Rapid maxillary expansion

Rapid maxillary expansion

84 Journal of Dentistry Vol. lo/No. 1 The first of the nine chapters deals very briefly with normal anatomy. In its ten pages, there is no menti...

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of Dentistry




The first of the nine chapters deals very briefly with normal anatomy. In its ten pages, there is no mention of lateral oblique and oblique occlusal views, nor of radiographs of the facial bones and sinuses. Although some of these are dealt with in the section on facial trauma, an initial comprehensive chapter on radiographic anatomy would be much more relevant to the needs of the undergraduate. In Chapter 2, the commoner developmental abnormalities are adequately covered, one-half of this chapter being devoted to unerupted teeth and their radiographic localization. However, the comments on vertex occlusal radiography are confused and unhelpful. The implication that it has little place in the localization of the unerupted upper canine would be refuted by many clinicians. Caries and periodontal disease, periapical changes and root resorption and root canal treatment are well described in three separate chapters. Results of trauma to the teeth and facial bones are also very well described, including a detailed account of fractures of the middle third of the face. By contrast, salivary calculi which for no apparent reason are dealt with in the same chapter, are allotted only nine lines. Tooth inhalation and swallowing is briefly mentioned, but no comment is made as to the relevance of chest and abdominal radiography in these patients. There is a good chapter on the Cysts of the Jaws, but a criticism is that even allowing for variation in classification of these cysts, inclusion of ameloblastoma tends to confuse rather than clarify. One omission is the term ‘keratocyst’ which should surely have been mentioned, even if only as synonymous with primordial cyst. Neoplasms are dealt with very satisfactorily. However, the statement ‘metastases from the bronchus, kidney and prostate may present in the jaws and may be lytic or sclerotic in appearance’ is misleading. For instance, this implies that a renal carcinoma may be expected to produce metastases which are sclerotic. Incidentally, the term ‘melanotic ameloblastoma’ should have been replaced by ‘neuroectodermal tumour of the jaw of infants’. The final chapter on Osteodystrophies includes sketchy descriptions of rare conditions, e.g. craniostenosis and cleidocranial dysostosis and it contains several noncontributory radiographs. These could have been omitted and the other subjects, fibrous dysplasia, Paget’s disease and hyperparathyroidism might then have been included in the previous chapter (headed ‘Neoplasms and Tumour-like Lesions of the Jaws’). This book is most suited to the needs of the undergraduate dental student. In spite of its uneven emphasis, he will find it a useful and readable book. It is competitively priced, but the student’s need for a further book on radiographic technique and anatomy has to be borne in mind. B. K. WignaB

RAPID MAXILLARY EXPANSION. Chicago, Quintessence. US$42.00.

By Donald J. Timms. 240


170 mm. Pp. 140. 1981. Illustrated.

It is noticeable that, in pursuit of higher standards of objectivity and statistical validity, many of today’s publications in orthodontics sacrifice the warmth and pleasure to be found in well-written prose. It is a welcome surprise, therefore, to encounter this textbook whose literary style captivates the reader in the manner of a good novel. As with many topics in orthodontics the subject of rapid maxillary expansion has a history extending over more than a century and has had its fair share of advocates and opponents whose passions have often dominated their objectivity. The additional ingredient in this particular area of controversy is the interrelated involvement of opponents and proponents from the ranks of the ENT specialists. Mr Timms has earned himself, by his numerous publications and teaching activities, a reputation as the leading contemporary authority on rapid maxillary expansion in the United Kingdom and his extensive experience and interest make him admirably qualified to produce this small yet comprehensive English language survey of the whole topic. He has proceeded methodically through the subject; beginning with a thoroughly researched historical background, leading on through a well-illustrated review of the anatomical areas involved into a consideration of the applicance, its clinical management and a consideration of the post-treatment situation. It is perhaps here that in this very controversial subject there is the greatest area of disagreement within the literature. There is a very interesting and informative chapter on the Medical Aspects of Rapid Maxillary Expansion; a chapter on the Use of Technique in Cleft Palate Cases and another which dispels the oft-held mistaken belief that this is a technique limited in its application to people below the age of 25 years. Cases treated by a team approach between an oral surgeon and Mr Tlmms are shown and one female patient of 49 years makes the point rather dramatically. To conclude the book there is a chapter devoted to the hazards, h&cations, contraindications, and radiographic analysis and, to quote the author, ‘The contraindications for RME are in inverse proportion to the indications, i.e. they are very few’.




