Headache Attributed to Masticatory Myofascial Pain: Clinical Features and Management Outcomes

AIMS

To describe the characteristics of headaches attributed to temporomandibular disorders (TMD) and assess the effects of two management strategies used for the management of TMD on headache intensity and frequency.

METHODS

The initial sample (n=60) of this randomized controlled trial comprised patients with masticatory myofascial pain according to the Research Diagnostic Criteria for TMD (RDC/TMD), and headache. The patients were divided into two groups: group 1 received only counseling for behavioral changes, and group 2 received counseling and an occlusal appliance. A 5-month follow-up period included three assessments. TMD-related headache characteristics, eg, headache intensity (scored on a visual analog scale [VAS]) and frequency were measured by a questionnaire. Two-way analysis of variance, chi-square, Friedman, and Mann-Whitney tests were used to test for differences considering a 5% significance level.

RESULTS

The main clinical features of headache attributed to masticatory myofascial pain were the long duration (≥4 hours), frontotemporal bilateral location, and a pressing/tightening quality. Forty-one subjects (group 1, 17 subjects; group 2, 24 subjects) were included in the final analysis. There was a reduction in headache intensity and frequency, with no significant differences between groups (P>.05). The mean (±SD) baseline VAS was 7.6 (±2.2) for group 1 and 6.5 (±1.6) for group 2; final values were 3.1 (±2.2) (P<.001) and 2.5 (±2.3) (P<.001), respectively.

CONCLUSION

Headache attributed to masticatory myofascial pain was mainly characterized by long duration, frontotemporal bilateral location, and a pressing/tightening quality. Also, counseling and behavioral management of masticatory myofascial pain improved headache, regardless of the use of an occlusal appliance.

Aetiology of a diagnosis: the key to success in treatment planning

Aetiology is the cause of a diagnosis. The essential key for the determination ofaetiology is a thorough examination: the history of the problems, the crucial elements in function, and habits. Our case report involves progression of a malocclusion and aggravation of the gum recessions which resolved following root planing and fixed orthodontic correction for the underlying cause, malocclusion, without any gum graft procedures.

Porcelain laminate veneers: reasons for 25 years of success

This article discusses failures that could occur if meticulous attention is not given to details such as planning the case, conservative (enamel saving) preparation of teeth, proper selection of ceramics to use, proper selection of the materials and methods of cementation of these restorations, proper finishing and polishing of the restorations, and proper planning for the continuing maintenance of these restorations. Some concerns as to newer products and methods and their effect on the continued success of this modality of treatment are also addressed.

Dental compression syndrome and TMD: examining the relationship

Fifty years ago, McCollum and Stuart described a subtle pathology of function in the human masticatory system that was difficult to understand. That subtle pathology is the damage that results from compression of teeth. It is subtle because often the patient is unaware. It is pathologic because it applies untoward stress to the dentition, alveolar bone, and the TMJ. It is difficult to understand for many reasons: multiple etiology, few patient complaints, poor understanding of the deformations caused by DCS, the role of equilibration during treatment is unclear, and the dissimilar ways it takes its toll. For proper management of DCS, the general dentist should monitor for signs of compression and wear, educate the patient about the problem, and provide treatment. While every patient with a flattened dentition should not have their teeth dramatically altered or reconstructed, the dental profession should form a consensus that the natural, sharp morphology of teeth is superior to a flattened dentition, and should be preserved throughout one's lifetime.

Current Indications and Methods of Periodontal Splinting

The paper discusses the reasons for using periodontal splints, together with advantages and disadvantages of their use. Different splinting techniques and criteria for selecting the most appropriate method are described. The need for care in planning treatment is emphasized. It is essential that, if the degree of attachment loss is such that splinting is likely to be needed, this is taken into account in the treatment planning at an early stage.

CLINICAL RELEVANCE

Used correctly, periodontal splinting can greatly improve the comfort, prognosis and outcome for a patient with serious periodontal disease. But used incorrectly, splinting can cause further deterioration in periodontal health.

