CURRENT LITERATURE

J Oral Maxillofac Surg59:841-845, 2001

Annotated AbstractsPell-Gregory Classification is Unreliable as a Predictorof Difficulty in Extracting Lower Third Molars. GarciaAG, Sampedro FG, Fey JG, et al. Br J Oral Maxillofac Surg38:585, 2000

The Pell and Gregory classification is widely used forpredicting the difficulty of extracting mandibular third mo-lars. The classification is based on the position of the toothin relationship to the occlusal plane (Classes A through C)and the ramus of the mandible (Classes 1 through 3). Thisstudy prospectively rated the difficulty of extracting 166vertical lower third molars using a I-IV rating scale ( I �forceps only; II � osseous surgery required; III � osseoussurgery and tooth sectioning; IV � extraction more com-plex). The teeth were also classified according to Pell andGregory. The usefulness of the Pell and Gregory classifica-tion was evaluated by calculating sensitivities and specific-ities, as well as likelihood ratios for predicting surgicaldifficulty. Using the Pell and Gregory Class C to indicate“difficult,” specificity was 88% but sensitivity was only 15%.Using the Pell and Gregory Class 3 to indicate “difficult,”specificity was 62% and sensitivity was 50%. Most of thelikelihood ratios were close to 1, indicating that the Pell andGregory classification did not predict that any particularclass of third molars would be more difficult to remove thanothers, with the exception of Class 1, which had a ratio of0.3. The results of this study show that the Pell and Gregoryclassification has low sensitivity as an indicator of surgicaldifficulty, ie, a high proportion of the difficult cases are notdetected.

Reviewer’s Comment: It is interesting to note that thismay be the first study that has tested the validity of usingthe Pell and Gregory classification as a measure of surgi-cal difficulty. It is obvious that the classification did notprove a worthwhile tool when used to predict the difficultyencountered in the removal of vertically positioned thirdmolars. Another important point is that many mandibu-lar third molars encountered in clinical practice are notvertically oriented. The Pell and Gregory classificationdoes not take the angulation of the tooth into account,and so this classification may have even less practicaluse.—EDWARD ELLIS III

Reprint requests to Dr Garcia: Factultad de Odontologia, Universityof Santiago de Compostela, Entrerrios s/n, Santiago de Compostela,Spain.

Vaccinations and the Risk of Relapse in Multiple Scle-rosis. Confavreux C, Suissa S, Saddier P, et al. N Engl J Med344:319, 2001

Hepatitis B Vaccination and the Risk of Multiple Scle-rosis. Ascherio A, Zhang S, Hernan M, et al. N Engl J Med344:327, 2001

The Risk of Vaccination—The Importance of NegativeStudies. Gellin B, Schaffmer W. N Engl J Med 344:372, 2001

Reports of results of 2 studies and an accompanyingeditorial address the negative association between hepatitisB vaccine and multiple sclerosis (MS). In the first case-crossover study 643 patients with MS and at least 1 relapsewere identified from the European Database for MultipleSclerosis. Patients were queried by a structured telephoneinterview about vaccines received over a 6-year period.Three hundred twenty-six patients received no vaccinationsand 260 received at least 1 confirmed vaccination. The 2months prior to the MS relapse was considered the at-riskperiod. No association was found between MS relapse andvaccination against hepatitis B, tetanus, and influenza (rel-ative risk 0.7, 95% confidence interval 0.4 to 1.3). In thesecond study, a nested case-control study of 2 large cohortsof nurses, 192 women with MS were identified and matchedagainst 534 healthy controls and 111 with breast cancer.Most of the subjects had received the customary 3 doses ofthe hepatitis vaccine. Again, no association was found be-tween hepatitis B vaccination and the onset of symptoms ofMS (relative risk 0.9, 95% confidence interval 0.5 to 1.6).The editorial cautions against reaching conclusions about“cause and effect” by focusing on the temporal associationbetween receiving a vaccine and the onset of MS, bothinvolving a patient’s immune system. In addition, the edi-tors remind readers that the public’s understanding of im-munizations is limited—25% of parents believed that theirchild’s immune system could be adversely affected by toomany immunizations and too many vaccines are being ad-ministered presently.

