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Case Name:	Date:	Contributor:	Rating:

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Case

Clinical Photos

Illustrations / Diagrams

Papillary Masses of the Oral Mucosa

Irritation Fibroma or Large Lesions Fibromatoses - Irritation Fibroma or Large Lesions Fibromatoses

Irritation Fibroma or Large Lesions Fibromatoses - Irritation Fibroma or Large Lesions Fibromatoses Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Irritation Fibroma or Large Lesions Fibromatoses<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Even an irritation fibroma, seen here on the lingual gingiva, may become large and lobulated. Some authorities prefer to call the large lesions fibromatoses.</span>

Figure 1 - Even an irritation fibroma, seen here on the lingual gingiva, may become large and lobulated. Some authorities prefer to cal...

Figure 1 - Even an irritation fibroma, seen here on the lingual gingiva, may become large and lobulated. Some authorities prefer to call the large lesions fibromatoses.

Biopsied Giant Cell Fibroma - Biopsied Giant Cell Fibroma

Biopsied Giant Cell Fibroma - Biopsied Giant Cell Fibroma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Biopsied Giant Cell Fibroma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> In giant cell fibroma, the giant cells are unusual fibroblases and can be alarming to a pathologist not familiar with the lesion.</span>

Figure 1 - In giant cell fibroma, the giant cells are unusual fibroblases and can be alarming to a pathologist not familiar with the le...

Figure 1 - In giant cell fibroma, the giant cells are unusual fibroblases and can be alarming to a pathologist not familiar with the lesion.

Exophytic Squamous Cell Carcinoma - Exophytic Squamous Cell Carcinoma

Exophytic Squamous Cell Carcinoma - Exophytic Squamous Cell Carcinoma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Exophytic Squamous Cell Carcinoma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Most intraoral exophytic squamous cell carcinomas have lobulated or fungated appearance. There is often a central necrosis or ulceration, as seen here.</span>

Figure 1 - Most intraoral exophytic squamous cell carcinomas have lobulated or fungated appearance. There is often a central necrosis o...

Figure 1 - Most intraoral exophytic squamous cell carcinomas have lobulated or fungated appearance. There is often a central necrosis or ulceration, as seen here.

Classic Papilloma - Classic Papilloma

Classic Papilloma - Classic Papilloma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Classic Papilloma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> This pedunculated mass (arrow) was on a 2.5 cm stalk, extending from the uvula. Microscopically, it proved to be a classic papilloma, with smooth clinical appearance</span>

Figure 1 - This pedunculated mass (arrow) was on a 2.5 cm stalk, extending from the uvula. Microscopically, it proved to be a classic p...

Figure 1 - This pedunculated mass (arrow) was on a 2.5 cm stalk, extending from the uvula. Microscopically, it proved to be a classic papilloma, with smooth clinical appearance

Clustered Individual Nodules or Papules - Clustered Individual Nodules or Papules

Clustered Individual Nodules or Papules - Clustered Individual Nodules or Papules Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Clustered Individual Nodules or Papules<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Enlargement and fibrosis of individual lingual papillae along the lateral margin gives the appearance of papillomatosis; multinodular would be a more accurate term.</span>

Figure 1 - Enlargement and fibrosis of individual lingual papillae along the lateral margin gives the appearance of "papillomatosis"; "...

Figure 1 - Enlargement and fibrosis of individual lingual papillae along the lateral margin gives the appearance of "papillomatosis"; "multinodular" would be a more accurate term.

Papillary Hyperplasia of the Palate - Papillary Hyperplasia of the Palate

Papillary Hyperplasia of the Palate - Papillary Hyperplasia of the Palate Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Papillary Hyperplasia of the Palate<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Papillary hyperplasia of the palate is an inflammatory entity, comprising numerous nodules or papules. A leaf-shaped irritation fibroma is also seen (arrow).</span>

Figure 1 - Papillary hyperplasia of the palate is an inflammatory entity, comprising numerous nodules or papules. A leaf-shaped irritat...

Figure 1 - Papillary hyperplasia of the palate is an inflammatory entity, comprising numerous nodules or papules. A leaf-shaped irritation fibroma is also seen (arrow).

Keratin Plug Resembling Papilloma - Keratin Plug Resembling Papilloma

Keratin Plug Resembling Papilloma - Keratin Plug Resembling Papilloma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Keratin Plug Resembling Papilloma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> A keratin plug protruding from a tonsillar crypt may have a stalk and a lobulated or papillary appearance, as seen here. These are easily removed with a tongue blade.</span>

Figure 1 - A keratin plug protruding from a tonsillar crypt may have a stalk and a lobulated or papillary appearance, as seen here. The...

Figure 1 - A keratin plug protruding from a tonsillar crypt may have a stalk and a lobulated or papillary appearance, as seen here. These are easily removed with a tongue blade.

Squamous Papilloma - Squamous Papilloma

Squamous Papilloma - Squamous Papilloma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Squamous Papilloma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> This keratinized papilloma of the dorsum of the tongue presents a classic appearance with long, blunted surface projections.</span>

Figure 1 - This keratinized papilloma of the dorsum of the tongue presents a classic appearance with long, blunted surface projections....

Figure 1 - This keratinized papilloma of the dorsum of the tongue presents a classic appearance with long, blunted surface projections.

Squamous Papilloma<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> On less keratinized oral mucosal surfaces, a typical papilloma is not white. This one presents with pointed rather than finger-like projections.</span>

Figure 2 - On less keratinized oral mucosal surfaces, a typical papilloma is not white. This one presents with pointed rather than fing...

Figure 2 - On less keratinized oral mucosal surfaces, a typical papilloma is not white. This one presents with pointed rather than finger-like projections.

Squamous Papilloma<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Gross appearance of a biopsied papilloma illustrates the pointed and blunted shapes of the surface projections.</span>

Figure 3 - Gross appearance of a biopsied papilloma illustrates the pointed and blunted shapes of the surface projections.

Squamous Papilloma<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Squamous papillomas can be several cm in diameter (mandibular mucosa). Large lesions may resemble verrucous carcinoma.</span>

Figure 4 - Squamous papillomas can be several cm in diameter (mandibular mucosa). Large lesions may resemble verrucous carcinoma.

Verruca Vulgaris (Common Wart) - Verruca Vulgaris (Common Wart)

Verruca Vulgaris (Common Wart) - Verruca Vulgaris (Common Wart) Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Verruca Vulgaris (Common Wart)<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Verruca vulgaris is usually located on the lip vermilion and is so heavily keratinized that it appears white.</span>

Figure 1 - Verruca vulgaris is usually located on the lip vermilion and is so heavily keratinized that it appears white.

