[Use of root-end filling materials in a surgical apical endodontic treatment in the Netherlands]. / Gebruik van vulmaterialen bij een chirurgische apicale endodontische behandeling in Nederland.

The material to be used for closing the root canal when carrying out a retrograde surgical apical endodontic treatment continues to be a subject of discussion. The aim of the present study was to inventory which materials are being used for this purpose at this moment by Dutch O&MF surgeons. All practicing Dutch OM&F surgeons (n = 195) were sent a questionnaire. The response rate was 77%. The results showed that at this moment intermediate restoration material (IRM) is the retrograde filling material most widely used by the Dutch O&MF surgeons (47.6%) in cases of surgical apical endodontic treatment. Amalgam, with 35%, was second, especially due to its plasticity and convenience. The choice of material is just as often determined by tradition, personal preference, individual experience or scientific results. There seems to be no relationship between the dental surgeon's number of years of experience and the type of retro grade filling material which he or she uses.

[A tooth located in a mandibular fracture line. Treatment by oral- and maxillofacial surgeons in The Netherlands]. / Mandibulafracturen met een gebitselement in de fractuurlijn. Behandelbeleid van kaakchirurgen in Nederland.

Mandibular fractures are among the most common facial bone injuries. Approximately 50% of the fractures occur in teeth bearing areas. Consequently, the likelihood that a tooth will be in the fracture line is substantial. A review of the literature reveals that there is not a clear guideline for preserving or removing a tooth in a mandibular fracture line. By means of a questionnaire, information was collected about how dental surgeons in The Netherlands deal with this problem. The research sample consisted of 194 active oral and maxillofacial surgeons in The Netherlands in 2005. One hundred and two surgeons responded (52.6%). The response rate was sufficient to allow for reliable deductions and statistical analysis. The results of the questionnaire showed that the respondents were in agreement. Generally, the respondents strove to preserve a tooth in the mandibular fracture line. The respondent's treatment of a mandibular fracture was in agreement with the state of the art as presented in the current literature. The respondent's choice of treatment did not depend on age, gender, university clinic at which the respondent was trained to be a dental surgeon, year of registration as a specialist, place of work and position. According to the respondents, the dentist's role in the aftercare of a mandibular fracture is treatment of the teeth injuries, follow-up of the posttraumatic oral self care, and regularly testing the vitality of the teeth in and around the mandibular fracture line.

[Serious complications following (removal after) ingestion of a partial denture]. / Ernstige verwikkelingen door een ingeslikte gebitsprothese.

Complications occurred in a 41-year-old woman (case 1) following a first attempt to remove a partial denture by oesophagoscopy. These were: laceration of the oesophagus with subsequent mediastinitis, pneumothorax, and pneumopericardium. With a second oesophagoscopy the denture was removed from the oesophagus using a flexible endoscope with a latex hood. Following antibiotic treatment the patient recovered. With a 45-year-old man (case 2) who had also swallowed a denture, the denture initially could not be localized. It was eventually recovered from the gastric antrum using a flexible scope with a latex hood, also in the second attempt. Psychiatric and mentally handicapped patients run a high risk of denture ingestion. Ingested dental prostheses are often radiolucent, and are difficult to visualize using conventional radiological methods. Extraction of the ingested foreign objects can lead to severe complications. This is why in this type of case, we recommend having an expert remove from a foreign object with the use of a flexible scope fitted with a latex hood. It is advisable to make removable dental prostheses radiopaque or to avoid using them with the identified risk-group.

[Face the facial furuncle]. / De furunkel in het (ge) zicht.

The furuncle is a staphylococcal infection of a single hair follicle which can occur on the skin in the maxillofacial region. Untreated, this infection can lead to life-threatening situations. This article discusses the etiology, clinical findings, possible complications as well as a series of differential diagnoses. In addition, several therapeutic and preventive strategies are described.

[Sound levels of the Piezosurgery. Risk of permanent damage to hearing]. / Geluidsniveau van de Piezosurgery. Risico van permanente gehoorschade.

In the past, research has regularly been carried out concerning the sound levels of various drilling devices and the impact these have on those who regularly use these devices. The present research is concerned with the possible permanent damage to hearing which can occur during the use of a newly developed instrument, the Piezosurgery. Measurements have been performed in a standardized set-up in which use is made of the lower jaws of pigs and a weight scale for measuring various degrees of pressure. The boundary values of the permissible exposure to noise were determined. The values of the Piezosurgery were compared with conventional drilling machines. It was concluded that using the Piezosurgery for less than 1.5 hours per day implies no risk of permanent damage to hearing. This means that the risk in the case of Piezosurgery is somewhat lower than that of conventional drilling devices.

[Cranio-maxillofacial traumatology]. / Traumatologie van het aangezicht.

