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The case report describes placement of an implant in the posterior maxilla so as to avoid a pneumatized sinus and also to avoid the need for a sinus lift procedure. An 81-year-old woman presented with an edentulous span in the upper right posterior maxilla. She had been missing teeth in this area for many years, and there was a combination of resorption of the alveolar ridge and pneumatization of the maxillary sinus. Eleven years previously, implants had been placed anterior to this region, but the patient was told that implants could not be placed posteriorly unless a sinus lift was done. At the time of the current presentation she was still unwilling to undergo a sinus lift procedure but wanted to know if implants could be placed in the posterior right maxilla. A tomogram obtained with a radiographic stent in place indicated that there was insufficient bone height to allow placement of implants at the usual angulation without a sinus lift. Therefore, to avoid the need for a sinus lift, 2 implants were placed with palatal angulation as guided by tomographically determined surgical stent. The treatment planning and surgical and restorative techniques are reviewed here. A favourable for the patient and the clinicians. In the situations where there is sufficient palatal bone medial to the maxillary sinus, placing implants at an angle may prevent the need for a sinus lift procedure, assuming that proper development of an occlusal restorative scheme is possible. [ABSTRACT FROM AUTHOR]

Until recently, the accepted standard for the classification of periodontal diseases was the one agreed upon at the 1989 World Workshop in Clinical Periodontics. This classification system, however, had its weaknesses. In particular, some criteria for diagnosis were unclear, disease categories overlapped, and patients did not always fit into any one category. Also, too much emphasis was placed on the age of disease limited to the gingiva existed. In 1999, an International Workshop for a Classification of Periodontal Diseases and Conditions was organized by the American Academy of Periodontology to address these concerns and to revise the classification system. The workshop proceedings have been published in the Annals of Periodontology. The major changes to the 1989 proceedings and the rationale for these changes are summarized here. In addition, the potential impact of these changes is discussed. [ABSTRACT FROM AUTHOR]

Traditionally, periodontal hand instruments are honed or sharpened during patient care as they dull easily during contact with enamel, calculus and cementum. This approach is taught in dental and hygiene schools around the world and remains the standard of care. Recently, some professional organizations have questioned whether this practice should be abandoned because of safety issues. Questions have been raised whether sharpening stones can be properly sterilized and whether the sharpening of contaminated instruments poses a health hazard for the provider. Using bacteria culture techniques and scanning electron microscopy, we tested whether contaminated ceramic sharpening stones can be sterilized. Our results demonstrate that the stones were sterile after being subjected to the manufacturer's sterilization protocol. In addition, over the last year, no incidents related to periodontal instrument sharpening have been reported among nearly 400 students at the faculty of dentistry, University of British Columbia, where chair-side sharpening is taught. Therefore, we conclude that ceramic sharpening stones can be sterilized using normal office protocols and that chair-side sharpening adds little risk beyond routine handling of operatory or periodontal instruments during patient care when proper protocols are followed. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article on cracked tooth syndrome by Christopher D. Lynch and Robert J. McConnell in the September 2002 issue.