Reviewer’s comment: Surgeons, dentists and theirstaff remain at high risk for contracting hepatitis B. Vac-cines now routinely administered to boost immunity tothe hepatitis B virus keep us from being included among350 million chronic carriers of hepatitis B. These studiesconfirm the safety of the hepatitis B vaccine and thenegative association with the debilitating neurologic dis-ease, MS. Collectively, we welcome these results and canrecommend with renewed confidence, hepatitis B vacci-nation to our colleagues and our staff.—R. WHITE

Reprint requests to Dr Ascherio: Department of Nutrition, HarvardSchool of Public Health, 665 Huntington Ave, Boston, MA 02115;e-mail: alberto.ascherio@channing.harvard.edu

Reprint requests to Dr Confavreux: EDMUS Coordinating Center,Hopital Neurologique, 59 blvd. Pinel, Lyons CEDEX 03, France.

841

AbstractsLong-Term Results of Uvulopalatopharyngoplasty forObstructive Sleep Apnea Syndrome. Boot H, van WegenR, Poublon RM, et al. Laryngoscope 110:469, 2000

The long-term results of uvulopalatopharyngoplasty(UPPP) for the treatment of obstructive sleep apnea syn-drome (OSAS) were evaluated in this study. Snoring, day-time sleepiness, and nocturnal oxygen desaturation index(ODI) were used as parameters of evaluation. A total of 58patients, 51 men and 7 women, with a mean age of 49 yearswere included in the study. UPPP were performed in be-tween February 1988 and September 1993. Long-term fol-low-up ranged from 11 to 74 months, with a median of 34months, after the surgical procedure. Snoring and daytimesleepiness were assessed with semiquantitative scales. TheODI values were calculated from pulse oximetry combinedwith polysomnography at baseline and polygraphy duringfollow-up in 38 patients. The results showed a significantlong-term improvement on snoring. Daytime sleepiness re-turned to preoperative values between 6 months and long-term follow-up. No significant long-term improvement wasnoted in ODI. In addition, the short-term improvement onODI significantly decreased 6 months after the operation.The authors concluded that the initial good results of UPPPfor OSAS decreased significantly over long-term follow-up.UPPP remains effective only in 20% of the patients withOSAS. UPPP combined with tonsillectomy is more effectivethan UPPP alone.—A.F. HERRERA

Reprints request to Dr Boot: Department of Neurology, ErasmusMedical Center of Rotterdam, Dijkzigt Hospital, PO Box 2040, 3000CA Rotterdam, The Netherlands.

Skin Care and the Topical Treatment of Aging Skin.Friedland JA, Buchel EW. Clin Plast Surg 27:501, 2000

The skin is a self-sustaining organ that efficiently repairsitself and renews its cells biweekly. It is the largest and mostvisible organ in the body, so changes of aging are pro-foundly evident. Intrinsically aged skin is thin, inelastic, andfinely wrinkled. Histologic changes seen in aged skin arethinning of the epidermis and dermis, with flattening of therete pegs at the dermal-epidermal junction. Extrinsicallyphotoaged skin is thickened, lax, rough, leathery, and blem-ished, possibly containing telangiectasias, lentigines, oreven malignancies. Histologic changes include epidermaldysplasia with cytologic atypia, inflammatory infiltration,decreased collagen, increased ground substance, and elas-tosis. The fundamental principle regarding skin care prob-lems because of aging is that 99% of all aging may be causedby free radical damage. Antioxidants such as vitamins A, C,and E act as free radical scavengers. Topical and systemicadministration have a photoprotective effect, and a combi-nation of the vitamins has been shown to significantlydecrease the sunburn reaction, which may result in a re-duction of all of the long-term sequelae of UV radiation,including photoaging and the formation of malignant skintumors. There are significant differences between the careand treatments provided in a commercial beauty salon orspa and those provided in a medical office under the super-vision of a physician. Home treatment programs consist ofthe use of skin exfoliants, stimulating agents, and protectiveand preventive agents. In the evening, products to exfoliate

