications. Here we report a new population of stem cells isolated from the root apical papilla of human teeth (SCAP, stem cells from apical papilla). Using a minipig model, we transplanted both human SCAP and periodontal ligament stem cells (PDLSCs) to generate a root/periodontal complex capable of supporting a porcelain crown, resulting in normal tooth function.

Transitioning patients from teeth to implants.

One major obstacle to treatment with implants is the transitional phase between a tooth supported occlusion and an implant supported occlusion. This is of particular concern when a patient with a failing dentition has not worn a removable prosthesis before and is planning to have a reconstruction supported by implants.

Connecting implants to teeth.

Osseointegrated implants have proven to have a high degree of success in the edentulous arches. This success has been replicated in partially edentulous arches. When natural teeth are present, it can be tempting to fabricate restorations using support from both implants and natural teeth.

Designing abutments for cement retained implant supported restorations.

In another article in this series the authors' preference for screw retained implant supported restorations was presented together with a literature review and rationale.(1) There remain situations when screw retention is not possible due to implant position, implant trajectory, aesthetics or function.

Genomic distribution and functions of uptake signal sequences in Actinobacillus actinomycetemcomitans.

Actinobacillus actinomycetemcomitans is naturally competent for transformation, with a transformation system similar to that of Haemophilus influenzae that preferentially takes up DNA bearing uptake signal sequences (USS) with the same 9-base USS core. This study examined the function of the extended 29-base USS, which comprises a highly conserved 1st region (containing the 9-base core) and 2nd and 3rd semi-conserved AT-rich regions, in transformation of A. actinomycetemcomitans.

Maturogenesis of a cariously exposed immature permanent tooth using MTA for direct pulp capping: a case report.

Successful direct pulp capping of cariously exposed permanent teeth with reversible pulpitis and incomplete apex formation can prevent the need for root canal treatment. A case report is presented which demonstrates the use of mineral trioxide aggregate (MTA) as a direct pulp capping material for the purpose of continued maturogenesis of the root. Clinical and radiographic follow-up demonstrated a vital pulp and physiologic root development in comparison with the contralateral tooth.

Screw versus cemented implant supported restorations.

Implant supported restorations can be attached to implants with screws or can be cemented to abutments which are secured to implants with screws. Screw retained implant restorations are the authors' preferred method of securing restorations to implants. This article will be written from this perspective and the advantages and disadvantages of each method of retention will be discussed under the following headings: Aesthetics, Retrievability, Retention, Implant placement, Passivity, Provisionals, Occlusion, Immediate loading, Impression procedures, Long term treatment planning.

Histologic evaluation of implants following flapless and flapped surgery: a study in canines.

Background: Flapless surgery requires penetration of the alveolar mucosa and bone without reflection of mucoperiosteal flaps. Do these techniques force gingival tissue or foreign materials into osteotomies? If so, do such tissues or materials interfere with osseointegration? A proof-of-principle study using a canine model attempted to answer these questions.

Methods: Five young adult Hound Labrador mongrel dogs received implants with a moderately roughened surface by anodic oxidation using flapless or conventional one-stage (control) surgery in contralateral jaw quadrants.

Treatment planning of the edentulous mandible.

Edentulism can be a debilitating handicap. Zarb described endentulous individuals who could not function as 'denture cripples'.(1) Most difficulty with complete denture prostheses arises from the inability to function with the mandibular prostheses.

Medical management of oral motor disorders: dystonia, dyskinesia and drug-induced dystonic extrapyramidal reactions.

This article reviews three of the involuntary hyperkinetic motor disorders that affect the orofacial region, namely orofacial dystonia, oromandibular dyskinesia, as well as medication-induced extrapyramidal syndrome-dystonic reactions. Specifically, it discusses and contrasts the clinical features and management strategies for spontaneous primary and drug-induced motor disorders in the orofacial region. The article provides a list of medications reported to cause drug-related extrapyramidal motor activity above and beyond the more commonly known antipsychotics medications.

Using oral medications, infusions and injections for differential diagnosis of orofacial pain.

