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Research in Clinical Dentistry—1964
Research in clinical dentistry— 1964
Jam es W . Bawden * D D S, M S , PhD , Chapel H ill, N C
T h e year 1964 brought num erous p u b lications of research in clinical dentistry. Findings in endodontics, oral surgery, op erative dentistry, orthodontics, pedodontics, oral diagnosis, periodontics and oral pathology, prosthetics and preventive dentistry, have been obtained from ob servation and study of patients, patient records and hum an tissues. T h e y are enu merated to help the practitioner select, m odify and im prove his treatm ent of patients on a scientific basis.
I t is difficult to define the m aterial to be included in a review of research in clini cal dentistry. M any basic investigations are im portant to clinical dentistry, but it was arbitrarily decided to include only the clinical studies. T hese publications present findings obtained from observa tion and study of hu m an patients, patient records and h u m an tissue. Case reports and descriptions of new technics have been excluded unless the new technic has been presented w ith supporting d a ta by w hich evaluation can be m ade. Studies of d ental m aterials and the m echanisms of dental caries have also been excluded since these subjects are being given special review.
E N D O D O N T IC S
Several articles evaluating the apparent success of conservative endodontic treat m ent have been published in the past year. Grossman, Shepard and Pearson1 reported on the clinical success of endo dontic treatm ent applied to 438 teeth th a t h ad been u n der observation for 1 to 5 years. Results in 90 per cent of all teeth treated by vital pulp extirpation were re garded as successful, and treatm ent of pulpless (nonvital) teeth achieved 89 per
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cent success. W hen teeth were treated w ith antibiotics, the success rate was higher than when conventional m edica m ents were used. Bender, Seltzer and Turkenkoph2 studied 2,335 endodontically treated teeth 6 m onths a fte r treat m ent and 706 such teeth after 2 years. T hey reported a success rate of 82 per cent overall. T eeth w ith radiographic evidence of bone rarefaction h a d a poor er prognosis th an teeth w ith no periapical radiolucency. Overfilling of canals re duced the rate of success below th a t of teeth in w hich the canals were filled flush w ith the apex. A study by Patterson, Shafer and H ealey3 indicated th a t a fa vorable clinical result was realized in 88 per cent of th e teeth treated by conserva tive endodontic technics. These three studies clearly indicate the degree of suc cess th a t m ight be expected in the routine, careful application of conserva tive endodontic treatm ent. P atterson and co-workers also investigated periapical le sions in 501 endodontically treated teeth th a t required surgery to com plete suc cessful treatm ent. Biopsy revealed th a t 84 per cent of th e lesions were granulom as; 14 p er cent, cysts, and 2 p er cent, other pathosis. A ttention also has been given to the bacteriology of root canals an d to the study of culture technics. Sulitzeanu, B eutner and Epstein4 found th a t cultures from 80 of 101 teeth undergoing endo dontic treatm ent were positive, b u t it was also significant th a t positive smears were obtained from some root canals th a t did not yield positive cultures. D a ta pre sented by Engstrom and Frost ell5 showed th a t, of the technics they used, m ore posi tive cultures were obtained w hen samples were incubated on both serum-dextrose and thioglycollate broth. This m ethod re quired a four-day incubation period. Shovelton6 noted th a t th e bacterial in vasion of dentin from the root canals of infected teeth occurred m ore often and the invasion was deeper in chronically in volved teeth than in teeth w ith acute symptoms. Such studies contribute to
continued im provem ent in endodontic treatm ent methods. ORAL S U R G E R Y
Reports concerning subjective and objec tive m easurem ent of stress endured by patients undergoing oral surgery have been published by Szmyd and others7 and by Shannon an d Davis.8 T h e form er noted a statistical correlation between the difficulty of oral surgery and increased blood levels of 17-ketosteroids, possibly indicative of greater stress. No correlation was found betw een pain and blood ster oid levels one h o u r postoperatively but, a t three hours, a positive relationship could be dem onstrated. Shannon and Davis8 observed hem atologic changes in white blood cell count, num ber of neu trophils, num ber of lymphocytes, packed cell volume and corrected sedim entation rate four hours after surgery. O nly the changes in sedim entation rate were sta tistically significant and seemed to per sist. Shannon a n d Davis related such changes to adrenocortical hyperactivity in response to stress. Significance in such studies is the developm ent of objective measurements of p atient physiologic re sponse to dental treatm ent. An investigation of histologic and clini cal findings in th e use of Teflon and Silas tic for m andibular replacem ent was pub lished by Small, Brown and Koberick.9 W hen hum an response was correlated w ith histologic findings in dogs, it was observed th a t the tissues treat both m ate rials as foreign bodies and will n o t retain them in the face of gross contam ination or inadequate fixation. W hen proper fixa tion is obtained and contam ination is avoided, however, clinical results with these m aterials in reconstruction have been encouraging. A num ber of 1964 publications related the clinical trial of drugs in oral surgery procedures. Positive results were reported in two double-blind, controlled studies on the effectiveness of tranquilizers (hy droxyzine and hydroxyphenam ate) in
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reducing anxiety and tension before surgery.10,11 A paper by M eyer and Jakubowski12 indicated th a t the local in jection of antihistam ines, tripelennam ine an d diphenhydram ine, m ay help to ob tain anesthesia w hen conventional local anesthetics are contraindicated. Adrenochrom e monosemicarbazone was com pared w ith a placebo in an attem pt to determ ine the effectiveness of the drug in the control of hem orrhage after the extraction of teeth.13 Findings from 395 patients did n o t reveal a significant re duction in hem orrhage from the drug therapy. Interest in postoperative reduction of pain and swelling in response to systemic m edication was reflected in the clinical testing of two preparations. Salem14 re ported th a t m ethylprednisolone-aspirin com bination was significantly m ore effec tive in th e control of pain and swelling th an aspirin alone, and a p lan t proteo lytic enzyme, brom elain, was found by Tassm an, Zafran, and Zayon15 also to have a positive result. O P E R A T IV E
In operative dentistry, three papers ap peared relating to effects of dental h a n d pieces. A n investigation by Sorenson, Cantwell and A plin16 showed th a t the m axim um rate of tooth rem oval, when using an air turbine handpiece, occurred at pressures significantly above those at w hich m axim um heat transfer to the tooth was observed, suggesting heavier cutting pressures may be indicated. Kasloff17 m ade a photographic evalua tion of enam el cracks in 90 teeth on w hich partial veneer preparations h ad been accom plished using various h an d pieces and rotary cutting instruments. U n d er th e conditions, diam ond instru m ents produced few er enam el cracks th an carbide burs; a high-speed w ater turbine handpiece caused less cracking th an an air turbine or low-speed h an d piece, and no direct correlation could be found betw een speeds of rotation and the
num ber of cracks in the enam el of teeth. Belting, H aberfelde and Ju h l18 pre sented evidence of a potential health hazard in the use of air turbine h a n d pieces. In this study positive cultures of M ycobacterium tuberculosis were ob tained by holding petri dishes as far as four feet in front of patients w ith pul m onary tuberculosis w hen a cavity was being prepared in a lower first molar. An air-w ater spray produced fewer colonies than air alone. D a ta useful in cavity design were pub lished by Fusayam a and K urosu19 as a result of a study on the diagnosis and dis tribution of pits and fissures. T eeth were exam ined for pits and fissures, then seri ally sectioned to determ ine the accuracy of the diagnosis. Clinical diagnosis proved accurate. Similarly, the distribution of pits and fissures and extension from one surface of the tooth to another was ob served in 4,887 teeth. Interesting findings have been pu b lished on the treatm ent of pulp tissue traum atized and exposed by operative procedures. D achi, Ross and Stigers20 studied the effect of prednisolone (a syn thetic glucocorticoid th a t suppresses the inflam m atory response) in the therm al sensitivity and pulpal reactions in am al gam -restored teeth. Fifty teeth scheduled for extraction were treated by a 60second application of either the predni solone solution or a placebo solution to the interior of the cavity preparation. Seven days after treatm ent findings indi cated th a t the application of prednisolone h a d reduced sensitivity and inflam m ation of the pulp. A nother steroid preparation, combined w ith an antibiotic, was com pared with the vehicle alone in the treatm ent of painful pulpitis and surgical pulp ex posures. Lawson and M itchell21 reported, on the basis of 50 clinical cases and lim ited histologic observations, th at this corticoid-antibiotic com bination was ef fective in controlling pulpal inflam m a tion and degeneration. K apur, Shapiro and Shklar22 used six different pulp cap
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ping technics on 50 caries-free teeth scheduled for extraction. Sterile celluloid disks, calcium hydroxide and zinc oxideeugenol w ere applied to the exposed pulps both directly and after use of a Hyfrecator. T h e num ber of samples in each group was too lim ited to allow valid histologic com parison of th e three medic am ents, b u t it was clear th a t use of the H yfrecator resulted in severe degenera tive changes in th e pulp. I t was also noted th at, eight weeks postoperatively, no com plete healing h ad occurred. Such infor m ation continues to accum ulate and assist the practitioner’s selection of vital pulp therapy technics. C harbeneau23 presented an appraisal of finishing and polishing procedures for dental am algam using a m echanicalelectronic instrum ent to determ ine the smoothness of am algam surfaces w ith ex trem e accuracy and included d ata on m any of the conventional polishing tech nics. O ne item of interest was th a t, after carving of a restoration w ith a sharp carver, surface smoothness was not im proved by using a cotton pellet in an a t tem pt to improve the finish. O R T H O D O N T IC S
