Wednesday, February 25, 2009

Flapless Implants and Immediate Loading : Dr Cesar Luchetti

By Dr. Cesar Luchetti from Argentina

DDS - National University of La Plata, Buenos Aires, Argentina.
MS in Oral Implantology - National University of La Plata, Buenos Aires, Argentina.
Associate Professor. Department of Implant Dentistry. National University of La Plata, Buenos Aires, Argentina.

Implant dentistry is pushing their limits towards less invasive procedures and with results in a day.

Although this is a valid approach, an adequate diagnosis is necessary to perform these cases in a secure way.

Flapless surgery is usually faster and gives more postoperative comfort to the patient. However, the adequate tridimensional position of the implants must not be sacrificed just to avoid a flap, especially in cases when bone reconstruction is needed.

Long term prognosis is influenced by a good tridimensional positioning of the implants which is determined by the biomechanical requirements of the teeth being replaced.

Immediate loading is useful because the patient retrieves the function instantaneously, but it must be done just in cases with a good initial fixation.

The following video shows a case with a flapless approach.

Implant site development was made with threaded expanders in order to increase bone density allowing a better initial fixation.

The implant used, B&W CIH (Argentina), has an implant carrier who can be adapted as an abutment. A provisory crown was made over it a few moments after surgery.

Dental Implants Video Series

Introduction to Implants
  • What are implants
  • Where to use implants
  • Time duration for completion of implants treatment
  • Outcome of implant dentistry

Thursday, February 12, 2009

Developmental Anomalies : Median Rhomboid Glossitis; Etiology Clinical Features Oral Manifestations and Treatment

The etiology is failure of retraction of the tuberculum impar before the starting of the fusion of the two halves of the tongue.
Candidal infection has been recently suggested because of isolation of fungal hyphae from the lesion.
It appears as a smooth red patch on the dorsum of the tongue.
It can be of various shapes like oval or round and sometimes irregular.
It does not contain filiform papillae.
The epithelium is hyperparakeratinized type and is devoid of papillae.
The spinous cell layer is larger than normal due to proliferation.
The rete pegs are elongated and may show branching and anastomosis.
The connective tissue shows lymphocytic infiltration.
Blood vessels and lymphatics are increase in number.
Degeneration and hyalinization of the underlying muscles.
There is no need for treatment.
Spontaneous remissions have been reported.
Nystatin and Amphotericin have shown good results in few cases.

Developmental Anomalies : Fibromatosis Gingivae; Etiology Clinical Features Oral Manifestations and Treatment

The disease is characterized by the diffuse nodular or smooth overgrowth of the gingiva.
One or both the arches can be affected.
The appearance of the gingival lesion coincides with the time of eruption of the central incisors.
Some times it has been noted at the time of birth.
It is neither painful nor hemorrhagic.
If it occurs before the eruption of the teeth it interferes with their eruption.
If it occurs after eruption then the growth is extensive enough to cover the crowns.
The epithelium is thickened with elongated rete pegs. The dense fibrous connective tissue comprises the major bulk of the lesion.
The blood vessels are few in number.
Surgery can be done to facilitate the eruption of the teeth.
Cosmetic reasons also require surgical approach.

Developmental Anomalies : Heck's Disease; Clinical Features Oral Manifestations and Treatment

It is also known as Focal Epithelial Hyperplasia.
It is mostly found in children between the age of 3 and 18 years.
The lesion occurs most commonly on the lips buccal mucosa and the tongue.
It has a sessile base and occurs in clusters.
It is soft and colour resembles that of the normal mucosa.
The size of the individual nodule is ranges from 1 – 5 mm.
Acanthosis along with thickening elongation and fusion of the rete pegs has been reported.
The connective tissue shows inflammatory cells like polymorphonuclear leukocytes and lymphocytes.
No treatment is required. Many cases have shown spontaneous regression.

Thursday, February 5, 2009

Developmental Anomalies : Fordyces Granules; Etiology Clinical Features Oral Manifestations and Treatment

The sebaceous glands sometimes ectopically develop in the various intraoral sites and are known as Fordyce’s granules.
The molar area of the buccal mucosa is the most frequent site of occurrence of the Fordyce’s granules.
They appear as small yellow spots projecting from the surface of the oral mucosa.
The histologic feature is normal and is the same as found on the skin.
Treatment is not required.
Dr. Hamid's Tip
The letters YCES of ForDYCES granules have a lot of hidden information in them.
Y – Yellow Spots
C – Concentrated near molars
E – Ectopically erupted
S – Sebaceous Glands

Developmental Anomalies : Peutz Jheghers Syndrome; Etiology Clinical Features Oral Manifestations and Treatment

The intestinal polyposis is a disease of the intestine. The polyps can be found all over in the intestine but manifest symptomatically only in the small intestine.
The patient frequently complains of abdominal pain. The examination reveals intussusception of the intestine.
The perioral skin shows numerous pigmented spots about 1-5 mm in diameters with greater concentration towards lips and gradually fading at the periphery.
The spots can similarly be concentrated at the eyes and nose also.
Intraorally buccal mucosa is most frequently affected with pigmentation while gingiva and the hard palate follow.
Previous Topic Developmental Anomalies : Cheilitis Granlomatosa
Next Topic Developmental Anomalies : Fordyces Granules

Developmental Anomalies : Cheilitis Granulomatosa; Etiology Clinical Features Oral Manifestations and Treatment

There is a diffuse, painless swelling of the lip. The adjoining soft tissues are normal but may appear erythematous sometimes.
Scaling fissuring, vesicles and pustules are less common features.
Melkersson – Rosenthal syndrome: A triad consisting of Cheilitis granulomatosa facial paralysis and scrotal tongue is known as Melkersson – Rosenthal syndrome.
There is a focal noncasseating granuloma formation. It has many epitheloid cells and Langhans type of giant cells.
The vascular channels are surrounded by an inflammatory infiltrate consisting of lymphocytes plasma cells and histiocytes.
No definitive treatment.
Previous Topic Developmental Anomalies : Cheilitis Glandularis
Next Topic Developmental Anomalies :Peutz Jhegers Syndrome

Developmental Anomalies : Cheilitis Glandularis; Etiology Clinical Features Oral Manifestations and Treatment

The opening of the accessory salivary glands on the lips become enlarged and appear as small red macules.
Enlargement of several salivary ducts lead\ to the enlargement of the lips.
Exudation of a dense fluid is found through the gland openings.
It has been classified into three types
1. Simple type
2. Superficial suppurative type also known as Bealz’s disease.
3. Deep suppurative type
The simple type is characterized by very tiny painless lesions.
The superficial suppurative type shows painless swelling, crustings and ulcerations apart from suppuration.
The deep suppurative type is painful, deep abscess formation.
A diverse array of alterations are seen in the surface epithelium as well as the submucosal tissues.
The minor salivary glands may show features of nonspecific sialadenitis.
Atrophy or distention of acini, ductal ectasia with or without squamous metaplasia, chronic inflammatory infiltration, replacement of glandular parenchyma, and interstitial fibrosis may be seen.
Suppuration and sinus tracts in cases of bacterial infection.
Edema, hyperemia, hyperkeratosis, erosion and ulceration may also be seen.
The lesion is treated surgically by stripping off the associated mucosa of the lip, or vermilionectomy.
Previous Topic Developmental Anomalies: Congenital Lip and Comissural Pits And Fistulas
Next Topic Developmental Anomalies : Cheilitis Granulomatosa