Multiple, large sialoliths of the submandibular gland duct: a case report.

This paper reviews the major clinical and radiographic features of sialoliths and illustrates these with an unusual case of multiple sialoliths within the submandibular gland duct. The differential diagnosis of other calcific structures both within and outside the salivary gland that may mimic a sialolith is also presented.

Treatment delays in paediatric dento-alveolar trauma at a tertiary referral hospital.

BACKGROUND: Paediatric dento-alveolar trauma is a common event. Delays in treatment can have adverse effects on long term outcomes and the aim of this study was to quantify the treatment delays in paediatric dento-alveolar trauma in a tertiary referral hospital. METHODS: All cases of paediatric dento-alveolar trauma over a two year period from July 2000 to June 2002 were identified and the charts were reviewed retrospectively. All children presenting to the emergency department with dento-alveolar trauma within 48 hours of injury during the time period were included. RESULTS: Forty-three patients were identified. The average age was 5.51 years, though there was a bias towards one and two year olds. Males were injured 1.5 times more frequently than females. There was an average delay of 9.6 hours between injury and treatment for all patients. Transit time from outside practitioners to hospital and waiting times in hospital made up the greatest delays. Children injured an average of 2.37 teeth and only 14 per cent were uncomplicated crown fractures. CONCLUSIONS: Children who present to children's hospitals for treatment of dento-alveolar trauma have more severe injuries than those treated elsewhere. They have large but potentially reducible delays between injury and treatment.

Tooth movement following third molar removal.

The mandibular dental arches of 45 young adults (mean age = 24.3 years) were analyzed by measuring study casts taken immediately before and twelve weeks after the removal of impacted third molar teeth. Arch length and width were measured at predetermined points on the study casts. The results showed significant buccal movement of mandibular second molar teeth following surgery (p < 0.01). Bilateral mesioangular impactions were associated with larger increases in mandibular arch width following surgery than unilateral mesioangular impactions or other classes of impaction (p < 0.05). The greatest amount of tooth movement was observed in cases where mandibular second molars had a pre-operative lingual inclination. It is hypothesised that mesioangularly impacted mandibular third molars can produce sufficient force to displace the adjacent second molar teeth in a lingual direction and when the adjacent third molar is removed this movement is reversed by functional forces.

Future educational standards and requirements.

The guidelines for accreditation of training programmes and positions in Oral and Maxillofacial Surgery are now established within the Royal Australasian College of Dental Surgeons. These take cognizance of both international trends and requirements as well as specific regional factors. The specialty remains fully committed to its dental base, however, with further reconciliation at all levels between dentistry and medicine, it should become more broadly based and recognized in the future.

Radiographic evaluation of intraosseous implants of endodontic materials.

Following several case reports of cyst development after endodontic treatment of decidous teeth, the osseous response to formaldehyde- or phenol-based materials was evaluated by a standardized radiographic technique. Endodontic medicaments contained in Teflon carriers were implanted between feline deciduous canine and molar teeth and the permanent successional teeth. Persistent radiolucency surrounding formocresol implants and sequestration of Kri-paste implants were noted in contrast to apparent bony healing around the zinc oxide-eugenol controls and those implants containing glutaraldehyde. These results suggest a greater tissue tolerance to glutaraldehyde-containing agents in contrast to the more traditional endodontic agents used in deciduous teeth.

Aberrations in pulpal histology and dentinogenesis in transplanted erupting teeth.

Responses of pulpal tissues were assessed histologically in teeth that had been transplanted after root formation was moderately well advanced. Degeneration occurred in the coronal third, but the area was repopulated by cells proliferating from the center of the pulp. Apically, the tissues, including the odontoblasts, remained vital and functional. Widespread intrapulpal formation of osteodentin was prominent in later observation periods. Apical closure occurred prematurely by production of osteodentin and cellular cementum in the form of an apical diaphragm; these mineralized tissues were confluent with a similarly active deposition of cellular cementum apically on the root surface.

Responses of periodontal tissues and cementum following transplantation of teeth.

Responses of periodontal tissues, particularly cementum, were assessed histologically in teeth which had been transplanted after root formation was moderately well advanced. When the epithelial root sheath persisted, it was associated with continued root formation. In instances where the sheath disintegrated prematurely, either as a consequence of the surgery or of functional factors such as occlusal forces, normal root formation did not proceed, but there was rapid and extensive production of cellular cementum apically and along the root of the tooth. A zone of imperfect cementum formation was frequently seen between the preoperative cementum and that which developed postoperatively. Dilaceration of the tip of the root, with subsequent envelopment in a bulbous mass of cementum, commonly resulted.

Proliferation of pulpal tissues following early transplantation of developing teeth.

The responses of pulpal tissues were assessed histologically in teeth that had been transplanted as soon as crown formation was completed. The teeth were unerupted at the time of surgery and were transferred to other bony crypts, where attempts were made to reproduce their natural alignment. The pulpal tissues remained viable, although variations occurred in cellularity, vascularity and texture. There was widespread production of intrapulpal bone and osteodentine, and confluence of these tissues with proliferating apical and adjacent bone often resulted in ankylosis. The view was supported that transplanted dental tissues have a strong likelihood of surviving if the procedure is undertaken relatively early during tooth development; however, structural variations and ankylosis may compromise their subsequent value.

Aberrations involving the enamel epithelium in transplanted developing teeth.

Structural changes that occurred when unerupted developing permanent teeth in dogs were transferred to other bony crypts or surgically prepared sockets were assessed histologically. The enamel epithelium and pieces of enamel matrix were often displaced from the developing teeth and contained within the dental sac. The epithelium underwent metaplasia, cysts frequently developed, and cementum was formed in moderate quantities when enamel matrix was directly in contact with connective tissues. Development of the crowns did not continue normally, and the teeth did not erupt.

A radiographic assessment of autologous tooth transplants in dogs.

This study assessed structural and functional changes that occurred when teeth in dogs were transplanted at various stages of development. Unerupted developing permanent teeth were transferred to other existing bony crypts or to surgically prepared bony sockets. Erupted teeth with varying degrees of root formation were transplanted to other sockets, some with increased functional influences. The development, morphologic features, and relationships of the transplanted teeth were assessed radiographically at intervals ranging from seven to 150 days postoperatively.