Condyloma Accuminatum (Venereal Wart) - Condyloma Accuminatum (Venereal Wart)

Condyloma Accuminatum (Venereal Wart) - Condyloma Accuminatum (Venereal Wart) Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Condyloma Accuminatum (Venereal Wart)<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Broad-based condyloma accuminatum (large arrow) is a contagious, sexually transmitted disease.</span>

Figure 1 - Broad-based condyloma accuminatum (large arrow) is a contagious, sexually transmitted disease.

Condyloma Accuminatum (Venereal Wart)<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> A condyloma is seen here on a lingual frenum, presumably traumatized during sexual activity.</span>

Figure 2 - A condyloma is seen here on a lingual frenum, presumably traumatized during sexual activity.

Focal Epithelial Hyperplasia (Heck's Disease) - Focal Epithelial Hyperplasia (Heck's Disease)

Focal Epithelial Hyperplasia (Heck's Disease) - Focal Epithelial Hyperplasia (Heck's Disease) Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Focal Epithelial Hyperplasia (Heck's Disease)<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Multiple papillary or papular masses are characteristic of a childhood infection, focal epithelial hyperplasia (Hecks disease).</span>

Figure 1 - Multiple papillary or papular masses are characteristic of a childhood infection, focal epithelial hyperplasia (Heck's disea...

Figure 1 - Multiple papillary or papular masses are characteristic of a childhood infection, focal epithelial hyperplasia (Heck's disease).

Verruciform Xanthoma - Verruciform Xanthoma

Verruciform Xanthoma - Verruciform Xanthoma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Verruciform Xanthoma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Verruciform xanthoma often resembles oral papilloma. Here, two lesions (arrow) are seen on the soft palate, a common location.</span>

Figure 1 - Verruciform xanthoma often resembles oral papilloma. Here, two lesions (arrow) are seen on the soft palate, a common locatio...

Figure 1 - Verruciform xanthoma often resembles oral papilloma. Here, two lesions (arrow) are seen on the soft palate, a common location.

Lymphangioma - Lymphangioma

Lymphangioma - Lymphangioma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Lymphangioma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Lymphangioma is often a papillary or pebbled mass (large arrow) with satellite lesions appearing like vesicles (small arrows).</span>

Figure 1 - Lymphangioma is often a papillary or pebbled mass (large arrow) with satellite lesions appearing like vesicles (small arrows...

Figure 1 - Lymphangioma is often a papillary or pebbled mass (large arrow) with satellite lesions appearing like vesicles (small arrows).

Pyogenic Granuloma - Pyogenic Granuloma

Pyogenic Granuloma - Pyogenic Granuloma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Pyogenic Granuloma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> A pyogenic granuloma protruding from an extraction socket may be pedunculated and lobulated, as seen here. Red color renders the lesion similar in appearance to hemangioma.</span>

Figure 1 - A pyogenic granuloma protruding from an extraction socket may be pedunculated and lobulated, as seen here. Red color renders...

Figure 1 - A pyogenic granuloma protruding from an extraction socket may be pedunculated and lobulated, as seen here. Red color renders the lesion similar in appearance to hemangioma.

Verrucous Carcinoma - Verrucous Carcinoma

Verrucous Carcinoma - Verrucous Carcinoma Contributed by Jerry E. Bouquot, DDS, MSD on 4/26/2012

Verrucous Carcinoma<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> A verrucous carcinoma of the right oral floor (arrows) demonstrates pointed and blunted surface projections.</span>

Figure 1 - A verrucous carcinoma of the right oral floor (arrows) demonstrates pointed and blunted surface projections.

Oral Health and Disease in Women

Oral Health Conditions Experienced by Women Patients - Oral Health Conditions Experienced by Women Patients

Oral Health Conditions Experienced by Women Patients - Oral Health Conditions Experienced by Women Patients Contributed by Linda C. Niessen, DMD, MPH on 5/9/2012

Oral Health Conditions Experienced by Women Patients<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Herpes labialis is one condition that can manifest as a result of hormonal changes.</span>

Figure 1 - Herpes labialis is one condition that can manifest as a result of hormonal changes.

Oral Health Conditions Experienced by Women Patients<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Recurrent aphthous ulcers can be associated with menstruation.</span>

Figure 2 - Recurrent aphthous ulcers can be associated with menstruation.

Oral Health Conditions Experienced by Women Patients<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Pregnancy gingivitis is the most common oral change seen in pregnancy; it occurs in 50% to 75% of women.</span>

Figure 3 - Pregnancy gingivitis is the most common oral change seen in pregnancy; it occurs in 50% to 75% of women.

Oral Health Conditions Experienced by Women Patients<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Buccal mucosa of a patient with pemphigus vulgaris, an autoimmune disease, occurring more frequently in women than men.</span>

Figure 4 - Buccal mucosa of a patient with pemphigus vulgaris, an autoimmune disease, occurring more frequently in women than men.

Oral Manifestations of Drug/Nutrient Interactions

Lichenoid and Xerostomia Reactions - Lichenoid and Xerostomia Reactions

Lichenoid and Xerostomia Reactions - Lichenoid and Xerostomia Reactions Contributed by Taline Dadian, MS, RDH on 5/9/2012

Lichenoid and Xerostomia Reactions<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> A lichenoid reaction resulting from a nutrient/drug interaction</span>

Figure 1 - A lichenoid reaction resulting from a nutrient/drug interaction

Lichenoid and Xerostomia Reactions<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Xerostomia is a frequent result of nutrient/drug interaction.</span>

Figure 2 - Xerostomia is a frequent result of nutrient/drug interaction.

Lichenoid and Xerostomia Reactions<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> This patient was affected by a nutrient/drug interaction. Note the acute atrophic candidiasis, chelitis, and clossitis accompanied by xerostomia.</span>

Figure 3 - This patient was affected by a nutrient/drug interaction. Note the acute atrophic candidiasis, chelitis, and clossitis accom...

Figure 3 - This patient was affected by a nutrient/drug interaction. Note the acute atrophic candidiasis, chelitis, and clossitis accompanied by xerostomia.

