Wound Healing

Stages of Wound Healing

1- Haemostasis Stage:
few minutes upon injury, the platelets (thrombocytes) tends to aggregate at the wound site to form what is called "fibrin clot" that controls the bleeding to finish the process of hemostasis.

2- Inflammatory Stage:
Vasodilatation and increase in vascular permeability occurs in 0-3 minutes, where inflammatory cells enter the wound site from the blood. Neurtophils and Phagocytes release cytokines that tends to remove infections and dead tissue by phogocyting the bacteria, while the phagocytosed bacteria and dead cells will cause migration, proliferation and collagen production.

3- Proliferation Stage:
Angiogenesis: New blood vissels are formed from the vascular endothelial cells.
Granulation tissue formation and fobroblasia: fibroblasts grow and form what is called "provisional extacellular matrix" by excreating collagen and fibronectin.
Re-Epithelialization of the epidermis: where the epithelial cells will proliferate to cover the wound
Contraction: is the grip of the wound edges together by the action of the myofibroblasts (contains Actin) to become smaller.

4- Remodeling and Maturation:
The collagen is remodelled and realigned along tension lines and cells that are no longer needed are removed by apoptosis.

--------------------

 Factors affecting Wound Healing:

 1- Local Factors:

• Mechanical Factors
• Edema
• Ischemia and Necrosis
• Foriegn Bodies
• Low Oxygen Tension

2- Systemic Factors:

• Inadequete Perfusion
• Inflammation
• Nutrient
• Metabolic Diseases
• Immunosuppression
• Connective Tissue Disorders
• Smoking

-------------------

Types of wound healing:

1- Primary Intension Wound Healing:
Healing by epithelialization when the wound edges are brought together by sutures (stitches),staples or adhesive tape, causing fast healing with no scaring left behind.
Examples: well-repaired lacerations, well reduced bone fractures, healing after flap surgery

2- Secondary Intention Wound Healing:
Healing by granulation tissue when the wound is covered with a gauze or use a drainage system , causing slower healing time, with larger scar formation results after healing, where the patient should always be care to encourage wound debris removal to allow for granulation tissue formation.
Examples: gingivectomy, gingivoplasty, tooth extraction sockets, poorly reduced fractures.

3- Tertiary Intention Wound Healing:
The wound left purposly opened, with 4-5 days of cleaning, debriding and observing for any abnormal changes (delayed primary closure OR secondary suturing), then sutured.
Examples: healing of wounds by use of tissue grafts.

-------------------------------

Complications of Wound Healing:

1.  Deficient Scar Formation: Result in wound dehiscence or rupture of the wound due to inadequate formation of granulation tissue.
2. Excessive Scar Formation: Hypertrophic scar, Keloid, Desmoid.
3. Exuberant Granulation (Proud Flesh).
4. Deficient Contraction (in skin grafts) or excessive contraction (in burns).
5. Others: Dystrophic calcification, pigmentary changes, painful scars, inscisional hernia etc.

------------------------

 If You Have Any Other Useful information, Please Feedback us
If You Have Any Questions In The Topic, Please Don't be Hesitate To Ask Back ..

Authored By,
:: World Of Dentistry :: TEAM

Fordyce Granules

Description:
Fordyce granules appear as flat or elevated yellow plaques just beneath the mucosal surface. The most common site is buccal mucosa although they may be found anywhere in oral mucosa. Development of the oral glands parallels those of the skin, reaching maximum numbers at puberty. Eighty percent of the population are affected. The number of granules is quite variable. Fig. 1 illustrated a large number of granules on buccal mucosa.

Etiology:
They are normal sebaceous glands and considering they are found in approximately 80% of the population, should be considered normal anatomic structures.

Differential Diagnosis:
The clinical
appearance is characteristic

Prognosis:
Good

Treatment:
No treatment is required for Fordyce granules, except for cosmetic removal of labial lesions. Inflamed glands can be treated topically with clindamycin. When surgically excised, recurrence does not occur. Neoplastic transformation is very rare but has been reported.
------------------------------------

If You Have Any Other Useful information, Please Feedback us
If You Have Any Questions In The Topic, Please Don't be Hesitate To Ask Back ..

Authored By,
:: World Of Dentistry :: TEAM

Eosinophilic Ulcer Of The Oral Mucosa

- Description:
Eosinophilic ulcer of the oral mucosa (also known as "Eosinophilic ulcer of the tongue," "Riga–Fede disease," and "Traumatic eosinophilic granuloma") is a condition characterized by an ulcer with an indurated and elevated border. The lesion might be tender, fast-growing and the patient often not be aware of any trauma in the area.

- Definition
Traumatic eosinophilic granuloma of the tongue (TEGT) is a reactive condition that commonly occurs on the ventral tongue.

 - Causes
It is often associated with trauma. However, other causes are suspected, such as drugs, inherent predisposition, immune reaction, or lymphoproliferative disorder.

