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1/96. Phase II therapy for a chronic pain patient: a clinical report.

    One of the roadblocks to success in treating temporomandibular joint dysfunction (TMD) patients is an accurate diagnosis. The terms "TMJ" or "TMD" are not specific enough to provide definitive treatment. Initially the disorder must be classified as a muscular or an internal derangement problem. Once accomplished, the further diagnostic breakdown of the problem will prepare the patient and the doctor for the scope of treatment necessary and the prognosis. This lack of a specific diagnosis can lead to inappropriate treatment and inadequate communication among clinical dentists, academia and patients. Our patients and the profession will continue to suffer until a single diagnostic system is universally agreed upon and utilized. ( info)

2/96. Molarization of the lower second premolars.

    This paper presents a case of extreme tooth variation. The patient was first observed during the mixed dentition period, when she presented a mild Class II malocclusion with increased overjet and acceptable overbite. In a panoramic radiograph, the presence of lower second premolars of disproportionate dimensions was discovered. When these oversized premolars erupted, the Class I malocclusion tended toward Class III, with an edge-to-edge bite. This created an unstable occlusion and the possible need for extractions. ( info)

3/96. Form follows function: occlusion based rationale for esthetic dentistry.

    Esthetic dentistry is one of the prime essential areas in dentistry today. The purpose of this article is to address the dependent relationship between excellent esthetics and optimum occlusion. Occlusal objectives must be addressed and achieved. If one is to expect to recreate ideal esthetics, one must first thoroughly investigate, diagnose, and establish an ideal occlusal scheme. The case study within this article revisits the most imperative principle with regards to esthetics and that is: form always follows function. ( info)

4/96. The "missing link" in the origin of trigeminal neuralgia: a new theory and case report.

    Tic Douloureux (trigeminal neuralgia) has afflicted mankind for centuries, perhaps for all time. This sharp stabbing paroxysm of pain along the branches of the trigeminal nerve is described as " of the most painful problems that plagues mankind." Many theories about the cause of trigeminal neuralgia have been previously presented. Often these theories build on the previous foundations when new research presents itself. The complete picture still eludes researchers today. Much of the mechanism has been proposed, but researchers lacked one essential component. There has never been an answer to why these pains only occur in cranial segments and why, thankfully, TN is rare. What sets the stage for the development of TN? The unique neurophysiology of the trigeminal nerve and the accompanying ability of the Temporomandibular joints to create a sensitized neural system are the last piece of the puzzle. This central sensitization of the trigeminal nerve allows the development of a small cluster of neurons that act as a central trigger for the paroxysmal pain. The role of the TMJ in trigeminal neuralgia is illustrated by this case report. ( info)

5/96. Sliding plates on complete dentures as a treatment of temporomandibular disorder: a case report.

    This work presents a case report of a woman, aged 62, who presented with signs and symptoms of temporomandibular disorder (TMD). The patient reported pain in the masticatory system and examination showed a reduction in the occlusal vertical dimension (OVD). She was treated with complete dentures incorporating a modification to the posterior regions developed by the authors and which were termed "sliding plates." Through analysis of photographs taken of the patient prior to the extraction of the patient's natural dentition, sliding plates were utilized to reestablish the OVD. The sliding plates also allowed for unrestricted eccentric mandibular movements, thereby accelerating the neuromuscular deprogramming and making it possible for the mandible to adopt a more physiologic position. The dentures reduced the pain and were well-accepted by the patient. Therefore, sliding plates may be of great benefit to completely edentulous patients with painful symptoms that result from alterations in the OVD and inappropriate condylar positioning. ( info)

6/96. Nonsurgical and nonextraction treatment of skeletal Class III open bite: its long-term stability.

    Two female patients, aged 14 years 5 months and 17 years 3 months with skeletal Class III open bite and temporomandibular dysfunction are presented. They had previously been classified as orthognathic surgical cases, involving first premolar removal. The primary treatment objective was to eliminate those skeletal and neuromuscular factors that were dominant in establishing their malocclusions. These included abnormal behavior of the tongue with short labial and lingual frenula, bilateral imbalance of chewing muscles, a partially blocked nasopharyngeal airway causing extrusion of the molars, with rotation of the mandible and narrowing of the maxillary arch. Resultant occlusal interference caused the mandible to shift to one side, which in turn produced the abnormal occlusal plane and curve of Spee. As a result, the form and function of the joints were adversely affected by the structural and functional asymmetry. These cases were treated by expanding the maxillary arch, which brought the maxilla downward and forward. The mandible moved downward and backward, with a slight increase in anterior facial height. Intruding and uprighting the posterior teeth, combined with a maxillary protraction, reconstructed the occlusal plane. A favorable perioral environment was created with widened tongue space in order to produce an adequate airway. myofunctional therapy after lingual and labial frenectomy was assisted by vigorous gum chewing during and after treatment, together with a tooth positioner. Normal nasal breathing was achieved. ( info)

7/96. Restoring anterior aesthetics and occlusion.

    The use of Empress2 material in this specific case produced the strong restoration desired and allowed reproduction of natural vitality and translucency. The results offered by the material exceeded patient as well as doctor expectations. ( info)

8/96. Interesting presentation of a retained upper deciduous incisor with apical fenestration.

    A case is described where intrusion of a primary incisor resulting in apical fenestration may have occurred secondary to occlusal forces. The effects on the permanent dentition and possible aetiological factors are discussed. ( info)

9/96. Restoring esthetics and anterior guidance in worn anterior teeth. A conservative multidisciplinary approach.

    BACKGROUND: Developments in adhesive dentistry have given the dental profession new restorative materials and technology to restore esthetics and function to the worn anterior dentition. This article illustrates, through a clinical case study, the clinical requirements for restoring esthetic harmony and functional stability to the worn anterior dentition. CASE DESCRIPTION: The author presents the case of a 24-year-old man who sought esthetic dental treatment because he was unhappy with the appearance of his maxillary anterior teeth. The review of his dental history revealed that he ground his teeth at night. The author performed a complete evaluation of the causes of the patient's bruxism and created a diagnostic preview to, among other things, develop the relationship between the condylar and anterior guidance and to establish the esthetic requirements for the final restorations. Treatment included periodontal recontouring, tooth preparation and placement of temporary and then permanent restorations; the patient also was given an occlusal guard to protect the restorations against future bruxing. CLINICAL IMPLICATIONS: Whatever the cause of occlusal instability, it is important that the restorative dentist be able to recognize its signs--such as tooth hypermobility, tooth wear, periodontal breakdown, occlusal dimpling, stress fractures, exostosis, muscle enlargement and loss of posterior disclusion. When restoring the worn dentition, the clinician should bear in mind the five P's: proper planning prevents poor performance. ( info)

10/96. Treatment of periodontal destruction associated with a cemental tear using minimally invasive surgery.

    BACKGROUND: A patient presented with moderate probing depth, pain on occlusal contact, and a fistula on a mandibular bicuspid. The probing depth increased 2 mm over a 3-month period despite relief of the occlusal trauma and resolution of the fistula. A radiograph showed an apparent separation of the cementum in the area of the pocket. methods: The lesion was treated using a minimally invasive surgical approach to place a bone graft. RESULTS: The probing depth was reduced to 2 mm with less than 1 mm of increased recession. A histologic examination of the damaged calcified tissue confirmed that it was cementum. CONCLUSIONS: The increasing probing depth associated with a cemental tear seems to indicate that this phenomenon contributed to loss of attachment and bone. Removal of the detached cementum in combination with bone grafting using a minimally invasive surgical approach appears to have successfully corrected the periodontal destruction. ( info)
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