Effect of virtual articulator settings on occlusal morphology of CAD/CAM restorations

PURPOSE

Determinants of mandibular movements, like condylar inclination and incisal guidance, should be considered in the fabrication of restorations in occlusion to prevent posterior excursive occlusal interferences. The aim of this study was to investigate differences in the occlusal morphology of the right mandibular molar resulting from high, average, and low values of settings for determinants of anteroposterior and transverse mandibular movement using a virtual articulation model.

MATERIAL AND METHODS

The articulation functionalities of computer integrated restorative technology by imaging and new acquisition (CYRTINA, Oratio B.V., Zwaag, The Netherlands) were used as a tool to examine the potential effect of determinants of mandibular movement on occlusal molar design. High, average, and low values for condylar guide inclination, incisal guide angle, and intercuspal contact area (antero-posterior determinants) and laterotrusion, mandibular lateral translation and intercuspal contact area (transverse determinants) were introduced and differences in molar morphology studied. The latter was done by comparing mesiodistal and buccolingual sections of the occlusal designs. These interocclusal differences were quantified as differences in frequency of occlusal distance intervals in an interocclusal range of 1 mm, measured from the occlusal surface of the molar model. The vertical distance with which a standard crown in occlusion had to be corrected to avoid interferences was calculated.

RESULTS

Among all parameters, the ipsilateral and contralateral mandibular lateral translation, sagittal condylar guide inclination, the ipsilateral laterotrusion and the incisal guide angle give substantial occlusal surface corrections. The high setting for the ipsilateral mandibular lateral translation required most correction.

CONCLUSION

High and low setting values of mandibular movement determinants require considerable adaptation of the occlusal surface of a crown to prevent occlusal disturbances.

Soft tissue recession around implants: is it still unavoidable?--Part II

Implant therapy is a predictable method of replacing lost teeth and involves consideration of numerous surgical and restorative criteria. Part I of this article explained the behavior of the hard and soft tissue around the implant and reviewed various parameters that influence tissue remodeling. Part II emphasizes surgical factors (eg, tridimensional implant placement, platelet-rich fibrin, and the use of connective tissue grafts) and restorative factors as means of limiting soft tissue recession around implants.

LEARNING OBJECTIVES

This article discusses tridimensional implant placement and the use of connective tissue grafting to complete the aesthetic restoration. Upon reading this article, the reader should: Become familiar with how platelet-rich fibrin enables the simple, effective, and predictable management of the gap between alveolar bone and an implant. Understand the benefits of connecting the final abutment at the surgical stage and leaving it undisturbed.

Influence of buccal segment size on prevention of side effects from incisor intrusion

INTRODUCTION

Deep overbite can be corrected by maxillary incisor intrusion. The purpose of this study was to determine whether the size of the maxillary buccal segment influences the amount of steepening, extrusion, or narrowing of the buccal segments, or the rate of intrusion that occurs with maxillary incisor intrusion.

METHODS

Twenty patients, 9 to 14 years of age, seeking treatment at a private practice, were divided into 2 groups. Patients in the long buccal-segment group had maxillary buccal segments that included the canines, both premolars, and the first molars. In the short buccal-segment group, the buccal segments consisted of only the maxillary first molars. Patient records were taken at the beginning and end of maxillary incisor intrusion.

RESULTS

Intermolar width increased slightly in the short buccal-segment group and decreased slightly in the long buccal-segment group. More steepening of the buccal segment occurred in the short buccal-segment group, and more proclination of the anterior segment in the long buccal-segment group. The size of the buccal segment had no influence on the rate of incisor intrusion or on the amount of buccal-segment extrusion. In both groups, the mean amount of incisor intrusion exceeded 2 mm.

CONCLUSIONS

A buccal segment that extends from canine to first molar will help minimize the side effects of incisor intrusion.

The importance of splinting of teeth in the therapy of periodontitis

AIM

The deep periodontal disease often leads to dental mobility with further aggravation of the symptomatology. The aim of the paper is to verify the importance of splinting of teeth in the therapy of periodontitis on the basis of parameters commonly studied [probing depth (PD), bleeding on probing (BOP), plaque index], and the role of the occlusal trauma as primary factor or second leading factor in periodontal diseases.

