Morbidity and mortality conference on anesthesia

Symposia the ages of 15 and 25 years. Any recommendation involving the health of this many individuals attracts scrutiny. Data supporting treatment recommendations must be current. Following a critical review of the literature directed to 3rd molar treatment, the AAOMS Board implemented a series of clinical trials designed to update knowledge on recovery after 3rd molar surgery and the potential clinical problems with retaining 3rd molars. A key component was enrolling asymptomatic patients willing to retain 3rd molars over time in a longitudinal trial. Blakey et al reported on baseline periodontal data from patients enrolled in the trial at the University of Kentucky and the University of North Carolina. Surprisingly, 25% had at least one periodontal probing depth ⱖ5 mm (PD) in the 3rd molar region, 33% if patients were at least 25 years old. White et al confirmed that these same patients had elevated levels of periodontal pathogens and elevated GCF inflammatory mediators, IL-1␤, in the 3rd molar region. Overall not considering 3rd molars, patients were periodontally healthy. Third molars were usually not studied in periodontal studies.

In analyses of available 3rd molar data from large data bases, NHANES III for younger subjects and ARIC for those 50 to 75 years old, the visible presence of 3rd molars increased the odds of finding increased periodontal PD more anterior in the studied quadrant. The recent focus on oral inflammation and a systemic inflammatory response has led clinical investigators to document an acute phase inflammatory response from the liver, increased serum CRP levels, in patients with periodontal disease. Our data suggest that 3rd molar periodontal pathology plays an important role in oral inflammation and in the systemic inflammatory response. References Ash MM, Costich ER, Hayward JR: A study of periodontal hazards of third molars. J Periodont 33:208, 1962 Blakey GH, Marciani RD, Haug RH, et al: Periodontal pathology associated with asymptomatic third molars. J Oral Maxillofac Surg 60:1227, 2002 Moss KL, Mauriello SM, Ruvo AT, et al: Reliability of third molar probing measures and the systemic impact of periodontal pathology. Submitted 3/05 J Oral Maxillofac Surg

MORBIDITY AND MORTALITY CONFERENCE ON ANESTHESIA Presented on Thursday, September 22, 2005, 3:00 pm—5:00 pm Moderator: Jeffrey D. Bennett, DMD, Indianapolis, IN Lewis N. Estabrooks, DMD, MS, South Portland, ME Karen E. Crowley, MS, DDS, Londonderry, NH

Alan L. Felsenfeld, DDS, Los Angeles, CA Charles H. Kates, DDS, North Miami Beach, FL

SYMPOSIUM ON ADVANCED IMAGING TECHNOLOGY Presented on Thursday, September 22, 2005, 3:00 pm—5:00 pm Moderator: Kevin S. Smith, DDS, Oklahoma City, OK

3D Craniofacial Imaging—Cone Beam Technology Jon P. Bradrick, DDS, Cleveland, OH Multi-slice, computed tomography technology has significantly improved patient treatment. Cone beam shaped x-radiation projection patterns, combined with helical data acquisition protocols, allowed decreased radiation exposure, rapid study times, and improved resolution already in hospital-based radiology departments. Increased cone beam angular dispersion, paired with complex reconstruction algorithms, allows scanning of large anatomic volumes in one revolution without subject movement. Elimination of the moveable couch of CT scanning equipment further reduced bulk and cost. 6

The result is comparatively inexpensive cone beam, CT technology for head and neck studies now available for the dental office. The hardware is comparable in size to a typical panorex machine and patients are seated during the examination. When combined with a desktop sized computer, head and neck CT studies can be obtained for less cost, less radiation exposure, and less patient inconvenience than hospitalbased CT equipment. Manipulation of data from in-office cone beam CT machines can be accomplished by desktop or laptop computers using Windows-based applications. Traditional two dimensional axial slice data presentation or orthogonal multi-planar reconstructions are available. Curved multi-planar reconstruction can even produce a panorex type image. The same software allows three dimensional reconstructions utilizing surface shaded display, or volume rendering formats. Data from these machines can be forwarded for construction of computer manufactured anatomic models. AAOMS • 2005