Several fine studies concerning dentofacial growth, developm ent an d physical anthropology offered findings of extreme interest in orthodontics, preventive ortho dontics and other clinical fields. T h e classic study by Dem pster, A dam s and D uddles24 of the arrangem ent of the roots of teeth in th e jaw s presented d a ta chal lenging concepts such as the Bonwill p a t tern, the curve of Spee and th e curve of M onson. Investigations by Lebret,25 R ich ardson and Brodie26 and by Sillman27 studying dimensional changes of the den tal arches during grow th result in articles highly recom m ended to the reader w ith an interest in grow th and development. V arious effects and results of the use of orthodontic appliances have also been in vestigated. Isaacson and others published two studies28, 29 of a screw-type appliance
used for m axillary arch expansion. Pres sures resulting from activation of the ap pliances were determ ined, and the use of m etallic im plants revealed th a t expansion of osseous segments of th e m axilla had been achieved in 4 of 5 patients in whom the appliance was used. Profile changes associated w ith orthodontic therapy, with specific attention to changes in lip posi tion, were investigated by R udee.30 R udee’s d a ta indicate a reasonably high correlation between changes in lip and incisor positions. A nother study, by H ug gins, O rth and Birch,31- recorded the stability of up p er incisors after their re traction by orthodontic therapy. I t was found, w hen 82 bicuspid extraction cases were evaluated, th a t the incisors had some degree of relapse in 69 per cent of the patients and w ere stable in the re m ainder of the sample. M ost of the re lapse occurred during the first six m onths’ posttreatm ent. T h e m ean am ount of in cisor m ovem ent was 1.1 mm. a t 6 months, 1.2 mm. a t 1 year and 1.3 m m . a t 3 years. O f particular interest in understanding certain aspects of the etiology of ortho dontic problems are studies dealing with evaluation of the pressures applied to the teeth by the orofacial m usculature. Proffit and others32 used pressure transducers to record tongue and lip pressures exerted against the dentition u n der various con ditions. T ongue pressure was invariably recorded from the lingual aspect of the u p p er m olars and incisors during swal lowing. T h e degree and p a ttern of pres sure, however, showed great variation from one individual to another and dif fered even in patients w ith sim ilar denti tion architecture. U sing a m ercury strain gauge attached a t the level of the larynx, K ydd and Neff33 recorded the frequency of deglutition of tongue-thrusters and com pared it w ith a population of “nor m al” swallowers. Surprisingly, it was found in this small sample th a t the tongue-thrusters’ m ean frequency of swallowing was approxim ately half th a t of the controls. T h e im plication is th at estimation of forces exerted by tongue-
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thrusting m ust consider force an d fre quency of pressure application. A nother aspect of orthodontic treat m ent was th e subject of a paper by Bloom and Brown,34 w hich reported on the effects of orthodontic appliances on the oral m icrobial flora. Saliva samples showed th a t th e increase in Lactobacillus population was the greatest of any of the categories studied and the only one in which treatm ent levels differed signifi cantly from p retreatm ent levels. A lthough the bacteriology of the saliva m ay not re late directly to the bacteriology of dental plaque, this study supports the clinical impression th a t oral hygiene problems in crease during orthodontic therapy. PE D O D O N T IC S
Clinical research pertaining to pedodontics provided two significant articles on the developm ent of the hum an dentition, one by Boiler35 on the prenatal develop m ent of th e h um an dentition, and a second by M oorrees, F anning an d H u n t36 on the age variation of form ation states for ten perm anent teeth. O ne of th e continuously perplexing problems in pedodontics, th a t of the sub merged deciduous m olar, was studied by V ia37 whose exam ination of 2,342 chil dren showed th a t 1 to 2 per cent h ad the condition. M ore im portant, th e d ata established a fam ilial tendency of sub merged molars. Frankel and Hawes38 based their per tinent study of the tim ing of tetracycline adm inistration and staining of teeth on 126 case histories of children. T h e criti cal tim e w hen adm inistration of tetracy clines will result in the staining of a p a r ticular tooth is tow ard the end of crown formation. W ith regard to pulp therapy, positive results were reported for indirect pulp capping in perm anent teeth39 an d for a formocresol pulpotom y technic in decid uous teeth.40 O th er studies concern findings on the correlation of traum atized anterior teeth
w ith occlusion,41 evaluation of the dental profile of neurom uscularly deficient p a tients,42 th e implications and interrela tions of oral habits,43 the gingival crevice m icrobiota of preschool children44 and the prevalence of congenitally missing teeth.45 O RAL D IA G N O SIS
In the field of oral diagnosis, a paper by Linenberg, W aldron and D elaune46 pointed u p the problems of accurate diagnosis of periapical lesions based on clinical and radiologic evidence. W hen 110 biopsy specimens from lesions in 68 m en, 17 to 25 years old, were examined, it was found th a t the pathologist’s results agreed w ith the clinical diagnosis in only 60 p er cent of the cases. Evans and C randell47 published one of the several articles on technics and effects. T h eir work shows th at, u n der laboratory conditions (not in p atien ts), the sharp ness of radiographic images can be im proved by using slow-speed films. It should be rem em bered, however, th at slow-speed films require a greater am ount of radiation and in most clinical applica tions their use is contraindicated. W hen D egering48 studied the effects of varia tions in the density of dental radiographs, he found th a t light-density images lack definition (d eta il), have inadequate con trast and give an incorrect impression of m ineralization. Use of dark-density films resulted in dim inution of the structural outline an d incorrect diagnostic impres sion of demineralization. R ichards49 used scintillation spectrom etry to study the quality of x-ray beams. T h e findings illustrated th a t the quantity of radiation em itted by a tube varies directly w ith tim e of exposure, tube cur ren t or both, b u t the quality of the beam rem ains unchanged. V oltage changes and filtration alter both quantity and quality. O ’Shaughnessy and M itchell50 im planted dosimeters in seven locations in a cadaver to observe changes in the radiation levels delivered to these regions under various
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conditions. Full-m outh radiographs were taken, altering target-film distance, filtra tion, collimation an d the kilovolt peak. Use of a long cone, added filtration and a collimated beam was the most effective com bination for reducing radiation to m ost sites, although radiation to all the dosimeters was minim al. P E R IO D O N T IC S A N D ORAL P A T H O L O G Y
Num erous clinical studies pertaining to periodontics an d oral pathology were re ported in th e scientific literature this last year. A group of U niversity of A labam a investigators reported on beneficial effects on gingival health of m ultivitam in-trace m ineral, protein an d vitam in C supple m ent as well as oral prophylaxis.51"54 T he patients studied included d ental students and subjects from the p atien t popula tion routinely seeking treatm ent in the teaching clinics at the school. Subjects were not selected on the basis of a poten tial dietary deficiency. Also on the subject of systemic influ ences on gingival inflam m ation, Shannon and Gibson55 could find no difference in responses to glucose tolerance tests in four groups of subjects classified as to the de gree of inflam m ation observed in the gingiva. Studying another systemic condition, Babcock and Nelson56 found a significant correlation betw een D ilan tin sodium levels in the saliva and the degree of gin gival hyperplasia observed in patients. W ith regard to the effect of local con ditions on th e gingival tissues, Ash, Gitlin and Sm ith57 reported a m oderately strong, positive correlation betw een the occur rence of plaque an d gingivitis. Such studies m ay be facilitated by using a Sim plified O ral Hygiene In d ex reported by Green and V erm illion.58 T h e S O H I (sixsurface) com pared favorably in accuracy w ith 12-surface and all-surface methods. A clinical condition, w hich m ay relate to isolated periodontal involvem ent of m olar
furcations, was pointed out by M asters and Hoskins.59 T h eir observations on 304 extracted molars showed th a t the contour of the cervical line was such th a t enam el dipped into the furcation region of 28 per cent of the teeth in the sample. In 4 p er cent, enam el actually projected into the furcation. I n a study of periadenitis aphthae, Graykowski, Barile and Stanley60 suc ceeded in isolating pure cultures of a transitional L-form bacteria from a biopsy of a periadenitis aphthae lesion. T hey injected the bacteria into rabbits and produced histologically similar le sions. T h e bacteria, probably a hemolytic Streptococcus, was recovered from the lesions in the rabbit. I t is clearly im pli cated in the condition. In one study61 com paring ultrasonic scaling instrum ents w ith conventional hand scaling m ethods, biopsies after 18 days indicated th a t wounds caused by scaling w ith ultrasonic instrum ents were m ore completely epithelized b u t that inflam m atory cellular infiltration was greater. Gross cem entum was removed m ore easily w ith hand curets from teeth extracted after treatm ent b u t effective root sm oothing could be done w ith u ltra sonic instrum ents.62 A nother study63 re ported stippling of root surfaces and greater loss of cem entum with ultrasonic technics. N o statistical difference could be dem onstrated w ith regard to the de gree of bacterem ia after hand and u ltra sonic scaling.64 T h e d a ta of these articles should be com pared by clinicians using ultrasonic instrum entation. O ther interesting studies have been published concerning control of cervical hypersensitivity,65' 67 the reliability of oral cytology in detection of cancer,68 func tional tooth contracts,69 the incidence of necrotizing ulcerative gingivitis in college students,70 the influence of periodontal disease on the pulp71 and salivary corpus cle activity.72 Space does not allow indi vidual com m ent on these reports, b u t they are w orth attention, and the reader is encouraged to exam ine them.