METHODS

Thirty patients suffering from periodontitis have been treated with the splinting of teeth, neither preceded nor followed from topical and systemic pharmacological therapy, nor from surgical or non surgical treatment of the periodontal tissues involved. During the 4 visits provided by the study, T0 (0 days), T1 (30 days), T2 (90 days) and T3 (180 days), PD, BOP and plaque index have been estimated.

RESULTS

From the comparison of the T0 PD and BOP with the T3 PD and BOP, a significant improvement of these parameters is observed (P<0.05).

CONCLUSION

On the basis of the clinical data obtained in this research, the authors suggest that the therapy by means of splinting improves the prognosis of teeth affected by periodontal disease; occlusal trauma and dental mobility cause the aggravation of periodontal lesions.

Dens Evaginatus: Literature Review, Pathophysiology, and Comprehensive Treatment Regimen

Dens evaginatus (DE) is an uncommon dental anomaly, having been well documented since 1925. It occurs primarily in people of Asian descent and is exhibited by protrusion of a tubercle from occlusal surfaces of posterior teeth, and lingual surfaces of anterior teeth. Tubercles have an enamel layer covering a dentin core containing a thin extension of pulp. These cusp-like protrusions are susceptible to pulp exposure from wear or fracture because of malocclusion, leading to pulpal complications soon after eruption. Endodontic intervention of permanent teeth with immature roots is unpredic for inflamed pulps, and leaves a tooth with compromised root structure when treating necrotic pulps. Efforts to ensure root maturity have involved preventive or prophylactic treatment with varying degrees of pulp invasiveness. Treatment options have changed as technology and materials have improved. The goal is to review the literature and pathophysiology regarding DE, and present a new comprehensive treatment regimen, including a truly prophylactic approach without pulpal invasiveness. A case study of a mestizo with DE is documented. Treatment of four affected mandibular premolars exhibiting three distinct diagnostic categories will illustrate various aspects of the treatment protocol presented, and tooth morphology of the anomaly is shown to aid clinical recognition.

The major part of dentistry you may be neglecting

Observation of occlusion, providing patient education about occlusion and treatment of occlusal conditions sadly are neglected in the profession. Occlusal equilibration is one of the major treatments for occlusally oriented diseases, and I estimate that this procedure is not accomplished frequently by many practitioners. I have discussed the conditions needing occlusal equilibration and suggested procedures for the conditions. I encourage practitioners needing education in occlusion to seek it.

A clinical evaluation of the clinical remount procedure

One hundred patients were treated with complete dentures. The patients were divided into two equal groups; the first group (50 patients) received complete dentures and a clinical remount procedure was performed, while the second group received complete dentures without a clinical remount. A four point, nine scale Patient Denture Satisfaction questionnaire was used to evaluate the patients' satisfaction with their dentures. When the clinical remount procedure was used, results have shown a highly significant improvement in the comfort of the upper dentures and in the fit and comfort of the lower dentures. There was a significant improvement in the chewing ability as well. In conclusion it is highly recommended the clinical remount procedure be used because it improves the patient's satisfaction with their dentures in many important aspects as shown in this study.

Occlusal pressure pattern analysis of complete dentures for evaluation of occlusal adjustment

The purpose of this study was to investigate occlusal pressure patterns of complete denture wearers to evaluate progress of occlusal adjustment of dentures. Thirty three edentulous subjects volunteered to participate in this study. A computer-based device was used to measure occlusal pressure sequence while tapping with their new dentures. The following variables obtained from each occlusal pressure pattern were assessed: Peak Time; Duration from the onset of pressure to the maximum pressure, Unloading Time; Duration from the maximum pressure to the end of pressure, Contacting Duration; Duration from the onset of pressure to the end of pressure, Tapping Cycle; Duration from the onset of pressure to the next onset, Peak Ratio; ratio of Peak Time to Unloading Time. Recordings were performed after the occlusal adjustment at each appointment and continued until denture adjustments were completed. Variables were analyzed using ANOVA and Bonferroni. A significant decrease was seen in Peak Ratio as the occlusal adjustments progressed (p<0.05). Its coefficient of variation was constantly the lowest among variables. The coefficient of variation of Peak Ratio was significantly lower than others at the completion of the adjustment (p<0.05). It was suggested that Peak Ratio was useful for evaluation of occlusal adjustment.

