Prosthetic considerations with periodontal root resective therapy, Part 1: Root amputations.

Root resective periodontal therapy is a procedure used to retain teeth needed for restorative abutments or occlusal support. Contraindications of root resective therapy include fused roots and inadequate bony support around remaining roots. When these situations exist, extraction is necessary. But in the appropriate cases, a patient with a periodontal condition resulting in alveolar bone loss in the furcation region is amenable to treatment with a predictable result using a combination of resective periodontal surgical therapy and subsequent timely prosthetic rehabilitation.

Prosthetic considerations with periodontal root resective therapy, Part 2. Hemisections.

When a root and the overlying anatomic crown are removed as a unit, this procedure is referred to as a hemisection. Hemisection of a maxillary or mandibular molar is often a means of retaining teeth needed for restorative abutments or occlusal support. This treatment can yield predictable results using proper diagnostic, endodontic, surgical, and prosthetic techniques.

The key to success: maintaining the long-term health of implants.

During the infancy years of dental implantology, the emphasis for long-term success of osseointegrated implants was the surgical phase of dental implantology. In the years that followed, the emphasis for success had switched from a purely surgical influence to focusing more on the proper fixture placement which would be dictated by the prosthetic and aesthetic needs of each particular case. In more recent years, the dental profession has recognized professional implant maintenance and diligent patient home care as two critical factors for the long-term success of dental implants. The microbiota and clinical presentation of peri-implantitis is the same as periodontitis around a natural tooth.

Aesthetic enhancement of pontic sites for fixed partial dentures.

The ridge expansion technique using tapered osteotomes can be used anywhere in the maxilla when a change in external ridge morphology would be advantageous for both aesthetics and/or proper dental implant placement. Usually subsequent to tooth loss, the maxilla is generally somewhat undercut in form. This ridge expansion technique can be used to reduce the undercut by bulging out the base of the facial/buccal plate. This would recreate the illusion of root prominences (Figure 12) or permit implant fixtures to be inserted in a more upright position. The tapered osteotomes can therefore predictably be used to expand the buccal bone to simulate the presence of a root prominence for optimal aesthetics for placement of a fixed partial denture prosthesis (Figure 13).

Implant-supported overdenture rehabilitation and progressive systemic sclerosis.

Progressive systemic sclerosis, or systemic scleroderma, is an autoimmune multisystemic disease associated with vascular abnormalities, connective tissue sclerosis, atrophy, and autoimmune changes. The complex oral problems that may develop in patients with the disease and the difficult oral access necessitate extreme care in preventing dental disease. The oral management of a patient with an edentulous mandible and progressive systemic sclerosis, using an overdenture supported by osseointegrated implants, is presented and discussed.

Vulvar intraepithelial neoplasia and skin appendage involvement.

Vulvar intraepithelial neoplasia may extend into the pilosebaceous units of the hairy and non-hairy skin of the vulva, and inadequate removal may cause treatment failure. We measured with a calibrated microscope the thickness of vulvar intraepithelial neoplasia and the depth to which it extended into the underlying pilosebaceous units of the vulvar skin. The mean thickness of vulvar intraepithelial neoplasia in 329 histologic sections from 62 cases was 0.38 mm; 99.5% of all vulvar intraepithelial neoplasia measured less than 0.77 and 0.69 mm in the hairy and non-hairy skin, respectively. Sebaceous-gland and hair-follicle involvement by vulvar intraepithelial neoplasia was 21 and 32%, respectively. The mean depth of sebaceous-gland involvement was 0.77 mm in the hairy skin and 0.50 mm in its non-hairy counterpart; 99.5% of all vulvar intraepithelial neoplasias extended less than 2.03 and 1.07 mm in the hairy and non-hairy skin, respectively. The mean depth of hair-follicle involvement was 1.04 mm; 99.5% of all hair follicles were involved less than 2.55 mm. Our findings suggest that removal of vulvar intraepithelial neoplasia to a depth of 1.0 and 2.0 mm in the non-hairy and hairy skin, respectively, is appropriate for successful treatment.

Immunohistochemical studies with monoclonal antibodies B72.3 and MA5 on histologic and cytologic specimens from benign and malignant breast lesions.

Monoclonal antibodies B72.3 and MA5 were tested by the avidin-biotin immunoperoxidase method in histologic sections of 38 benign, 22 precancerous and 22 cancerous breast lesions, as well as in fine needle aspiration (FNA) smears and cell blocks of 25 breast carcinomas. Neither B72.3 nor MA5 was specific for breast cancer cells: both also reacted with cells from benign and precancerous conditions. B72.3 as a "detector" of malignant cells or their precursors was superior to MA5, however: it was not reactive to cells in most benign breast lesions (mammary duct ectasia, fibroadenoma and ductal hyperplasia, with and without atypia). Cancerous cells had heterogeneous immunostaining with B72.3, which may lead to false-negative results in relatively hypocellular FNA samples. FNA samples prepared as both smears and cell blocks provided the most abundant cellular samples and the lowest false-negative immunostaining reaction of cancerous cells with B72.3.