Caring for Special Needs Patients

Providing Care for Patients With Disabilities - Providing Care for Patients With Disabilities

Providing Care for Patients With Disabilities - Providing Care for Patients With Disabilities Contributed by Barry Waldman, BA, DDS, MPH, PhD on 5/9/2012

Providing Care for Patients With Disabilities<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Patients with disabilities may need to be treated in modified operatories with specialized equipment such as the restraints depicted.</span>

Figure 1 - Patients with disabilities may need to be treated in modified operatories with specialized equipment such as the restraints...

Figure 1 - Patients with disabilities may need to be treated in modified operatories with specialized equipment such as the restraints depicted.

Providing Care for Patients With Disabilities<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Modifications to the hygiene room were necessary to treat this wheelchair-bound patient.</span>

Figure 2 - Modifications to the hygiene room were necessary to treat this wheelchair-bound patient.

Oral Candidiasis in the Dental Patient

Diagnosis and Treatment of Oral Candidiasis - Diagnosis and Treatment of Oral Candidiasis

Diagnosis and Treatment of Oral Candidiasis - Diagnosis and Treatment of Oral Candidiasis Contributed by Susan L. Zunt, DDS, MS on 5/15/2012

Diagnosis and Treatment of Oral Candidiasis<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> A painful mouth with white plaques on the buccal mucosa (pseudomembranous candidiasis)</span>

Figure 1 - A painful mouth with white plaques on the buccal mucosa (pseudomembranous candidiasis)

Diagnosis and Treatment of Oral Candidiasis<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> White plaques are easily removed with a cement spatula or moistened tongue depressor revealing an erythematous mucosa.</span>

Figure 2 - White plaques are easily removed with a cement spatula or moistened tongue depressor revealing an erythematous mucosa.

Diagnosis and Treatment of Oral Candidiasis<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Fungal pseudohyphane present in material removed from the white plaques (Periodic acid/Schiff/Papanicolaou stain).</span>

Figure 3 - Fungal pseudohyphane present in material removed from the white plaques (Periodic acid/Schiff/Papanicolaou stain).

Diagnosis and Treatment of Oral Candidiasis<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Erythematous mucosa beneath a partial denture (atrophic candidiasis)</span>

Figure 4 - Erythematous mucosa beneath a partial denture (atrophic candidiasis)

Diagnosis and Treatment of Oral Candidiasis<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Resolution of erythema after two weeks of fluconazole and daily treatment of the denture in a disinfectant solution.</span>

Figure 5 - Resolution of erythema after two weeks of fluconazole and daily treatment of the denture in a disinfectant solution.

Diagnosis and Treatment of Oral Candidiasis<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Painful mouth of several months duration. Patient also had severe xerostomia and mild systemic lupus erythematosus.</span>

Figure 6 - Painful mouth of several months duration. Patient also had severe xerostomia and mild systemic lupus erythematosus.

Diagnosis and Treatment of Oral Candidiasis<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> Complete resolution with 2 weeks of fluconazole therapy. After several recurrences in the next few months, all of which responded to fluconazole therapy, patient was tested and found to be positive for antibodies SS-A and SS-B, consistent with a diagnosis of Sjogrens syndrome.</span>

Figure 7 - Complete resolution with 2 weeks of fluconazole therapy. After several recurrences in the next few months, all of which resp...

Figure 7 - Complete resolution with 2 weeks of fluconazole therapy. After several recurrences in the next few months, all of which responded to fluconazole therapy, patient was tested and found to be positive for antibodies SS-A and SS-B, consistent with a diagnosis of Sjogren's syndrome.

Removal of Third Molars

Clinical Indications for the Removal of Third Molars - Clinical Indications for the Removal of Third Molars

Clinical Indications for the Removal of Third Molars - Clinical Indications for the Removal of Third Molars Contributed by Daniel M. Laskin, DDS, MS, DSc on 5/29/2012

Clinical Indications for the Removal of Third Molars<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Radiograph of an impacted third molar causing severe periodontal destruction as well as caries involving the second molar. This could have been prevented by earlier removal of the third molar.</span>

Figure 1 - Radiograph of an impacted third molar causing severe periodontal destruction as well as caries involving the second molar. T...

Figure 1 - Radiograph of an impacted third molar causing severe periodontal destruction as well as caries involving the second molar. This could have been prevented by earlier removal of the third molar.

Clinical Indications for the Removal of Third Molars<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Impacted third molar causing resorption of the distal root of the second molar.</span>

Figure 2 - Impacted third molar causing resorption of the distal root of the second molar.

Clinical Indications for the Removal of Third Molars<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Post-extraction radiograph reveals the extend of the damage.</span>

Figure 3 - Post-extraction radiograph reveals the extend of the damage.

Clinical Indications for the Removal of Third Molars<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Impacted third molar in linguoversion appearing to be causing resorption of the second molar.</span>

Figure 4 - Impacted third molar in linguoversion appearing to be causing resorption of the second molar.

$Clinical Indications for the Removal of Third Molars<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Mandibular fracture in the third molar region.</span>$ Figure 5 - Mandibular fracture in the third molar region.

Figure 5 - Mandibular fracture in the third molar region.

Clinical Indications for the Removal of Third Molars<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Radiograph of an impacted third molar in a patient in whom the second molar is at risk due to a deep restoration.</span>

Figure 6 - Radiograph of an impacted third molar in a patient in whom the second molar is at risk due to a deep restoration.

Clinical Depictions of Dental Caries

Case 1 - Rampant Caries - Rampant Caries

Case 1 - Rampant Caries - Rampant Caries Contributed by Kellie R. Murphree, RDH, MS on 5/30/2012

Case 1 - Rampant Caries<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> The patient presented with rampant caries as demonstrated in this retracted facial view.</span>

Figure 1 - The patient presented with rampant caries as demonstrated in this retracted facial view.

Case 1 - Rampant Caries<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Panoramic radiograph demonstrates the presence of rampant caries.</span>

Figure 2 - Panoramic radiograph demonstrates the presence of rampant caries.

Case 1 - Rampant Caries<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Note the black areas around teeth #8 and #9 in this lingual view of the maxilla, indicating severe decay.</span>

Figure 3 - Note the black areas around teeth #8 and #9 in this lingual view of the maxilla, indicating severe decay.

Assessment of the Temporomandibular Joint

Diagnosing the Temporomandibular Joint - Diagnosing the Temporomandibular Joint

Diagnosing the Temporomandibular Joint - Diagnosing the Temporomandibular Joint Contributed by Ann-Marie C. DePalma, RDH, BS on 5/30/2012

Diagnosing the Temporomandibular Joint<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> A transcranial radiograph of a healthy TMJ in closed position.</span>

Figure 1 - A transcranial radiograph of a healthy TMJ in closed position.