and stimulate the skin are used because the patient is home,at rest, and not exposed to the sun or environment. Themorning program is oriented toward prevention and pro-tection. Plastic surgery skin care treatments can be dividedinto those performed by licensed aestheticians or nurses inthe office and those performed by the physician in a majortreatment area or operating room. Dermaplaning, microp-eels, light chemical peels, microdermabrasion, microwavehair removal, and small vein ablation fall into the categorytreated by ancillary personnel. Deep chemical peels, derm-abrasions, laser resurfacing, and laser hair and vein removalare performed by the physician. The fundamentals of allskin peels are the same. The depth of the peel and not thepeeling agent is the most important factor in determiningthe cosmetic result. Chemical peels traditionally have beendivided into superficial or light, medium, and deep catego-ries. The degree of ablation involves the epidermis, epider-mal/dermal junction, and deep papillary or papillary retic-ular dermis, respectively. When the reticular dermis isdamaged, wound healing and permanent scars may result.The preoperative preparation of the patient’s facial andneck skin by office skin treatments and the appropriate useof home treatment skin care products are important treat-ment factors. There are several bottom-line questions thatmust be considered by the physician before becoming in-volved with and providing skin care to patients in themedical office. Do these ancillary services increase liability?Do these ancillary services increase income? The future ofmedical skin care, particularly for the skin care specialist, isbright.—R.H. HAUG

Reprint requests to Dr Friedland: 101 East Coronado Rd, Phoenix,AZ, 85004-1556.

Dietary Fat and Fish Intake and Age-Related Macu-lopathy. Smith W, Mitchell P, Leeder S. Arch Ophthalmol118:401, 2000

Age-related maculopathy (ARM) is a leading cause ofirreversible blindness in Australia and the United States.Although the causes of ARM are not known, there are somerisk factors including systemic hypertension, vascular dis-ease, high serum cholesterol, body mass index, and plasmafibrinogen level. The human retina and macula have a highamount of omega-3 fatty acids in them, particularly docosa-hexaenoic acid. Docosahexaenoic acid is found in oily fishand is involved in the normal functioning of the retina.During this study, a survey was given to 3,654 people aged49 years or older (the participation rate was 82.4%). Thisquestionnaire asked about medical history, smoking history,and family history of ARM. The subjects also underwent aneye examination of at least 1 eye (3,582 participated). Theresults were that low fish consumption was crudely associ-ated with increasing age, female sex, smoking, and a historyof angina. More frequent consumption of fish appeared toprotect against late ARM (after adjusting for age, sex, andsmoking). Also, total and saturated fat intake were associ-ated with borderline significant increase in risk for earlyARM. The biological plausibility of a protective effect ofomega-3 fatty acids against the development of ARM issupported by the high levels of polyunsaturated fatty acidsin the retina. They may be involved in the maintenance ofthe cell membrane and the constant renewal of retinal

842 CURRENT LITERATURE

components after oxidative damage. Protection againstARM may also be provided by omega-3 fatty acids through adirect or indirect antiatherosclerotic effect.—S.J. FONTANA

Reprint requests to Dr Smith: National Centre for Epidemiology andPopulation Health, Australian National University, Australian Capi-tal Territory, 0200 Australia; e-mail: wayne.smith@anu.edu.au

Palatal Distraction in the Canine Cleft Palate Model.Ascherman JA, Marin VP, Rogers L, et al. Plast Reconstr Surg105:1687, 2000

The author’s aim was to determine whether the caninehard palate could be lengthened by distraction osteogenesisin a cleft palate model using a mostly submucosal distractor.The study was conducted using 5 mongrel dogs. The tech-nique involved raising palatal mucoperiosteal flaps and cut-ting midline strips of palatal bone to simulate the cleftdefect. This was followed by a transverse osteotomy of thepalate to separate the posterior from the anterior palatalsegments. Posterior osteotomies were then made laterally,parallel to the teeth so that the posterior segment was madeinto 2 subsegments. The distractor devices were thenplaced submucosally, attached to the anterior and to the 2posterior segments. Radiopaque markers were placed andthe distractors activated after a 10-day waiting period.Progress was measured using serial radiographs. The dis-tractors were activated by 0.675 mm/d until a total of10.125 mm total distraction was achieved. The distractorswere left in place for an additional 8 weeks, at which timethe animals were killed. Radiographic and histological ex-amination showed new bone formation in all animals. Theauthors suggest that this may be an effective and controlla-ble technique for the correction of velopharyngeal insuffi-ciency in humans that also involves less surgery and lessmorbidity than currently available techniques.—C.G. PAGNI

Reprint request to Dr Ascherman: Columbia-Presbyterian MedicalCenter, 161 Ft. Washington Ave, New York, NY 10032.