- Differential Diagnosis
Squamouce Cell Carcinoma, Pyogenic granulomas, Lesions of a chronic granulomatous disease and Mesenchymal tumors

- Treatment
When the lesion is excised, recurrence often occurs. Palliative care with nonsteroidal anti-inflammatory drugs (NSAIDs) may be used, and topical steroids can be curative. If the lesion does not respond to treatment, biopsy is required.


------------------------------------

If You Have Any Other Useful information, Please Feedback us
If You Have Any Questions In The Topic, Please Don't be Hesitate To Ask Back ..

Authored By,
:: World Of Dentistry :: TEAM

Osteoporotic Bone Marrow Defect

- Description:
It is a localized increase of hematopoietic bone marrow that creates a radiolucent radiographic defect.
They occur more commonly in women in the midyears and show a predilection for the molar region of the mandible.
They are especially common in extraction sites.
Scattered trabeculae may extend short distances into the defect or, in some instances, through it giving the defect a fairly characteristic appearance. Naturally there are no clinical symptoms.

- Etiology:
The etiology remains unknown.

- Treatment:
No treatment is required.

- Prognosis:
Good

- Differential Diagnosis:
This defect may easily be mistaken for a cyst or tumor. In those cases, Biopsy is required.

------------------------------------

If You Have Any Other Useful information, Please Feedback us
If You Have Any Questions In The Topic, Please Don't be Hesitate To Ask Back ..

Authored By,
:: World Of Dentistry :: TEAM

Idiopathic Osteosclerosis

Definition:
Focal radiodensity of the jaw which is not inflammatory, dysplastic, neoplastic or a manifestation of a systemic disease.
It's an area of dense but normal bone in the jaws, which is usually painless and discovered by Routine Dental Radiographic Examination.

Description:
Osteosclerosis may occur anywhere in the jaws.
Most commonly, it appears to be attached to a tooth, specially around roots and inter-radicular.
The shape ranges from round to linear streaks to occasional angular forms.
They are more common in the mandibular molar-premolar area.
They are usually discovered on radiographs taken during the course routine dental care.
It appears in 5% of population, most commonly in the teen of 20s.

Etiology:
A reaction to past trauma or infection but it's difficult to rule out in some cases.

Treatment:
Because osteosclerosis is not a disease, no treatment is required. If there is doubt about the diagnosis, periodic X-rays are taken. Although some lesions may slowly enlarge, most remain
unchanged with time.

Prognosis:
Good

Differential Diagnosis:
Condensing osteitis, sclerosing osteomyelitis, cementoblastoma, hypercementosis.
Condensing osteitis may resemble idiopathic osteosclerosis, however, associated teeth are always
nonvital in condensing osteitis.

------------------------------------

If You Have Any Other Useful information, Please Feedback us
If You Have Any Questions In The Topic, Please Don't be Hesitate To Ask Back ..

Authored By,
:: World Of Dentistry :: TEAM

Torus Palatinus and Torus Mandibularis

- Description:
Bony exostoses found in midline of the hard palate and on the lingual aspect of the mandible.
It may be inherited whereas others say it's environmental.
The exostoses start in childhood and reach its peak in Adolescence.
Once they have reached to the full size, their growth stops.
In the mandible, they may form a row of nodules.
In most individuals they occur bilaterally.
In the palate, they may form a cluster of nodules, divided by deep grooves.
It has been estimated that palatal tori occur in 20-35% of the population. Mandibular tori are less common, about 10% of the population are affected.

 - Etiology:
Tori are developmental over-growths of normal bone and as previously stated they may be inherited.

- Treatment:
Not causing symptoms, and do not require removal, unless interferes with prosthetic appliances.

- Prognosis:
Good 

- Occurrence:
Torus Palatinus 20-35% Of population.
Torus Mandibularis 10% Of population.

------------------------------------

If You Have Any Other Useful information, Please Feedback us
If You Have Any Questions In The Topic, Please Don't be Hesitate To Ask Back ..

Authored By,
:: World Of Dentistry :: TEAM

Varix

- Descriptions:
- Appear as red, blue, or deep purple broad-based elevations in oral mucosa.
- An enlarged and convoluted vein, artery, or lymphatic vessel.
- The size is usually less than 5 mm.
- Most commonly found in buccal mucosa, however, they are also found in lip mucosa and ventral and lateral mucosa of the tongue and floor of the mouth.
- On ventral tongue they are apt to be multiple and is termed “caviar tongue”.
- They are seen more commonly in the elderly.

- Etiology:
The reason for venous distention and convulsion is unclear but may be related to weakening of the vessel wall secondary to aging.

- Treatment:
None usually required. They often thrombose but this is of little clinical consequence.

- Prognosis:
Good

- Differential Diagnosis:
Mucocele, hemangioma and angina bullosa hemorragica.
---------------------------------------

If You Have Any Other Useful Information, Please Feedback us.
For Any Questions, Please Don't be Hesitate to ask back ...

Yours,
:: World Of Dentistry :: TEAM

Lymphoid Aggregates

 
- Description:
- Small, slightly elevated nodules that may be normal colored or have a slight yellow-orange hue.
- Most commonly found on soft palate.
- Found anywhere in the mucosa but are especially common where the mouth meets the throat and the base of the tongue.
- This lymphoid rich area has been called Waldeyer’s ring. When they occupy the same area as the foliate papillae.
- In the tongue they have been referred to as “lingual tonsils.”

