How problems evolve and dissolve: integrating narrative and strategic concepts.

This article presents an approach to therapy that links narrative and strategic concepts. The term "strategic" is used not in the prescriptive, impositional sense that has come to be associated with the method, but in terms of having a clear therapeutic direction in promoting change. The authors outline an approach to therapy that expands upon the fundamental principles of the MRI (Mental Research Institute) Brief Therapy model, elaborating more upon its constructivist premises than its prescriptive practices. They propose that by mapping how ordinary life events affect a person's preferred view, the therapist can locate the key narrative elements that shape the course of the problem and direct its solution. The authors suggest a framework for how problems evolve and dissolve. When new events are construed as contradicting family members' preferred narrative accounts, problems evolve. Problems dissolve when family members see the event, and the ideas and actions of others, as consonant with their preferred ways of being and acting.

Use of osseointegrated implants to support a maxillary denture for a patient with repaired cleft lip and palate.

Although many cleft lip and palate patients retain their dentition, some develop partial or complete edentulism. The configuration of the residual maxillary alveolar ridge may provide little support for a complete or partial maxillary denture. The success of the Branemark dental implant has been well established, and although placement of implants in the maxilla may present a surgical challenge, implants are very effective in providing support and, therefore, retention and stability. Application of implants to the cleft palate maxilla is particularly valuable because of the difficulty in constructing well-fitting conventional dentures for CLP patients, and the relatively compromised nature of the prostheses when made. This report presents the prosthetic treatment of a nearly edentulous cleft lip and palate patient.

Trismus appliances and indications for use.

Trismus is a condition that impairs eating, interferes with oral hygiene, restricts access for dental procedures, and may adversely affect speech and facial appearance. The success of treatment depends on recognition of the cause and initiation of appropriate management. Ideally, trismus appliances are used in conjunction with physical therapy and are most effective when the condition is the result of muscle fibrosis or scar tissue that has not yet matured. Trismus appliances act either externally or internally, and the forces they impart can be continuous or intermittent, light or heavy, and elastic or inelastic. Six appliances have been described in the literature. A seventh appliance, a plastic tapered cylinder, is also effective. The tapered cylinder relies on the patient's depressor muscles to separate the jaws, and allows easy appreciation of the progress made. The stretching force applied with this appliance is limited by the strength of the patient's depressor muscles.