32

NEW ZEALAND DENTAL JOURNAL

MARCH

2011

proceedings
The Faculty of Dentistry Clinical Excellence Day was was held on Tuesday 25 May 2010 at the Otago Museum. Keynote addresses were given by Dr Brett Lyons (Radiologist, Southem District Health Board) and Associate Professor Anita Nolan (Faculty of Dentistry). We are grateful to symposium organiser Professor Tom Kardos for the opportunity to print these abstracts.
Keynote address: Recent advances in dentomaxillofaeial imaging Dr Brett Lyons Cross-sectional imaging technology has become commonplace in medical imaging. Computed Tomography (CT) owes its origins to Sir Godfrey Hounsfield, who first conceived the idea as a marriage of radar, pattern recognition and newly emerging computer technology. The first test scanner was installed in London in 1971. The rapid advancement of computer, x-ray tube and flat panel detector technology has reduced slice acquisition times from minutes to fractions of a second and is responsible for the latest generation of small and increasingly commercially viable scanners. Conebeam Computed Tomography (CBCT) represents a recent evolution of CT technology. This lecture compares CBCT with conventional CT technology and examines the advantages and disadvantages and the challenges ahead. Identification of metallic substances in oral pigmented lesions using SeM EDS: A case report HM Hussaini, JN Waddell, L Girvan, AM Rich Amalgam tattoo is a common pigmented lesion of the oral mucosa. It usually occurs due to implantation of dental amalgam within the oral soft tissue during dental procedures and presents as a brown/grey/black asymptomatic macule. Pigmentation associated with other dental materials is rare. We report a case of a 17-year-old female presenting to an oral and maxillofacial surgeon with symmetrical bilateral pigmented macules on the mandibular gingiva. The lesions were excised and a report of amalgam tattoo was issued. Subsequently, the pathologist was informed that the patient had never had any form of dental restorative procedures. This prompted further investigation of the material that was embedded in her mucosa. The histological slides were analysed at the Otago Centre for Electron Microscopy, University of Otago using field emission scanning electron microscopy (SEM) and electron dispersive spectrography (EDS). The metallic element analysis showed that the substance was mainly silver alloy, not a usual component of dental materials. Further discussion with the patient revealed that she had recently completed orthodontic treatment which included silver soldering of the orthodontic brackets. Silver alloys used in orthodontic soldering are subject to corrosion because they have a tendency to emit electro-galvanic currents in the oral environment and consequently release metal ions which can deposit themselves in the mucosa in the form of a tattoo. Conclusion: This was a case of oral metallic tattoos as a result from corrosion of material used in orthodontic treatment. SEM EDS proved to be a powerful diagnostic tool in identifying the metallic substance within the oral mucosa. The importance of the periodontal review in periodontal therapy Emi Noor The ultimate goal in the treatment of chronic periodontitis is maintenance of the teeth in function with comfort while conforming to the aesthetic expectations of the patient. Periodontal therapy can be divided into three main stages: cause-related therapy, corrective therapy and maintenance therapy. The specific elements of each phase are determined by the initial examination and by subsequent periodontal reviews; thus, the periodontal review plays an important role in deciding periodontal treatment strategies. A case report will be presented that describes the management of a patient presenting with chronic periodontitis who has been followed up since 2007, highlighting the importance of frequent periodontal reviews for a successful periodontal treatment outcome. Keynote address: Looking in the mouth for Crohn's disease Associate Professor Anita Nolan The oral cavity provides the clinician with a unique opportunity to provide excellence in care, not just from a dental perspective, but also to make a major contribution to patients' medical management. Many medical conditions manifest oral signs, including Crohn's Disease. Crohn's Disease (CD) is an incurable, chronic and relapsing inflammatory bowel disease that causes considerable suffering and disruption to life, affecting all age groups. The incidence is increasing worldwide, with parts of New Zealand now reporting one of the highest incidences in the world. Healthcare costs are now well in excess of $58 million per annum. There is increasing recognition that the presence of the mouth lesions, termed "Oral Crohn's Disease" (OCD), may precede the first clinical signs of intestinal disease by many years and may be the first indication that treatment of Crohn's Disease is failing. Furthermore, OCD may be associated with a particular pattem of intestinal disease and be a marker for future significant disease burden (that is, a more severe CD). From a dental perspective. Oral Crohn's Disease can be painftil, disfiguring and challenging to manage. This presentation reviews case histories of patients with OCD, describes the contemporary management of OCD, and explores how a future combined dentalmedical approach may improve the clinical outcome for patients with the oral and intestinal lesions of Crohn's Disease. Management of an endodontic-periodontic lesion Kimmy Lin There is a close inter-relationship between the dental pulp and the periodontium, with potential pathways of communication via exposed dentinal tubules in areas devoid of cementum, lateral/ accessory canals, and the apical foramen. Clinically, these provide an avenue for pathogens and their by-products to move between the two structures, and this may result in endodontic-periodontal disease. "Endo-Perio" lesions can be classified into endodontic disease, periodontal disease, and combined disease. Combined diseases include (1) primary endodontic disease with secondary periodontal involvement, (2) primary periodontal disease with secondary endodontic involvement, and (3) true combined disease. A case of primary periodontal disease with secondary endodontic involvement will be presented, demonstrating the importance of initial diagnosis in determining treatment and prognosis. Prosthodontic management of a severely compromised dentition Jaafar Abduo This clinical report describes the rehabilitation of a 50-yearold male who expressed dissatisfaction with his existing dental condition and complained that it was affecting his quality of life. Following examination, the dental problems were summarised as partial edentulism, overeruption of the remaining teeth and a severely compromised occlusal scheme. The remaining maxillary and mandibular teeth were unopposed which had led to a deviation in his occlusal plane. Despite being able to function normally with the existing dental condition, he was concerned about the future of his dentition and requested dental treatment that could restore his dental function and appearance in a predictable manner. Following the diagnostic procedure, a well-coordinated prosthodontic treatment that involved liaison with other dental disciplines was indicated. The rehabilitative treatment comprised two phases. The first phase involved provision of a series of provisional restorations that restored his occlusion and allowed close assessment of function, aesthetics and comfort. The definitive prostheses were provided in the second phase. In the mandible, all the remaining teeth were restored with crowns and the edentulous area was restored with an implant-fixed partial denture. In the maxilla, all upper teeth will be