Temporary Crowns: Repositioning Key as a New Technical Approach in the Clinical Relining Phase

To accomplish prosthetic rehabilitation, a series of important procedures must be followed to achieve the correct final prosthetic outcome. The protocol presented in this article proposes a different approach that involves relining the temporary crowns during the provisional phase by means of a repositioning key. This approach is especially useful for therapeutic provisional restoration in patients with temporomandibular joint disorders.

CLINICAL SIGNIFICANCE

The methodology presented allows the exclusion of arbitrary repositioning in the three-dimensional space of the provisional restoration, considering it as a fixed starting point. Our results tend to emphasize this technique not only for the ease of use, but also for the shorter time required for the occlusal fitting procedures in the final finishing phases.

Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale

Due to lack of the periodontal ligament, osseointegrated implants, unlike natural teeth, react biomechanically in a different fashion to occlusal force. It is therefore believed that dental implants may be more prone to occlusal overloading, which is often regarded as one of the potential causes for peri-implant bone loss and failure of the implant/implant prosthesis. Overloading factors that may negatively influence on implant longevity include large cantilevers, parafunctions, improper occlusal designs, and premature contacts. Hence, it is important to control implant occlusion within physiologic limit and thus provide optimal implant load to ensure a long-term implant success. The purposes of this paper are to discuss the importance of implant occlusion for implant longevity and to provide clinical guidelines of optimal implant occlusion and possible solutions managing complications related to implant occlusion. It must be emphasized that currently there is no evidence-based, implant-specific concept of occlusion. Future studies in this area are needed to clarify the relationship between occlusion and implant success.

Conformative, Re-organized or Unorganized?

'Occlusion' is presented within the concept of the articulatory system, and guidance is given on how to avoid unplanned occlusal changes. When and how to examine the occlusion is explained, and this is expanded to cover the needs of restoring a patient to the 're-organized approach'. In addition, the merits of the different types of occlusal records are discussed. In order to avoid a lengthy explanation of the terminology in the text, a glossary is appended; any term that is defined in the glossary is marked by an *.

[Study on the occlusal surface design methods of CAD/CAM all-ceramic coping crown]

OBJECTIVE

To evaluate the accuracy of occlusal surface design methods for Cerec2 CAD/CAM all-ceramic coping crown.

METHODS

Ten first molar all-ceramic crown preparations were made. Five were normal occlusion, and five were abnormal. The crown was designed by Cerec 2 CAD/CAM using three methods, namely Extrapolation, Correlation and Function, for every preparation. The Z values of mesiobuccal, mesiolingual, distobuccal, distolingual angle in marginal ridge were recorded.

RESULTS

In the normal occlusion group, there was no statistical difference among the three occlusal surface design methods (P > 0.05). In the abnormal occlusion group, there were statistical differences between the occlusal surface design methods (P < 0.05); the function method was noted to be more accurate than the others.

CONCLUSION

The results indicate that the extrapolation method can be applied to patients with normal occlusion and the function method can be applied to patients with abnormal occlusion.

Occlusal Principles and Clinical Applications for Endosseous Implants

Endosseous implant dentistry has become a predictable clinical modality. The role of the restorative dentist is to minimize overload to the crestal bone by utilizing implant occlusal principles. The prosthetic stages of treatment should follow a disciplined sequence. This article reviews occlusal principles and clinical applications for long-term success of endosseous implants.