Diagnosing the Temporomandibular Joint<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> A transcranial radiograph of a health TMJ in open position.</span>

Figure 2 - A transcranial radiograph of a health TMJ in open position.

Diagnosing the Temporomandibular Joint<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> A transcranial radiograph of a TMJ in closed position with limited joint spacing and osseous changes. Note the proximity of the condyle to the temporal bone.</span>

Figure 3 - A transcranial radiograph of a TMJ in closed position with limited joint spacing and osseous changes. Note the proximity of...

Figure 3 - A transcranial radiograph of a TMJ in closed position with limited joint spacing and osseous changes. Note the proximity of the condyle to the temporal bone.

Amalgam Restorations in the Posterior Quadrant

Replacement of defective amalgam restorations in the posterior mandible - Replacement of defective amalgam restorations in the posterior mandible...

Replacement of defective amalgam restorations in the posterior mandible - Replacement of defective amalgam restorations in the posterior mandible Contributed by Richard Trushkowsky, DDS on 6/14/2012

Replacement of defective amalgam restorations in the posterior mandible<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Tooth #18 with occlusal caries and tooth #19 with distal caries and defective margins.</span>

Figure 1 - Tooth #18 with occlusal caries and tooth #19 with distal caries and defective margins.

Replacement of defective amalgam restorations in the posterior mandible<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> An etching solution was applied to the teeth.</span>

Figure 2 - An etching solution was applied to the teeth.

Replacement of defective amalgam restorations in the posterior mandible<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> A bonding agent was then applied in several coats.</span>

Figure 3 - A bonding agent was then applied in several coats.

Replacement of defective amalgam restorations in the posterior mandible<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> The dentin should be shiny. If not, additional coats of adhesive are required.</span>

Figure 4 - The dentin should be shiny. If not, additional coats of adhesive are required.

Replacement of defective amalgam restorations in the posterior mandible<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> The bonding agent is light cured for 20 seconds.</span>

Figure 5 - The bonding agent is light cured for 20 seconds.

Replacement of defective amalgam restorations in the posterior mandible<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Appropriate anatomy is carved.</span>

Figure 6 - Appropriate anatomy is carved.

Replacement of defective amalgam restorations in the posterior mandible<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> The amalgam is polished at a later visit.</span>

Figure 7 - The amalgam is polished at a later visit.

Use of Direct Resin for Chairside Repairs

Repair of Missing Acrylic Veneer Using a Direct Resin Approach - Repair of Missing Acrylic Veneer Using a Direct Resin Approach

Repair of Missing Acrylic Veneer Using a Direct Resin Approach - Repair of Missing Acrylic Veneer Using a Direct Resin Approach Contributed by Richard Trushkowsky, DDS on 6/14/2012

Repair of Missing Acrylic Veneer Using a Direct Resin Approach<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Tooth #13 exhibits a missing facing and macroretention cut into the metal.</span>

Figure 1 - Tooth #13 exhibits a missing facing and macroretention cut into the metal.

Repair of Missing Acrylic Veneer Using a Direct Resin Approach<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> The adhesive is applied in several layers, air dryed, and light cured.</span>

Figure 2 - The adhesive is applied in several layers, air dryed, and light cured.

Repair of Missing Acrylic Veneer Using a Direct Resin Approach<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Opaque resin is applied to the metal and then light cured.</span>

Figure 3 - Opaque resin is applied to the metal and then light cured.

Repair of Missing Acrylic Veneer Using a Direct Resin Approach<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Hybrid and microfil resin are built up in layers, light cured, and then polished.</span>

Figure 4 - Hybrid and microfil resin are built up in layers, light cured, and then polished.

Management of Temporomandibular Disorders

Prevention of TMJ Syndrome by Placement of Anterior Point Stop Device - Prevention of TMJ Syndrome by Placement of Anterior Point Stop Device

Prevention of TMJ Syndrome by Placement of Anterior Point Stop Device - Prevention of TMJ Syndrome by Placement of Anterior Point Stop Device Contributed by James P. Boyd, DDS on 6/18/2012

Prevention of TMJ Syndrome by Placement of Anterior Point Stop Device<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Passive fit of the anterior point stop matrix is confirmed.</span>

Figure 1 - Passive fit of the anterior point stop matrix is confirmed.

Prevention of TMJ Syndrome by Placement of Anterior Point Stop Device<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> An acrylic-filled matrix is placed, removed at initial cure, trimmed, and polished.</span>

Figure 2 - An acrylic-filled matrix is placed, removed at initial cure, trimmed, and polished.

Prevention of TMJ Syndrome by Placement of Anterior Point Stop Device<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Posterior and canine disclusion is verified (normal freeway space is adequate).</span>

Figure 3 - Posterior and canine disclusion is verified (normal freeway space is adequate).

Recording and Communicating Tooth Shade and Color

Use of Digital Photography for Documenting Color - Use of Digital Photography for Documenting Color

Use of Digital Photography for Documenting Color - Use of Digital Photography for Documenting Color Contributed by Pascal Zyman, DDS on 7/10/2012

Use of Digital Photography for Documenting Color<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> The central maxillary incisor has to be replaced. Multiple views (ie, frontal 1:1, magnified 2:1, value) must be taken to demonstrate proper shape and shade.</span>

Figure 1 - The central maxillary incisor has to be replaced. Multiple views (ie, frontal 1:1, magnified 2:1, value) must be taken to de...

Figure 1 - The central maxillary incisor has to be replaced. Multiple views (ie, frontal 1:1, magnified 2:1, value) must be taken to demonstrate proper shape and shade.

Use of Digital Photography for Documenting Color<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Facial view with shade tab is obtained for evaluation of color.</span>

Figure 2 - Facial view with shade tab is obtained for evaluation of color.

Use of Digital Photography for Documenting Color<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> A black-and-white digital photograph is obtained for comparison of value.</span>

Figure 3 - A black-and-white digital photograph is obtained for comparison of value.

Use of Digital Photography for Documenting Color<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> When adjusting the curves using computer software, the internal structures (eg, dentin mamelons, translucency) can be seen.</span>

Figure 4 - When adjusting the curves using computer software, the internal structures (eg, dentin mamelons, translucency) can be seen.