- Etiology:
They are normal structures, components of Waldeyer’s ring.

- Treatment:
None required.

- Prognosis:
Good. They may enlarge or regress in relationship to oral or upper respiratory infections.

- Differential Diagnosis:
Although foliate papillae and lymphoid aggregates of lingual tonsils may occupy the same area, they are different entities.

----------------------------------------

If You Want To Share More Information About Topic You Can Feedback Us
For Any Questions, Please Don't hesitate to ask back ...

Yours,
:: World Of Dentistry :: TEAM

Oral Lichen Planus (OLP)

 

- It's an inflammatory condition that affects mucous membranes inside your mouth.

- It may appear as white, lacy patches; red, swollen tissues; or open sores, and These lesions may cause burning, pain or other discomfort.

Etiology:
It's an autoimmune condition that is mediated by the T-Lymphocyte that attacks the stratified squamous epithelium which leads to hyperkeratosis with erythema or striations.
While the lichenoid eruptions are some unwanted reactions to some drugs.

Causes:
The main cause is still unknown, where the pathogen is still not fully involoved, but it may be:
1- allergic reactions to medications for high blood pressure, heart disease and arthritis, in such cases termed drug-induced lichenoid reactions.
2- complication of chronic hepatitis C virus infection.
3- a sign of chronic graft-versus-host disease of the skin (Lichenoid reaction of graft-versus-host disease)
4- true lichen planus may respond to stress.
5- Reactions to amalgam fillings may contribute to the oral lesions very similar to lichen planus
6- can be part of Grinspan's syndrome, alopecia areata, dermatomyositis, lichen sclerosis et atrophicus, morphea, myasthenia gravis, primary biliary cirrhosis, ulcerative colitis, and vitiligo.

Clinical Picture:
Affecting most commonly the females >40 years old and the children.
It's Bilaterally symmetrical.
Appears in the Buccal mucosa, lateral aspect of the tongue and Gingiva.
Appears as white striations, white papules, white plaques, erythema, erosions or blisters.

Clinical Patterns:
- Reticular Pattern
- Papular Pattern
- Plaque-like Pattern
- Erosive Pattern
- Atrophic Pattern
- Bullous Pattern

Appearance:
1- Lacy, white, raised patches of tissues, OR
2- Red, swollen, tender patches of tissues, OR
3- Open sores.

Location:
1- Inside of the cheeks, the most common location (Bilateral)
2- Gums
3- Tongue
4- Inner tissues of the lips
5- Throat
6- Esophagus

Histology:
- Hyperkeratosis, Elongated Rete Pigs, Saw-tooth Appearance, Prominent Glandular-cell appearance, Acanthosis and basal cell liquefaction.
- Lymphocytes Located just beneath the epithelium

Other signs or symptoms:
- A metallic taste or a blunted taste sensation if the tongue is affected
- Dry mouth
- Difficulty swallowing if the throat or esophagus is affected
- Sensitivity to hot or spicy foods
- Bleeding and irritation with tooth brushing

Other types of lichen planus:
1- Skin: Lesions usually appear as purplish, flat-topped bumps that are often itchy.
2- Genitals: Lesions on external genitalia resemble those affecting the skin. Lesions affecting the mucous membrane of the vagina resemble those affecting the mouth.
3- Scalp: When skin lesions appear on the scalp — a rare condition — they may cause temporary or permanent hair loss.
4- Nails: Lichen planus of the toenails or fingernails, also rare, may result in ridges on the nails, thinning or splitting of nails, and temporary or permanent nail loss.

Infection and Recurrence:
- Oral lichen planus can't be passed from one person to another.
- It tends to be a recurrent disease in teenagers and adults varying from one person to another, and are thought to be triggered by exposure to sunlight, febrile diseases, physical and psychogenic trauma, and other irritants.
- Patients who suffer recurrent intraoral herpes are few, tend to occur as vesicles followed by small ulcers, mainly on the hard palate mucosa and often follow trauma to the area, such as palatal injections or periodontal therapy.

Treatment:
- This is a chronic condition that is somehow difficult to manage, but, we should make our best to heal lesions and to lessen pain or other discomfort.
 - Drugs that are used are: Corticosteroids, Retinoids, Nonsteroidal ointments and Addressing triggers.

- Corticosteriods: To reduce the inflammation, but increases the side-effects that are to be managed, for example:
if the corticosteroids are given topically, then increases the risk of oral thrush, so that anti-fungal medication are to be prescribed to the patient, although, Long-term use of topical corticosteroids may also cause suppression of adrenal gland function and a lessening of the treatment effect.
if the corticosteroids are given orally, then the long-term use can cause weakening of the bones (osteoporosis), diabetes, high blood pressure, high cholesterol and other serious side effects.
 if the corticosteroids are given in Injections, then administered directly into lesions and repeated use can cause some of the same side effects as oral corticosteroids.

