Besides other indications, the spring cantilever bridge can solve the difficult clinical problem of providing diastema on either side of a pontic. Unlike the conventional bridges, it has a somewhat controversial design in that the anterior pontic is connected to its retainer on a posterior abutment by a relatively long flexible palatal bar. This paper presents a case report of a spring bridge which fractured due to metal fatigue after 30 years of continued service. Other studies reported a mean life span of 8-10 years for conventional bridges. The advantages of the spring cantilever bridge are also discussed.
The epithelial cystic linings and adjacent connective tissues of 61 cases of odontogenic cysts (radicular cysts[RC], dentigerous cysts[DC] and odontogenic keratocysts[OKC]) and unicystic ameloblastomas(UA) were described and compared histopathologically. The type of epithelium in relation to the presence of rete processes and the distribution of chronic inflammatory cells were analyzed statistically. Significant associations between the presence of rete processes in the non-keratinized epithelial linings and inflammation in the subjacent connective tissues of RC and DC were found in this study. There was also a statistically significant association between the presence of rete Processes and nonkeratinized epithelial linings in OKC. The results also showed that in inflamed OKC, the cystic lining epithelium exhibited hyperplasia indistinguishable from lining epithelium of RC and DC. This study further showed that ameloblastomatous-like epithelial cystic linings were present in inflammed odontogenic cysts. All except for one case of unicystic ameloblastomas in this study showed ameloblastomatous epithelial cystic linings. It is recommended that the lining epithelium of RC and DC be examined carefully in order to rule out OKC. Similarly, ameloblastomatous-like lining epithelium arising from chronic inflammation in RC and DC should be differentiated from true ameloblastomatous cystic lining. Such careful examinations are diagnostically important in view of the similarities of epithelial cystic linings of inflamed OKC with DC and RC aggressive behavior ofOKC and UA.
The preliminary investigation was carried out to assess the severity of malocclusion between two centres, the dental schools in Leeds, United Kingdom and Kuala Lumpur, Malaysia. A total of 99 study models were analysed using the Index ofOrthodontic Treatment Need (lOIN). Thestudy models were ofpatients aged 8to 15years, equally distributed between male and female patients taken from the undergraduate and staff clinics. Forty nine and fifty study models were analysed at the Leeds Dental School and FacultyofDentistry,University ofMalaya,respectively.Fromthisobservation, it appeared that the sample of patients treated at the Faculty of Dentistry, Kuala Lumpur presented approximately 25%higher with casesin the severe end of the malocclusion based on the dental health component and almost 70%more with the aesthetic component. Factors contributing to this finding are discussed.
Twenty-one patients who underwent ablative surgery for head and neck cancer at Bristol Dental Hospital and School, England between the years 1996 and 2002 were enrolled in the study. A self-completed questionnaire based on Head and Neck Specific measures was addressed to the patients. The overall post-operative quality of life among these patients is acceptable. About half of the patients complained of moderate to severe difficulty in opening mouth wide (55%) and dry mouth (45%) and about one-third had major problems in swallowing solid food (36%), sleep disturbance (32%), trouble eating and enjoying meals (32%) and speech problems (32%). The study shows a tendency for the quality of life to improve steadily with increasing post-operative interval. It is hoped that the results will provide an insight into the patients' functional and psychological recovery, which will in turn help to facilitate the planning of appropriate strategies to improve their quality of life.
The application of PCR technique in genetic screening was demonstrated using the genetic materials from buccal cells of the students in the class. Two factors were taken into consideration when designing the experiments. The DNA region to be amplified should not be associated with any disease state. This is to eliminate any emotional and ethical problems associated with the experiments. In this practical, the presence and absence of a 38 bp sequence in the intron of COLIA2 gene were studied. The students were also shown on how to analyse the presence of homozygous and heterozygous alleles and the genetic variations that might be observed in the different ethnic groups of students. Another factor was the time taken to complete the experiment. Our experience showed that this experiment would take at least six hours to obtain and analyse the results. It is therefore suitable to be used in class teaching.
Oral lichen planus (OLP) which belongs to the spectrum of LP, is a commonly encountered
oral mucosal problem among patients seeking treatment in the Oral Medicine clinic. Its counterpart, oral
lichenoid reaction (OLR), which resembled OLP clinically and microscopically, is often encountered in
these patients as well. Although the various clinical forms of OLP/OLR are well-recognized, the disease
pattern in regards to lesion-active and lesion-free periods in these patients remains poorly characterized.
Thus the aim of this study was to determine the clinical and demographic profile of those patients with
active OLP/OLR lesions and compare them with those patients who are clinically lesion-free.