Response to Tissue Injury. Peled ZM, Chin GS, Liu W, etal. Clin Plast Surg 27:489, 2000

In the adult mammal, cutaneous injury in any form,whether by scalpel, laser, or chemical, results in the forma-tion of a scar. This response to tissue injury involves acomplex series of events that eventually result in a restora-tion of tissue continuity. The adult mammalian wound heal-ing response takes place in 3 distinct phases. Upon injury,the inflammatory phase begins. The key functions of thisphase are to achieve hemostasis and to initiate an inflam-matory response that acts to debride the wound. The nextphase of wound healing often is termed the proliferativephase. In this phase, mesenchymal cells proliferate, angio-genesis begins, and epithelialization occurs. By day 3 post-wounding, collagen synthesis by fibroblasts begins. Woundcontraction begins approximately 4 to 5 days postinjury.The final phase of wound healing is called the remodelingphase and begins roughly 3 weeks after tissue injury.Wound healing is a dynamic biologic process involvingnumerous cell to cell and cell to matrix interactions in acomplex milieu of local and systemic influences. When thehealing process goes awry, one ends up with overhealedwounds like keloids. The term keloid is derived from theGreek word chele, meaning crab claw, which refers to themanner in which the lesions grow laterally into normaltissue. Demographically, it has been estimated that over

15% of blacks, Hispanics, and Asians suffer from keloids,with the same prevalence in male and female sexes and thehighest incidence in the second decade of life. Histologi-cally, keloids are characterized as having collagen bundlesthat appear stretched and aligned in the same plane as theepidermis, in contrast to normal scar tissue with randomlyarrayed architecture. A hypertrophic scar is defined as ex-cessive scar tissue that raises above skin level yet stayswithin the confines of the original lesion or injury. Theincidence of hypertrophic scarring varies from 39% to 68%after surgery, and 33% to 91% after burn injury dependingon the depth of the wound. The character of immunereaction is believed to be an important factor in the forma-tion of excessive scars. In recent years, scientists have notedthe remarkable ability of early gestation fetal skin to healwithout scar formation. Fetal wounds differ in their inflam-matory response to wounding, the composition of the ex-tracellular matrix (ECM), the rate at which this ECM isproduced and degraded, the cytokine milieu of the fetalwound, and the external environment to which they areexposed. As the intricacies of the fetal and adult woundhealing mechanisms begin to unravel, clinicians as well asscientists are attempting to apply this new knowledge toreduce scarring. In the case of keloids and hypertrophicscars, the focus has been on providing the stop signals thatmay lead to pathologic scarring. These strategies include theuse of antiproliferative agents, such as bleomycin and hexade-cylphosphocholine, and glucocorticoids, such as triamcino-lone acetate, to prevent collagen synthesis. Another potentialstop signal for scar formation is the testosterone receptor.Although some investigators have focused on ameliorating theeffects of overhealing lesions, others have focused on reducingthe scarring seen in adult animals. In these cases the goal hasbeen to minimize or prevent scar formation. Future targets formanipulating wound healing are likely to involve combinedmodalities that manipulate the fibroblast, the inflammatoryresponse, and the ECM in the hope scarless skin regenerationcan be achieved.—R.H. HAUG

Reprint requests to Dr Longaker: New York University MedicalCenter, Room H-169, 550 First Ave, New York, NY 10016.

Prognostic Indicators for Vision and Mortality inShaken Baby Syndrome. McCabe CF, Donahue SP. ArchOphthalmol 118:373, 2000

Shaken baby syndrome (SBS) can occur after a severeshaking injury to children aged 3 years or younger oftenseen with intracranial and retinal hemorrhaging, diarrhea,bradycardia, hypothermia, hypotonia, irritability, seizures,bulging fontanels, and external and radiologic signs of phys-ical abuse. The authors found that histologic studies ofpostmortem eyes of children with SBS show ocular hemor-rhages at the vitreous, preretinal, intraretinal, and subretinallayers; perineural sheath of the optic nerve; and in theintrascleral perioptico regions. In this retrospective studyinvolving 30 cases, it was the authors’ objective to studyocular and nonocular signs of patients diagnosed with SBSand to determine prognostic indicators for vision and mor-tality. The medical records of cases involving child abuseassociated with bilateral retinal hemorrhaging were ob-tained and reviewed. Visual function and papillary lightreaction along with location of retinal hemorrhages, neuro-imaging findings, ventilatory requirement, and skeletal inju-ries were among the focus of admission time records inthese patients. The information obtained was then corre-lated with visual prognosis and mortality. The results indi-