Chronic orofacial pain is a rapidly evolving and challenging field that deals with the management of pain originating from neurogenic, osseous, muscular, or vascular structures of the head and neck. The challenge lies in the accurate diagnosis of orofacial pain conditions, which may be difficult to differentiate in many clinical situations. As pain cannot be "seen" or precisely located or its intensity measured with any device, clinicians must rely heavily on the patient's own description of type, duration and location of pain, and thus, history plays a crucial role in diagnosis.

Diagnostic imaging for chronic orofacial pain, maxillofacial osseous and soft tissue pathology and temporomandibular disorders.

Since dentists can be faced by unusual cases during their professional life, this article reviews the common orofacial disorders that are of concern to a dentist trying to diagnose the source of pain or dysfunction symptoms, providing an overview of the essential knowledge and usage of nowadays available advanced diagnostic imaging modalities. In addition to symptom-driven diagnostic dilemmas, where such imaging is utilized, occasionally there are asymptomatic anomalies discovered by routine clinical care and/or on dental or panoramic images that need more discussion. The correct selection criteria of an image exam should be based on the individual characteristics of the patient, and the type of imaging technique should be selected depending on the specific clinical problem, the kind of tissue to be visualized, the information obtained from the imaging modality, radiation exposure, and the cost of the examination.

Burning mouth syndrome: an update on diagnosis and treatment methods.

Burning mouth syndrome is characterized by both positive (burning pain, dysgeusia and dysesthesia) and negative (loss of taste and paraesthesia) sensory symptoms involving the lips and tongue, mainly the tip and anterior two-thirds. BMS patients report a persistently altered (metallic) taste or diminished taste sensations. Acidic foods such as tomatoes and orange juice cause considerable distress.

Persistent orodental pain, atypical odontalgia, and phantom tooth pain: when are they neuropathic disorders?

Patients with unrelenting pain in the teeth, gingival, palatal or alveolar tissues often see multiple dentists and have multiple irreversible procedures performed and still have their pain. Up to one-third of patients attending a chronic facial pain clinic have undergone prior irreversible dental procedures for their pain without success. In these cases, if no local source of infectious, inflammatory, or other pathology can be found, then the differential diagnosis must include a focal neuropathic pain disorder.

Immediate implant placement: treatment planning and surgical steps for successful outcomes.

Diagnosis and treatment planning are key factors in achieving successful outcomes after placing and restoring implants placed immediately after tooth extraction. The efficacy of immediate implant placement has been established and shown to be predictable if reasonable guidelines are followed. Some or all of the following suggestions, depending on individual circumstances, should be considered when evaluating a patient for dental implants: thorough medical and dental histories, clinical photographs, study casts, periapical and panogram radiographs as well as a linear tomography or computerised tomography of the proposed implant sites.

Establishment and characterization of an immortomouse-derived odontoblast-like cell line to evaluate the effect of insulin-like growth factors on odontoblast differentiation.

Insulin-like growth factors (IGF-I and IGF-II) play important roles in regulating growth and differentiation of many different organs including teeth. The presence of these factors in the developing tooth has been demonstrated. In vitro studies using tooth explants grown in the presence of IGFs suggest that they promote differentiation of ameloblast and odontoblasts cells.

A novel saliva test for caries risk assessment.

A new saliva test for caries risk assessment introduced in this study integrates a variety of host factors to predict for children, individual risk levels that are tooth-group specific. These various host factors correlate with caries history, DFT (decayed and filled teeth) or DFS (decayed and filled surfaces) in young adults. The test is based on the pattern of genetically determined oligosaccharides present on salivary glycoproteins.

Treatment planning of implants in the aesthetic zone.

Aesthetic restoration of anterior teeth with implant supported restorations is one of the most difficult procedures to execute. Bone resorption following anterior tooth extraction often compromises gingival tissue levels for the implant restoration. In the last 10 years the focus has shifted from osseointegration, to creation of an implant borne restoration which is in harmony with the surrounding hard and soft tissue.

Treatment planning of implants in posterior quadrants.

Differences in anatomy and biomechanics make treatment of posterior quadrants with dental implants substantially different to that of anterior areas. Without implants, when posterior teeth were lost, treatment options included a long span fixed partial denture or a removable prosthesis, especially when no terminal abutment was available. Today, with the use of implants, options are available that allow preservation of unrestored teeth.