- Retinoids: are synthetic versions of vitamin A that can be applied as a topical ointment or taken orally. The topical treatment doesn't cause the same side effects associated with corticosteroids, but it may irritate the mucous membranes of your mouth. Retinoids should not be given to pregnant females and who are planning to be pregnant in the near future.

- Nonsteroidal ointments: Examples of these topical medications include tacrolimus (Protopic ointment) and pimecrolimus (Elidel cream)

- Addressing triggers: That it might be related to other causes such as Drugs, Hepatitis C, Stress and Allergen.
if related to Drugs: then stop the drug or use an alternative.
if related to Hepatitis C: then should be referred to infection or liver specialists.
if related to Stress: then should be referred to a psychotherapist, psychiatrist or other specialist in mental health car.
if related to Allergen: then should be advised to avoid the allergen, and may need to see a dermatologist or an allergist for additional treatment.

Prognosis:
- The disease may last for years, few patients with oral lesions experience spontaneous remission.
- Topical drugs provide relief but not a cure. Systemic steroids are effective but there is the risk of adverse effects and the disease may recur following discontinuance of therapy.

Differential Diagnosis:
- Squamous Carcinoma (dysplasia) "DSCQ"
- Lupus Erythematosus "SLE"
- Benign Mucous Membrane Pemphigoid "BMMP"
- Candidiasis
- Lichenoid Drug Eruptions.

------------------------------

This Article is authored by :: World Of Dentistry :: TEAM

For more informations and questions please don't be hesitate to ask back.
for support, you'll be most welcomed.

Yours,
:: World Of Dentistry :: TEAM

Foliate Papillae

Description:

Foliate papillae appear as an area of vertical folds and grooves
Located on the posterior-lateral surface of the tongue.
They are occasionally Misdiagnosed as tumors or inflammatory disease.
They are usually bilaterally symmetrical.
Sometimes they appear small and inconspicuous, whereas they may be prominent.
Lingual tonsils are found immediately beneath the foliate papillae and, when hyperplastic, cause a prominence of the papillae.

ETIOLOGY:

They are normal anatomical structures.

TREATMENT:

None required.

PROGNOSIS:
Good

DIFFERENTIAL DIAGNOSIS:
Hyperplastic lingual tonsils, squamous carcinoma, soft tissue tumors.

---------------------------

Authored By:

:: World Of Dentistry :: TEAM

Mandibular Fractures

Classification of Mandibular Fracture

• According to the type of fracture:

1. Simple

2. Compound
3. Comminuted
4. Pathological

• According to the site of fracture:
1. Dento alveolar
2. Condyle
3. Coronoid
4. Ramus
5. Angle
6. Body
7. Parasymphysis
8. Symphysis

• Another classification:
1. Unilateral fracture
2. Bilateral fracture
3. Multiple fracture
4. Comminuted fracture

• According to the treatment point of view:
1. stable fracture
2. Unstable fracture

Fracture of Mandibular Condyle: Clinical Features and Management

Clinical feature:

Common features:
1. Swelling over the TMJ area
2. Hemorrhage from the ear
3. Tenderness of the affected area
4. Edema
5. Restricted condylar movement
6. Anaesthesia & parasthesia of lower lip
Occlusal feature:

Unilateral Fracture :
1. Unilateral crossbite
2. Premature contact

Bilateral Fracture :
1. Bilateral crossbite

Management:

Treatment : 

It may be surgical & non surgical.

Non surgical approach:
Condylar facture without or with minimum displacement:
• No active treatment
• Restricted movement & soft diet for 10-15 days followed by active movements

In case of deviation of mouth on opening without much occlusal discrepancy:
• Muscle training
• Class II elastic traction on the involved side
• Vertical elastic forces on normal side

In case of condylar over riding:
• Elastic traction
• IMF for 2-3 weeks
• Early mobilization

Surgical management:
When there is-
• Facture & dislocation in the auditory canal
• Anterior dislocation with restricted mandibular movement
• Bilateral condylar factures associated with a comminuted Le fort type III craniofacial dysfunction.

-------------------------------

Authored By:
:: World Of Dentistry :: TEAM

Le Fort Complex Fractures

Le Fort I Fracture : Clinical features & Management

Le Fort I fracture is also known as low level fracture or, dento-alveolar fracture. The Le Fort I fracture line is “It starts from the lateral wall of the floor of the base of the pyriform aperture, crosses laterally over the alveolar bone& ends by fracturing the lower 3rd of the pterygoid plate“.

Clinical feature:
1. Disharmony of the occlusion: anterior open bite, cross bite, reverse over jet etc
2. Swelling & edema of the lower part of the face including the upper lip.
3. Pain of the affected part, especially during speaking & moving the jaw.
4. Mobility of the dento-alveolar portion of the jaw.
5. Ecchymosis & epistaxis may be present.

Treatment:
After proper initial management Treatment is done by-
• IMF along with zygomatico-mandibular suspension wiring
• Open reduction followed by internal fixation by transosseous wiring & miniplate osteosynthesis.

