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Supporting Your Practice

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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My next patient is diabetic: what are the implications for the dental treatment I provide?

(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. Diabetes Mellitus Diabetes mellitus (DM) is a disease of glucose, fat, and protein metabolism characterized by hyperglycemia, which results from impaired insulin secretion or varying degrees of insulin resistance, or both. • Types: Type 1 DM, Type 2 DM, Gestational DM Local Anesthetic Precautions  Use vasoconstrictors with caution: Routine use of local anesthetic with 1:100,000 epinephrine is generally well tolerated. However, epinephrine has a pharmacologic effect that is opposite to that of insulin, so blood glucose could rise ...

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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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What is the impact of emerging radiographic technologies on cumulative patient ionizing radiation exposure?

(Content under development) The following question was submitted by a practising dentist: I have seen an exponential growth in the marketing of CBCT to dentists (shouldn’t we ALL have one?), and have seen an emerging trend of dentists using them to reverse engineer pans etc. Most recently, an advert came across my desk where bitewings engineered from a pan are the answer. What is the impact of emerging radiographic technologies on cumulative patient ionizing radiation exposure? JCDA Editorial Consultants Drs Ernie Lam of the University of Toronto, Garnet Packota of the University of Saskatchewan and Elaine Orpe of Vancouver provided these ...

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What is the most effective antibiotic therapy for an acute odontogenic infection?

(Content under development) The following question was submitted by a practising dentist: What is the most effective antibiotic therapy for an acute odontogenic infection? If you ask the oral surgeons they say doxycycline , when you ask the infectious disease specialists they say amoxicillin. In the literature some papers state clindamycin and then others the combination of flagyl. JCDA Editorial Consultant Dr. Mark Donaldson of Kalispell, Montana provided this initial response for consideration: The correct antibiotic is the one that works! If we remember that the basic tenet of infectious diseases is to match the right drug to the right ...

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