CURRENT LITERATURE 843

cated that the mean age of the patient was 9.3 months with40% of these patients having fix-and-follow vision. Twenty-eight percent preretinal and 100% intraretinal hemorrhag-ing were observed as more common than 10% vitreoushemorrhages. Subdural hematomas were detected in 70% ofpatients with 67% having seizures and 53% requiring venti-latory support, 47% suffering bruises, and 13% long bonefractures. All patients with nonreactive pupils on presenta-tion died. Eighty-six percent of patients with midline shiftdied; 91% with no midline shift survived. On conclusion, ithas been suggested by the authors that nonreactive pupilsand midline shift of the brain structures correlate highlywith mortality. It is also suggested that ventilatory require-ment, and not visual acuity on presentation, predicts visualoutcome.—S.C. OLTEAN

Reprint requests to Dr Donahue: Department of Ophthalmologyand Visual Sciences, 1215 21st Ave S, Nashville, TN 37232-8808.

Lower Extremity Revascularization in Diabetes: LateObservations. Akbari CM, Pomposelli FB Jr, Gibbons GW,et al. Arch Surg 135:452, 2000

Despite the successes of infrainguinal arterial bypass indiabetic limb and foot salvage, optimism remains guardedbecause of purported high late mortality and limb loss inpatients with diabetes. To better define the long-term out-come of these patients, the authors of this study presentedtheir experience with a cohort of diabetic and nondiabeticpatients undergoing lower-extremity revascularization, withfollow-up of at least 5 years. Eight hundred forty-threeconsecutive patients undergoing infrainguinal arterial by-pass with vein graft for lower extremity arterial reconstruc-tion from July 1, 1990 through July 31, 1993 were includedin the study. Graft patency, limb salvage, and survival rateswere analyzed. A total of 962 vein grafts (843 patients) wereperformed; 795 grafts (82.6%) were performed in patientswith diabetes (DM group) and 167 (17.4%) in nondiabeticpatients (NDM group). Average age was 68.4 years, and waslower in the DM group. In-hospital 30-day perioperative mor-tality was 1.4%, lower in the DM group (0.9% vs 4.2%). Thetarget vessel was more frequently infrageniculate in the DMgroup. Five-year primary and secondary graft patencies were74.7% and 76.2%, respectively. The 5-year overall limb salvagerate was 87.1%, also unaffected by diabetes (DM 87.3% vsNDM 85.4%). Survival at 5 years was 58.1% overall and virtuallyidentical in the DM (58.2%) and NDM groups (58.0%). Theseresults showed that Diabetes mellitus does not influence latemortality, graft patency or limb salvage rates after lower ex-tremity arterial reconstruction.—A.J. LIBUNAO

Reprint requests to Dr Akbari: 110 Francis St, Suite 5B, Boston, MA02215; e-mail: cakbari@caregroup.harvard.edu

Overview: Soft Tissue Augmentation. Ashinoff R. ClinPlast Surg 27:479, 2000

The world of filler substances has undergone a small revo-lution over the last several years and many more substancesare now available for soft tissue augmentation. The most de-sirable filler is a substance that is autologous so that there is norisk of allergy or reaction; long-lasting, but not necessarilypermanent; painless for the patient and easy to use for thephysician in terms of technique and material injectability; andinexpensive. It should also have reproducible results, withminimal side effects such as bruising, irritation, infection, mi-gration, or tissue reactions and loss. In the United States, one