Use of Digital Photography for Documenting Color<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> The technician can simply document the laboratory buildup so that the clinician can observe the restoration throughout the fabrication process.</span>

Figure 5 - The technician can simply document the laboratory buildup so that the clinician can observe the restoration throughout the f...

Figure 5 - The technician can simply document the laboratory buildup so that the clinician can observe the restoration throughout the fabrication process.

Use of Digital Photography for Documenting Color<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Digital photos enable the technician to visualize the result intraorally. Using computer software, the clinician can also d4raw the distal emergence profile.</span>

Figure 6 - Digital photos enable the technician to visualize the result intraorally. Using computer software, the clinician can also d4...

Figure 6 - Digital photos enable the technician to visualize the result intraorally. Using computer software, the clinician can also d4raw the distal emergence profile.

Use of Digital Photography for Documenting Color<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> Facial view of the definitive porcelain crown on the master model. Note the translucency in the incisal third.</span>

Figure 7 - Facial view of the definitive porcelain crown on the master model. Note the translucency in the incisal third.

Use of Digital Photography for Documenting Color<br/> Figure 8. <span style='font-size: 16px; font-weight: normal'> Postoperative view of the cemented full-coverage crown restoration. Note the harmonious aesthetic result achieved with effective communication.</span>

Figure 8 - Postoperative view of the cemented full-coverage crown restoration. Note the harmonious aesthetic result achieved with effec...

Figure 8 - Postoperative view of the cemented full-coverage crown restoration. Note the harmonious aesthetic result achieved with effective communication.

Matching Color in Natural Teeth and Implant Crowns - Matching Color in Natural Teeth and Implant Crowns

Matching Color in Natural Teeth and Implant Crowns - Matching Color in Natural Teeth and Implant Crowns Contributed by Pascal Zyman, DDS on 7/10/2012

Matching Color in Natural Teeth and Implant Crowns<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Preoperative facial view of two missing lateral incisors. The treatment consists of implant placement and prosthetic restoration with two all-ceramic crowns.</span>

Figure 1 - Preoperative facial view of two missing lateral incisors. The treatment consists of implant placement and prosthetic restora...

Figure 1 - Preoperative facial view of two missing lateral incisors. The treatment consists of implant placement and prosthetic restoration with two all-ceramic crowns.

Matching Color in Natural Teeth and Implant Crowns<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Buccal view of right maxillary lateral incisor 8 months following implant placement.</span>

Figure 2 - Buccal view of right maxillary lateral incisor 8 months following implant placement.

Matching Color in Natural Teeth and Implant Crowns<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> At the try-in stage, a black-and-white photograph is taken and sent to the laboratory so that value can be adjusted for improved shade match.</span>

Figure 3 - At the try-in stage, a black-and-white photograph is taken and sent to the laboratory so that value can be adjusted for impr...

Figure 3 - At the try-in stage, a black-and-white photograph is taken and sent to the laboratory so that value can be adjusted for improved shade match.

Matching Color in Natural Teeth and Implant Crowns<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Right buccal view of all-ceramic crown placed on customized metal-ceramic abutment (with ceramic base).</span>

Figure 4 - Right buccal view of all-ceramic crown placed on customized metal-ceramic abutment (with ceramic base).

Matching Color in Natural Teeth and Implant Crowns<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> Postoperative facial view of seated and cemented full-coverage crowns. Note integration of restorations with adjacent natural teeth.</span>

Figure 5 - Postoperative facial view of seated and cemented full-coverage crowns. Note integration of restorations with adjacent natura...

Figure 5 - Postoperative facial view of seated and cemented full-coverage crowns. Note integration of restorations with adjacent natural teeth.

Variables Affecting Shade Determination in the Clinical Environment - Presentation of physical, physiological, and psychological variables affect...

Variables Affecting Shade Determination in the Clinical Environment - Presentation of physical, physiological, and psychological variables affecting shade determination Contributed by Irfan Ahmad, BDS on 8/2/2012

Variables Affecting Shade Determination in the Clinical Environment<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> As the color coordinates of the custom shade tab and the maxillary dentition are identical, the tab and the natural teeth appear to match under an electronic flash.</span>

Figure 1 - As the color coordinates of the custom shade tab and the maxillary dentition are identical, the tab and the natural teeth ap...

Figure 1 - As the color coordinates of the custom shade tab and the maxillary dentition are identical, the tab and the natural teeth appear to match under an electronic flash.

Variables Affecting Shade Determination in the Clinical Environment<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Viewed under daylight, the tab and the teeth no longer match. This metamersim is attributed to the differing spectral curves of each referent (despite their identical color coordinates).</span>

Figure 2 - Viewed under daylight, the tab and the teeth no longer match. This metamersim is attributed to the differing spectral curves...

Figure 2 - Viewed under daylight, the tab and the teeth no longer match. This metamersim is attributed to the differing spectral curves of each referent (despite their identical color coordinates).

Variables Affecting Shade Determination in the Clinical Environment<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> The context influences the perceived color of an object. All shade tabs in this picture are identical, but are perceived differently based on their corresponding background colors.</span>

Figure 3 - The context influences the perceived color of an object. All shade tabs in this picture are identical, but are perceived dif...

Figure 3 - The context influences the perceived color of an object. All shade tabs in this picture are identical, but are perceived differently based on their corresponding background colors.

Variables Affecting Shade Determination in the Clinical Environment<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Brightness or lightness constancy is demonstrated by a tooth tab of the same value that appears brighter in front of a black background than it does in front of the white background.</span>

Figure 4 - Brightness or lightness constancy is demonstrated by a tooth tab of the same value that appears brighter in front of a black...

Figure 4 - Brightness or lightness constancy is demonstrated by a tooth tab of the same value that appears brighter in front of a black background than it does in front of the white background.

Variables Affecting Shade Determination in the Clinical Environment<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> The hue, value, and chroma of a red pepper can easily be assessed when viewed without an optical barrier.</span>

Figure 5 - The hue, value, and chroma of a red pepper can easily be assessed when viewed without an optical barrier.

Variables Affecting Shade Determination in the Clinical Environment<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> When glass sheets of increasing opacity are placed in the field, the chroma of the pepper decreases but its hue remains unchanged. The increasing value of the glass is directly proportional to its increasing opacity.</span>

Figure 6 - When glass sheets of increasing opacity are placed in the field, the chroma of the pepper decreases but its hue remains unch...

Figure 6 - When glass sheets of increasing opacity are placed in the field, the chroma of the pepper decreases but its hue remains unchanged. The increasing value of the glass is directly proportional to its increasing opacity.