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P R O S T H E T IC S
T he m aterial cited p e rtain in g to pros thetics relates to rem ovable prosthesis since reports relating to research in fixed prosthetics were few. Changes after the in sertion of complete dentures were the object o f several studies. Johnson’s three studies73-75 showed th a t a rapid reduction o ccurred in the w idth and height of the m axillary ridge after placem ent of an im m ediate denture. This period lasted from 6 to 24 weeks under slightly varying technics. Swerdlow76 in vestigated 40 patients ran g in g from 17 to 65 years of age and fo u n d th a t th e vertical dimension, after placem en t of complete dentures, decreases by th e end of six m onths. An interesting aspect of this study was the discovery th a t the “phonetic” m ethod of determ ining vertical dimension gave a significantly different m easure m ent for vertical dim ension th a n did the “swallow” m ethod. T h e values recorded for interm axillary distance w ith the m an dible at “rest” were, on th e average, greater than the values obtained by use of the swallow technic. Bergman, Carlsson an d H edegard77 reported th a t stability in denture patients decreased in some cases during the first six months but did n o t change m uch in the next 18. O cclusal balance was re tained reasonably well fo r six m onths b u t then deteriorated rapidly. These studies complement each o th e r and provide pos sible cause-and-effect relationships be tween changes in th e functional status of complete dentures. T hree investigations78' 80 also supported the theory th a t d en tu re wearers have low chewing efficiency. Efficiency of these patients in m asticating certain test foods was less than 20 p er c e n t of th a t of sub jects with natural dentitions. Sheppard81 shows th a t incisal co n tact seldom occurs in complete denture wearers. R a th er surprising d a ta presented by K ydd, D utton and S m ith 82 indicated th a t the force (tim e-force) exerted on abut m ent teeth by p artial dentures was twice
as high in swallowing as in mastication. Strain gauges incorporated in the clasp arms of the dentures were used to obtain m easurements. P R E V E N T IV E D E N T IS T R Y
Considerable attention in preventive den tistry was given to evaluation of the elec tric toothbrush. Five studies reported th at use of the m echanical brush was superior to h an d brushing,83"88 and three other studies could detect no difference.89'91 These investigations were carried out u nder a wide variety of conditions, w ith different methods to m easure effective ness and w ith different electric and hand brushes. Such circumstances m ake it im possible to generalize on the effectiveness of the m echanical brushes and indicate only th a t they are or are not superior to h and brushes un d er a specific set of circumstances. A continuing accum ulation of data was published in 1964 indicating the beneficial effects of w ater fluoridation in the reduction of dental decay.92'97 Favor able results were also reported for topical applications of stannous fluoride, a pro phylactic paste containing stannous fluo ride and a stannous fluoride tooth paste.98’99 O ne other report, however, could detect no difference between a stannous fluoride tooth paste and the control.100 Brudevold, Chilton and Wellock101 published a prelim inary study showing d a ta from 1,861 children, ob served for one year, w hich indicated a promising reduction in incidence of decay resulting from use of acidulated sodium fluoride in a tooth paste. SU M M A RY
T h e articles cited in this review should provide valuable inform ation to practi tioners of clinical dentistry. A question is occasionally answered by the results of a single investigation, b u t it m ore often happens th at an accum ulation of d ata from a considerable num ber of investiga
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tions is necessary before firm conclusions can be reached. Clinical research p ub lished in 1964 contributed significantly to the fund of inform ation th a t aids the practitioner in selecting, modifying and im proving his treatm ent of patients on a scientific basis. *D e n ta l Research C e nter, U n iversity o f N o rth C a ro lin a , C hapel H ill, N C . 1. G rossm an, L. I., Shepard, L. I., and Pearson, L. A . R o e n tg e n o lo g ic and c lin ic a l e v a lu a tio n o f end odontic a lly tre a te d te e th . O ra l Surg., O ra l M e d . & O ra l Path. 17:368 M arch 1964. 2. Bender, I. B., Seltzer, S., and T urkenkopf, S. To cultu re o r n o t to c u ltu re ? O ra l Surg., O ra l M e d . & O ra l Path. 17:527 O c t. 1964. 3. Patterson, S. S., Shafer, W . G ., and H e aley, H . J . P e riapica l lesions associated w ith e n d o n tic a lly tre a te d te e th . J A D A 68:19! Feb. 1964. 4. Sulîtzeanu, A ., Beutner, E. H ., and Epstein, L. I. B a c te rio lo g ic studies o f p u lp -in v o lv e d teeth by c u ltu ra l and m iscroscopic m ethods. J A D A 69:300 Sept. 1964. 5. Engstrom . B., and F ro ste ll, G . Experiences^ o f b a c te rio lo g ic a l ro o t canal c o n tro l. A c ta o d o n t. scandinavica 22:40 Feb. 1964. . S hovelton, D. S. The presence and d is trib u tio n o f m icro-orga nism s w ith n o n -v ita l te e th . Brit. D. J . 117:101 A u g . 1964. 7. Szmyd, L., Shannon, I. L., H ester, W . R., and S tum pf, A . S u b je ctive and o b je c tiv e m easurem ent o f re sponses to th ir d m o la r im p a c tio n surgery. O ra l Surg., O ra l M e d . & O ra l Path. 17:257 Feb. 1964. . Shannon, I. L., and Davis, E. E. Stress in d e n ta l patie nts. I I I . H e m a to lo g ic changes fo llo w in g sim p le exod o n tia . J . D. M e d . 19:18 June 1964. 9. S m all, I. A ., Brown, S., and K oberîck, S. D. Teflon and S ila stic fo r m a n d ib u la r re p la c e m e n t: e xpe rim en tal studies and r e p o rt o f cases. J . O ra l Surg., A n esth. & H osp. D. Serv. 22:377 Sept. 1964. 10. G re e n w a ld , A . S. R e lie f o f tension in d e n ta l pa tie n ts : a c o n tro lle d study w ith hydroxyphenam ate. J A D A 68:708 M ay 1964. 11. Linenberg, W . B., and others. E valuation o f hy droxyzine, s e c o b a rb ita l and p la c e b o : results o f a d o u b le -b lin d study. J . O ra l Surg., Anesth. & H o sp. D. Serv. 22:305 J u ly 1964. 12. M eyer, R. A ., and Jakub ow ski, W . The use o f trip e ie n n a m in e and d ip h e n h y d ra m in e as lo c a l anes th e tics. J A D A 69:112 A u g . 1964. 13. Form an, G . H ., and H a y lo r, M . N . H e m o s ta tic p ro p e rtie s o f adreno chrom e m onosem icarbazone in den ta l surgery. B rit. D. J . 117:280 O c t. 1964. 14. Salem , J . W . M eth y lp re d n îs o lo n e -a s p îrin in o ro fa c ia l surgery: c o n tro lle d c lin ic a l tr ia l. J A D A 68:188 Feb. 1964. 15. Tassman, G . C ., Z a fra n , J . N ., and Zayon, G . M . E valuation o f a p la n t p r o te o ly tic enzyme fo r the con tro l o f in fla m m a tio n and p a in . J. D. M e d . 19:73 A p r il 1964. 16. Sorenson, F. M ., C a n tw e ll, K. R., and A p lin , A . W . T herm ogenics in c a v ity p re p a ra tio n using a ir tu rb in e hand pieces: the re la tio n s h ip o f heat tra n s fe rre d to rate o f to o th re m o va l. J . Pros. Den. 44:524 M ay-June 1964. 17. Kasloff, Z . Enamel cracks caused by ro ta ry in stru ments. J . Pros. Den. 14:109 J an.-F eb. 1964. 18. B e lting, C . M ., H a b e rfe ld e , G . C ., and Juhl, L. K. S pread o f organism s fro m d e n ta l a ir ro to r. J A D A 68:648 M ay 1964.
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19. Fusayama, T., and Kurosu, A . Diagnosis and d is trib u tio n o f pits and fissures. J . Pros. Den. 14:117 Jan.Feb. 1964. 20. Dachi, S. F., Ross, A ., and S tigers, R. W . Effects o f prednisolo ne on th e th e rm a l sensitivity and p u lp a l re actions o f a m a lg a m -re sto re d te e th . J A D A 69:565 N ov. 1964. 21. Lawson, B. F.t and M itc h e ll, D. F. P h arm acologic tre a tm e n t o f p a in fu l p u lp itis . O ra l Surg., O ra l M e d . & O ra l Path. 17:47 Ja n . 1964. 22. Kapur, K., Shapiro, S., and Shklar, G . The re sponse o f human d e n ta l p u lp to various physical and
c h e m ic a l agents: a c o rre la te d c lin ic a l and h is to p a th o lo g ic stu d y. O ra l Surg., O ra l. M e d . & O ra l Path. 17:640 M ay 1964. 23. C h arb eneau, G . T. An ap p ra is a l o f fin is h in g and p o lis fiin g procedures fo r d en tal a m a lg a m . J . M ic h ig a n D. A . 46:135 M ay 1964. 24. R. A . JA D A 25. 43:610
D e m pster, W . T., A d am s, W . J ., and D uddles, A rra n g e m e n t in th e jaws o f the roots o f th e te e th . 67:779 Dec. 1963. L e b re t, L. P hysiologic to o th m ig ra tio n . J . D. Res. J u ly -A u g . 1964.
