Endodontic and restorative management of a resorbed eight-unit fixed partial denture abutment tooth: report of case.

Treating internal resorption is one of dentistry's most difficult challenges. This pathological process is difficult to manage in an advanced stage. The usual treatment involves surgery or, in many cases, extraction of the resorbed tooth. It is often difficult for the patient to understand and accept such a radical treatment approach. This report of case illustrates severe internal resorption that destroyed a major portion of a key abutment tooth supporting an eight-unit fixed partial denture. The resorptive pathosis was treated by a nonsurgical endodontic approach. The severely damaged abutment was reinforced and restored so that the existing eight-unit fixed partial denture could be preserved. The patient was pleased with the method of treatment and was commended for seeking regular recall professional care. It would have been easy to postpone treatment as the problem was asymptomatic. However, to do so probably would have resulted in loss of the resorbed abutment tooth, thus creating a complex restorative situation. The original prosthesis is currently 14 years old, functioning well, and showing no apparent evidence of pathosis. Costly and time-consuming remake procedures were avoided and patient satisfaction was maintained.

Periodontal disease awareness.

New forms of patient education are needed to increase the periodontal disease awareness of the general public. Patients are more likely to seek professional treatment for periodontal disease when they are aware of its existence. The general practitioner should be encouraged, through the dental literature and continuing education courses, to assume responsibility for the diagnosis and management of the majority of periodontal problems. Increased periodontal awareness by the dentist would be beneficial in three areas: increased periodontal diagnosis and treatment planning would help reduce the number of lawsuits that can result from existing undiagnosed periodontal disease, the number of failures in restorative treatment would be reduced and longevity of existing restorative dentistry increased, and unfilled appointment time in the dentist's schedule could be filled by patients who need periodontal therapy.

Composite resin interim restorations for broken-down nonvital posterior teeth.

The fabrication of interim restorations using a retentive groove preparation design with a custom composite resin core material has been used in my private practice for more than ten years with gratifying results. In the past 2 1/2 years, more than 800 such restorations have been documented and placed at the University of Southern California School of Dentistry. Pre-endodontic preparation of nonvital teeth with advanced carious lesions and defective restorations eliminates potential impediments to pulp therapy. A quality interim restoration provides the dentist with a diagnosis of restorability before pulp therapy, protects severely damaged teeth, and promotes periodontal health. Future endodontic treatment is simplified and patient satisfaction is increased.

Periodontal and restorative considerations in rotary gingival curettage.

A relatively new surgical gingival retraction technique has been discussed from a periodontal point of view. This technique provides a method of enlarging the gingival sulcus so preparation margins for cast restorations can be visualized and accurately recorded in impression material. The preoperative health of the periodontium is an important consideration when selecting this technique. The attachment apparatus must be free of inflammation and the marginal gingiva must have an acceptable width and a high degree of keratinization. If these criteria are met, a hemorrhage-free opened gingival trough will be easily and consistently obtained. The following restorative sequence was suggested and should be used and completed one step at a time: pulp therapy, buildup restoration, supragingival casting preparation, rotary gingival curettage, reversible hydrocolloid wet field impression technique, indirect provisionalization, placement of final cast restoration. These recommendations were based on the compatibility with the periodontal tissues. Such periodontal compatibility is evident in consistent postoperative tissue healing. There is minimal or no change in the position of the epithelial attachment and location of the crest of the free marginal gingiva. Histological and longitudinal clinical research studies are needed on the rotary gingival curettage technique. Clinical studies on the reversible hydrocolloid wet field technique would also be helpful. Until such evidence is available, my clinical experience indicates that rotary gingival curettage is an excellent technique producing predictable and gratifying results if the treatment planning and restorative sequence suggested in this paper are followed.

The anorexia nervosa syndrome.

This article reviews the medical and dental literature on the anorexia nervosa syndrome and presents the oral and systemic manifestations of this serious disease process. A case is reported which demonstrates the generalized destruction of tooth structure, primarily as a result of the direct effect of gastric acid on this patient's dentition during a 5-year period of self-induced vomiting. The systemic, psychological, and social aspects of this syndrome are classically illustrated in this case history.

Validity of health history data collected from dental patients and patient perception of health status.

Recently, dental practitioners have recognized the need to be aware of the patient's medical history before proceeding with treatment. However, the validity of the data acquired by the usual means, written questionnaire and dialogue history, has been questioned. A study was made comparing results obtained with the two methods to determine the accuracy of each.