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Dental Specialties

Based on scientific evidence, what is the best method of post-operative pain management following surgical extractions?

For a surgical extraction (flap, bone removal) what do you usually prescribed? Leave us your comments. Has the new legislative requirements in Ontario on narcotic prescriptions changed your practice? From Dr. Stephen Cho, Oral & Maxillofacial Surgeon, Coronation Dental Specialty Group & Staff Surgeon, Cambridge Memorial Hospital Pain management in dentistry is an important objective, necessary for patients’ comfort and trust.  There are numerous medications and strategies which could be utilized for post-operative pain management following surgical extractions such as wisdom teeth extration. In his review on combination analgesic therapy in dental pain, Mehlisch suggests that monotherapy (eg acetaminophen alone) in treatment ...

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What concentration of hypochlorite do you use for endo?

Interesting debate going on in Monday’s post comments. What is the appropriate concentration of hypochlorite? 5% is used by many endodontists, .5% is often recommended in case of hypochlorite accident, 1.25% was recently recommended for in vitro studies for regenerative endo to preserve any live cells in HERS. According to the recent article in JCDA Express there are other options. What do you use?

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A periapical xray of necrotic tooth #3.5 with a blunderbuss apex

Clinical Case: How would you save this tooth with an open apex?

Dr. Sarah Abitbol, Endodontist, Coronation Dental Specialty Group with Dr. Ian Furst, Oral & Maxillofacial Surgeon, Coronation Dental Specialty Group Here’s a case that involves regenerative endodontics. If you’re not sure what regenerative endodontics is or if you’d like a quick tutorial on the biologic basis for it, we’ve created an interactive backgrounder. For a flash version (desktops) click here For a non-flash version (HTML5, ipads and some phones) click here. (some phones do not support the audio), appx 9MB file Clinical Question An 11 year old girl presents with swelling and pain in the left mandible and a fistula adjacent to ...

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Misplaced tooth #1.3

Clinical Cases Update: How would you design the surgical flap for this case? The ectopic canine

Ian Furst, Oral & Maxillofacial Surgeon, Coronation Dental Specialty Group The solution we used; The consensus from the comments is that most would have waited for the tooth to erupt.  In this case, the orthodontist had asked that tooth 1.4 be extracted and the 1.3 be further exposed and bonded.  Because we are a multi-disciplinary practice, I had the luxury of having the periodontist I work with take a look as well.  Both of us were concerned that tooth 1.3 would develop recession on traction.  Because there would be a good band of keratinized tissue between 1.3 and the extraction site of 1.4, I ...

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How do I manage postoperative bleeding following periodontal surgery?

(Peer-reviewed content that will appear in the JCDA OASIS “point of care” searchable database at www.jcdaoasis.ca – which will be introduced at the beginning of 2013) How do I manage postoperative bleeding following periodontal surgery? Brennan Mui, Thomas T. Nguyen, Simon D. Tran Postoperative bleeding may present immediately, within the first 24 hours following periodontal surgery, or as delayed postoperative bleeding up to 7-10 days following surgery. Excessive bleeding may occur following routine periodontal surgical procedures, such as pocket reduction surgery or grafting, if stable hemostasis cannot be initially achieved. Normally, hemostasis is achieved within 30 to 60 minutes after surgical procedures ...

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Is there an accepted protocol for managing peri-implantitis?

(Content under development) The following question was submitted by a practising dentist: Is there an accepted protocol for the treatment/management of peri-implantitis and associated bone loss? JCDA Editorial Consultant Dr. Anastasia Cholakis of the University of Manitoba provided these initial comments for consideration: At this time, prevention of peri-implantitis seems to be the safest bet. According to the latest consensus of the 7th European Workshop on Periodontology “clinical and radiographic data should routinely be obtained after prosthesis installation on implants in order to establish a baseline for the diagnosis of peri-implantitis during maintenance of implant patients.” A proper in-office peri-implant maintenance protocol ...

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Does crown-root ratio matter or not with an integrated implant?

(Content under development) The following linked questions were submitted by a practising dentist: Does crown-root (C/R) ratio matter or not with an integrated implant and, then more importantly, what do you do in your practice? What does the literature say about C/R ratio for implants with regard to short implants and crowns that are long or longer than the 50/50 guide for natural teeth? JCDA Editorial Consultants Drs. Reynaldo Todescan of the University of Manitoba, David Chvartszaid of the University of Toronto, and Ken Sutherland of the University of Saskatchewan provided these initial comments for consideration: According to Dr. Todescan: ...

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For the frail elderly, how often should fluoride varnish be applied and in what doses?

(Content under development) The following question was submitted by a practising dentist: I am working in a residential care centre with mostly frail elderly. I am looking for information on Fluoride varnish application and dental caries. How often should it be applied and in what doses? JCDA Editorial Consultants Drs. Michael MacEntee of Vancouver, Michael Wiseman and Rita Hurley of Montreal and Mary McNally of Halifax provided this initial discussion for consideration: Dr. McEntee opened the discussion: Management of caries requires a multifaceted approach (which includes applying fluoride varnish periodically), the primary objective of which is to stabilize the normal sequence ...

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