26. Richardson, E. R., and B rodie, A . G . L o n g itu d in a l study o f g ro w th o f m ax illa ry w id th . A n g le O rth o d o n t. 34:1 J a n . 1964. 27. S illm a n , J . H . D im ensional changes o f th e d e n ta l a rches: L o n g itu d in a l study fro m b irth to 25 years. A m . J . O r th o d o n t. 50:824 N ov. 1964. 28. Isaacson, R. J ., W o o d , J . L., and In g ra m , A . H . Forces p ro d u c e d by ra p id m a x illa ry expansion. I. De sign o f th e fo rc e m easuring system. II. Forces present d u rin g tre a tm e n t. A n g le O rth o d o n t. 34:256 O c t. 1964. 29. Isaacson, R. J ., and M urp hy, T. D. Some effects o f ra p id m a x illa ry expansion in c le ft lip and p a la te pa tients. A n g le O rth o d o n t. 34:143 J u ly 1964. 30. R udee, D. A . P ro p o rtio n a l p ro file changes concu r rent w ith o rth o d o n tic th e ra p y . A m . J . O rth o d o n t. 50:421 June 1964. 31. H u g g in s ,_ D. G ., O rth , D., and Birch, R. H . A c e p h a lo m e tric in v e s tig a tio n o f s ta b ility o f u p p e r incisors fo llo w in g th e ir re tra c tio n . A m . J . O rth o d o n t. 50:852 Sept. J964. 32. P ro ffit, W . R., and others. In tra o ra l pressures in a y o u n g a d u lt g ro u p . J . D. Res. 43:555 J u ly -A u g . 1964. 33. K y d d , W . L., and N e ff, C . W . Frequency o f d e g lu titio n o f to n g u e thrusters c o m pared to a sam ple p o p u la tio n o f n orm al sw allow ers. J . D. Res. 43:363 M ay-June 1964. 34. B lo o m , R. H ., and Brown, L. R. A s tudy o f the effects o f o rth o d o n tic app lia nces on th e o ra l m ic ro b ia l flo ra . O r a l Surg., O ra l M e d . & O ra l Path. 17:658 M ay 1964. 35. B o ile r, R. J . Fetal m orphogenesis o f th e human d e n titio n . J . Den. C h ild re n 31:67 2nd q u a rt. 1964. 36. M o o rre e s , C . F. A ., Fanning, E. A ., and H unt, E. E., J r . A g e v a ria tio n o f fo rm a tio n stages fo r ten p e rm a n e n t te e th . J . D. Res. 42:1490 N o v.-D ee . 1963. 37. V ia , W . F. Subm erged d e c iduous m o la rs : fa m il ia l te n d e n c ie s . J A D A 69:127 A u g . 1964. 38. F ra n k e l, M . A ., and Hawes, R. R. T e tra cyclin e a n tib io tic s and to o th d is c o lo ra tio n . J . O ra l T he rap . & Pharm. 1:147 Sept. 1964. 39. H e ld -W y d le r, E. " N a tu r a l" (In d ir e c t) p u lp c a p p in g . J . Den. C h ild re n 31:107 1st q u a rt. 1964. 40. Law , D. B., and Lewis, T. M . Form ocresol p u lp o tom y in d e c id u o u s te e th . J A D A 69:601 N o v . 1964. 41. E ichenb aum , I. W . A c o rre la tio n o f tra u m a tiz e d a n te rio r te e th to occlusion. J . Den. C h ild re n . 30:229 4th q u a rt. 1963. 42. A lb u m , M . M ., and others. A n e v a lu a tio n o f the d en tal p r o f ile o f neurom uscular d e fic it p a tie n ts : a p ilo t study. J . Den. C h ild re n . 31:204 4th q u a rt. 1964. 43. P o rte r, D. R. Im p lic a tio n s and in te rre la tio n s o f oral h a b its . J . Den. C h ild re n . 31:164 2nd q u a rt. 1964. 44. d e A ra u jo , W . C ., and M acD on ald, J . B. The g in g iv a l c re v ic e m ic ro b io ta o f preschool c h ild re n . J . Peri o d o n t. 35:285 J u ly -A u g . 1964. 45. G le n n , F. B. A consecutive six-year study o f the p re v a le n c e o f c o n g e n ita lly missing teeth in p riv a te pe d o d o n tic p r a c tic e o f tw o g e o g ra p h ic a lly s e pa rated areas. J . Den. C h ild re n 31:264 4th q u a rt. 1964. 46. L in e n b e rg , W . B., W a ld ro n , C . A ., and Delaune, G . F., J r . A c lin ic a l, ro e n tg e n o g ra p h ic , and h is to p a th o lo g ic e v a lu a tio n o f p e ria p ic a l lesions. O ra l Surg., O ra l M e d . & O r a l Path. 17:467 A p r il 1964. 47. Evans, M . R., and C ra n d e ll, C . E. Im ag e sharp ness and film speed. O ra l Surg., O ra l M e d . & O ra l Path. 17:36 J a n . 1964. 48. D e g e rin g , C . I. A ro e n tg e n o g ra p h ic film density m easurem ent o f b io lo g ic structures. O ra l Surg., O ra l M ed. & O r a l Path. 17:605 N ov. 1964. 49. R ichards, A . G . Q u a lity o f an x-ray bea m . O ra l Surg., O ra l M e d . & O ra l Path. 17:739 June 1964. 50. O ’Shaughnessy, P. E., and M itc h e ll, O . F. E ffe ct o f
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a lte rin g physical ro e n tg e n o g ra p h ic fa c to rs on p a tie n t r a d ia tio n dose levels. J A D A 69:335 S e pt. 1964. 51. R ingsdo rf, W . M ., J r., and C heraskin, E. Perio d o n ta l pathosis in m an. V II. Effect o f m u ltiv ita m in tra c e m in e ra l versus p la c e b o su p p le m e n ta tio n on sulcus d e p th . J A D A 68:1 Jan. 1964. 52. C heraskin, E., and Ringsdorf, W . M ., J r . Perio d o n ta l pathosis in man. IX. Effect o f c o m b in e d versus a nim a l p ro te in sup p le m e n ta tio n upon g in g iv a l state. J . D. M e d . 19:82 A p r il 1964. 53. El-A shiry, S . M ., Ringsdorf, W . M ., J r., and C heraskin, E. Local and systemic in fluences in p e rio d o n ta l disease. I I. E ffe ct o f pro p h yla xis and natural versus syn th e tic v ita m in C upon g in g iv itis . J . P e riodont. 35:250 M ay-June 1964. 54. C heraskin, E., and Ringsdorf, W . M ., J r . V ita m in C sta te in a d e n ta l school p a tie n t p o p u la tio n . J . South. C a lifo rn ia D. A . 32-375 O c t. 1964. 55. Shannon, I. L., and G ibson, W . A . O ra l glucose to le ra n c e responses in hea lthy young a d u lt males classi fie d as t o caries status and p e rio d o n ta l response. J . A m . Soc. P e rio d o n t. 2:292 Jan.-F eb. 1964. 56. Babcock, J . B., and Nelson, G . H . G in g iv a l hyp e rp la sia and D ila n tin content o f th e s a liv a : a p ilo t study. J A D A 68:195 Feb. 1964. 57. Ash, M . M ., G itlin , B. N ., a n d Sm ith, W . A . C o rre la tio n between p la q u e and g in g iv itis . J . P e riodont. 35:424 S e p t.-O c t. 1964. 58. G reen, J. C ., and V e rm illio n , J . R. The s im p lifie d o ra l hygiene index. J A D A 68:7 J a n . 1964. 59. M asters, D. H ., and Hoskins, S. W . P rojection o f c e rv ic a l enam el in to m o la r fu rc a tio n s . J . P e rlodont. 35:49 Ja n .-F e b . 1964. 60. G rayko w ski, E. A ., Barile, M . F., and Stanley, H . R. P e riadenitis a p h th a e : c lin ic a l and h is to p a th o lo g ic aspects o f lesions in the p a tie n t o f lesions p ro d u c e d in r a b b it skin. J A D A 69:118 A u g . 1964. 61. Schaffer, E. M ., Stende, G ., and King, D. H e a lin g o f p e rio d o n ta l p o c k e t tissues fo llo w in g ultra s o n ic scal in g and hand p la n n in g . J . P eriodont. 35-140 M a rc h -A p ril 1964. 62. M oskow , B. S., and Bressman, E. C e m en tal re sponse to u ltra so n ic and hand in s tru m e n ta tio n . J A D A 68:698 M a y 1964. 63. B e ltin g , C . M ., and Spjut, P. J . Effects o f h ig h speed p e r io d o n ta l instrum ents on th e ro o t surface d u r in g s u b g in g iv a l calculus rem o val. J A D A 69:578 N ov. 1964. 64. Bandt, C . L., Korn, N . A ., a n d Shaffer, E. M . B acterem ias fro m ultra so n ic and hand in stru m e n ta tio n . J . P e riodont. 35:214 M ay-June 1964. 65. S m ith, B. A ., and Ash, M . M . A study o f a d e sensitizing d e n tifric e and c e rv ic a l h y p e rs e n s itiv ity . J. P e riodont. 35:222 M ay-June 1964. . S m ith, B. A ., and Ash, M . M ., J r. E valuation o f a desensitizing d e n tifric e . J A D A 68:639 M ay 1964. 67. Jansen, A . L. H yp e rse n sitiv ity c o n tro lle d by io n to phoresis: d o u b le b lin d in v e stig a tio n . J A D A 68:216 Feb. 1964. . S a ndle r, H . C . R e lia b ility o f o ra l e x fo lia tiv e cy to lo g y fo r d e te c tio n o f o ra l cancer. J A D A 68:489 A p r il 1964.