Variables Affecting Shade Determination in the Clinical Environment<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> A tab from the red guide absorbs the colors of the visible spectrum (with the exception of a pure single color) to allow an accurate assessment of the body or dentin shade of a tooth.</span>

Figure 7 - A tab from the red guide absorbs the colors of the visible spectrum (with the exception of a pure single color) to allow an...

Figure 7 - A tab from the red guide absorbs the colors of the visible spectrum (with the exception of a pure single color) to allow an accurate assessment of the body or dentin shade of a tooth.

Variables Affecting Shade Determination in the Clinical Environment<br/> Figure 8. <span style='font-size: 16px; font-weight: normal'> A tab from the blue guide, with cervical/enamel effects, is a more realistic representation of a tooth in the oral environment. Reflected colors are not as pure as those in figure 7.</span>

Figure 8 - A tab from the blue guide, with cervical/enamel effects, is a more realistic representation of a tooth in the oral environme...

Figure 8 - A tab from the blue guide, with cervical/enamel effects, is a more realistic representation of a tooth in the oral environment. Reflected colors are not as pure as those in figure 7.

Variables Affecting Shade Determination in the Clinical Environment<br/> Figure 9. <span style='font-size: 16px; font-weight: normal'> In each value group, the chroma increases from the top to the bottom tabs, represented by the increasing depth of color of the red beams.</span>

Figure 9 - In each value group, the chroma increases from the top to the bottom tabs, represented by the increasing depth of color of t...

Figure 9 - In each value group, the chroma increases from the top to the bottom tabs, represented by the increasing depth of color of the red beams.

Variables Affecting Shade Determination in the Clinical Environment<br/> Figure 10. <span style='font-size: 16px; font-weight: normal'> Within a specific value group, the M tabs represent an orange hue (central beam), the L tabs a yellow hue (left beam), and the R tabs a red hue (right beam).</span>

Figure 10 - Within a specific value group, the M tabs represent an orange hue (central beam), the L tabs a yellow hue (left beam), and...

Figure 10 - Within a specific value group, the M tabs represent an orange hue (central beam), the L tabs a yellow hue (left beam), and the R tabs a red hue (right beam).

Variables Affecting Shade Determination in the Clinical Environment<br/> Figure 11. <span style='font-size: 16px; font-weight: normal'> Enamel thickness is identical for all shade tabs. The left tabs have been sectioned in a sagittal plan and the right tabs in a mesiodistal plane. Note the uniform enamel thickness of all tabs.</span>

Figure 11 - Enamel thickness is identical for all shade tabs. The left tabs have been sectioned in a sagittal plan and the right tabs i...

Figure 11 - Enamel thickness is identical for all shade tabs. The left tabs have been sectioned in a sagittal plan and the right tabs in a mesiodistal plane. Note the uniform enamel thickness of all tabs.

Variables Affecting Shade Determination in the Clinical Environment<br/> Figure 12. <span style='font-size: 16px; font-weight: normal'> Facial view of a shade guide placed in front of a smiling patient.</span>

Figure 12 - Facial view of a shade guide placed in front of a smiling patient.

Variables Affecting Shade Determination in the Clinical Environment<br/> Figure 13. <span style='font-size: 16px; font-weight: normal'> Preparation of half the left maxillary central incisor to independently assess dentin and enamel color.</span>

Figure 13 - Preparation of half the left maxillary central incisor to independently assess dentin and enamel color.

Variables Affecting Shade Determination in the Clinical Environment<br/> Figure 14. <span style='font-size: 16px; font-weight: normal'> The value group that corresponds to the tooth must be ascertained. In this instance, the value group of the maxillary central incisors is 2.</span>

Figure 14 - The value group that corresponds to the tooth must be ascertained. In this instance, the value group of the maxillary centr...

Figure 14 - The value group that corresponds to the tooth must be ascertained. In this instance, the value group of the maxillary central incisors is 2.

Variables Affecting Shade Determination in the Clinical Environment<br/> Figure 15. <span style='font-size: 16px; font-weight: normal'> Using the M tab, the chroma is assessed as 2.</span>

Figure 15 - Using the M tab, the chroma is assessed as 2.

Variables Affecting Shade Determination in the Clinical Environment<br/> Figure 16. <span style='font-size: 16px; font-weight: normal'> The hue must be selected from the L, M, or R tabs. M was selected to be the nearest match. The definitive shade prescription would now be 2M2.</span>

Figure 16 - The hue must be selected from the L, M, or R tabs. M was selected to be the nearest match. The definitive shade prescriptio...

Figure 16 - The hue must be selected from the L, M, or R tabs. M was selected to be the nearest match. The definitive shade prescription would now be 2M2.

Digital Radiography: Partially Edentulous Patient

Bitewing Radiograph of the Partially Edentulous Mandible - Digital radiograph of the partially edentulous patient

Bitewing Radiograph of the Partially Edentulous Mandible - Digital radiograph of the partially edentulous patient Contributed by Shawneen Gonzalez, DDS on 9/20/2012

Bitewing Radiograph of the Partially Edentulous Mandible<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Mandibular molar exposure produces bitewing radiograph of the partially edentulous patient.</span>

Figure 1 - Mandibular molar exposure produces bitewing radiograph of the partially edentulous patient.

Bitewing Radiograph of the Partially Edentulous Mandible<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Mandibular premolar exposure yields this bitewing radiograph of the partially edentulous patient.</span>

Figure 2 - Mandibular premolar exposure yields this bitewing radiograph of the partially edentulous patient.

Bitewing Radiograph of the Partially Edentulous Mandible<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Left mandibular premolar exposure in partially edentulous patient.</span>

Figure 3 - Left mandibular premolar exposure in partially edentulous patient.

Bitewing Radiograph of the Partially Edentulous Mandible<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Bitewing radiograph demonstrates bone resorption in mandibular arch. Left mandibular exposure in partially edentulous patient.</span>

Figure 4 - Bitewing radiograph demonstrates bone resorption in mandibular arch. Left mandibular exposure in partially edentulous patien...

Figure 4 - Bitewing radiograph demonstrates bone resorption in mandibular arch. Left mandibular exposure in partially edentulous patient.

Panoramic Radiographs of Interrradicular Bone Loss in the Partially Edentulous Patient - Digital pantomographs of the partially edentulous patien...

