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Treatment of crown fractures with exposed pulps.
J Calif Dent Assoc. 2002 Jun;30(6):419-25.
Blanco L, Cohen S.
Traumatic injuries are a common cause of pulpal damage in anterior teeth.
Crown fractures with exposed pulps represent 18 percent to 20 percent of the traumatic
injuries that involve the teeth. This clinical study comprised 36 patients, who were
referred for 40 crown fractures with pulp exposures. There were 39 maxillary incisors
and one mandibular incisor. The partial pulpotomy (Cvek's technique) consists of amputating
exposed pulp tissue to a depth of 1 to 2 mm below the point of pulp exposure.
After partial pulpotomy, the pulpal wound is covered with calcium hydroxide;
and the cavity is sealed with glass ionomer cement or a composite crown. Clinical
and radiographic assessment of the hard-tissue barrier was done after three months.
Patients were monitored for periods ranging from one to 12 years. The purpose of
this clinical report was to evaluate Cvek's technique in the management of coronal
fractures with pulp exposures and the long-term outcome of the partial pulpotomy
in immature and mature teeth. In virtually all of the cases, this treatment was
successful. Careful partial pulpotomy remains a prudent treatment choice with proper case selection.
Challenges influencing the future of endodontics. New technologies for endodontic education.
Aust Endod J. 2001 Dec;27(3):116-8.
Cohen S.
The major challenge of contemporary dental education is teaching students to transfer their acquired
knowledge from one setting to another. New technology-based educational tools such as IMPACT,
Interactive Multimedia Patient Case Tutor, developed at the Virginia Commonwealth University School of Dentistry,
can assist in this educational paradigm shift by teaching students basic science in the context of patient dental problems.
The interactivity of technology as used in the IMPACT program links students' basic science knowledge base to the description,
understanding and solution of patient problems.
Early radiographic diagnosis of inflammatory root resorption.
Gen Dent. 2003 May-Jun;51(3):235-40.
Cohen S, Blanco L, Berman LH.
Inflammatory root resorption (IRR) is a common sequelae to oral trauma. Anticipating root
resorption after trauma and taking some preventive measures may avoid this outcome.
Endodontics and radiographic examination play an important role in the early diagnosis
and treatment of root resorption. Subtle radiographic clues can lead to timely
implementation of appropriate treatment (if any) according to the kind of resorption
discovered. This article describes the most current classification of inflammatory root
resorption (usually following trauma)
and utilizes a clinical study to provide radiographic clues for its early detection.
Vertical root fractures: clinical and radiographic diagnosis.
J Am Dent Assoc. 2003 Apr;134(4):434-41.
Cohen S, Blanco L, Berman L.
BACKGROUND: Early detection and management of vertical root fractures, or VRFs,
remain a vexing issue that has caused needless suffering for patients as well as
for dentists. The authors present techniques to aid the dentist in recognizing VRFs.
METHODS: During a five-year period, the authors examined 36 patients who had VRFs.
Absent control subjects and a larger number of patients, the authors did not design
this investigation for statistical analysis. They diagnosed VRFs through dental
histories and clinical and radiographic examinations. RESULTS: The study revealed
VRFs in 36 teeth, two of which were vital and 34 of which were nonvital
(that is, endodontically treated). The 34 VRFs resulted from excessive operative
procedures performed in the root canal after endodontic therapy. Thirty-one of
these 34 VRFs were caused by poorly designed dowels (too long, too wide or both)
or inappropriate selection of the tooth as a bridge abutment; two VRFs were caused
by a restoration that exerted lateral pressure on the axial walls of the preparation;
and one VRF was caused by overzealous endodontic forces. The VRFs in the two vital
teeth were in men who had a history of bruxism or clenching.
CONCLUSIONS AND CLINICAL IMPLICATIONS: VRFs can be detected early by listening to
the patient's chief complaints, carefully examining periapical
and bitewing radiographs and performing a thorough clinical examination.
Endodontics and litigation: an American perspective.
Int Dent J. 1989 Mar;39(1):13-6.
Cohen S.
Dentists can reduce the risk of legal entanglements following endodontic treatment.
Dentists should not fail to meet the standard of care required at one or more of the
several stages in endodontic treatment: at diagnosis, in record keeping, by accidentally
treating the wrong tooth, by not using rubber dam, by breaking endodontic instruments in
the root canal, by using inappropriate endodontic implants, by creating root perforations,
by failing to give adequate instructions for home care and by not providing emergency care.
Recognition of problems likely to rise to
litigation and the methods to be used in their avoidance are emphasized.
Origin, diagnosis, and treatment of the dental manifestations of vitamin D-resistant rickets: review of the literature and report of case.
J Am Dent Assoc. 1976 Jan;92(1):120-9.
Cohen S, Becker GL.
Previous discussions center on early diagnosis, initial treatment, and follow-up therapy for
the patient with vitamin D-resistant rickets. Both the medical and dental aspects of treatment
for these patients has a long-range effect on the normal developmental patterns.
Although treatment is begun at an early age, some rachitic skeletal effects such as minor
bowing of the legs and bossing of the skull will invariably be noticed. In patients with
controlled rickets the alveolar processes undergo normal development, with apparent normal
dental eruption. The poor development and calcification of the alveolus seen in the untreated
patient leads to loss of the lamina dura and periodontal ligament of the teeth. Patients with
resistant rickets possess a functional dentition, although not without inherent defects.
Various degrees of fracture and attrition of enamel can be seen, and hypoplasia of dentin
is nearly a universal result. Defects extending to the dentinoenamel junction have been
shown in repeated cases. Cementum, because of its close relationship with dentin
calcification, also appears abnormal. Pulp tissue may undergo abberations of physiology
in resistant rickets, although further work in this respect is needed. With respect
to the possible dental pathoses seen in this disease, the dental history of the patient
with resistant rickets discussed in this report showed that several of the deciduous teeth,
possibly the mandibular left second premolar and right first molar, and definitely the maxillary
right second premolar and canine and the mandibular left canine had all undergone pulpal
degeneration of apparently unknown causation. In the maxillary right second premolar and the
mandibular left canine, enamel fractures were clinically and radiographically apparent. However,
the maxillary right canine originally had an acute abscess with no defects other than normal,
minimal wear facets. No causative factor for its necrosis could be found. Overt enamel
fractures in the maxillary right second premolar and the mandibular left canine may have led to microexposures of the pulp with subsequent bacterial pulpal contamination.
Suppuration present in several of the pulps when first entered during endodontic treatment,
as well as chronic fistulas in several areas, support the conclusion that contamination by
some means does indeed occur.
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