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32 NEW ZEALAND DENTAL JOURNAL M A R C H 2 0

proceedingsThe Faculty of Dentistry Clinical Excellence Day was was held on Tuesday 25 May 2010 at the Otago Museum. Keynotaddresses were given by Dr Brett Lyons (Radiologist, Southem District Health Board) and Associate Professor Anita Nola(Faculty of D entistry). We are grateful to sym posium organiser Professor Tom K ardos for the oppo rtunity to print these abstract

Keynote address: Recent advances in dentomaxillofaeialimagingDr Brett LyonsCross-sectional imaging technology has become commonplacein medical imaging. Computed Tomography (CT) owes itsorigins to Sir Godfrey Hounsfield, who first conceived the ideaas a marriage of radar, pattern recognition and newly emergingcomputer technology. The first test scanner was installed in Londonin 1971. The rapid advancement of computer, x-ray tube and flatpanel detector technology has reduced slice acquisition times fromminutes to fractions of a second and is responsible for the latestgeneration of small and increasingly commercially viable scanners.Conebeam Computed Tomography (CBCT) represents a recentevolution of CT technology. This lecture compares CBCT withconventional CT technology and examines the advantages anddisadvantages and the challenges ahead.Identification of metallic substances in oral pigmented lesionsusing SeM EDS: A case reportHM Hussaini, JN W addell, L Girvan, AM RichAmalgam tattoo is a common pigmented lesion of the oralmucosa. It usually occurs due to implantation of dental amalgamwithin the oral soft tissue during dental procedures and presentsas a brown/grey/black asymptomatic macule. Pigmentationassociated with other dental materials is rare. We report a case of a17-year-old female presenting to an oral and maxillofacial surgeon

with symmetrical bilateral pigmented macules on the mandibulargingiva. The lesions were excised and a report of amalgam tattoowas issued. Subsequently, the pathologist was informed that thepatient had never had any form of dental restorative procedures.This prompted further investigation of the material that wasembedded in her mucosa. The histological slides were analysedat the Otago Centre for Electron Microscopy, University of Otagousing field emission scanning electron microscopy (SEM) andelectron dispersive spectrography (EDS). The metallic elementanalysis showed that the substance was mainly silver alloy, nota usual component of dental materials. Further discussion withthe patient revealed that she had recently completed orthodontictreatment which included silver soldering of the orthodonticbrackets. Silver alloys used in orthodontic soldering are subject tocorrosion because they have a tendency to emit electro-galvaniccurrents in the oral environment and consequently release metalions which can deposit themselves in the mucosa in the form ofa tattoo. Con clusion: This was a case of oral metallic tattoos asa result from corrosion of material used in orthodontic treatment.SEM EDS proved to be a powerful diagnostic tool in identifyingthe metallic substance within the oral mucosa.The importance of the periodontal review in periodontaltherapyEmi NoorThe ultimate goal in the treatment of chronic periodontitis ismaintenance of the teeth in function with comfort while conformingto the aesthetic expectations of the patient. Periodontal therapy canbe divided into three main stages: cause-related therapy, corrective

therapy and maintenance therapy. The specific elements of eachphase are determined by the initial examination and by subsequentperiodontal reviews; thus, the periodontal review plays an important