TMJ fractures in children and adolescents: treatment guidelines

TMJ fractures must be focused not only as a cause of direct damage to osseous structures, but also of future disturbances of dentofacial development. Treatment is aimed at restoring normal joint function, occlusion and symmetry. Any disturbance of condylar cartilage will result in alteration of mandibular development. The subsequent deformity of jaw and face will depend not only on the type, intensity extent and chronology of the noxious agent, but also on the particular time of occurrence and growth activity. Thus the effect will be more decided if the disturbance occurs early in life, during childhood, when growth activity is greater and mandibular shape and size have not been assumed yet. This report will include basic information on both prevention and first aid in these types of injuries. The correct application of these precautions immediately following the trauma should improve the short and long-term outcome. Information on diagnosis and treatment of lesions of the bone and soft tissues, which may coexist with dental trauma, a critical first step in the overall management of traumatized patients, will be given. Follow-up procedures of these patients will be illustrated. The guidelines described in this paper for the treatment of traumatic TMJ fractures in children and youths are based on our clinical experience. They are intended as an aid to practioners in the management and treatment of these traumas, by professional must always use professional judgement. There are no guarantees of any positive results associated with the use of these guidelines, although it is felt that time and proper treatment will maximize the chances of success.

Making occlusion work: 2. Practical considerations

In the first of these two articles, occlusal terminology, techniques for examining the occlusion, articulators and interocclusal records were discussed. Here the authors consider some of the practical applications.

Use of a removable splint in the treatment of subluxated, luxated and root fractured anterior permanent teeth in children

AIM

The aim of this study was to evaluate the prognosis of subluxated, luxated and root fractured teeth in children treated by removable splints, designed to stabilize mobile anterior teeth and eliminate occlusal trauma due to malocclusion.

MATERIAL AND METHODS

A total of 227 traumatized anterior teeth (91 subluxated, 105 luxated and 31 root fractured teeth) treated with a removable splint were observed for 3 years. The traumatized teeth were from 79 children aged between 6-12 years (mean 8 years 5 months). If a traumatized tooth was extremely mobile, a fixed splint was first made before the impression was taken for the removable splint. Two weeks after completion of the removable splint treatment, an impression was taken again to evaluate the occlusal relationship of pre- versus post-treatment of removable splint.

RESULTS

The treatment period with a removable splint averaged 3 weeks in subluxated teeth, 3-5 weeks in luxated teeth, 4-6 weeks in apical third root fracture injuries, and more than 5 weeks in middle third root fracture injuries. All the subluxated teeth and 74.1% of the luxated teeth maintained their pulp vitality during the 3-year follow-up period. Two of 21 (9.5%) apical third root fracture teeth and three of five (60%) middle third root fracture teeth had pulp necrosis in the coronal fragments. Internal resorption was not found in any of the traumatized teeth. External replacement resorption was not found in subluxated and luxated teeth. All the root fractured teeth displayed transient external resorption around the fracture lines. The surface resorption appeared to be self-limiting and not to threaten the retention of the tooth. Inflammatory resorption was observed in teeth with pulp necrosis, but in all cases this was reversed with endodontic treatment. Eight of 23 (39%) apical third root fractured teeth displayed replacement resorption in their apical fragments, but the resorption was not serious enough to extract the tooth. No obvious alteration in the occlusal relationship was found comparing pre- and post-treatment casts. The removable splints appeared to positively affect healing after traumatic injuries, as evidenced by the low number of complications at the 3-year follow-up period.

Occlusal splints and temporomandibular disorders: why, when, how?

Occlusal splints are one form of treatment in the management of patients with a temporomandibular disorder. Appliances are often used in conjunction with other forms of treatment such as physiotherapy or medication. A variety of splints is described in the literature and the dentist must ensure that the splint prescribed is of a design that has a proven success rate for the specific diagnosis. General principles that apply to the provision of all splints are outlined in this paper.

Computer modeling of occlusal surfaces of posterior teeth with the CICERO CAD/CAM system

STATEMENT OF PROBLEM

Static and dynamic occlusal interference frequently needs to be corrected by selective grinding of the occlusal surface of conventional cast and ceramic-fused-to-metal restorations. CAD/CAM techniques allow control of the dimensional contours of these restorations. However, parameters responsible for the occlusal form need to be determined. In most articulators, these parameters are set as default values. Which technique is best for minimizing the introduction of occlusal interference in restorations has not been determined.