Materials and methods: The study subjects comprised 20 patients who attended the Oral Medicine
Clinic at the Faculty of Dentistry, University of Malaya for follow-up appointments/management. They
were interviewed according to a pre-designed questionnaire, and clinical examination was carried out. All
these were conducted under the supervision of Oral Medicine specialists. OLP was diagnosed according
to the internationally accepted criteria.
Results: The cohort consisted of predominantly female (n=14; 70%) and Chinese (n=9; 45%) patients,
with an overall age range of 26-79 years (median, 56 years). Fifteen (75%) patients presented with
active OLP/OLR lesions and the remaining 5 (25%) were lesion-free. The lesion-active group comprised
3 (15%) males and 12 (60%) females whereas the lesion-free had 3 (15%) males and 2 (10%) females.
Reticular LP was the most common type (n=21/35; 60%) and the gingiva was the most prevalent site
(n=21/46; 45.65%). Social habits, medical histories and medications were not significantly different
between lesion-active and lesion-free OLP patients.
Conclusions: Findings suggest that demographic parameters, lifestyle and systemic diseases do not
appear to influence the disease pattern and lesion severity in OLP.
A retrospective study was carried out to review the records of 47 patients who had had in total 80 supernumerary teeth (ST) removed under general anaesthesia between 1975 and 2002. Malays made up 38.30%, Chinese 51.06%, and Indians 10.64% of the patients. The predominant age group was 6-10 year-old. The mean age was 12.96 ± 9.49 years. The male and female ratio was 1.35:1. Most of the patients had either one ST (n=31; 65.96%) or two ST (n=11; 23.40%). Five cases of multiple supernumeraries were recorded. Two patients experienced late formation of subsequent ST after the first surgery, thus requiring a second surgery. The majority of ST were conical in shape (n=35; 43.75%). Most of the ST were located in the premaxilla (n=55; 68.8%). Almost a quarter (23.75%) of ST were inclined towards the oral cavity. Some of the effects on the dentition were diastema, cystic changes, rotation, displacement, and retention of the permanent teeth and these were the indications for removal of ST. The most common surgical approach for maxillary ST was from the labial, buccal or labio-buccal approach.
Temporary obturator is necessary for maxillectomy procedures to minimise functional disabilities of speech and the swallowing of food and fluid following surgery.l.2 It also provides a base to hold surgical packing and/ or tissue conditioners in place. This packing helps to restore function and counter act contraction during healing of the ,tissues at the operated site. Dental clinicians are often faced with the problem of surgical staffs requesting an obturator for their patients at short notice.This article describes a fast technique of constructing an immediate surgical obturator.
This systematic review focuses on the management of two types of osseous defects, i.e. dehiscence and fenestration that arise during the placement of dental implant in the edentulous area (delayed implant placement). A systematic online search of main database from 1975 to 2009 was made. Five randomised controlled trials have been identified based on the inclusion criteria. Different management procedures were identified, in which guided bone regeneration procedure was most commonly advocated. Resorbable and non-resorbable m'embranes were compared, in which resorbable membrane was preferred as it caused less complicatiQn of membrane exposure or risk of infection. The benefit of using bone substitute along with membrane in rypairing bony defects cannot be concluded.
Desquamative gingivitis (DG) is a manifestation of a number of mucocutanenous disorders, one of it being oral lichen planus (OLP). OLP is an autoimmune disease. The aetiology for this condition is unknown, but there are few factors associated with its occurrence, for example alcohol drinking, smoking, allergic reaction to certain medications or restorative material. DG lesions increase the long-term risk for plaque-induced periodontal disease. At the same time, dental plaque and calculus cause gingival OLP resulting in the erosive disease. This report presents the management of a case of oral lichen planus associated with desquamative gingivitis with periodontitis. The expertise involved are from the oral medicine, periodontic and prosthodontic clinics. The uniqueness of the case management was the introduction of single tufted brush, Tepe® compact tuft toothbrush, to perform “solo brushing technique”. It was able to remove plaque effectively and did not cause irritation to the gingivae. Patients presenting with mucocutaneous disorders which exarcebates other oral conditions requires multidisciplinary management. Proper treatment planning will significantly improve their oral health related quality of life.
Osteosarcoma is a primary malignant neoplasm of the bone. Osteosarcoma of the jaws especially those of maxilla is rare. The diagnosis of osteosarcomas is difficult and challenging. In this case report we highlight a rare case of osteosarcoma of the maxilla in a 29 year old male patient which was highly aggressive and was initially diagnosed as rhabdomyosarcoma. This case highlights the difficulty in diagnosing osteosarcoma merely from incisional biopsy specimens which may not be representative of the whole tumour. Limited clinical information at incisional biopsy also adds to the difficulty in arriving at the definitive diagnosis. We further discuss the treatment modalities followed in this case.
