Annals of the Royal Australasian College of Dental Surgeons最新文献

This literature review summarizes current knowledge on the systemic levels of selected markers of inflammation in periodontitis. From the available literature it appears that the total numbers of leukocytes and plasma levels of C-reactive protein (CRP) are consistently higher in periodontitis patients compared with healthy controls. Some systemic markers of inflammation discussed in this review are also regarded as predictive markers for cardiovascular diseases. Therefore changes in these markers in periodontitis may be part of the explanation why periodontitis is associated with cardiovascular diseases and/or cerebrovascular events in epidemiological studies. It is hypothesized that possibly daily episodes of a bacteremia originating from the periodontal lesion are the cause of the changes in systemic markers in periodontitis; the overall size of periodontal lesions in the untreated severe patient may amount to 1500-2000 mm2.

Current techniques for intra-coronal bleaching of stained root-filled teeth employ oxidative bleaching with hydrogen peroxide. However, it has been shown that hydrogen peroxide and hydroxyl radicals, the by-products of the bleaching process, diffuse from the pulp chamber to the outer root surface. The control of such diffusion may be of importance in minimizing the risk of invasive cervical resorption (ICR) which has been linked to intracoronal bleaching. A novel reductive-oxidative bleaching process using a thiourea and hydrogen peroxide regimen is proposed as a more effective and safer bleaching protocol. Also, other clinical considerations during the intra-coronal bleaching of root-filled teeth are discussed.

The application of distraction osteogenesis in the maxillofacial region is gaining popularity. However, it remains controversial whether distraction osteogenesis can produce better outcomes than the conventional orthognathic surgery particularly in cleft lip and palate (CLP) patients. This paper presents the two treatment methods--conventional orthognathic surgery and distraction osteogenesis in the management of maxillary hypoplasia in CLP patients. One clinical case was selected for illustration on each method. The discussion is based on the current literature focusing on the differences in indications, surgical techniques, morbidities, relapse, speech and velopharyngeal changes.

This study identifies factors that predict for outcome and complications in patients with mouth cancer. Out of a total of 276 patients, one third received radiotherapy alone and the remainder surgery (182) of which 62 also received adjuvant radiotherapy. Factors predicting an adverse outcome at a univariate level were male gender, recurrent disease, no partner, co-existing systemic disease (abdomen and respiratory), alcohol intake, non Caucasian, stage of disease, scale of surgery, decreasing differentiation of tumour, increasing hospital stay and blood loss. On multivariate analysis, female gender, reduced scale of surgery, absence of recurrence, excess alcohol consumption, increased hospital stay and duration of surgery were predictive of improved survival. Complications occurred in 85 patients (47%). Predictive variables on univariate analysis were preexisting cardio-respiratory disease, alcohol consumption, stage of disease, nature and scale of surgery. The 5 year disease specific survival was 87% for stage I, 75% for stage II, 62% for stage III and 43% for stage IV with a 3.2% operative death rate.

Anticonvulsant drugs are the initial treatment of choice in trigeminal neuralgia. Historically, carbamazepine is and remains the gold standard. Many similarities between the pathophysiologic phenomena observed in epilepsy models and neuropathic pain models justify the rationale for the use of anticonvulsants in the management of neuropathic pain disorders. We have evidence that there is a high intensity of Gamma-aminobutyric acid transporters in the trigeminal sensory nuclei, and that Gamma-aminobutyric transporters expression was increased in the spinal trigeminal nucleus of rats after facial carrageenan injections. These are correlated with increased Gamma-aminobutyric acid uptake in the synaptosomal preparation from the spinal trigeminal nucleus of rats that received the injections and can be antagonised with glial uptake inhibitors. We conclude that Gamma-aminobutyric acid uptake inhibitors may prove to be a novel generation of GABAergic drugs for trigeminal neuralgia.

The objective of this study was to investigate the feasibility of creating archetypal 3D faces through computerized 3D facial averaging. A 3D surface scanner Fiore and its software were used to acquire the 3D scans of the faces while 3D Rugle3 and locally-developed software generated the holistic facial averages. 3D facial averages were created from two ethnic groups; European and Japanese and from children with three previous genetic disorders; Williams syndrome, achondroplasia and Sotos syndrome as well as the normal control group. The method included averaging the corresponding depth (z) coordinates of the 3D facial scans. Compared with other face averaging techniques there was not any warping or filling in the spaces by interpolation; however, this facial average lacked colour information. The results showed that as few as 14 faces were sufficient to create an archetypal facial average. In turn this would make it practical to use face averaging as an identification tool in cases where it would be difficult to recruit a larger number of participants. In generating the average, correcting for size differences among faces was shown to adjust the average outlines of the facial features. It is assumed that 3D facial averaging would help in the identification of the ethnic status of persons whose identity may not be known with certainty. In clinical medicine, it would have a great potential for the diagnosis of syndromes with distinctive facial features. The system would also assist in the education of clinicians in the recognition and identification of such syndromes.

Aims: To investigate the results of a minimally invasive approach to the management of obstructive salivary gland disease.

Materials and methods: Five hundred and thirty-seven patients with symptomatic obstructive salivary gland disease (455 calculi, 82 strictures) consisting of 330 submandibular and 207 parotid cases were treated using minimally invasive techniques. Extra-corporeal shock wave lithotripsy (ECSWL), fluoroscopically guided basket retrieval, or intra-oral stone removal under general anaesthesia, were used for salivary calculi, either alone or in combination. Strictures were treated using fluoroscopically guided balloon dilatation.

Results: ECSWL achieved complete success (stone and symptom free) in 87/221 (39%) of cases (84/218 primary, 3/3 secondary) of which submandibular 43/131, parotid 44/90. Basket retrieval cured 124/166 (75%) cases (103/136 primary, 21/30 secondary) of which submandibular 80/109, parotid 44/57. Intra-oral surgical removal provided a cure in a further 137/143 (96%) submandibular cases (99/101 primary, 36/38 secondary and 2/4 tertiary). The overall success rate for the three techniques was 348/455 (76%). Balloon dilatation resulted in complete elimination of the stricture in 44/82 (54%) and a reduction in the stricture in 32/82 (39%) and no improvement in 6/82 (7%). Review at six months showed resolution 14/32 (44%), improvement 16/32 (50%) and no change 2/32 (6%) of symptoms.

Conclusions: A minimally invasive approach to the management of obstructive salivary gland disease is to be encouraged. All four techniques described have a low morbidity and afford the possibility of retaining a functional gland.

The application of imaging modalities to head and neck oncology is addressed from a surgical perspective. The optimal use of ultrasound, CT, MRI, PET and sentinel node biopsy to the management of salivary and oral neoplasia is discussed in the context of the primary lesion, the assessment of the neck, evaluation of the recurrent lesion and management of the palliative case.