Triple-flap technique for reconstruction of large nasal defects.

OBJECTIVE: To determine the usefulness of a triple-flap technique for repair of large zone 2 Mohs defects of the nose. METHODS: The triple-flap technique was performed on 10 fresh adult cadaver heads that had been injected intravascularly with blue dye. Two distances were measured and recorded: (1) the distance from the most lateral portion of the alar crease to the transverse facial artery; and (2) the distance from the dorsal nasal artery to the medial canthi. Data were also collected on patient age and sex and on the size of the Mohs defect in a series of 10 patients. RESULTS: The cadaver study showed that the dorsal nasal artery was located a mean distance of 7.4 mm superior to the medial canthal tendon and that the transverse facial artery was located a mean distance of 19.2 mm lateral to the alar crease. In our series of 10 patients (2 of whom are described herein), zone 2 defects (including full-thickness unilateral alar defects) as large as 3.5 x 5.0 cm were reconstructed in 1 stage using local anesthesia. No flap loss resulted. CONCLUSIONS: Cadaver dissection enabled us to identify the blood supply of the dorsal nasal flap in relation to the medial canthal tendon and the blood supply to the superior melolabial flap in relation to the alar crease. For a select group of patients with large zone 2 Mohs defects of the nose, the use of the triple-flap technique to repair the defect is a viable alternative to the use of a forehead flap technique.

Oral ketamine for pediatric outpatient dental surgery sedation.

This study compared the sedative effectiveness of orally administered ketamine to a combination of oral meperidine/promethazine (Demerol/Phenergan) in two groups of children. One group received ketamine at a dose of 6 mg/kg and the other group received meperidine/promethazine combination at a dose of 2 mg/kg and 0.5 mg/kg, respectively. All children received nitrous oxide 30-50% titrated to effect. A four-point modification of the Houpt et al. rating scale for the overall behavior was used in the evaluations. The quality of sedation, as rated by subjective measurement of overall behavior (sleep, crying, body movement), was higher in the ketamine group (borderline significance; P = 0.07). Mean onset time was significantly shorter (P < 0.001) for ketamine (20.5 min) than meperidine/promethazine (42.4 min) and postoperative sleep time (recovery) was also shorter (borderline significance; P = 0.08) for ketamine (55.6 min) than meperidine/promethazine (106.8 min). Operative times were similar, but the placement of rubber dam and local anesthetic were slightly better tolerated in the ketamine group. Vomiting was significantly more prevalent (P = 0.05) among those who received oral ketamine. Vital signs were consistent for the two groups with no oxygen desaturation below 95%.

Indirect composite resin crowns as an esthetic approach to treating ectodermal dysplasia: a case report.

This article presents a case report describing the indirect fabrication of composite resin crowns for the restoration of primary anterior teeth. A 3-year-old with a confirmed diagnosis of hypohidrotic ectodermal dysplasia was provided with composite resin crowns that were both esthetic and functional. The indirect method decreases clinical time, provides a durable restoration, and allows treatment of patients who lack the cooperative ability to endure prolonged direct bonding appointments. The indirect technique may be feasible for the restoration of carious teeth as well as the presented case.

Influence of vitamins and iron on plasma fluoride levels in rats.

Thirty female Sprague-Dawley rats (250 +/- 10 g) were divided randomly into five equal groups. After overnight fasting, a silastic catheter was placed in the jugular vein of each rat. Each group was intragastrically administered 0.25 mg F/250 g rat weight in 1 ml of one of the following forms of fluoride supplements: Pediaflor (Abbott/Ross, Columbus, OH), Tri-Vi-Flor, Tri-Vi-Flor + iron; Poly-Vi-Flor or Poly-Vi-Flor + iron (Mead Johnson Nutritionals, Bristol-Myers Squibb Co., Evansville, IN). Timed blood samples were collected and plasma fluoride concentration was determined using the microdiffusion method. The presence of iron and vitamins affect the bioavailability of fluoride as measured by the area under the time-plasma fluoride concentration curve.

Posterior composite Class II restorations: in vitro comparison of preparation designs and restoration techniques.

The aim of this study was to evaluate conservative preparation designs for the restoration of Class II lesions with posterior resin composite. Fourteen primary and 14 permanent molars were obtained. Conservative modified MO and DO preparations were placed in half the teeth; conventional MO and DO preparations were placed in the remaining teeth. Randomly, a glass-ionomer liner was placed over the exposed dentin in one preparation of each tooth, a calcium hydroxide liner was placed in the remaining preparations. Posterior resin composite was placed in all teeth, and the teeth were loaded with a 17-kg force. Teeth were thermocycled, stored in 37 degrees C water, then immersed in 50% silver nitrate solution and placed in developer. The teeth were sectioned and photographed. Microleakage was calculated according to the depth of dye penetration, on a 6-degree scale. Results demonstrated the conservative modified restorations and conventional restorations, when glass-ionomer liner was used, to have less marginal microleakage, in both primary and permanent teeth, than their calcium hydroxide counterparts.

An in vitro investigation of the effects of glass inserts on the effective composite resin polymerization shrinkage.

We placed an MOD preparation in each of 12 permanent molars, then restored each tooth with a posterior composite resin by means of six different application techniques (I-polymerization as one complete unit; II--polymerization as one complete unit with glass inserts; III--polymerization in gingivo-occlusal increments; IV-polymerization in gingivo-occlusal increments with glass inserts; V--polymerization in bucco-lingual increments; and VI--polymerization in a gingival increment with glass inserts, then bucco-lingual increments). A precision strain gauge was attached to the buccal surface of each tooth and balanced at zero. After each increment was polymerized, the strain appearing on the strain gauge indicator was recorded. Each tooth was restored by use of all techniques; two teeth started with each technique. Results demonstrated the average microstrain units to be 127-I, 102-II, 105-III, 86-IV, 72-V, and 66-VI. A randomized block design was the format used for data evaluation. Scheffé's Test indicated that composite resin placement and polymerization in bucco-lingual increments (V) created significantly less cuspal deflection than polymerization as one complete unit, with or without glass inserts (I and II), p less than 0.001, and gingivo-occlusal increments (III), p less than 0.05. Placement and polymerization in a gingival increment with glass inserts, then bucco-lingual increments (VI), also created significantly less internal deflection than polymerization as one complete unit, with or without glass inserts (I and II), p less than 0.001, and gingivo-occlusal increments (III), p less than 0.005.