Amalgam has been widely used in dentistry and its components may cause some oral mucosal changes (OMC), commonly presenting as oral lichenoid lesions (OLLs), acute or generalized sensitivity reaction or amalgam tattoo. Our objective was to determine the demographic and clinical profile of patients with and without OMC adjacent to their amalgam restorations (AR) and to evaluate the prevalence and types of AR-related OMC and associated clinical parameters. Materials and methods: In this retrospective crosssectional study, 83 outpatients attending the Primary Dental Care Unit at the Faculty of Dentistry, University Malaya were examined for the presence of AR-related OMC. The study period was from early to mid July 2016. Firstly, patients’ personal details (age, gender, medical status, social habits) were analyzed and history of AR (the age, condition and number of restorations) was determined. Clinical examination of patient’s oral cavity was carried out to detect any AR-related OMC. The data collected was analyzed using SPSS 12.0.1 Result: Approximately 14.6 % patients had OMC. OLLs and amalgam tattoo made up 1.2% and 13.4% respectively. Females (8.4%) had higher predilection and Chinese were more commonly affected (8.4%). Social habits were not associated with OMC. Certain systemic diseases, age (p=0.005) and duration of amalgam (p=0.007) in the oral cavity were significant risk factors for OMC. Conclusions: Present findings suggest that AR-related OMC is uncommon. Three key parameters namely systemic diseases, patient’s age and duration of AR were identified as significant risk factors predisposing to the development of OMCs.
Verruco-papillary lesions (VPLs) of the oral cavity
described in the literature involve a spectrum of conditions
including squamous papilloma, verruca vulgaris, focal
epithelial hyperplasia, condyloma, proliferative verrucous
leukoplakia and verrucous carcinoma. The majority of the
VPLs are slow growing, benign in nature and have a viral
aetiology (1). Mucosal HPV types (HPV 6, 11, 13, 30,
32, 45, 52, 55, 59, 69, 72 and 73) have been implicated
as possible etiological causes for these benign lesions (2)
while virus associated benign mucosal outgrowths are not
too difficult to diagnose either clinically or by microscopy.
Apart from virus-associated lesions, VPLs harboring
malignant potential such as verrucous carcinoma,
proliferative verrucous leukoplakia and oral verrucous
hyperplasia (OVH) need to be further clarified for better
understanding of their predictable biologic behavior and
appropriate treatment. In particular, the condition referred
to as oral verrucous hyperplasia (OVH) poses a major
diagnostic challenge. OVH represents a histopathological
entity whose clinical features are not well recognised and
is usually clinically indistinguishable from a verrucous
carcinoma (3).
In 1980, Shear and Pindborg classified OVHs into
two clinical variants, a sharp variety comprising of long,
narrow, heavily keratinized verrucous processes which
appears white as a result of heavy keratinization and a
second variant referred to as the blunt variety consisting
of verrucous processes that are broader, flatter and not
heavily keratinized (3). A new pathological entity distinct
from what Shear and Pindborg earlier described has been
found in recent years among betel-quid chewers mainly
from Taiwan. In 2005, Chung et al., in a field survey of
1075 adults noted 9 verrucous lesions which they described
as exophytic outgrowths, which the authors hinted had
hitherto not been reported in the scientific literature (4).
Their Figure: 1 illustrated this newly described “verrucous
lesion”. Subsequently in 2009 Wang et al described a case
series of 60 cases from Taipei and classified these lesions as
plaque-type and mass-type lesions primarily based on their
histopathological features. It was also documented that the
mass-type verrucous hyperplasia may manifest as single
or multiple verrucous whitish pink lesions clinically while
the plaque-type lesions may appear as whitish verrucous
plaques. They also concluded that the terminology OVH
should be reserved to denote only the mass-type lesions
both clinically and histologically and suggested that the
plaque-type lesions should be clinically classified as oral
verruciform leukoplakia and histologically as verruciform
hyperplasia (5).
In an effort to bring uniformity in reporting
these lesions both clinically and histopathologically a
consensus meeting was held in Kuala lumpur, Malaysia
during December 15-18, 2013. A working committee
that included specialists working on oral malignant andpotentially malignant disorders attempted to formulate the
clinical and histopathological criteria of OVH based on
the discussion among the participants in the meeting. The
meeting was attended by 46 participants from 7 countries
and included specialists and trainees in the disciplines
of Oral Medicine and Oral and Maxillofacial Pathology.
Consensus guidelines arising from this meeting is as
follows.
