Hassan ElAbdin,
Department of Biomedical Dental Sciences, College of Dentistry, King Saud University, P. O. Box 60169, Riyadh 11545, Saudi Arabia.

This is a very uncommon lesion and was first described by Abrams¹ in 1973 as a benign ulcerative lesion occurring mainly in the palate. It is thought to be the result of a compromised blood supply to area involved. The initial ischaemia cause a prodromal sign of numbness in the affected area. This is followed several days later by development of a deep ulcer with sharp margins. The lesion is characteristically involving the hard palate although some cases were reported in the lips, cheek and even the major salivary gland. Only one case was reported in the tongue.

The significance of this lesion is that diagnostic problems both clinically and microscopically can occur. Caution has been urged for distinguishing between necrotizing sialometaplasia and malignancy, so as to avoid mutilating surgical treatment resulting from misdiagnosis. The lesion may closely resemble squamous cell carcinoma or mucoepidermoid carcinoma. Seven cases out of forty-four were misdiagnosed as squamous cell carcinoma, and eleven cases as mucoepidermoid carcinoma.²

The case presented here occurred in the tongue and was diagnosed provisionally as squamous cell carcinoma by the referring dentist and we are trying to bring this rare disease to the attention of the practising dentist, since misdiagnosis will result in grave consequences.

References

A retrospective review of patients with advanced malignant tumors, that underwent mandibular resection and reconstruction using AO plates, at the King Faisal Specialist Hospital and Research Center was performed.

Eighteen patients with malignancy that required a mandibular resection with plate reconstruction from 1983 through 1989 were reviewed. Patients ages at the time of surgery ranged from 17 to 90 years (X 53), with an even sex distribution. The resections were of 3 types: hemi-mandibulectomies, partial mandibular resections, and angle to angle resections. The pathologic diagnoses were : squamous cell carcinoma (15), then adenoid cystic carcinoma (2) and Ewing's carcinoma (1). All patients with the diagnosis of squamous cell carcinoma were either stage three of stage four. The long term survival rate of these patients is guarded. Radiotherapy was administered post-operatively to 14 of the patients.

Nine patients were successfully reconstructed. Nine plates were removed for the following reasons : three due to infection, three due to extrusions either intra or extraorally, and three were removed because of tumor recurrence.

The use of mandibular reconstruction plates in patients with advanced tumors is indicated. The flap used to insulate the plates must have adequate muscle and tissue mass.

Saudi Dental Journal 1992;4(SI)-Abstr.47:p48.

  A. D. McCaughey,
Dental Department, Riyadh Military Hospital, P. O. Box 7896, 1547, Riyadh 11159, Saudi Arabia.

The provision of an interim or transitional maxillary obturator for a patient, following removal of the immediate obturator placed at the time of surgery, has posed several problems. Patients often report difficulties in adapting to conventional acrylic prostheses which may feel hard and uncommfortable. In addition, these acrylic obturators may require regular relining during the healing period.

A new technique is described for the production of a two part maxillary obturator using a removable hollow bung moulded in polythene. This technique results in an obturator which is light, comfortable, retentive and ideal for use in the healing period to replace the immediate obturator with a gutta-percha bung. This design has now been used successfully for several patients as a transitional obturator. In addition, it has been found that with the use of a functional impression material on the obturator bung, a satisfactory impression can be taken and used to construct the definitive acrylic hollow bulb obturator.

Saudi Dental Journal 1992;4(SI)-Abstr.48:p49.

  Hugh N. Burkett, DMD, Damon R. Pence, DMD,
King Faisal Specialist Hospital and Research Center, P.O. 3354, Riyadh 11211, Saudi Arabia.

Infrequently, a patient presents for care with a loose abutment retainer or broken connector on an otherwise clinically/radiographically acceptable long span fixed partial denture. This presentation describes one technique which, when applicable, minimizes chairtime and expense and permits salvaging of the fixed prosthesis. A terminal retainer was loose from its abutment on a full arch splint opposing another full arch splint. The retainer was sectioned and the abutment preparation was refined simultaneously with a near parallel preparation of the molar pontic located adjacent to the abutment tooth. A two-unit prosthesis was fabricated which included an 'overcasting' of the pontic. The unit was cemented using zinc phosphate cement for the abutment retainer and composite resin for the etched overcasting. 18 months later, the entire full arch prosthesis was still intact and functioning as did the original.

Hybrids of this and other repair techniques and improvisations can be applied in other repair-demanding situations. Repairs should not be attempted when a fixed prosthesis is clinically unacceptable or when replacing the prosthesis would be easier and more time efficient for both patient and dentist.

Saudi Dental Journal 1992;4(SI)-Abstr.49:p50.

  Karl Fehlner,
8636 Weitramsdorf, Republic of Germany.

For the improvement of masticatory function, the implantation of two IMZ-implants in each cuspid region of the edentulous mandible to accommodate a bar-retained prosthesis may be indicated.

Successful oral implantation requires a well developed systematic treatment plan. Preliminary steps are:

In the first phase of surgery, preparation of the implant receptor situ and placement of the implant body is done. After at least three months of stress-free healing, in a second phase of surgery, the osseointegrated implants will be uncovered in preparation for:

After total implant and prosthetic rehabilitation, the patient must be put on a systematic, constant recall system for routine evaluation of oral hygiene, gnathological and periodontal conditions.

Saudi Dental Journal 1992;4(SI)-Abstr.50:p51.