Le Fort II fracture: Clinical features & Management

Le Fort II fracture is also known as mid-level fracture or, Sub zygomatic fracture. The Le Fort II fracture line is “It starts mid portion of the nasal bone as well as frontal process of maxilla & lacrimal bone. Then it appears in the floor of the orbit, runs anteriorly fracturing the inferior orbital rim & then passes downwards through the infraorbital foramen or, medial to it. Then it curves laterally below the zygomatic buttress & then fractures the posterior wall of maxilla & mid portion of the pterygoid plate “.

Clinical feature:
1. Epistaxis
2. Diplopia
3. Enopthalmus
4. Exopthalmus
5. Subconjuntival hemorrhage
6. Periorbital ecchymoses

Treatment:
After proper initial management Treatment is done by-
• Open reduction by sub cilliary or, sub conjunctival or, infraorbital rim incision & fixation of the fragmented bones by transosseous wiring & miniplate osteosynthesis. During this procedure assurance of the Diplopia correction is a must.
• For the control of epistaxis, nasal pack is needed.
• IMF along with zygomatico-mandibular suspension wiring
• If the orbital floor fracture is gross, then antral pack is needed especially for correction of Diplopia.

Le Fort III fracture: Clinical feature & Management

Le Fort III fracture is also known as high level fracture or, Supra zygomatic fracture. It is mainly separation of the face from the cranial base. The Le Fort III fracture line is- “The fracture or separation starts from the root of the nasal bone, runs laterally & posteriorly to the orbit. The optic canal & supra orbital fissures area are fractured and reaches the lateral wall of the orbit and fractures the front-zygomatic suture & finally separate the pterygoid plate from its roots“.

Clinical feature:
1. Lengthening/ hooding of the face
2. Epistaxis
3. CSF rhinorrhoea
4. Diplopia
5. Enopthalmus
6. Exopthalmus
7. Subconjuntival hemorrhage
8. Periorbital ecchymoses

Treatment:
After proper initial management Treatment is done by-
• Open reduction followed by internal fixation. By bicoronal incision lateral eyebrow incision along with incision over the root of the nasal bon
• After reduction CSF rhinorrhoea stopping is ensured
• Antibiotics to prevent meningitis
• IMF along with zygomatico-mandibular suspension wiring

-----------------------------

Authored By:
:: World Of Dentistry :: TEAM

Broken Orthodontic Braces

Braces often get damaged in some way throughout the course of treatment. Although most kids are pretty careful (or lucky), we have cases of broken braces from time to time. It is very common to have some kind of problem with braces--be careful, but expect some normal problems. Here are a few of the most common:

1. Loose Bracket- The bracket comes loose from the tooth (very common). It usually stays attached to the wire but tends to roll around or move some. This is usually not an emergency. The bracket (or a new one) can be re-bonded at the next orthodontic appointment (hint--let the office know ahead of time).

2. Wire poking - Sometimes the wire slides around to one side and can cause discomfort in the back part of the mouth and cheek. This seems to occur in the earlier stages of treatment when the teeth are beginning to move and the wire straightens out. However, it can happen anytime. Usually the wire is clipped off or the wire slid back around into place with a simple adjustment.

3. Appliance Loose/Off- Sometimes an orthodontic band, space maintainer, expander, or other dental appliance may come loose from the tooth. If only one part or side is loose, it often just moves up and down, but can be re-cemented. Sometimes the appliance is damaged and needs repair or replacement.

4. Band Broken or Appliance Damaged- Orthodontic ligatures, bands or other attachments can become damaged and create an ulcer on the soft tissues of the cheek, lips or tongue.

5. Traumatic Injury- If the lips are traumatized into orthodontic hardware, they can become "stuck" in the braces. A gentile tug can free the lip. Otherwise, the dentist can free the tissue. Braces can actually protect the teeth in cases of major trauma, preventing teeth from being knocked out or more severely displaced.

-------------------------------

Note: If You have any Suggestions about the Topic, Please Don't hesitate to comment ...

Shared By:

:: World Of Dentistry :: TEAM

Dental Composite Resin :: In Details ...

Definition

Dental composite resins are types of synthetic resins which are used in dentistry as restorative material or adhesives. Synthetic resins evolved as restorative materials since they were insoluble, aesthetic, and insensitive to dehydration and were inexpensive. It is easy to manipulate them as well. Composite resins are most commonly composed of Bis-GMA monomers or some Bis-GMA analog, a filler material such as silica and in most current applications, a photoinitiator. Dimethacrylates are also commonly added to achieve certain physical properties such as flowability. Further tailoring of physical properties is achieved by formulating unique concentrations of each constituent.Unlike Amalgam which essentially just fills a hole, composite cavity restorations when used with dentin and enamel bonding techniques restore the tooth back to near its original physical integrity.