Acrylic resin is commonly used to fabricate removable prostheses due to its adequate physical, mechanical
properties and cost effectiveness. There has been continuous development of the materials to improve their
properties and to widen their applications in different clinical settings. This study aimed to provide a
historical development of the acrylic resin and elaborate on the properties of different types and the
processing methods of acrylic resins used to fabricate denture base which are commercially available in the
market. This would help dental clinicians to choose the best material of choice in the market. The authors
have summarized the history, development and classification of different types of acrylic resins used in
fabricating dentures and processing methods based on published research available on this topic using
published materials available in the Dental Library, University of Malaya and the database (Science Direct,
PubMed). Every type of acrylic denture base material has its pros and cons. Therefore, careful selection of
the material and processing method is crucial to ensure patients are receiving the best outcome in
prosthodontic treatment hence upholding the patients’ best interest and improving their quality of life.
This article reviews the concept of Combination Syndrome and presents a clinical case of a patient with a modern variation to this clinical scenario': The clinical procedures involved in the provision of a maxillary complete denture against a mandibular implant-supported complete fixed prosthesis is described with some suggestions on how to optimise the treatment outcome for the patient.
Aim: To manufacture a clinical simulation apparatus for the undergraduates' endodontic radiography teaching Objectives: • To provide a model for teaching of parallax method using Kelly's forcep • To provide a model for undergraduates to practice radiographic localization employing parallax method. • To allow students to practice taking radiographs in a way that simulates the clinical situations with a good diagnostic quality Methods: Impressions of a dentate arch (maxillary and mandibullary) were used to form a stone cast. A section of the cast, in the area where the natural teeth were to be placed, is sectioned and removed. Three maxillary extracted teeth (canine, first and second premolar) were selected and mounted with acrylic resin at the sectioned area. The resin was cured in a light box. The arches were mounted in a phantom head with a placement of rubber cheek. The first premolar was isolated with rubber dam. The intraoral holder (Kelly's forcep) was attached to a robotic arm. The students were taught the correct angulations of the x-ray cone for the paralleling technique and parallax method using Kelly's forcep during root canal treatment. Results: All students managed to complete the exercise and were considered competent when they produced acceptable quality of radiographs. Conclusion: The model described was improvised from a model that has been used during the past 2 years for undergraduates' endodontic courses. It has been well accepted as it simulates the clinical situation more closely than was possible previously.
Tooth transposition is a rare developmental anomaly
affecting less than 1% of the population. The
permanent maxillary canine and 1st premolar are the
most commonly affected teeth. Bilateral maxillary
canine-1st premolar transpositions are extremely rare
with only a handful of cases being reported in the
literature. We report one such case of bilateral
maxillary canine-1st premolar transposition in a 28
year old Malaysian female which was associated with
other dental anomalies.
A preliminary investigation to assess the relationship
in the severity of periodontal disease in diabetics when
compared with non-diabetic subjects. Materials and
Methods: A retrospective, comparative study using
periodontal case notes of 40 subjects (20 Type 2 diabetics,
20 non-diabetics) who were selected based on the
inclusion and exclusion criteria. Severity of periodontal
disease was assessed through number of periodontal
pocket ≥5mm. The results were compared between
subjects whose age, gender and plaque scores are matched
with the test group. Data obtained was then analyzed by
SPSS Version 12. Results: When comparisons were made
between test (Type 2 diabetic) and control (non-diabetic)
groups, there were no significant difference (p>0.05) in
the severity of periodontal disease. However, there was
a clinically mean difference between the two groups.
Conclusions: This preliminary investigation indicated
that the severity of chronic periodontitis, as indicated in
periodontal pocketing, increased in diabetic patients when
compared to non-diabetics clinically, although it was not
statistically significant. The finding of this investigation
was thus not conclusive as it was only a retrospective
study using patients’ case notes. However, the results
are now being further investigated with a proper clinical
trial which examines periodontal parameters and diabetic
status (HbA1c) of the subjects to determine the association
between periodontal disease and diabetes mellitus.
This paper attempts to review epidemiological studies of oral cancer and precancer in Malaysia. The defmitions of prevalence, incidence, risk habits and oral cancer and precancers were discussed to better understand' the different types of studies conducted, which would be important in making comparisons between studies. Currently, epidemiological data on oral cancer in Malaysia are sketchy. The only incidence data for oral cancer in Malaysia was reported by Hirayama in 1966, 35 years ago. He estimated that 3.1 new cases per 100,000 population were diagnosed for the year 1963. A number of histopathological data of oral and maxillofacial biopsies were reported. Oral cancer accounted for one-fifth of all oral biopsies. A national study on oral mucosal lesions in Malaysia carried out in 1993/4 reported that there was a variation seen in the occurrence of oral premalignancy among the ethnic groups. The Indians and the indigenous people of Sabah and Sarawak were identified as high risk groups for oral cancer and precancer. It was also observed that both of the ethnic groups chewed betel quid. In conclusion, the epidemiological studies have provided useful data, which may be used in planning for future oral health programmes and research towards enhancing Malaysia's on-going effort in preventing the occurrence of these diseases.