It would be churlish to single out several of the contentious statements contained in this book; particularly as, despite their ultimate truth or otherwise, they are invariably supported by adequate references. Having had the pleasure of reading this very eloquent book I would unhesitatingly agree with the author that, ‘No matter whether one prefers removable, functional or fiied, Begs or edgewise or whatever, RME is nonconformist and the joker in the orthodontic pack’. One is also inclined to agree with his explanation that too little, if any, place is given to RME in the formal teaching curricula of dental schools and it seems to be largely a matter of chance exposure which determines whether many otherwise thorough and competent orthodontists fail to consider this valuable adjunct as being of possible assistance in a proportion of their treatments. It is to be hoped that the appearance of this book will direct the attention of such people to the additional possibilities available to them. M. S. Munday

A COLOUR ATLAS OF ORAL CANCERS. By Ame Burkhardt Pp. 186. Illustrated. London, Wolfe Medical. $24.00.

and Reinhard Maerker. 258 X 196 mm.

This colour atlas of oral cancers comprises a great number of clinical pictures of cancers and leukoplakias together with their histopathology. The colour reproduction of the clinical pictures and most of the photomicrographs is excellent. However, the readership at which thii book is aimed is by no means clear, as in essence the message of the book seems to be the unsurprising one that dysplastic, potentially premalignant lesions can produce a wide variety of appearances and that early recognition of these lesions and of cancers is Important. No one would quarrel with such ideas, but one wonders whether they need to be illustrated on so abundant a scale. Moreover, the authors tend to damage their case by several highly questionable statements. Thus they say, for example, that ‘Dysplasia. . . will as a rule precede malignant degeneration’. If ‘dysplasia’ is intended here to mean detectable lesions then the authors should provide some evidence for their statement, which is contrary to most workers’ fmdings. Another highly questionable statement is that ‘Tobacco abuse and poor oral hygiene must be regarded as the principal risk factors’ for leukoplakia and oral cancer. In fact, the enormous increase in cigarette smoking has been associated with a progressive decline in the incidence of oral cancer in most parts of the world where reliable data is available and the role of poor oral hygiene has never been quantified. The cliche of ‘secondary’ candidal infection of leukoplakias is also uncritically trotted out. Paradoxically, however, the main measure recommended for dysplastic candidal lesions is antifungal treatment. Most baffling of alI is the statement in relation to several of the examples that the condition is ‘clinically harmless and there is no need for a biopsy’. If white lesions can really be recognized so reliably as harmless by their clinical features alone that biopsy can be dispensed with, then there seems to be no point in introducing such terms as ‘carcinoma disshmtlans or indeed of even producing this book at all. It is unfortunate, therefore, in view of the authors’ considerable clinical experience and the trouble taken with the illustrations, that more thought has not been given as to the intended readership and that the supporting text has not been written more carefully with fuller consideration of current knowledge. R. A. Cawson

CRANIOFACIAL EMBRYOLOGY (DENTAL PRACTITIONER HANDBOOK, No. 15) 3rd ed. By G. H. Sperber. 216 x 138mm. Pp. 204.1981. Illustrated. Bristol, Wright PSG. $9.50. Professor Sperber’s book is one of the best known and useful of the Dental Practitioner Handbooks. This third edition maintains the standard of its predecessor and has been thoroughly revised and augmented with new material. Compared with the second edition it has an extra chapter, improved illustrations and some 30-40 extra pages. New material is scattered throughout the book so that the reviewer feels dippointed when here and there a chapter has remained unaltered. The major additions fii important gaps in the previous edition, notably a much more detailed description of the development of the individual bones of the skull and treatment of Skull Growth and Cephalometrics as a separate chapter. The sections on the mandible are largely unaltered. Extra detail is given on R&k& pouch, the hyoid bone, pharynx and the phenomenon of growth spurts. The section on the development of the face is rewritten to take account of the increased realization of the importance of the neural crest. For example it is now seen as giving rise to the cells of the cartilages of the pharyngeal arches rather than merely contributing to them.