Composition

Dental composite resin.
As with other composite materials, a dental composite typically consists of a resin-based oligomer matrix, such as a bisphenol A-glycidyl methacrylate (BISMA) or urethane dimethacrylate(UDMA), and an inorganic filler such as silicon dioxide (silica). Compositions vary widely, with proprietary mixes of resins forming the matrix, as well as engineered filler glasses and glass ceramics. The filler gives the composite wear resistance and translucency. A coupling agent such as silane is used to enhance the bond between these two components. An initiator package (such as: camphorquinone (CQ), phenylpropanedione (PPD) or lucirin (TPO)) begins the polymerizationreaction of the resins when external energy (light/heat, etc.) is applied. A catalyst package can control its speed.

Advantages

The main advantage of a direct dental composite over traditional materials such as amalgam is improved aesthetics. Composites can be made in a wide range of tooth colours allowing near invisible restoration of teeth. Composites are glued into teeth and this strengthens the tooth's structure. The discovery of acid etching (producing enamel irregularities ranging from 5-30 micrometers in depth) of teeth to allow a micromechanical bond to the tooth allows good adhesion of the restoration to the tooth. This means that unlike silver filling there is no need for the dentist to create retentive features destroying healthy tooth. The acid-etch adhesion prevents microleakage; however, all white fillings will eventually leak slightly. Very high bond strengths to tooth structure, both enamel and dentine, can be achieved with the current generation of dentine bonding agents. The downside[vague] to composite when compared to amalgam is a shorter lifespan of the filling, and the high likelihood of requiring root canal therapy if the failure of the filling is not caught quickly. Amalgam fillings may crack a portion of the tooth off, but otherwise tend to fail at a much slower rate.

Disadvantages

Composite resin restorations have several disadvantages: They are technique-sensitive meaning that without meticulous placement they may fail prematurely. They take up to 50% longer to place than amalgam fillings and are thus more expensive. In addition clinical survival of composite restorations placed in posterior teeth has been shown to be significantly lower than amalgam restorations.[1].
Survival and reasons for failure of amalgam versus composite posterior restorations placed in a randomized clinical trial.

Direct dental composites

Direct dental composites are placed by the dentist in a clinical setting. Polymerization is accomplished typically with a handheld curing lightthat emits specific wavelengths keyed to the initiator and catalyst packages involved. When using a curing light, remember that the light should be held as close to the resin surface as possible, a shield should be placed between the light tip and the operator's eyes, and that curing time should be increased for darker resin shades. Light cured resins provide denser restorations than self-cured resins because no mixing is required that might introduce air bubble porosity.
Direct dental composites can be used for:

• Filling gaps (diastemas) between teeth using a shell-like veneer or
• Minor reshaping of teeth
• Partial crowns on single teeth

Indirect dental composites

This type of composite is cured outside the mouth, in a processing unit that is capable of delivering higher intensities and levels of energy than handheld lights can. Indirect composites can have higher filler levels, and are cured for longer times. As a result, they have higher levels and depths of cure than direct composites. For example, an entire crown can be cured in a single process cycle in an extra-oral curing unit, compared to a millimeter layer of a filling.
As a result, full crowns and even bridges (replacing multiple teeth) can be fabricated with these systems. A stronger, tougher and more durable product is likely.
Indirect dental composites can be used for:

• Filling cavities in teeth, as fillings, inlays and/or onlays
• Filling gaps (diastemas) between teeth using a shell-like veneer or
• Reshaping of teeth
• Full or partial crowns on single teeth
• And even bridges spanning 2-3 teeth

Composite shrinkage

Composite resins have a notorious reputation for shrinking upon curing, however, uses as a dental restorative material focus on low shrinkage composites. Composite shrinkage can be reduced by altering the molecular and bulk composition of the resin. For example, UltraSeal XT Plus uses Bis-GMA without dimethacrylate and was found to have a shrinkage of 5.63%, 30 minutes after curing. On the other hand, this same study found that Heliomolar, which uses Bis-GMA, UDMA and decandiol dimethacrylate, had a shrinkage of 2.00%, 30 minutes after curing.[3] In the field of dental restorative materials, reduction of composite shrinkage is a "hot topic". Soon to be introduced are patent pending, is a safe, non-leaching antimicrobial agent which minimizes recurrent decay of the tooth and reduces the harmful effects of micro-organisms and which some may cause gingivitis and periodonttitis (periodontal disease).

--------------------------------

Note: If You Have Any More Useful Information About the Topic, Please Comment ...

Shared By:
:: World Of Dentistry :: TEAM

Odontogenic Mandibular Cysts

1- Periapical cyst (Radicular Cyst)
2- Lateral Periodontal Cyst
3- Dentigerous cys
4- Primordial cystResidual cyst
5- Lateral periodontal cyst
6- Gingival cyst of the newborn
7- Gingival cyst of the adul
8- Odontogenic keratocyst (keratocystic odontogenic tumor)
9- Gorlin Cyst Syndrome (Calcifying Odontogenic Cyst)
10- Basal cell nevus syndrome
11- Mandibular Infected Buccal Cyst (MIBC - buccal bifurcation cyst - Paradental cyst)
12- Glandular Odontogenic Cyst (GOC - Sialo-Odontogenic Cyst)

---------------------------------

Note: If You can Find more Odontogenic Mandibular Cysts, please support us by commenting ...