During the last 50 years, significant developments have taken place in the treatment of cranio-maxillofacial fractures. The aim of treatment is to achieve the most complete possible restoration of facial functions Epidemiologic figures for these fractures are sparsely available in the literature, but traffic accidents, acts of violence and sports injuries appear to be the main causes. Currently, treatment of facial trauma is aimed at early and (nearly) complete restoration of function. To achieve this goal almost exclusive use is made of stable osteosynthesis methods in The Netherlands. An optimal fixation method exists for nearly every cranio-maxillofacial trauma due to the availability of a large variety of osteosynthesis materials, from micro-plates to reconstruction plates.

[Osteomyelitis of the jaws]. / Osteomyelitis van de kaak.

In the western world osteomyelitis of the jaws is not frequently encountered these days. In order to establish the actual incidence a survey was conducted, based on the number of patients treated for osteomyelitis of the jaw at a Dutch university medical centre between 1996 and 2001. 44 patients were identified. Their symptoms, afflicted areas and specific types of osteomyelitis were recorded, and compared to the literature. The incidence of osteomyelitis at the university medical centre was found to be in line with other, similar medical centres in the western world (approximately 3-4 per 100.000 annually). However, since recent data from comparable centres are either of limited use or altogether lacking, no firm conclusions could be drawn. Although there appears to be a slight increase in incidence in recent years, there is no hard evidence to support this.

[Non ordinary radiopacity on a panoramic radiograph]. / Een niet-alledaagse radiopake afwijking op het orthopantomogram.

A dental panoramic radiograph of a 56-years-old Sudanese woman revealed calcifications, which could be attributed to atherosclerotic lesions of the carotid artery. The occurence of these lesions is related to the incidence of cardiovascular and cerebrovascular diseases, such as transient ischemic attack or cerebrovascular accident. Carotid calcifications can be detected in 2 to 3.8% of panoramic radiographs of patients over 50 years of age. If detected early, treatment of the disease and the underlying risk factors can significantly reduce vascular related complications. There is a significant role to be played for dentists in early referral of patients.

[Diagnostic image (266). A woman with a non-healing wound on the chin]. / Diagnose in beeld (266). Een vrouw met een niet-genezend wondje op de kin.

A 67-year-old woman presented with a non-healing spot on the right side of her chin, which was caused by a dental fistula arising from a periapical granuloma of the right lower second premolar.

A noisy zygoma fracture--complication of carotid-cavernous sinus fistula: total recovery of monocular blindness and frozen-eye after endoarterial coil embolization.

A case of a patient with a zygoma fracture in combination with a carotid-cavernous sinus fistula--an arterio-venous fistula between the internal carotid artery and the cavernous sinus--is presented. The most frequent cause is trauma, but the carotid-cavernous sinus fistula itself may have been the cause of trauma. The patient showed complete loss of ocular motility and total monocular blindness. Treatment of the fistula with endoarterial coil embolization was followed by improvement of vision and ocular motility, until finally complete recovery of ocular functions, which is exceptional. In this case, careful analysis of the MRA's showed that the CCSF most likely developed in the posttraumatic phase.

Juxtacortical chondrosarcoma of the mandible: report of a unique case and review of the literature.

The clinical, radiographic, and pathological features of a juxtacortical chondrosarcoma of the mandible in a 25-year-old Caucasian woman are presented and the differential diagnostic aspects are discussed. To the best of our knowledge, this rare tumor has not previously been reported in the maxillofacial skeleton. Ten years after surgery there is no evidence of local recurrence or metastatic disease. As the prognosis of juxtacortical chondrosarcoma of the long bones seems to be relatively favorable compared with the usual central chondrosarcoma of similar grade of malignancy, this might also be expected for a similar tumor presentation in the maxillofacial skeleton.

[Diagnostic image (185). A man with a pimple on the upper lip. Carbuncle of the upper lip]. / Diagnose in beeld (185). Een man met een puistje op de bovenlip. Karbonkel van de bovenlip.

A 24-year-old man presented with a carbuncle of the upper lip. Surgical drainage was installed and flucloxacillin was administered. Full recovery ensued. In culture Staphylococcus aureus was abundant.

An adult case of oral infection with Kingella kingae.

An exceptional case of microbiologically confirmed oral infection with Kingella kingae in an immunocompetent adult (30-year-old woman) is presented and the pathogenesis is discussed and related to known literature data.K. kingae is a rather common but yet relatively unknown commensal corroding bacterium from the oro- and nasopharynx in healthy children, which might turn into a human pathogen causing osteomyelitis, arthritis, spondylitis, endocarditis and intervertebral diskitis in young children and rarely endocarditis, septic arthritis, meningitis, epiglottitis, diskitis and bacteraemia in adults. Sofar K. kingae associated stomatitis was reported in children and a few adults, however, with concomitant herpes simplex virus infections, and without microbiological confirmation. In the described case no viral infection was found. The proven K. kingae stomatitis represents an extension of the pathogenic spectrum and suggests that the breach of the oral mucosal barrier can be caused by the bacterial pathogen itself. Whether a concomitant viral infection is necessary forK. kingae to actually invade the bloodstream remains to be considered.