66
68
69. A d am s, S. H ., II, and Zander, H . A . Functional to o th con ta cts in la te ra l and in c e n tric occlusion. J A D A 69:465 O c t. 1964. 70. G ld d o n , D. B., Zachin, S. J., and G o ld h a b e r, P. A c u te n e cro tizin g u lce ra tive g in g iv itis in c o lle g e stu den ts. J A D A 68:381 M arch 1964. 71. M azur, B., and M assler, M . Influence o f p e rio d o n ta l disease on th e d e n ta l p u lp . O ra l Surg., O ra l M e d . & O ra l Path. 17:592 M ay 1964. 72. R ovelstad, G . H . S a liva ry corpuscle a c tiv ity . J A D A 68:364 M arch 1964. 73. Johnson, K. A study o f th e dim e n s io n a l changes o c c u rrin g in th e m axilla a fte r to o th e x tra c tio n . Part I I. C losed face im m e d ia te d en ture. A u s tra l. D. J . 9:6 Feb. 1964. 74. Johnson, K. A study o f the d im en siona l changes o c c u rrin g in the m axilla a fte r to o th e x tra c tio n . Part III. O pen fa ce Im m e d ia te d en ture tre a tm e n t. A u s tra l. D. J . 9:127 A p r il 1964. 75. Johnson, K. A study o f th e d im e n s io n a l changes o c c u rrin g in the m axilla a fte r to o th e x tra c tio n . Part IV.
In te rs e p ta l a lv e o le c to m y and closed face im m e d ia te d en ture tre a tm e n t. A u s tra l. D. J . 9:312 A u g . 1964. 76. S w erdlow , H . R o entgenceph alom etric study o f v e r tic a l dim ension changes in im m e d ia te d e n tu re patie nts. J . Pros. Den. 14:635 J u ly -A u g . 1964. 77. Bergm an, B., Carlsson, G . E., and H e d e g a rd , B. A lo n g itu d in a l tw o -y e a r study o f a num ber o f fu ll den tu re cases. A c ta , o d o n t. scandinavica 22:3 Feb. 1964. 78. Kapur, K., Soman, S., and Yurkstas, A . Test foods f o r m easuring m a s tic a to ry perfo rm a n c e o f d en ture w e ar ers. J . Pros. Den. 14:483 M ay-June 1964. 79. Kapur, K., and Soman, S. D. M a s tic a to ry p e rfo rm ance and e ffic ie n c y in d e n tu re wearers. J. Pros. Den. 14:687 J u ly -A u g . 1964. 80. Yurkstas, A . A ., and Emerson, W . H . Decreased m a s tic a to ry fu n c tio n in d en ture w earers. J . Pros. Den. 14:931 S e p t.-O c t. 1964. 81. S h eppard, I. M . Incisive and re la te d m ovem ents o f th e m a n d ib le . J . Pros. Den. 14:898 S e p t.-O c t. 1964. 82. Kydd, W . L., D utton, D. A ., and Sm ith, D. W . L ateral force s exerted on a b u tm e n t te e th by dentures. J A D A 68:859 June 1964. 83. Lobene, R. R. The e ffe c t o f an a u to m a tic to o th brush on g in g iv a l hea lth. J . P e riodont. 35:137 M arch A p r il 1964. 84. Lobene, R. R. Evaluation o f a lte re d g in g iv a l health fro m perm issive pow ered to o th b ru s h in g . J A D A 69:585 N ov. 1964. 85. Derbyshire, J. C ., and M a n k o d i, S. M . C leansing effectiveness o f conve ntional and e le c tric tooth bru shes: a c lin ic a l com parison . J A D A 69:317 Sept. 1964. 86. D erbyshire, J . C ., and M ankodi,^ S. M . G in g iv a l k e ra tin iz a tio n w ith hand and e le c tric tooth bru shes: a c y to lo g ic a l com parison . J A D A 68:255 Feb. 1964. 87. Soparkar, P. M ., and Q u ig le y , G . A . Power versus hand brushing: e ffe c t on g in g iv itis . J A D A 68:182 Feb. 1964. 88. Iwersen, A . E., and W e rk in g , D. H . H and and a u to m a tic tooth bru shes: effectiveness in in h ib itin g brown p e llic le . J A D A 68:178 Feb. 1964. 89. Ash, M . M ., Rainey, B. L., and Sm ith, W . A . Eval u atio n o f m anual and m o to r d riv e n toothbrushes. J A D A 69:321 Sept. 1964. 90. Kobayashi, L. Y., and Ash, M . M ., J r . A c lin ic a l e v a lu a tio n o f an e le c tric too th b ru s h used by o rth o d o n tic patie nts. A n g le O rth o d o n t. 34:209 J u ly 1964. 91. Sm ith, W . A ., and Ash, M . M ., J r . A c lin ic a l e v a lu a tio n o f an e le c tric to o th b ru s h . J . P e riodont. 35:127 M a rc h -A p ril 1964. 92. E nglander, H . R., Reuss, R. C ., and Kesel, R. G . D ental caries in ad u lts who consume flu o rid a te d versus flu o rid e -d e fic ie n t w a ter. J A D A 68:14 J a n . 1964. 93. Steinm an, R. R., and W oods, R. W . H e re d ity , en v ironm ent, d ie t, and caries in c h ild re n . J . South. C a li fo rn ia D. A . 32:163 M ay 1964. 94. W ay, R. M . The e ffe c t on d e n ta l carles o f a change fro m a n a tu ra lly flu o rid a te d to flu o rid e -fre e com m unal w a te r. J . Den. C h ild re n 31:151 2nd q u a rt. 1964. 95. A rra , M . C ., and Lemke, C . Effects o f adju ste d flu o rid a te d w a te r on d e n ta l caries in school ch ild re n o f A m ery, W isconsin. J A D A 69:460 O c t. 1964. 96. Blayney, J . R., and H ill, I. N . Evanston d e n ta l caries study. XX IV. Prenatal flu o rld e s -v a lu e o f w a te r borne flu o rid e s d u rin g pregna ncy. J A D A 69:291 Sept. 1964. 97. Sogaro, L. H . P h iliip s b u rg , N . J.-E aston, Pa. flu o r i d a tio n study. J A D A 69:295 Sept. 1964. 98. M erce r, V., and M uh le r, J . C . The e ffe c t o f a 30 second to p ic a l SnF2 tre a tm e n t on d e n ta l caries re d u c tio n s in c h ild re n . J . O ra l Therap. & Pharm . 1:141 Sept. 1964. 99. Bixler, D., and M uhle r, J . C . C o m b in e d use o f thre e agents co n ta in in g stannous flu o rid e : a p ro p h y la c tic paste, a solu tio n and a d e n tifric e . J A D A 68:792 June 1964. 100. Slack, G . L., and M a rtin , W . J . The use o f a d e n tifric e co n ta in in g stannous flu o rid e in th e c o n tro l o f d e n ta l carles. B rit. D. J . 117:275 O c t. 1964. 101. B rude vold, F.t C h ilto n , N . W ., and W e llo c k , W . D. A p re lim in a ry com parison o f a d e n tifric e con ta in in g flu o rid e and s oluble phosphate and e m p lo y in g a c a lc iu m -fre e abrasive w ith o th e r types o f flu o rid e d e n tifric e s . J . O ra l Therap. & Pharm. I : ! J u ly 1964.
Jam es W . Bawden * D D S, M S , PhD , Chapel H ill, N C
T h e year 1964 brought num erous p u b lications of research in clinical dentistry. Findings in endodontics, oral surgery, op erative dentistry, orthodontics, pedodontics, oral diagnosis, periodontics and oral pathology, prosthetics and preventive dentistry, have been obtained from ob servation and study of patients, patient records and hum an tissues. T h e y are enu merated to help the practitioner select, m odify and im prove his treatm ent of patients on a scientific basis.