Keynote address: Looking in the m outh for Crohn's diseasAssociate Professor Anita NolanThe oral cavity provides the clinician with a unique opportunito provide excellence in care, not just from a dental perspective, balso to make a major contribution to patients' medical managem enMany medical conditions manifest oral signs, including CrohnDisease. Crohn's D isease (CD) is an incurable, chronic and relapsiinflammatory bowel disease that causes considerable sufferinand disruption to life, affecting all age groups. The incidence increasing worldwide, with parts of New Zealand now reportinone of the highest incidences in the world. Healthcare costs anow well in excess of $58 million per annum. There is increasinrecognition that the presence of the mouth lesions, termed "OrCrohn's Disease" (OCD), may precede the first clinical signs intestinal disease by many years and may be the first indication thtreatment of C rohn's D isease is failing. Furthermore, OCD may bassociated with a particular pattem of intestinal disease and bemarker for future significant disease burden (that is, a more seveCD). From a dental perspec tive. Oral Cro hn's Disease can be painfdisfiguring and challenging to manage. This presentation reviewcase histories of patients with OCD, describes the contemporamanagement of OCD, and explores how a future combined dentamedical approach may improve the clinical outcome for patienwith the oral and intestinal lesions of Crohn's Disease.Management of an endodontic-periodontic lesionKimmy LinThere is a close inter-relationship between the dental pulp anthe periodontium, with potential pathways of communication vexposed dentinal tubules in areas devoid of cementum, lateraaccessory canals, and the apical foramen. Clinically, these provian avenue for pathogens and their by-products to move betweethe two structures, and this may result in endodontic-periodontdisease. "Endo-Perio" lesions can be classified into endodontdisease, periodontal disease, and combined disease. Combinediseases include (1) primary endodontic disease with secondaperiodontal involvement, (2) primary periodontal disease wisecondary endodontic involvement, and (3) true combined diseasA case of primary periodontal disease with secondary endodontinvolvement will be presented, demonstrating the importance

initial diagnosis in determining treatment and prognosis.Prosthodontic management of a severely compromised dentitioJaafar AbduoThis clinical report describes the rehabilitation of a 50-yeaold male who expressed dissatisfaction with his existing dentcondition and complained that it was affecting his quality of lifFollowing examination, the dental problems were summariseas partial edentulism, overeruption of the remaining teeth andseverely compromised occlusal scheme. The remaining maxillaand mandibular teeth were unopposed which had led to a deviatioin his occlusal plane. Despite being able to function normally withe existing dental condition, he was concerned about the future his dentition and requested dental treatment that could restore hdental function and appearance in a predictable manner. Followin

the diagnostic procedure, a well-coordinated prosthodonttreatment that involved liaison with other dental disciplines windicated. The rehabilitative treatment com prised two phases. Th

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MARCH 2011 NEW ZEALAND DENTAL JOURNAL 33

restored with crowns that incorporate milled palatal surfaces, and aprecision removable partial denture will be fabricated to restore theedentulous areas.Excessive overbite - a surgical approachE Lam, W Harding, R De Silva, H ChoiBilateral sagittal split osteotomy (BSSO) is the most commonlyused procedure for the treatment of maxillofacial deformities suchas mandibular retrognathism or prognathism. Mandibular ramussagittal spit osteotomy is the most common technique used formandibular advancement surgery. Clinical case: Bessie was 22years and 9 months at the time of consultation. She presented witha skeletal Class 11 pattern with spacing of her upper dentition. Shehad a large overjet and a full overbite involving the palatal mucosa.She also had full-unit Class II molar and canine relationships. Thetreatment plan involved fixed orthodontic treatment in preparationfor mandibular advancement surgery, and then post-surgicalorthodontic treatment. To date, Bessie has had her mandibularadvancement surgery in March this year. She is currently in herpost-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 molarassociated with cervical enamel projections: a case report andmini-reviewFaizal HidayatDental anatomical features such as cervical enamel projections(CEPs) may predispose the periodontium to disease. CEPs areflat, ectopic deposits of enamel apical to the normal cemento-enamel junction (CEJ) level in molar furcation areas. These enameldeposits usually have a triangular shape and a tapering form,extending apically into furcation areas. They are commonly foundat the buccal surfaces of mandibular molars. CEPs in the furcationareas of molars have no true attachment and are therefore highlypredisposed to the creation of a deep periodontal pocket. Here, acase report is presented of CEP affecting a mandibular first molar,and its management with odontoplasty and regenerative procedureby placement of graft in the osseous defect.Dentine hypomineralisationNoren HasmunA nine-year-old boy (KF) was referred by his dental therapistfor management of hypoplastic teeth. KF was bom in Russia andcame to New Zealand with his adopting parents two years ago. Acomplete medical and dental history is not available but he did haverickets in infancy. Several primary teeth w ere extracted prior com ingto New Zealand. Dental examination showed severe breakdown ofthe enamel of the permanent first molars. Radiographs revealedcaries in primary molars and severe post-eruptive breakdown of first