MARCH 2011

NEW ZEALAND DENTAL JOURNAL

33

restored with crowns that incorporate milled palatal surfaces, and a precision removable partial denture will be fabricated to restore the edentulous areas. Excessive overbite - a surgical approach E Lam, W Harding, R De Silva, H Choi Bilateral sagittal split osteotomy (BSSO) is the most commonly used procedure for the treatment of maxillofacial deformities such as mandibular retrognathism or prognathism. Mandibular ramus sagittal spit osteotomy is the most common technique used for mandibular advancement surgery. Clinical case: Bessie was 22 years and 9 months at the time of consultation. She presented with a skeletal Class 11 pattern with spacing of her upper dentition. She had a large overjet and a full overbite involving the palatal mucosa. She also had full-unit Class II molar and canine relationships. The treatment plan involved fixed orthodontic treatment in preparation for mandibular advancement surgery, and then post-surgical orthodontic treatment. To date, Bessie has had her mandibular advancement surgery in March this year. She is currently in her post-surgical stage of treatment. She has had 15 months of active treatment to date. I am hoping to complete her treatment this year. Localised severe periodontitis of a mandibular molar associated with cervical enamel projections: a case report and mini-review Faizal Hidayat Dental anatomical features such as cervical enamel projections (CEPs) may predispose the periodontium to disease. CEPs are flat, ectopic deposits of enamel apical to the normal cementoenamel junction (CEJ) level in molar furcation areas. These enamel deposits usually have a triangular shape and a tapering form, extending apically into furcation areas. They are commonly found at the buccal surfaces of mandibular molars. CEPs in the furcation areas of molars have no true attachment and are therefore highly predisposed to the creation of a deep periodontal pocket. Here, a case report is presented of CEP affecting a mandibular first molar, and its management with odontoplasty and regenerative procedure by placement of graft in the osseous defect. Dentine hypomineralisation Noren Hasmun A nine-year-old boy (KF) was referred by his dental therapist for management of hypoplastic teeth. KF was bom in Russia and came to New Zealand with his adopting parents two years ago. A complete medical and dental history is not available but he did have rickets in infancy. Several primary teeth were extracted prior coming to New Zealand. Dental examination showed severe breakdown of the enamel of the permanent first molars. Radiographs revealed caries in primary molars and severe post-eruptive breakdown of first permanent molars. The treatment plan included comprehensive care under general anaesthesia because ofthe sensitivity ofthe permanent molars and the difficulty of achieving adequate local analgesia. Care was carried out on 29.05.09. The lower left first permanent molar (36) was extracted because of severe post-eruptive breakdown meaning that it was not restorable. The histology report noted hypomineralisation of the dentine. The aetiology and management of dentine hypomineralisation (including its association with rickets) will be discussed. Small mouth - big problems: dental implications of scleroderma S Hamzah, E MacFadyen, G Ling Scleroderma (systemic sclerosis) is a rare autoimmune disease of unknown aetiology. It progressively affects the connective tissues and is characterised as a collagen-vascular disease which mainly manifests in the skin as abnormal thickening due to excessive collagen deposition. Vascular andfibroticchanges causefibrosisofthe skin and intemal organs to varying degrees. The involvement of the orofacial region poses a serious challenge to the patients and oral health professionals in maintaining adequate oral health care. Common oral manifestations of scleroderma include microstomia, xerostomia and osseous rsorption, which lead to various types of dental and oral mucosal diseases requiring appropriate care. A 42-year-old Caucasian