I t is difficult to define the m aterial to be included in a review of research in clini cal dentistry. M any basic investigations are im portant to clinical dentistry, but it was arbitrarily decided to include only the clinical studies. T hese publications present findings obtained from observa tion and study of hu m an patients, patient records and h u m an tissue. Case reports and descriptions of new technics have been excluded unless the new technic has been presented w ith supporting d a ta by w hich evaluation can be m ade. Studies of d ental m aterials and the m echanisms of dental caries have also been excluded since these subjects are being given special review.
E N D O D O N T IC S
Several articles evaluating the apparent success of conservative endodontic treat m ent have been published in the past year. Grossman, Shepard and Pearson1 reported on the clinical success of endo dontic treatm ent applied to 438 teeth th a t h ad been u n der observation for 1 to 5 years. Results in 90 per cent of all teeth treated by vital pulp extirpation were re garded as successful, and treatm ent of pulpless (nonvital) teeth achieved 89 per
1464-J . A M ER . DENT. A S SN .: V o l. 70, June 1945
cent success. W hen teeth were treated w ith antibiotics, the success rate was higher than when conventional m edica m ents were used. Bender, Seltzer and Turkenkoph2 studied 2,335 endodontically treated teeth 6 m onths a fte r treat m ent and 706 such teeth after 2 years. T hey reported a success rate of 82 per cent overall. T eeth w ith radiographic evidence of bone rarefaction h a d a poor er prognosis th an teeth w ith no periapical radiolucency. Overfilling of canals re duced the rate of success below th a t of teeth in w hich the canals were filled flush w ith the apex. A study by Patterson, Shafer and H ealey3 indicated th a t a fa vorable clinical result was realized in 88 per cent of th e teeth treated by conserva tive endodontic technics. These three studies clearly indicate the degree of suc cess th a t m ight be expected in the routine, careful application of conserva tive endodontic treatm ent. P atterson and co-workers also investigated periapical le sions in 501 endodontically treated teeth th a t required surgery to com plete suc cessful treatm ent. Biopsy revealed th a t 84 per cent of th e lesions were granulom as; 14 p er cent, cysts, and 2 p er cent, other pathosis. A ttention also has been given to the bacteriology of root canals an d to the study of culture technics. Sulitzeanu, B eutner and Epstein4 found th a t cultures from 80 of 101 teeth undergoing endo dontic treatm ent were positive, b u t it was also significant th a t positive smears were obtained from some root canals th a t did not yield positive cultures. D a ta pre sented by Engstrom and Frost ell5 showed th a t, of the technics they used, m ore posi tive cultures were obtained w hen samples were incubated on both serum-dextrose and thioglycollate broth. This m ethod re quired a four-day incubation period. Shovelton6 noted th a t th e bacterial in vasion of dentin from the root canals of infected teeth occurred m ore often and the invasion was deeper in chronically in volved teeth than in teeth w ith acute symptoms. Such studies contribute to
continued im provem ent in endodontic treatm ent methods. ORAL S U R G E R Y
Reports concerning subjective and objec tive m easurem ent of stress endured by patients undergoing oral surgery have been published by Szmyd and others7 and by Shannon an d Davis.8 T h e form er noted a statistical correlation between the difficulty of oral surgery and increased blood levels of 17-ketosteroids, possibly indicative of greater stress. No correlation was found betw een pain and blood ster oid levels one h o u r postoperatively but, a t three hours, a positive relationship could be dem onstrated. Shannon and Davis8 observed hem atologic changes in white blood cell count, num ber of neu trophils, num ber of lymphocytes, packed cell volume and corrected sedim entation rate four hours after surgery. O nly the changes in sedim entation rate were sta tistically significant and seemed to per sist. Shannon a n d Davis related such changes to adrenocortical hyperactivity in response to stress. Significance in such studies is the developm ent of objective measurements of p atient physiologic re sponse to dental treatm ent. An investigation of histologic and clini cal findings in th e use of Teflon and Silas tic for m andibular replacem ent was pub lished by Small, Brown and Koberick.9 W hen hum an response was correlated w ith histologic findings in dogs, it was observed th a t the tissues treat both m ate rials as foreign bodies and will n o t retain them in the face of gross contam ination or inadequate fixation. W hen proper fixa tion is obtained and contam ination is avoided, however, clinical results with these m aterials in reconstruction have been encouraging. A num ber of 1964 publications related the clinical trial of drugs in oral surgery procedures. Positive results were reported in two double-blind, controlled studies on the effectiveness of tranquilizers (hy droxyzine and hydroxyphenam ate) in
Bawden: C L IN IC A L D E NTISTRY-1465
reducing anxiety and tension before surgery.10,11 A paper by M eyer and Jakubowski12 indicated th a t the local in jection of antihistam ines, tripelennam ine an d diphenhydram ine, m ay help to ob tain anesthesia w hen conventional local anesthetics are contraindicated. Adrenochrom e monosemicarbazone was com pared w ith a placebo in an attem pt to determ ine the effectiveness of the drug in the control of hem orrhage after the extraction of teeth.13 Findings from 395 patients did n o t reveal a significant re duction in hem orrhage from the drug therapy. Interest in postoperative reduction of pain and swelling in response to systemic m edication was reflected in the clinical testing of two preparations. Salem14 re ported th a t m ethylprednisolone-aspirin com bination was significantly m ore effec tive in th e control of pain and swelling th an aspirin alone, and a p lan t proteo lytic enzyme, brom elain, was found by Tassm an, Zafran, and Zayon15 also to have a positive result. O P E R A T IV E
In operative dentistry, three papers ap peared relating to effects of dental h a n d pieces. A n investigation by Sorenson, Cantwell and A plin16 showed th a t the m axim um rate of tooth rem oval, when using an air turbine handpiece, occurred at pressures significantly above those at w hich m axim um heat transfer to the tooth was observed, suggesting heavier cutting pressures may be indicated. Kasloff17 m ade a photographic evalua tion of enam el cracks in 90 teeth on w hich partial veneer preparations h ad been accom plished using various h an d pieces and rotary cutting instruments. U n d er th e conditions, diam ond instru m ents produced few er enam el cracks th an carbide burs; a high-speed w ater turbine handpiece caused less cracking th an an air turbine or low-speed h an d piece, and no direct correlation could be found betw een speeds of rotation and the
num ber of cracks in the enam el of teeth. Belting, H aberfelde and Ju h l18 pre sented evidence of a potential health hazard in the use of air turbine h a n d pieces. In this study positive cultures of M ycobacterium tuberculosis were ob tained by holding petri dishes as far as four feet in front of patients w ith pul m onary tuberculosis w hen a cavity was being prepared in a lower first molar. An air-w ater spray produced fewer colonies than air alone. D a ta useful in cavity design were pub lished by Fusayam a and K urosu19 as a result of a study on the diagnosis and dis tribution of pits and fissures. T eeth were exam ined for pits and fissures, then seri ally sectioned to determ ine the accuracy of the diagnosis. Clinical diagnosis proved accurate. Similarly, the distribution of pits and fissures and extension from one surface of the tooth to another was ob served in 4,887 teeth. Interesting findings have been pu b lished on the treatm ent of pulp tissue traum atized and exposed by operative procedures. D achi, Ross and Stigers20 studied the effect of prednisolone (a syn thetic glucocorticoid th a t suppresses the inflam m atory response) in the therm al sensitivity and pulpal reactions in am al gam -restored teeth. Fifty teeth scheduled for extraction were treated by a 60second application of either the predni solone solution or a placebo solution to the interior of the cavity preparation. Seven days after treatm ent findings indi cated th a t the application of prednisolone h a d reduced sensitivity and inflam m ation of the pulp. A nother steroid preparation, combined w ith an antibiotic, was com pared with the vehicle alone in the treatm ent of painful pulpitis and surgical pulp ex posures. Lawson and M itchell21 reported, on the basis of 50 clinical cases and lim ited histologic observations, th at this corticoid-antibiotic com bination was ef fective in controlling pulpal inflam m a tion and degeneration. K apur, Shapiro and Shklar22 used six different pulp cap
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ping technics on 50 caries-free teeth scheduled for extraction. Sterile celluloid disks, calcium hydroxide and zinc oxideeugenol w ere applied to the exposed pulps both directly and after use of a Hyfrecator. T h e num ber of samples in each group was too lim ited to allow valid histologic com parison of th e three medic am ents, b u t it was clear th a t use of the H yfrecator resulted in severe degenera tive changes in th e pulp. I t was also noted th at, eight weeks postoperatively, no com plete healing h ad occurred. Such infor m ation continues to accum ulate and assist the practitioner’s selection of vital pulp therapy technics. C harbeneau23 presented an appraisal of finishing and polishing procedures for dental am algam using a m echanicalelectronic instrum ent to determ ine the smoothness of am algam surfaces w ith ex trem e accuracy and included d ata on m any of the conventional polishing tech nics. O ne item of interest was th a t, after carving of a restoration w ith a sharp carver, surface smoothness was not im proved by using a cotton pellet in an a t tem pt to improve the finish. O R T H O D O N T IC S