would prefer that the Food and Drug Administration (FDA)approve the material. There is no substance at this time thatcan fulfill all of these requirements. The first material to be-come available approximately 20 years ago for injection intorhytides and scars was bovine collagen. Bovine dermal colla-gen is 95% type I and 5% type III collagen. The major problemwith bovine collagen is that it is not an autologous substance,thus, allergy is a major consideration. Adverse reactions toinjectable bovine collagen can occur on an allergic and non-allergic basis. Transient reactions include bruising, reactivationof herpes, and bacterial superinfection, skin necrosis withsubsequent scarring, and blindness. Bovine collagen has beenused by almost 2 million people worldwide. It has been shownto be safe and effective for nonpermanent correction of rhyt-ides in the perioral, nasolabial, and oral commissure area. Italso has been shown to be effective in the glabella and peri-ocular region. Autologen (Collagenesis Inc, Beverly, MA) iscomposed of collagen harvested from the patient often at thetime of a previous surgery. After processing, it is composed ofintact human dermal collagen fibers, which have their telopep-tides still attached and are very stable and resist enzymaticdigestion. The major drawback with the use of Autologen isthat a relatively large piece of tissue is necessary, such as froman abdominoplasty or rhytidectomy, to ensure enough mate-rial for injection. Isolagen (Isolagen Technologies, Paramus,NJ) is autologous collagen harvested in a 3-mm punch biopsy,usually obtained from the postauricular skin. It is sent back tothe company in a special packaging kit where the skin iscultured and grown for 6 weeks. The company suggests a skintest so that any byproduct allergy is detected. Two weeks later,1 mL to 1.5 mL of the patient’s cells and collagen are sent tothe physician for treatment. This mixture then can be injectedevery 2 to 3 weeks until the desired degree of correction isobtained. Patients aged over 60 years are not candidates forIsolagen because their skin is not capable of producing vigor-ous fibroblasts. Isolagen produces better results in finer peri-orbital and perioral lines than in deeper furrows, such asnasolabial folds. Dermalogen (Collagenesis Inc) is a humantissue matrix implant. It is acellular and composed of collagen,elastin, and glycosaminoglycans. It is composed of mostlyintact normal human collagen fibers type I, III, and VI. Thematerial is obtained from human cadavers screened exten-sively by the Musculoskeletal Transplant Foundation, which isa member of the American Association of Tissue Banks. Der-malogen can be useful in nasolabial folds, glabella, oral com-missures, and scars. Hyperpigmentation over injection siteshas been reported. Artecoll (Rofil Medical International B.V.,Breda, The Netherlands) contains polymethyl methacrylatemicrospheres suspended in a bovine collagen solution withsaline and 0.3% lidocaine added. It can be used for deepglabellar furrows, nasolabial lines, lip augmentation, and acnescars. Short-term side effects, as with any injection, includeswelling, bruising, and sensitivity. Allergic reactions can occur.Resoplast (Rofil Medical International B.V.) is a bovine mono-molecular collagen in solution at 3.5% and 6.5% concentra-tions. It is essentially Artecoll without the polymethyl methac-rylate beads. Hylaform Gel (Biomatrix, Inc, Ridgefield, NJ) is ahyaluronic acid derivative derived from rooster combs. Resty-lane (Q-Med, Uppsala, Sweden) is another hyaluronic acidderivative. It is derived from fermentation of sugar by strepto-cocci. The material then is alcohol precipitated, filtered, anddried. It also is nontoxic and nonimmunogenic. Adverse reac-tions include erythema, ecchymoses, and acneiform dermati-tis, and intermittent swelling of the implant. Alloderm (LifeCell Corporation, The Woodlands, TX) is an acellular humandermal allograft that presently only comes in sheets for injec-tion into dissected dermal tunnels. It is now available in an

844 CURRENT LITERATURE

injectable form as well. Gore-Tex (W.L. Gore and Associates,Flagstaff, AZ) is composed of expanded polytetrafluoroethyl-ene (ePTFE) and is used for deep skin folds to achieve correc-tion that suffices alone or with overlying collagen, most com-monly for nasolabial folds and for lip augmentation. Manyphysicians have not liked this material because it may have anunnatural feel and it also may migrate and extrude. There isalso a problem with malalignment of the material, which isvery technique-dependent. The SoftForm facial implant (Col-lagen Corporation, Palo Alto, CA) is a new ePTFE implant forsoft tissue augmentation. Unlike Gore-Tex threads, SoftForm iscomposed of a hollow tube that is designed to promote in-growth of fibroblasts with subsequent production of collagen.Results with SoftForm have been satisfactory; however, therestill remains a tendency for extrusion or exposure of the endsof the material because of migration.—R.H. HAUG

Reprint requests to Dr Ashinoff: Ronald O. Perelman, Departmentof Dermatology, New York University Medical Center, 530 FirstAve, Suite 7R, New York, NY 10016.