Authored By:
:: World Of Dentistry :: TEAM

Temporomandibular Joint Dysfunction and Pain Syndromes (MFPDS)

Synonym:

TMJ pain dysfunction syndrome, myofascial pain disorder, myofascial pain-dysfunction syndrome, facial arthromyalgia, craniomandibular dysfunction, Costen's syndrome

Definition:

Temporomandibular disorders (TMDs) refers to a group of disorders affecting the temporomandibular joint (TMJ), masticatory muscles and the associated structures.These disorders share the symptoms of pain, limited mouth opening and joint noises.

Epidemiology

Temporomandibular joint symptoms are relatively common, occurring in 10-25% of the population; only about 5% of people with symptoms will seek treatment. Temporomandibular disorders may occur at any age, but are more common in women and in early adulthood.

Aetiology

TMJ disorders are thought to have a multifactorial aetiology, but the pathophysiology is not well understood. Causes can be classified into factors affecting the joint itself, and factors affecting the muscles and joint function. The American Academy of Orofacial Pain has also produced a diagnostic classification.

Factors affecting muscles and joint function - myofascial pain and dysfunction

This type of TMJ problem is most common. Often it is difficult to determine a single cause, but contributing factors may be:

• Chronic pain syndromes or increased pain sensitivity.
• Psychological factors may contribute (as with other chronic pain syndromes).
• Muscle overactivity: bruxism1 (jaw clenching at night); orofacial dystonias.4
• Dental malocclusion was formerly considered to be an important factor; indeed TMJ dysfunction was often considered as a dental problem. However, the evidence does not support this, and TMJ dysfunction is now seen as a multifactorial problem rather than a dental condition.1,5

Factors affecting the joint

The most common problems are:

• Intra-articular disc derangement (various types)
• Osteoarthritis
• Rheumatoid arthritis

Other problems affecting the joint are:

• Other types of arthropathy, e.g. gout, pseudogout or spondyloarthropathy
• Trauma
• TMJ hypermobility or hypomobility
• Infection
• Congenital disorders, e.g. branchial arch disorder
• Tumours (rare)

Symptoms

The three cardinal symptoms of TMJ disorders are: facial pain, restricted jaw function and joint noise.

• Pain:
  • Located around the TMJ, but may be referred to the head, neck and ear.
  • Pain, located immediately in front of the tragus of the ear, projecting to the ear, temple, cheek and along the mandible, is highly diagnostic for temporomandibular disorder.
• Restricted jaw motion:
  • May affect mandibular movement in any direction.
  • Jaw movements increase the pain.
  • Patients may describe a generally tight feeling, which is probably a muscular disorder, or a sensation of the jaw "catching" or "getting stuck", which usually relates to internal derangement of the joint.1
• Joint noise:
  • Clicks and other joint sounds are common; they are not significant unless there are other symptoms.

Other symptoms:

• Ear symptoms - otalgia, tinnitus, dizziness.
• Headache.
• Neck pain.
• "Locking" episodes - inability to open or close the mouth. Inability to open the mouth is more common.

Examination

• Palpate the joint by placing the fingertips in the preauricular region just in front of the tragus of the ear. The patient is then asked to open their mouth and the fingertip will fall into the depression left by the translating condyle.
• Palpate head, neck and masticatory muscles for areas of tenderness
• Joint clicks or grating sounds on jaw movement may be palpable, or may be heard with a stethoscope over the preauricular area.
• Assess mandibular movement:
  • Measure the distance of painless vertical mouth opening, using inter-incisal distance (normal range 42-55 mm)
  • Observe the line of vertical jaw opening: straight or deviating, smooth or jerky
  • Examine lateral movements and jaw protrusion
• Assess other orofacial structures - salivary glands, oral cavity, dentition, ears and cranial nerves.

Differential diagnosis

• Giant cell arteritis (temporal arteritis).
• Cardiac pain (angina and acute coronary syndromes) can radiate to the neck and jaw, but is usually more acute.
• Dental problems.
• Trigeminal neuralgia.
• Migraine and other causes of headache.
• Herpes zoster.
• Other ENT disorders, e.g. salivary gland disorders and ENT neoplasms.

The location of the pain helps in diagnosis. The pain in TMDs is centred immediately in front of the tragus of the ear and projects to the ear, temple, cheek and along the mandible.1

Investigations

No tests may be needed in straightforward cases. Possible investigations are:

• Blood tests: ESR, CRP for inflammation.
• Plain radiographs - show gross bony pathology such as degeneration or trauma.
• CT or MRI scan of the joint. MRI scan shows the soft tissues and intra-articular disc well.
• Diagnostic nerve block.6
• Arthroscopy.

Management

• Initial care is usually with conservative treatment, which is effective in most cases.
• Psychological aspects of pain management are important7 - as with other chronic pain andsomatisation disorders.
• Surgical intervention may be used in selected cases, where there is structural pathology not responding to conservative treatment.
• With symptoms of locking: intermittent locking often responds to conservative treatment. A 'closed lock' (difficulty opening the mouth) which is longstanding, is more likely to need intra-articular steroid injection or arthroscopy.