Several fine studies concerning dentofacial growth, developm ent an d physical anthropology offered findings of extreme interest in orthodontics, preventive ortho dontics and other clinical fields. T h e classic study by Dem pster, A dam s and D uddles24 of the arrangem ent of the roots of teeth in th e jaw s presented d a ta chal lenging concepts such as the Bonwill p a t tern, the curve of Spee and th e curve of M onson. Investigations by Lebret,25 R ich ardson and Brodie26 and by Sillman27 studying dimensional changes of the den tal arches during grow th result in articles highly recom m ended to the reader w ith an interest in grow th and development. V arious effects and results of the use of orthodontic appliances have also been in vestigated. Isaacson and others published two studies28, 29 of a screw-type appliance
used for m axillary arch expansion. Pres sures resulting from activation of the ap pliances were determ ined, and the use of m etallic im plants revealed th a t expansion of osseous segments of th e m axilla had been achieved in 4 of 5 patients in whom the appliance was used. Profile changes associated w ith orthodontic therapy, with specific attention to changes in lip posi tion, were investigated by R udee.30 R udee’s d a ta indicate a reasonably high correlation between changes in lip and incisor positions. A nother study, by H ug gins, O rth and Birch,31- recorded the stability of up p er incisors after their re traction by orthodontic therapy. I t was found, w hen 82 bicuspid extraction cases were evaluated, th a t the incisors had some degree of relapse in 69 per cent of the patients and w ere stable in the re m ainder of the sample. M ost of the re lapse occurred during the first six m onths’ posttreatm ent. T h e m ean am ount of in cisor m ovem ent was 1.1 mm. a t 6 months, 1.2 mm. a t 1 year and 1.3 m m . a t 3 years. O f particular interest in understanding certain aspects of the etiology of ortho dontic problems are studies dealing with evaluation of the pressures applied to the teeth by the orofacial m usculature. Proffit and others32 used pressure transducers to record tongue and lip pressures exerted against the dentition u n der various con ditions. T ongue pressure was invariably recorded from the lingual aspect of the u p p er m olars and incisors during swal lowing. T h e degree and p a ttern of pres sure, however, showed great variation from one individual to another and dif fered even in patients w ith sim ilar denti tion architecture. U sing a m ercury strain gauge attached a t the level of the larynx, K ydd and Neff33 recorded the frequency of deglutition of tongue-thrusters and com pared it w ith a population of “nor m al” swallowers. Surprisingly, it was found in this small sample th a t the tongue-thrusters’ m ean frequency of swallowing was approxim ately half th a t of the controls. T h e im plication is th at estimation of forces exerted by tongue-
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thrusting m ust consider force an d fre quency of pressure application. A nother aspect of orthodontic treat m ent was th e subject of a paper by Bloom and Brown,34 w hich reported on the effects of orthodontic appliances on the oral m icrobial flora. Saliva samples showed th a t th e increase in Lactobacillus population was the greatest of any of the categories studied and the only one in which treatm ent levels differed signifi cantly from p retreatm ent levels. A lthough the bacteriology of the saliva m ay not re late directly to the bacteriology of dental plaque, this study supports the clinical impression th a t oral hygiene problems in crease during orthodontic therapy. PE D O D O N T IC S
Clinical research pertaining to pedodontics provided two significant articles on the developm ent of the hum an dentition, one by Boiler35 on the prenatal develop m ent of th e h um an dentition, and a second by M oorrees, F anning an d H u n t36 on the age variation of form ation states for ten perm anent teeth. O ne of th e continuously perplexing problems in pedodontics, th a t of the sub merged deciduous m olar, was studied by V ia37 whose exam ination of 2,342 chil dren showed th a t 1 to 2 per cent h ad the condition. M ore im portant, th e d ata established a fam ilial tendency of sub merged molars. Frankel and Hawes38 based their per tinent study of the tim ing of tetracycline adm inistration and staining of teeth on 126 case histories of children. T h e criti cal tim e w hen adm inistration of tetracy clines will result in the staining of a p a r ticular tooth is tow ard the end of crown formation. W ith regard to pulp therapy, positive results were reported for indirect pulp capping in perm anent teeth39 an d for a formocresol pulpotom y technic in decid uous teeth.40 O th er studies concern findings on the correlation of traum atized anterior teeth
w ith occlusion,41 evaluation of the dental profile of neurom uscularly deficient p a tients,42 th e implications and interrela tions of oral habits,43 the gingival crevice m icrobiota of preschool children44 and the prevalence of congenitally missing teeth.45 O RAL D IA G N O SIS
In the field of oral diagnosis, a paper by Linenberg, W aldron and D elaune46 pointed u p the problems of accurate diagnosis of periapical lesions based on clinical and radiologic evidence. W hen 110 biopsy specimens from lesions in 68 m en, 17 to 25 years old, were examined, it was found th a t the pathologist’s results agreed w ith the clinical diagnosis in only 60 p er cent of the cases. Evans and C randell47 published one of the several articles on technics and effects. T h eir work shows th at, u n der laboratory conditions (not in p atien ts), the sharp ness of radiographic images can be im proved by using slow-speed films. It should be rem em bered, however, th at slow-speed films require a greater am ount of radiation and in most clinical applica tions their use is contraindicated. W hen D egering48 studied the effects of varia tions in the density of dental radiographs, he found th a t light-density images lack definition (d eta il), have inadequate con trast and give an incorrect impression of m ineralization. Use of dark-density films resulted in dim inution of the structural outline an d incorrect diagnostic impres sion of demineralization. R ichards49 used scintillation spectrom etry to study the quality of x-ray beams. T h e findings illustrated th a t the quantity of radiation em itted by a tube varies directly w ith tim e of exposure, tube cur ren t or both, b u t the quality of the beam rem ains unchanged. V oltage changes and filtration alter both quantity and quality. O ’Shaughnessy and M itchell50 im planted dosimeters in seven locations in a cadaver to observe changes in the radiation levels delivered to these regions under various
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conditions. Full-m outh radiographs were taken, altering target-film distance, filtra tion, collimation an d the kilovolt peak. Use of a long cone, added filtration and a collimated beam was the most effective com bination for reducing radiation to m ost sites, although radiation to all the dosimeters was minim al. P E R IO D O N T IC S A N D ORAL P A T H O L O G Y
Num erous clinical studies pertaining to periodontics an d oral pathology were re ported in th e scientific literature this last year. A group of U niversity of A labam a investigators reported on beneficial effects on gingival health of m ultivitam in-trace m ineral, protein an d vitam in C supple m ent as well as oral prophylaxis.51"54 T he patients studied included d ental students and subjects from the p atien t popula tion routinely seeking treatm ent in the teaching clinics at the school. Subjects were not selected on the basis of a poten tial dietary deficiency. Also on the subject of systemic influ ences on gingival inflam m ation, Shannon and Gibson55 could find no difference in responses to glucose tolerance tests in four groups of subjects classified as to the de gree of inflam m ation observed in the gingiva. Studying another systemic condition, Babcock and Nelson56 found a significant correlation betw een D ilan tin sodium levels in the saliva and the degree of gin gival hyperplasia observed in patients. W ith regard to the effect of local con ditions on th e gingival tissues, Ash, Gitlin and Sm ith57 reported a m oderately strong, positive correlation betw een the occur rence of plaque an d gingivitis. Such studies m ay be facilitated by using a Sim plified O ral Hygiene In d ex reported by Green and V erm illion.58 T h e S O H I (sixsurface) com pared favorably in accuracy w ith 12-surface and all-surface methods. A clinical condition, w hich m ay relate to isolated periodontal involvem ent of m olar
furcations, was pointed out by M asters and Hoskins.59 T h eir observations on 304 extracted molars showed th a t the contour of the cervical line was such th a t enam el dipped into the furcation region of 28 per cent of the teeth in the sample. In 4 p er cent, enam el actually projected into the furcation. I n a study of periadenitis aphthae, Graykowski, Barile and Stanley60 suc ceeded in isolating pure cultures of a transitional L-form bacteria from a biopsy of a periadenitis aphthae lesion. T hey injected the bacteria into rabbits and produced histologically similar le sions. T h e bacteria, probably a hemolytic Streptococcus, was recovered from the lesions in the rabbit. I t is clearly im pli cated in the condition. In one study61 com paring ultrasonic scaling instrum ents w ith conventional hand scaling m ethods, biopsies after 18 days indicated th a t wounds caused by scaling w ith ultrasonic instrum ents were m ore completely epithelized b u t that inflam m atory cellular infiltration was greater. Gross cem entum was removed m ore easily w ith hand curets from teeth extracted after treatm ent b u t effective root sm oothing could be done w ith u ltra sonic instrum ents.62 A nother study63 re ported stippling of root surfaces and greater loss of cem entum with ultrasonic technics. N o statistical difference could be dem onstrated w ith regard to the de gree of bacterem ia after hand and u ltra sonic scaling.64 T h e d a ta of these articles should be com pared by clinicians using ultrasonic instrum entation. O ther interesting studies have been published concerning control of cervical hypersensitivity,65' 67 the reliability of oral cytology in detection of cancer,68 func tional tooth contracts,69 the incidence of necrotizing ulcerative gingivitis in college students,70 the influence of periodontal disease on the pulp71 and salivary corpus cle activity.72 Space does not allow indi vidual com m ent on these reports, b u t they are w orth attention, and the reader is encouraged to exam ine them.
