Periodontal Microsurgery: AlloDerm Root Coverage

Recession, Limited Gingival Band, Esthetics and Stability are addressed with this Periodontal Microsurgical procedure using a purified collagen implant: AlloDerm

Indications for OPG requests

An OPG or "ORTHOPANTOGRAM", gives a panoramic view of the mandible and teeth.
It is performed using a technique called "tomography". The X-ray tube moves around the head, the x-ray film moves in the opposite direction behind your head. This generates an image slice where the mandible and teeth are in focus, and the other structures are blurred.

Why to get it ?

Dental Disease

* Caries - appear as different shaped areas of radiolucency in the crowns or necks of teeth.
* Peridontioiditis - when inflammation extends into the underlying alveolar bone and there is a loss of attachment.
* Peridontal Abscess - Radiolucent area surrounding the roots of the teeth.

Extraction of teeth (eg. wisdom teeth)

* OPG shows angulation, shape of roots, size and shape of crown, effect on other teeth.

Teeth Abnormalities

* Eg. Developmental, to show size, number, shape and position.

Trauma to teeth and facial skeleton

* Mandible fractures are often bilateral.
* Panoramic view of mandible to view the fracture.
* Determine site and direction of fracture lines.
* Relationship of teeth to fracture lines.
* Alignment of bone fragments after healing.
* Evidence of infection or other complications post intervention.
* Follow up to assess healing.

Transplant workup

* To look for evidence of any underlying dental disease (eg. abscess)
* Patients on steriods after a transplant are immunosuppressed and the mouth is a common site of infection.

Indirect IA (Inferior Alveolar) nerve block on a model

University of The Pacific Arthur A. Dugoni School of Dentistry present a video illustrating the technique of Inferior Alveolar Nerve Block on a model by Dr. Anders Nattestad, Professor and Director, Department of Oral and Maxillofacial Surgery.

Dental Implant Surgery (lateral incisor)

Full surgery of a zirconia dental implant. Implant type 12. Upper Left Lateral Incisor. 8 min. Very esthetic. 100% biocompatible. Metal Free. High percentage of osseointegration.

Anatomical parts of Gingiva

The image above shows the actual anatomy of the gingiva, known commonly as the "gums". The lighter pink colored gum tissue is called the "attached gingiva" because it is firmly attached to the underlying bone. It has the same consistency as the gums overlying the hard palate . The darker pink tissue above it is called the unattached gingiva also called the Alveolar Mucosa. It is not firmly attached to the underlying bone.
The junction between them is called the mucogingival junction. The small margin of tissue outlined in yellow on the lower diagram is called the free or marginal gingiva (sometimes called the free gingival margin), and it is the unattached, sleevelike portion of the gingiva that encircles the tooth to form the gingival sulcus.

The Vermillion border is the junction of the dry, pink part of the lip with the skin of the face. The labial (lip) vestibule is marked on the diagram. The Upper Labial Frenum is also visible.

Palato-Pharyngeal Function

Surgical patients with parts of their faces surgically removed show palato-pharyngeal functions.

Angular cheilosis

Cheilitis and cheilosis are both used to describe the same disease. The lesion appears as fissuring and maceration at the commissures of the lips.

Etiology: Experimental subjects on a riboflavin deficient diet develop angular cheilosis. It is doubtful that vitamin deficiency contributes to the disease in the United States.
Two factors may work in concert to produce angular cheilosis. Overclosure from the loss of vertical interdental dimension creates a moist skin fold at the commissures. This area is susceptible to infection with oral and skin bacteria and fungi. Candida is thought to be one of the major pathogens.

 In those patients who have obvious overclosure, restoration of vertical dimension is of benefit. Application of nystatin ointment to eliminate Candida organisms is indicated. 

Palate of pipes smokers :Nicotine Stomatitis

Description: The classic form of this disease occurs in the palate of those who smoke pipes. The palatal mucosa is white and criss-crossed by fissures, giving the appearance of a dried creekbed. Small red elevations scattered throughout the lesion are thought to be inflamed orifices of minor salivary gland ducts. It produces no symptoms and may be discovered in a routine oral examination.

Etiology: This lesion is caused by smoking, chiefly pipe smoking. A report of thermally induced nicotine stomatitis in a woman who drank scalding hot tea and soup suggests heat rather than tobacco products are responsible for this condition.

Treatment: This disease usually dissappears after discontinuance of smoking.
Differential diagnosis: The clinical appearance of nicotine stomatitis coupled with a history of pipe smoking is virtually diagnostic. Biopsy is seldom necessary.

Traumatic Ulcer

An ulcer by definition is a localized area on the skin or mucosa in which the surface epithelium has been destroyed. The shape and size of traumatic ulcers are so variable as to defy a simple description. They are usually painful and of short duration.

This photo descriped as Erythematous area surrounding a central yellow fibrinopurulent membrane located in right lateral border of tongue

Etiology: Common causes of traumatic ulcers include: denture irritation, biting injuries, hard foods, chemicals, toothbrush and dry cotton rolls.

Treatment: The treatment is to remove the cause if it is known. Relief of pain can be achieved with topical anesthetics such as Orabase with Benzocaine.
Prognosis: The ulcer should heal if the cause is removed. An ulcer which does not heal within two to three weeks should be biopsied to rule out malignancy.

Differential diagnosis: Traumatic ulcers must be differentiated from squamous carcinoma and ulcerative mucosal diseases such as lichen planus.

Fluorosis-Dental staining

IT is descriped as brown discoloration of teeth ,manifests as white, yellow, or brown streaks, stains, and pits. This may be the first visible sign of systemic injury to bones, joints, immune function and other metabolic activities.

This photo for a 22-year-old woman with discoloured teeth came from the fluorosis striken area of Andra Pradesh state in India.

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Effects of Some drugs on teeth

Hypertrophied gums are most likely the result of which of the following?

• a.Hutchinson’s teeth
• b.Tetracycline administration
• c.Administration of diphenylhydantoin
• d.Overdose of fluoride
• e.Lead poisoning
• f.Bulimia

The answer is ( C ).
Use of the anticonvulsant diphenylhydantoin, or of the calcium channel blocker nifedipine, may cause fibrous hyperplasia of the gingiva, leading to hypertrophied gums.

Tetracycline given to children or pregnant women causes
enamel hypoplasia and discoloration of the teeth. Ingestion of large amounts of fluoride may cause mottling of the tooth enamel. Lead poisoning causes the formation of a black “lead line” in the gums.
Hutchinson’s teeth are the congenital notched teeth of syphilis. Bulimia causes erosion of
the enamel on the surfaces of the teeth due to frequent gastric acid exposure.

Atlas of Minor Oral Surgery: Principles and Practice

The Atlas of Minor Oral Surgery is a striking, highly illustrated reference book that is tailor-made for the general dentist who wants to expand the services offered in the dental office. This book is a definitive resource on both clinical and patient management aspects of outpatient minor oral surgery as the dentist can learn how to perform oral and surgical techniques that he or she previously referred to the oral surgeon.

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