PURPOSE

This study investigated differences in crown structure of a crown designed in static occlusion (STA) with designs adapted for dynamic occlusal interferences. Therefore, values from an optoelectronic registration system (String-Condylocomp, KAVO), an occlusal generated path (OGP) technique and default settings (DEF) were used in the CICERO CAD/CAM system.

MATERIAL AND METHODS

Morphology of CON, DEF, and OGP crowns was compared with that of the STA crown with respect to differences in a buccolingual section and frequency of occlusal distances in an interocclusal range of 1 mm, measured from the occlusal surface of the crown.

RESULTS

All crown types fulfilled the esthetic and morphologic criteria for restorations in clinical dentistry. Difference in the morphology of the OGP crown, compared with that of the STA crown, was greater than that for the CON and DEF crowns. These differences were seen especially in the distobuccal part of the occlusal surface; however, the number of occlusal contacts was considered sufficient to stabilize occlusion.

CONCLUSION

Functional occlusion, adapted to dynamic occlusion in a CICERO crown for the first mandibular molar, can be obtained using data acquired with the String-Condylocomp registration system. The OGP technique was preferred to other techniques because of the simplicity of the technique for eliminating potential problems with opposing teeth during motion. However, this is achieved at the cost of fewer points of contact during occlusion than with the CON crown.

The double arch impression technique: a solution to prevent supraocclusion in the indirect restoration

The literature relating to inaccuracies in the mounting of casts of semi-adjustable articulators and other factors that influence the fabrication of indirect restorations is reviewed. The effects of such discrepancies often result in "high" cast restorations which require considerable adjustment clinically before definitive placement. Some solutions to "high" cast restorations are offered with indications and contraindications for their use.

Computerized occlusal management of a fixed/detachable implant prosthesis

The long-term success of an implant-supported prosthesis is related to the management of occlusal forces upon the restoration. Since implants are not anchored in bone with periodontal ligament proprioceptors, subjective confirmation by the patient is not always an accurate means of determining occlusion. A computerized occlusal analysis system has been developed to determine the timing and nature of the occlusal forces on tooth contacts. This article details the implementation of this system as an aid in the occlusal adjustment procedure of an implant-supported fixed/detachable prosthesis.

Programmed occlusal reconstruction in anticipation of tooth wear

A procedure is presented that developed posterior lateral contacts in group function, despite existence of an anterior canine disclusion. This procedure allows a smooth transition into group function as the canine is subjected to natural attrition.

Fabricating a gold occlusal platform on a removable partial denture to help prevent extrusion of mandibular incisors

A clinical procedure is presented in which a maxillary removable partial denture (RPD) replacing anterior teeth was fabricated with a cast gold anterior occlusal platform. This treatment is indicated to correct abrasion caused by extruded mandibular anterior teeth on the maxillary RPD. The advantages compared with prosthetic teeth supported by an acrylic resin base or metal-backed facings are discussed. This technique allows for development of optimal esthetics, strength, and durability, while preventing further extrusion and excessive wear of the teeth occluding against prosthesis.

Periodontal trauma and mobility. Diagnosis and treatment planning

With the dearth of well-controlled human clinical studies, it is still impossible to answer the question of whether occlusal trauma modifies the progression of attachment loss resulting from inflammatory periodontal disease and the companion questions related to the treatment of occlusal trauma and mobility. Teeth with stable mobility are apparently at no greater risk of attachment loss than nonmobile teeth. Increasing mobility is a concern that must be addressed by inflammatory control, occlusal adjustment, and perhaps some type of stabilization or splinting of the tooth in question. In addition, greater attachment gains have been noted when occlusal adjustment was included as part of surgical therapy. There is no question that aspects of occlusal therapy have an empiric base. It is incumbent on the clinician to examine for, diagnose, and treat trauma from occlusion to stabilize the dentition. Proper occlusal management assists in maintaining the patient's natural dentition in a state of health and comfortable function.