permanent molars. The treatment plan included comprehensive careunder general anaesthesia because ofthe sensitivity ofthe permanentmolars and the difficulty of achieving adequate local analgesia. Carewas carried out on 29.05.09. The lower left first permanent m olar(36) was extracted because of severe post-eruptive breakdownmeaning that it was not restorable. The histology report notedhypomineralisation of the dentine. The aetiology and managementof dentine hypomineralisation (including its association with rickets)will be discussed.Small mouth - big problems: dental implications ofsclerodermaS Hamzah, E MacFadyen, G LingScleroderma (systemic sclerosis) is a rare autoimmune disease ofunknown aetiology. It progressively affects the connective tissuesand is characterised as a collagen-vascular disease which mainlymanifests in the skin as abnormal thickening due to excessive collagen

woman presented at the Special Care Unit (School of Dentistry) withvery limited mouth opening (10 to 15 mm interincisal distance); shehad been referred by a general dental practitioner for extraction ofroot remnants in the maxillary arch and the replacement of missingteeth with an upper partial denture. Typical signs of scleroderma wereobserved, nam ely thin and stiff tethered skin, h ands with a claw -likeshape, a lack of facial expression ("Mona Lisa face"), incompletelip closure, diminished mouth aperture and the typical pointy nose.Plaque-induced gingivitis, gingival recession associated with tooth41 , dental caries and xerostomia were also noted. Comprehensivedental treatment was carried out under general anaesthesia. Thisincluded full-mouth scaling and cleaning, restoration ofthe carious21 , and extraction ofthe roots of 15, 16, 13, 25 and 26. Follow-upplan comprised home care and professional care with special carerequired. Stretching exercises were incorporated to increase therange of motion of the mouth.

Osteoma and Gardner's syndromeHan Choi and Adrian B estOsteomas of the facial skeleton and cranial vault can occur andmay be an extra-colonic manifestation of Gardner's syndrome. Thedental practitioner can play an important role in detecting suchlesions and early recognition may lead to timely diagnosis andmanagement of this potentially life-threatening syndrome.

Mysteries of human m olarsAmna SiddiquiElimination of bacteria and their toxins from the root canalsystem is one ofthe goals of endodontic treatment. This is achievedby chemo-mechanical preparation of the root canal systemfollowed by three-dimensional root filling. Variations in root canalmorphology, especially in multi-rooted teeth, present constantchallenges for diagnosis and successful treatment. Comprehensiveknowledge of root canal anatomy and its variations is mandatory.The prognosis for root canal treatment exhibiting com plex anatomyis unfavourable if the clinician fails to identify and treat extracanals. The clinical management of a rare case of a maxillary molarwith six canals and some other molars with anatomical variations ispresented. These cases highlight the significance of morphologicalvariations in molar teeth and the importance of utilizing the modemendodontic armamentarium to achieve biological aims and afavourable treatment ou tcome."My Teeth Don't Meet" - the challenges associated with thetreatment of anterior open bitesKimberley TimminsAnterior open bites occur in a small proportion ofthe population;however, such malocclusions may prove to be problematic totreat. A num ber of treatment strategies may be used to treat

such patients. Treatment of anterior open bites often includesa combination of orthodontics and orthognathic surgery. Newadvances in orthodontics have resulted in the increasing use oftemporary anchorage devices to provide additional anchorage inthe treatment of a range of malo cclusions . This presentation willaddress the aetiology and possible treatment options for patientswith anterior open bites and present one such case that has beentreated in a novel way w ith temporary anchorage devices.Management of a partially dentate patient with fixedprosthesesChae ParkThis clinical presentation illustrates the managem ent of a partiallydentate patient with fixed prostheses. The patient was referred

to the Department of Oral Rehabilitation by his general dentalpractitioner for prosthodontic treatment of severe tooth wear and thereplacement of missing teeth. He had lost 11 teeth over the years,

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