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P R O S T H E T IC S
T he m aterial cited p e rtain in g to pros thetics relates to rem ovable prosthesis since reports relating to research in fixed prosthetics were few. Changes after the in sertion of complete dentures were the object o f several studies. Johnson’s three studies73-75 showed th a t a rapid reduction o ccurred in the w idth and height of the m axillary ridge after placem ent of an im m ediate denture. This period lasted from 6 to 24 weeks under slightly varying technics. Swerdlow76 in vestigated 40 patients ran g in g from 17 to 65 years of age and fo u n d th a t th e vertical dimension, after placem en t of complete dentures, decreases by th e end of six m onths. An interesting aspect of this study was the discovery th a t the “phonetic” m ethod of determ ining vertical dimension gave a significantly different m easure m ent for vertical dim ension th a n did the “swallow” m ethod. T h e values recorded for interm axillary distance w ith the m an dible at “rest” were, on th e average, greater than the values obtained by use of the swallow technic. Bergman, Carlsson an d H edegard77 reported th a t stability in denture patients decreased in some cases during the first six months but did n o t change m uch in the next 18. O cclusal balance was re tained reasonably well fo r six m onths b u t then deteriorated rapidly. These studies complement each o th e r and provide pos sible cause-and-effect relationships be tween changes in th e functional status of complete dentures. T hree investigations78' 80 also supported the theory th a t d en tu re wearers have low chewing efficiency. Efficiency of these patients in m asticating certain test foods was less than 20 p er c e n t of th a t of sub jects with natural dentitions. Sheppard81 shows th a t incisal co n tact seldom occurs in complete denture wearers. R a th er surprising d a ta presented by K ydd, D utton and S m ith 82 indicated th a t the force (tim e-force) exerted on abut m ent teeth by p artial dentures was twice
as high in swallowing as in mastication. Strain gauges incorporated in the clasp arms of the dentures were used to obtain m easurements. P R E V E N T IV E D E N T IS T R Y
Considerable attention in preventive den tistry was given to evaluation of the elec tric toothbrush. Five studies reported th at use of the m echanical brush was superior to h an d brushing,83"88 and three other studies could detect no difference.89'91 These investigations were carried out u nder a wide variety of conditions, w ith different methods to m easure effective ness and w ith different electric and hand brushes. Such circumstances m ake it im possible to generalize on the effectiveness of the m echanical brushes and indicate only th a t they are or are not superior to h and brushes un d er a specific set of circumstances. A continuing accum ulation of data was published in 1964 indicating the beneficial effects of w ater fluoridation in the reduction of dental decay.92'97 Favor able results were also reported for topical applications of stannous fluoride, a pro phylactic paste containing stannous fluo ride and a stannous fluoride tooth paste.98’99 O ne other report, however, could detect no difference between a stannous fluoride tooth paste and the control.100 Brudevold, Chilton and Wellock101 published a prelim inary study showing d a ta from 1,861 children, ob served for one year, w hich indicated a promising reduction in incidence of decay resulting from use of acidulated sodium fluoride in a tooth paste. SU M M A RY
T h e articles cited in this review should provide valuable inform ation to practi tioners of clinical dentistry. A question is occasionally answered by the results of a single investigation, b u t it m ore often happens th at an accum ulation of d ata from a considerable num ber of investiga
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tions is necessary before firm conclusions can be reached. Clinical research p ub lished in 1964 contributed significantly to the fund of inform ation th a t aids the practitioner in selecting, modifying and im proving his treatm ent of patients on a scientific basis. *D e n ta l Research C e nter, U n iversity o f N o rth C a ro lin a , C hapel H ill, N C . 1. G rossm an, L. I., Shepard, L. I., and Pearson, L. A . R o e n tg e n o lo g ic and c lin ic a l e v a lu a tio n o f end odontic a lly tre a te d te e th . O ra l Surg., O ra l M e d . & O ra l Path. 17:368 M arch 1964. 2. Bender, I. B., Seltzer, S., and T urkenkopf, S. To cultu re o r n o t to c u ltu re ? O ra l Surg., O ra l M e d . & O ra l Path. 17:527 O c t. 1964. 3. Patterson, S. S., Shafer, W . G ., and H e aley, H . J . P e riapica l lesions associated w ith e n d o n tic a lly tre a te d te e th . J A D A 68:19! Feb. 1964. 4. Sulîtzeanu, A ., Beutner, E. H ., and Epstein, L. I. B a c te rio lo g ic studies o f p u lp -in v o lv e d teeth by c u ltu ra l and m iscroscopic m ethods. J A D A 69:300 Sept. 1964. 5. Engstrom . B., and F ro ste ll, G . Experiences^ o f b a c te rio lo g ic a l ro o t canal c o n tro l. A c ta o d o n t. scandinavica 22:40 Feb. 1964. . S hovelton, D. S. The presence and d is trib u tio n o f m icro-orga nism s w ith n o n -v ita l te e th . Brit. D. J . 117:101 A u g . 1964. 7. Szmyd, L., Shannon, I. L., H ester, W . R., and S tum pf, A . S u b je ctive and o b je c tiv e m easurem ent o f re sponses to th ir d m o la r im p a c tio n surgery. O ra l Surg., O ra l M e d . & O ra l Path. 17:257 Feb. 1964. . Shannon, I. L., and Davis, E. E. Stress in d e n ta l patie nts. I I I . H e m a to lo g ic changes fo llo w in g sim p le exod o n tia . J . D. M e d . 19:18 June 1964. 9. S m all, I. A ., Brown, S., and K oberîck, S. D. Teflon and S ila stic fo r m a n d ib u la r re p la c e m e n t: e xpe rim en tal studies and r e p o rt o f cases. J . O ra l Surg., A n esth. & H osp. D. Serv. 22:377 Sept. 1964. 10. G re e n w a ld , A . S. R e lie f o f tension in d e n ta l pa tie n ts : a c o n tro lle d study w ith hydroxyphenam ate. J A D A 68:708 M ay 1964. 11. Linenberg, W . B., and others. E valuation o f hy droxyzine, s e c o b a rb ita l and p la c e b o : results o f a d o u b le -b lin d study. J . O ra l Surg., Anesth. & H o sp. D. Serv. 22:305 J u ly 1964. 12. M eyer, R. A ., and Jakub ow ski, W . The use o f trip e ie n n a m in e and d ip h e n h y d ra m in e as lo c a l anes th e tics. J A D A 69:112 A u g . 1964. 13. Form an, G . H ., and H a y lo r, M . N . H e m o s ta tic p ro p e rtie s o f adreno chrom e m onosem icarbazone in den ta l surgery. B rit. D. J . 117:280 O c t. 1964. 14. Salem , J . W . M eth y lp re d n îs o lo n e -a s p îrin in o ro fa c ia l surgery: c o n tro lle d c lin ic a l tr ia l. J A D A 68:188 Feb. 1964. 15. Tassman, G . C ., Z a fra n , J . N ., and Zayon, G . M . E valuation o f a p la n t p r o te o ly tic enzyme fo r the con tro l o f in fla m m a tio n and p a in . J. D. M e d . 19:73 A p r il 1964. 16. Sorenson, F. M ., C a n tw e ll, K. R., and A p lin , A . W . T herm ogenics in c a v ity p re p a ra tio n using a ir tu rb in e hand pieces: the re la tio n s h ip o f heat tra n s fe rre d to rate o f to o th re m o va l. J . Pros. Den. 44:524 M ay-June 1964. 17. Kasloff, Z . Enamel cracks caused by ro ta ry in stru ments. J . Pros. Den. 14:109 J an.-F eb. 1964. 18. B e lting, C . M ., H a b e rfe ld e , G . C ., and Juhl, L. K. S pread o f organism s fro m d e n ta l a ir ro to r. J A D A 68:648 M ay 1964.
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19. Fusayama, T., and Kurosu, A . Diagnosis and d is trib u tio n o f pits and fissures. J . Pros. Den. 14:117 Jan.Feb. 1964. 20. Dachi, S. F., Ross, A ., and S tigers, R. W . Effects o f prednisolo ne on th e th e rm a l sensitivity and p u lp a l re actions o f a m a lg a m -re sto re d te e th . J A D A 69:565 N ov. 1964. 21. Lawson, B. F.t and M itc h e ll, D. F. P h arm acologic tre a tm e n t o f p a in fu l p u lp itis . O ra l Surg., O ra l M e d . & O ra l Path. 17:47 Ja n . 1964. 22. Kapur, K., Shapiro, S., and Shklar, G . The re sponse o f human d e n ta l p u lp to various physical and
c h e m ic a l agents: a c o rre la te d c lin ic a l and h is to p a th o lo g ic stu d y. O ra l Surg., O ra l. M e d . & O ra l Path. 17:640 M ay 1964. 23. C h arb eneau, G . T. An ap p ra is a l o f fin is h in g and p o lis fiin g procedures fo r d en tal a m a lg a m . J . M ic h ig a n D. A . 46:135 M ay 1964. 24. R. A . JA D A 25. 43:610
D e m pster, W . T., A d am s, W . J ., and D uddles, A rra n g e m e n t in th e jaws o f the roots o f th e te e th . 67:779 Dec. 1963. L e b re t, L. P hysiologic to o th m ig ra tio n . J . D. Res. J u ly -A u g . 1964.
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