Panoramic Radiographs of Interrradicular Bone Loss in the Partially Edentulous Patient - Digital pantomographs of the partially edentulous patient Contributed by Shawneen Gonzalez, DDS on 9/20/2012

Panoramic Radiographs of Interrradicular Bone Loss in the Partially Edentulous Patient<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Panoramic radiograph demonstrates presence of interradicular bone loss in partially edentulous patient.</span>

Figure 1 - Panoramic radiograph demonstrates presence of interradicular bone loss in partially edentulous patient.

Panoramic Radiographs of Interrradicular Bone Loss in the Partially Edentulous Patient<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Panoramic radiograph of interradicular bone loss in mandibular arch of partially edentulous patient.</span>

Figure 2 - Panoramic radiograph of interradicular bone loss in mandibular arch of partially edentulous patient.

Panoramic Radiographs of Interrradicular Bone Loss in the Partially Edentulous Patient<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Pantomograph demonstrates interradicular bone loss in the maxillary and mandibular arches of this partially edentulous patient.</span>

Figure 3 - Pantomograph demonstrates interradicular bone loss in the maxillary and mandibular arches of this partially edentulous patie...

Figure 3 - Pantomograph demonstrates interradicular bone loss in the maxillary and mandibular arches of this partially edentulous patient.

Panoramic Radiographs of Interrradicular Bone Loss in the Partially Edentulous Patient<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Panoramic radiograph of interradicular bone loss in the partially edentulous patient.</span>

Figure 4 - Panoramic radiograph of interradicular bone loss in the partially edentulous patient.

Panoramic Radiographs of Impacted Teeth - Panoramic radiograph if impacted third molar in partially edentulous patient

Panoramic Radiographs of Impacted Teeth - Panoramic radiograph if impacted third molar in partially edentulous patient Contributed by Shawnee Gonzalez, DDS on 9/20/2012

Panoramic Radiographs of Impacted Teeth<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Panoramic radiograph of impacted tooth #17 in the partially edentulous patient.</span>

Figure 1 - Panoramic radiograph of impacted tooth #17 in the partially edentulous patient.

Digital Radiography: Fully Edentulous Patient

Panoramic Radiograph of the Fully Edentulous Patient - Digital pantomographs of fully edentulous patients

Panoramic Radiograph of the Fully Edentulous Patient - Digital pantomographs of fully edentulous patients Contributed by Shawnee Gonzalez, DDS on 9/20/2012

Panoramic Radiograph of the Fully Edentulous Patient<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Digital panoramic radiograph of fully edentulous patient--vital for determining alveolar bone present.</span>

Figure 1 - Digital panoramic radiograph of fully edentulous patient--vital for determining alveolar bone present.

Panoramic Radiograph of the Fully Edentulous Patient<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Panotmograph of the edentulous patient, used often to detect retained roots, impacted teeth, cysts, and foreign bodies. Panoramic radiographs yield important information on the quantity and quality of bone present.</span>

Figure 2 - Panotmograph of the edentulous patient, used often to detect retained roots, impacted teeth, cysts, and foreign bodies. Pano...

Figure 2 - Panotmograph of the edentulous patient, used often to detect retained roots, impacted teeth, cysts, and foreign bodies. Panoramic radiographs yield important information on the quantity and quality of bone present.

Management of Special Needs Patients

Case 1 - Managing Patients with Spina Bifida - This case depicts the birth defect spina bifida, and suggests ways to deal with a dental patient s...

Case 1 - Managing Patients with Spina Bifida - This case depicts the birth defect spina bifida, and suggests ways to deal with a dental patient suffering from this condition. Contributed by JoAnn Campoli Scofield, RDH, BAAS on 10/10/2012

Case 1 - Managing Patients with Spina Bifida<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Back view of the patient.</span>

Figure 2 - Back view of the patient.

Case 1 - Managing Patients with Spina Bifida<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Side view of the patient. Note the gibbus, for which accommodation must be made so the patient will be comfortable.</span>

Figure 3 - Side view of the patient. Note the gibbus, for which accommodation must be made so the patient will be comfortable.

Management of Radicular Anomalies

Treatment Options for the Radicular Lingual Groove - Diagnosing various forms of radicular lingual grooves and their prognoses.

Treatment Options for the Radicular Lingual Groove - Diagnosing various forms of radicular lingual grooves and their prognoses. Contributed by Tom G. Gound, DDS, MS on 11/21/2012

Treatment Options for the Radicular Lingual Groove<br/> Figure 1. <span style='font-size: 16px; font-weight: normal'> Case 1. Radiograph of a radicular lingual groove in maxillary left lateral incisor. Note radiolucent parapulpal line superimposed over root canal.</span>

Figure 1 - Case 1. Radiograph of a radicular lingual groove in maxillary left lateral incisor. Note radiolucent "parapulpal line" super...

Figure 1 - Case 1. Radiograph of a radicular lingual groove in maxillary left lateral incisor. Note radiolucent "parapulpal line" superimposed over root canal.

Treatment Options for the Radicular Lingual Groove<br/> Figure 2. <span style='font-size: 16px; font-weight: normal'> Case 2. Radiograph of RLG in the maxillary lateral incisor. Endodontic treatment was completed 10 years previously; RLG was not diagnosed. Tooth was extracted.</span>

Figure 2 - Case 2. Radiograph of RLG in the maxillary lateral incisor. Endodontic treatment was completed 10 years previously; RLG was...

Figure 2 - Case 2. Radiograph of RLG in the maxillary lateral incisor. Endodontic treatment was completed 10 years previously; RLG was not diagnosed. Tooth was extracted.

Treatment Options for the Radicular Lingual Groove<br/> Figure 3. <span style='font-size: 16px; font-weight: normal'> Palatal view of the maxillary site with gingival irritation present.</span>

Figure 3 - Palatal view of the maxillary site with gingival irritation present.

Treatment Options for the Radicular Lingual Groove<br/> Figure 4. <span style='font-size: 16px; font-weight: normal'> Palatal view. Periodontal probing reveals a 10-mm pocket.</span>

Figure 4 - Palatal view. Periodontal probing reveals a 10-mm pocket.

Treatment Options for the Radicular Lingual Groove<br/> Figure 5. <span style='font-size: 16px; font-weight: normal'> 5A. Radiograph of the extracted maxillary lateral incisor with one canal. 5B. Photograph of the extracted tooth with mild form of simple radicular lingual groove.</span>

Figure 5 - 5A. Radiograph of the extracted maxillary lateral incisor with one canal. 5B. Photograph of the extracted tooth with mild fo...