New Book AnnotationsDental Drug Reference (ed 5). Gage TW, Pickett FA. StLouis, MO, Mosby, 2001, 815 pages, paperback

This new edition continues to provide quick, concise,and accurate drug information. By undergoing revision ev-ery 2 years, it tends to be a relatively current compilation,with a web site available for periodic updates. Its easy-to-usedesign provides rapid access to essential informationneeded when doing a medical history review and patientevaluation. Additionally, it provides guidance regarding den-tal considerations related to management of patients takingparticular drugs.

Surgical Pathology of the Head and Neck (ed 2). BarnesL (ed) with 32 contributors. New York, NY, Marcel Dekker,Inc, 2001, 3 volumes, 2368 pages, illustrated, $575.00

This new edition has been updated, reorganized, andrevised throughout, providing an interdisciplinary approachto the diagnosis and treatment of the various diseases anddisorders of the head and neck. Included for each conditionis a discussion of its incidence, etiology, clinical presenta-tion, pathology, differential diagnosis, treatment, and prog-nosis. The extensive bibliography following each chapter isgenerally divided into sections according to the specificcondition, making it easy to identify the sources of thevarious references.

Atlas of Minor Oral Surgery. Dym H, Ogle OE (eds) with14 contributors. St Louis, MO, Mosby, 2001, 301 pages,illustrated

The 9 sections in this book cover the broad scope ofoutpatient surgical procedures, ranging from exodontia andimplant and third molar surgery to periodontal and end-odontic surgery and the management of salivary gland dis-eases. Also included is material on antibiotics, sedationtechniques, and local anesthesia. A unique feature of thebook is the extensive summation of important information

in table form.

Orofacial Pain: From Basic Science to Clinical Manage-ment. Lund JP, Lavigne GJ, Dubner R, Sessile BJ (eds) with13 contributors. Chicago, IL, Quintessence, 2001, 300pages, illustrated, paperback

This book provides concise summaries of the currentknowledge in the area of orofacial pain by some of theleading experts in the field. The 24 chapters are divided intosections on clinical problems and epidemiology, the neuro-biology of pain, pain and behavior, and management oforofacial pain. Whenever possible, the information pro-vided is evidence-based, and it is made clear whenever suchinformation is lacking.

The Branemark Novum Protocol for Same-Day Teeth:A Global Perspective. P-I Branemark (ed) with 14 contrib-utors. Chicago, IL, Quintessence, 2001, 166 pages, illus-trated in color

This book introduces the Branemark Novum system forproducing an implant supported prosthesis, including boththe surgical and prosthetic aspects, in less than 8 hours. Itdescribes the biologic principles underlying the success ofthe method and then provides a large series of illustratedcase reports from 13 centers around the world.

Periodontics: Current Concepts and Treatment Strat-egies. Galgut PN, Dowsett SA, Kowolik MJ. New York, NY,Thieme, 2001, 240 pages, illustrated, $89.95

The current concepts of periodontal disease and thechanging conceptual framework within which preventionand treatment can be considered are reviewed in this book.Mechanical treatment, the role of surgery, and the use ofchemotherapeutic agents are discussed. Also included arechapters on microbiology, systemic influences, the hostresponse, and the epidemiology of periodontal disease.

Implants and Restorative Dentistry. Scortecci GM,Misch CE, Benner K-V (eds) with 28 contributors. NewYork, NY, Thieme, 2001, 466 pages, illustrated, $199.95

This text is designed as a guide to the practical applica-tion of implant dentistry. It covers diagnosis and treatmentplanning, clinical aspects and laboratory procedures, andcomplications and maintenance. Although the basis for thematerial provided in this text is the Disc implant� and theStructure� implant system, much of what is included canalso be applied to other implant systems.

Cleft Lip and Palate: Lesions, Pathophysiology andPrimary Treatment. Malek R (ed) with 5 contributors.New York, NY, Thieme, 2001, 360 pages, illustrated,$175.00

The contents of this book are divided into 4 parts. Thefirst section is devoted to general aspects of the cleft prob-lem. In part 2, there are discussions of the normal andabnormal anatomy of the lip and nose, as well as the pri-mary treatment of the conditions involving these structures.Part 3 is devoted to the isolated cleft palate and part 4involves complete clefts. Early management is emphasizedand long-term results are presented to support this concept.

CURRENT LITERATURE 845