woman presented at the Special Care Unit (School of Dentistry) with very limited mouth opening (10 to 15 mm interincisal distance); she had been referred by a general dental practitioner for extraction of root remnants in the maxillary arch and the replacement of missing teeth with an upper partial denture. Typical signs of scleroderma were observed, namely thin and stiff tethered skin, hands with a claw-like shape, a lack of facial expression ("Mona Lisa face"), incomplete lip closure, diminished mouth aperture and the typical pointy nose. Plaque-induced gingivitis, gingival recession associated with tooth 41, dental caries and xerostomia were also noted. Comprehensive dental treatment was carried out under general anaesthesia. This included full-mouth scaling and cleaning, restoration ofthe carious 21, and extraction ofthe roots of 15, 16, 13, 25 and 26. Follow-up plan comprised home care and professional care with special care required. Stretching exercises were incorporated to increase the range of motion of the mouth. Osteoma and Gardner's syndrome Han Choi and Adrian Best Osteomas of the facial skeleton and cranial vault can occur and may be an extra-colonic manifestation of Gardner's syndrome. The dental practitioner can play an important role in detecting such lesions and early recognition may lead to timely diagnosis and management of this potentially life-threatening syndrome. Mysteries of human molars Amna Siddiqui Elimination of bacteria and their toxins from the root canal system is one ofthe goals of endodontic treatment. This is achieved by chemo-mechanical preparation of the root canal system followed by three-dimensional root filling. Variations in root canal morphology, especially in multi-rooted teeth, present constant challenges for diagnosis and successful treatment. Comprehensive knowledge of root canal anatomy and its variations is mandatory. The prognosis for root canal treatment exhibiting complex anatomy is unfavourable if the clinician fails to identify and treat extra canals. The clinical management of a rare case of a maxillary molar with six canals and some other molars with anatomical variations is presented. These cases highlight the significance of morphological variations in molar teeth and the importance of utilizing the modem endodontic armamentarium to achieve biological aims and a favourable treatment outcome. "My Teeth Don't Meet" - the challenges associated with the treatment of anterior open bites Kimberley Timmins Anterior open bites occur in a small proportion ofthe population; however, such malocclusions may prove to be problematic to treat. A number of treatment strategies may be used to treat such patients. Treatment of anterior open bites often includes a combination of orthodontics and orthognathic surgery. New advances in orthodontics have resulted in the increasing use of temporary anchorage devices to provide additional anchorage in the treatment of a range of malocclusions. This presentation will address the aetiology and possible treatment options for patients with anterior open bites and present one such case that has been treated in a novel way with temporary anchorage devices. Management of a partially dentate patient with fixed prostheses Chae Park This clinical presentation illustrates the management of a partially dentate patient with fixed prostheses. The patient was referred to the Department of Oral Rehabilitation by his general dental practitioner for prosthodontic treatment of severe tooth wear and the replacement of missing teeth. He had lost 11 teeth over the years, and a number of removable partial dentures were made to replace the missing teeth. However, the patient was unable to wear plastic partial dentures successfully due to a severe gag reflex. The patient agreed to the restoration of all teeth in the maxillary and mandibular arches with crowns and bridges, and the edentulous spaces with implant-fixed prostheses. This case report highlights the benefits of a multidisciplinary approach to manage a compromised dentition.

Copyright of New Zealand Dental Journal is the property of New Zealand Dental Association Incorporated and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.