Figure 5 - 5A. Radiograph of the extracted maxillary lateral incisor with one canal. 5B. Photograph of the extracted tooth with mild form of simple radicular lingual groove.

Treatment Options for the Radicular Lingual Groove<br/> Figure 6. <span style='font-size: 16px; font-weight: normal'> Case 3. Radiograph of maxillary lateral incisor. Endodontic therapy began 1 year previously; RLG was diagnosed and the tooth was extracted.</span>

Figure 6 - Case 3. Radiograph of maxillary lateral incisor. Endodontic therapy began 1 year previously; RLG was diagnosed and the tooth...

Figure 6 - Case 3. Radiograph of maxillary lateral incisor. Endodontic therapy began 1 year previously; RLG was diagnosed and the tooth was extracted.

Treatment Options for the Radicular Lingual Groove<br/> Figure 7. <span style='font-size: 16px; font-weight: normal'> Preoperative clinical view. The groove is evident on the lingual surface.</span>

Figure 7 - Preoperative clinical view. The groove is evident on the lingual surface.

Treatment Options for the Radicular Lingual Groove<br/> Figure 8. <span style='font-size: 16px; font-weight: normal'> 8A. Lingual view of the extracted tooth. A large groove is evident between the fused roots. 8B. Radiograph exhibits the second root and canal; neither was evident on preoperative radiographs.</span>

Figure 8 - 8A. Lingual view of the extracted tooth. A large groove is evident between the fused roots. 8B. Radiograph exhibits the seco...

Figure 8 - 8A. Lingual view of the extracted tooth. A large groove is evident between the fused roots. 8B. Radiograph exhibits the second root and canal; neither was evident on preoperative radiographs.

Treatment Options for the Radicular Lingual Groove<br/> Figure 9. <span style='font-size: 16px; font-weight: normal'> 9A. Case 4. Radiograph of the files in both canals. 9B. Lateral view of radiograph of the files in both canals. Note parapulpal line.</span>

Figure 9 - 9A. Case 4. Radiograph of the files in both canals. 9B. Lateral view of radiograph of the files in both canals. Note parapul...

Figure 9 - 9A. Case 4. Radiograph of the files in both canals. 9B. Lateral view of radiograph of the files in both canals. Note parapulpal line.

Treatment Options for the Radicular Lingual Groove<br/> Figure 10. <span style='font-size: 16px; font-weight: normal'> Case 5. Clinical evaluation of a 9-mm suppurative periodontal pocket palatal to the maxillary left central incisor. No apparent inflammation is present.</span>

Figure 10 - Case 5. Clinical evaluation of a 9-mm suppurative periodontal pocket palatal to the maxillary left central incisor. No appa...

Figure 10 - Case 5. Clinical evaluation of a 9-mm suppurative periodontal pocket palatal to the maxillary left central incisor. No apparent inflammation is present.

Treatment Options for the Radicular Lingual Groove<br/> Figure 11. <span style='font-size: 16px; font-weight: normal'> Radiograph sent by referring clinician. Root canal therapy had been deemed impossible due to periodontal-pulpal involvement. Significant radiolucency suggests complex RLG.</span>

Figure 11 - Radiograph sent by referring clinician. Root canal therapy had been deemed impossible due to periodontal-pulpal involvement...

Figure 11 - Radiograph sent by referring clinician. Root canal therapy had been deemed impossible due to periodontal-pulpal involvement. Significant radiolucency suggests complex RLG.

Treatment Options for the Radicular Lingual Groove<br/> Figure 12. <span style='font-size: 16px; font-weight: normal'> Saucerization of the entire groove, including pulp tissue and palatal half of the canal. Medium and fine round diamond burs used to plasty the root to the apex.</span>

Figure 12 - Saucerization of the entire groove, including pulp tissue and palatal half of the canal. Medium and fine round diamond burs...

Figure 12 - Saucerization of the entire groove, including pulp tissue and palatal half of the canal. Medium and fine round diamond burs used to plasty the root to the apex.

Treatment Options for the Radicular Lingual Groove<br/> Figure 13. <span style='font-size: 16px; font-weight: normal'> Dense particulate hydroxyapatite is used to fill the RLG defect to the crest of the surrounding bone. Flap is repositioned an closed with silk suture. Healing is uneventful.</span>

Figure 13 - Dense particulate hydroxyapatite is used to fill the RLG defect to the crest of the surrounding bone. Flap is repositioned...

Figure 13 - Dense particulate hydroxyapatite is used to fill the RLG defect to the crest of the surrounding bone. Flap is repositioned an closed with silk suture. Healing is uneventful.

Treatment Options for the Radicular Lingual Groove<br/> Figure 14. <span style='font-size: 16px; font-weight: normal'> One-year postoperative radiograph indicates increased radiolucency of the apical half of the root.</span>

Figure 14 - One-year postoperative radiograph indicates increased radiolucency of the apical half of the root.

Treatment Options for the Radicular Lingual Groove<br/> Figure 15. <span style='font-size: 16px; font-weight: normal'> Palatal view at 18 months demonstrates gingival tissue health with attachment gain of 7 mm. The palatal aspect of the tooth probed 4 mm without bleeding.</span>

Figure 15 - Palatal view at 18 months demonstrates gingival tissue health with attachment gain of 7 mm. The palatal aspect of the tooth...

Figure 15 - Palatal view at 18 months demonstrates gingival tissue health with attachment gain of 7 mm. The palatal aspect of the tooth probed 4 mm without bleeding.

Treatment Options for the Radicular Lingual Groove<br/> Figure 16. <span style='font-size: 16px; font-weight: normal'> Clinical follow-up at 18 months postoperatively demonstrates that the maxillary left central incisor is comparable to the vital right central incisor in color and contour.</span>

Figure 16 - Clinical follow-up at 18 months postoperatively demonstrates that the maxillary left central incisor is comparable to the v...

Figure 16 - Clinical follow-up at 18 months postoperatively demonstrates that the maxillary left central incisor is comparable to the vital right central incisor in color and contour.

Repair of Dentition Damaged by Tongue Piercings

Treatment for Reversible Pulpitis Associated with Cracked Teeth - A 23-year-old male patient presented with pain associated with mastication and...

Treatment for Reversible Pulpitis Associated with Cracked Teeth - A 23-year-old male patient presented with pain associated with mastication and a parafunctional habit of biting on a stainless steel tongue bar. Contributed by Deborah S. Cobb, DDS, MS on 1/10/2013