Non-invasive (conservative) treatment

Non-drug treatment

• Explanation and reassurance:
  • Most TMJ disorders are benign and will improve with non-invasive treatment.
• Rest, patient education and self-care:
  • Limit excessive jaw movement by eating soft foods. Avoid wide yawning, singing, and chewing gum.
  • Massage affected muscles and apply heat.
  • Use relaxation techniques; identify and reduce life stresses.
• Occlusal splints:
  • These are also known as "bite guards", and are removable devices made by dentists, to be worn over the teeth, on the principle that they may help with malocclusion or bruxism. Some studies have shown benefit from these, although systematic reviews did not find evidence of benefit.8,9
• Other treatments:7,10,11
• Acupuncture may be helpful, but the evidence is not conclusive.12

• Physiotherapy
• Behavioural techniques, e.g. postural training, biofeedback and proprioceptive retraining.

Drug treatment

• Analgesics, non-steroidal anti-inflammatory drugs and/or muscle relaxants.
• Antidepressants:
  • Tricyclic antidepressants, e.g. starting with a low or moderate bedtime dose for 2-4 weeks; if helpful, continue for 2-4 months and then taper down to a low maintenance dose.
  • An alternative is a newer antidepressant such as a selective norepinephrine reuptake inhibitor, e.g. duloxetine.
  • Selective serotonin reuptake inhibitor (SSRI) antidepressants have been used, but some (fluoxetine and paroxetine) may increase bruxism and are not recommended.
• Benzodiazepines have been used, but there is a risk of dependence.
• One small case study suggested that tiagabine may be helpful for bruxism.13

Invasive treatments

• Intra-articular injection, using steroid or hyaluronic acid.14,15 The effectiveness of hyaluronic acid is uncertain.16
• Surgery may be indicated for some patients, mainly when conservative treatments are not successful. It is usually supported by non-invasive treatment before and afterwards.17 Surgical options include:
  • Therapeutic arthroscopy.
  • Arthrocentesis.
  • Removal of loose bone fragments.
  • Reshaping the condyle.
  • More complex procedures, including joint replacement,6 depending on the pathology involved.
• Botulinum toxin A (BtA) injections:
  • These may help when excessive muscle activity or dystonia is a major factor. This method has been used successfully to treat both excessive clenching and recurrent TMJ dislocation.4However, a literature review of BtA use in chronic facial pain suggested that it was no better than other treatments.
  
  
  -------------------------------
  
  
  Shared By:
  :: World Of Dentistry :: TEAM

Enamel lamellae, Tufts & Spindles

Enamel lamellae:

Type of hypomineralized structure in teeth that extend either from the dentinoenamel junction (DEJ) to the surface of the enamel, or vice versa. In essence, they are prominent linear enamel defects, but are of no clinical consequence. These structures contain proteins, proteoglycans, and lipids.

------------------------------

Enamel tufts:

Small, branching defects that are found only at the DEJ, and so differ from lamellae which can be facing either direction and are strictly linear.

------------------------------

Enamel spindles:

Linear defects, they can be found only at the DEJ, because they are formed by entrapment of odontoblast processes between ameloblasts prior to and during amelogenesis.


:: World Of Dentistry :: ADMINS

Management Of Patients with Renal Failure and Kidney Dysfunction

Befor oral surgery :

1- preview Lab Values to detect any bleeding diathesis

2- Monitor Blood Pressure

3- Avoid Nephrotoxic drugs ... Ex: Aspirin, NSAID

4- Decrease the doses of drugs Metabolized in the kidney

5- Aggressively manage the oro facial Infections

6- Enssure that the parients recieving Hemodialysis not undergo rurgery for at least 4 hrs to avoid heparin-induced bleeding

Drugs to be Avoided:

1- Nehrotoxic Drugs ( Ex: Aspirin, NSAIDs

2- Drugs Converted to toxic metabolites ( Ex: Meperidine )

3- Drugs contain excessive electrolytes ( Ex: Penicilin G )

Analgesics to avoid:

1- Aspirin

2- Acetaminophen

3- NSAID's

4- Meperidine

5- Morphine

Antibiotics to Avoid:

1- Cephalosporines.

2- Tetracycline.

3- AminoGlycosides.

4- Erythromycin.

-----------------------------

Authored By:
:: World Of Dentistry ::

Welcome To :: World Of Dentistry ::

First Of All, I'd like to start this new project that is related to the Dental Education Field

:: World Of Dentistry :: Blog

World Of Dentistry is an educational blog to release daily dental topics in all the subjects of Dentistry concerning students, interns and other dental stuff

First Described in Facebook as a FanPage

:: World Of Dentistry :: Facebook FanPage

 

Then, Admins thought that the blog site will be more helpful to spread out more knowledge in the Dental Field

Hope this blog to be useful for you all

Follow, Connect and keep in touch

To Get Benefit

Yours,

Dr. Osama Zourob

Dr. Mahmoud El Masry

:: World Of Dentistry :: ADMINS