Non-crown and bridge stabilization of severely mobile, periodontally involved teeth. A 25-year perspective

It is the author's belief, after analyzing forces and stresses on the periodontium for more than 30 years, that stabilization of severely mobile teeth can retain teeth, if in health, almost indefinitely. Because these teeth are retained using restorative materials, recurrent caries is a problem that needs to be treated. Tooth loss resulting from caries can occur. In the author's 26 years of using extracoronal adhesive resins for splinting, the technology of adhesive bonding and restorative resins have been improved. Earlier shortcomings of the physical properties of these materials never dissuaded the author from recommending splinting. When the cases were presented to the patient and the referring dentist, the types of the current materials used to splint teeth were immaterial. Realizing that improvements in adhesives and resins would be developed, the near-hopeless teeth were retained. Because the elderly population is the fastest-growing segment of the population, caries control is more of a concern than it was 50 or more years ago. Because teeth are being retained longer in this cohort, and because caries has a greater potential to exist, supportive periodontal therapy and recalls and caries examination become more important.

A device to prevent jaw clenching

This article describes a device that is intended to prevent the clenching of the teeth. The principle involved is that to clench the teeth for an extended period, an intraoral vacuum must be formed and maintained. A tube or drinking straw held between the lips extending out of the mouth will prevent a vacuum. The article explains and illustrates how such a device can be made that will exploit this principle. Disadvantages and advantages are discussed.

Trans-antral temporalis transfer for the repair of adult cleft palates

Temporalis muscle transfer is a versatile technique frequently used for reconstructive procedures in the maxillofacial region. However the thickness of the pedicle may interfere with masticatory function when used anteriorly in the oral cavity. To repair full-length mid-palatal defects in fully dentate patients the flap can be passed through the maxillary sinus and combined with local repair of the soft palate, thus avoiding any occlusal trauma from the posterior teeth. The operation is a single stage procedure with low morbidity and few complications, and is a useful technique for repairing the large untreated clefts frequently encountered in developing countries. The procedure is used by members of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons Bangladesh Project who have operated in Dhaka teaching hospitals on a regular basis since 1991.

Posterior bite raising effect on the length of the ramus of the mandible in primary anterior crossbite: case report

Posterior occlusal acrylic resin blocks were bonded to the mandibular primary molars. This removes incisal interferences while correcting the anterior crossbite with Utility Archwire Appliance. Since the first permanent molars were not included in the occlusal coverage, the permanent molars were free to erupt to a new plane of occlusion. This resulted in an increased length of the ramus by 11 mm and counterclockwise rotation of the mandible is reported.

Refining cast implant-retained restorations by electrical discharge machining

The UCLA abutment was developed to create implant-retained restorations with ideal contours, excellent esthetics, and minimal vertical space requirements for restorative materials. A major drawback of this abutment is that casting inaccuracies in the lost-wax process are difficult to control. This article describes a method of refining cast implant-retained restorations by use of electrical discharge machining.

In vivo vertical forces on implants

Vertical forces applied to dental implants during oral functions have not been quantified precisely. The key problem has been the lack of suitable measuring devices. This article introduces a new technique for placing a transducer directly in the implant without any increase in vertical dimension. Results were compared to loads applied to teeth. Implants in the molar position that were fixed to a premolar with a prosthesis withstood maximum vertical forces of 60 to 120 N during chewing. Single molars and premolars carried maximum vertical forces of 120 to 150 N. Clenching in centric occlusion caused a load level of approximately 50 N for both natural and artificial abutments. Occlusal prematurities on the implant restoration that were less than 200 microns in height showed no significant increase of the implant load level.

Posterior bite raising effects on a primary anterior crossbite case

Stainless steel crowns were cemented on the mandibular primary molars to make bite raising for an anterior reversed bite case. Chewing force and MKG were recorded before and after bite raising. Data from MKG revealed that co-ordination pattern of muscle activities after bite raising became higher in masseter muscles than those before anterior reversed bite was corrected easily without any incisal interferences by using this treatment method.