Feline procedural sedation and analgesia: When, why and how

Practical relevance: Procedural sedation and analgesia (PSA) describes the process of depressing a patient’s conscious state to perform unpleasant, minimally invasive procedures, and is part of the daily routine in feline medicine. Maintaining cardiopulmonary stability is critical while peforming PSA. Clinical challenges: Decision-making with respect to drug choice and dosage regimen, taking into consideration the cat’s health status, behavior, any concomitant diseases and the need for analgesia, represents an everyday challenge in feline practice. While PSA is commonly perceived to be an uneventful procedure, complications may arise, especially when cats that were meant to be sedated are actually anesthetized. Aims: This clinical article reviews key aspects of PSA in cats while exploring the literature and discussing complications and risk factors. Recommendations are given for patient assessment and preparation, clinical monitoring and fasting protocols, and there is discussion of how PSA protocols may change blood results and diagnostic tests. An overview of, and rationale for, building a PSA protocol, and the advantages and disadvantages of different classes of sedatives and anesthetics, is presented in a clinical context. Finally, injectable drug protocols are reported, supported by an evidence-based approach and clinical experience.

Conservative Esthetic Approach of Anterior Teeth Using Minimal Intervention and Preservation of all Sound Tooth Tissue: a Case Report

This clinical case report describes a conservative approach to a smile harmony rehabilitation performing a gingivoplasty, dental bleaching and resin-based composites to finalize the case. This clinical article describes the case report of a patient in need of an esthetic and corrective solution for the anterior teeth, which presented a disharmonic smile, in its shape and color, besides the gingival smile. As a result, gingivoplasty, dental bleaching and restoration with composite resin were done. Gingivoplasty with bone preservation was possible because there was a large volume of soft tissue, and a distance ≥ 2 mm from the bone crest to the junction cementum enamel was confirmed. Bleaching was performed with the use of associated techniques: office (Whiteness HP 35%) and supervised at-home (Whiteness Perfect 10%) bleaching were performed, and then the "buccolingual technique" using a nanocomposite resin IPS was used from a diagnostic wax-up to perform the restorative procedure for the anterior teeth. The use of minimally invasive techniques is an effective alternative for the anterior teeth rehabilitation. As in this case, the gingivoplasty, dental bleaching with associated techniques, and restorations with nanocomposites allowed satisfactory esthetic results, even more so in relation to dental preservation, mainly in young patients. Keywords: Tooth Bleaching. Gingivoplasty. Esthetic. Dental RestorationAbstractThis clinical case report describes a conservative approach to a smile harmony rehabilitation performing a gingivoplasty, dental bleaching and resin-based composites to finalize the case. This clinical article describes the case report of a patient in need of an esthetic and corrective solution for the anterior teeth, which presented a disharmonic smile, in its shape and color, besides the gingival smile. As a result, gingivoplasty, dental bleaching and restoration with composite resin were done. Gingivoplasty with bone preservation was possible because there was a large volume of soft tissue, and a distance ≥ 2 mm from the bone crest to the junction cementum enamel was confirmed. Bleaching was performed with the use of associated techniques: office (Whiteness HP 35%) and supervised at-home (Whiteness Perfect 10%) bleaching were performed, and then the "buccolingual technique" using a nanocomposite resin IPS was used from a diagnostic wax-up to perform the restorative procedure for the anterior teeth. The use of minimally invasive techniques is an effective alternative for the anterior teeth rehabilitation. As in this case, the gingivoplasty, dental bleaching with associated techniques, and restorations with nanocomposites allowed satisfactory esthetic results, even more so in relation to dental preservation, mainly in young patients. Keywords: Tooth Bleaching. Gingivoplasty. Esthetic. Dental Restoration

Maintaining Sexual Desire and Satisfaction in Securely Bonded Couples

Emotion-focused therapy has made major contributions to the field of couple and marital therapy, especially with its emphasis on securely bonded couples. This conceptual/clinical article explores strategies and techniques to enhance sexual desire and satisfaction in securely bonded couples, with special attention to choosing a couple sexual style that facilitates strong, resilient desire. We advocate for both communication and integration between the fields of couple therapy and sex therapy.

Endodontic Management of an Unusual Maxillary First Molar with a Single Buccal Root

ABSTRACT Aim The aim of this clinical article is to describe the unusual anatomy that was detected in a maxillary first molar during routine endodontic treatment. Background Variation in root and root canal morphology especially in multirooted teeth presents a constant challenge for a clinician in their detection and management. The literature is replete with cases that have extra canal or root but cases with fused root and fewer numbers of canals are sparse. Case description This case report describes the endodontic management of one such unusual case of maxillary first molar presenting with a single fused buccal and a palatal root. The confirmatory diagnosis of this morphologic aberration was done with the help of spiral computerized tomography, which revealed that the contralateral tooth also had a similar morphology. Conclusion Dental practitioners should always be aware of the fact that abnormalities need not be in form of extra roots or root canals; anomalies can also be in form of fewer number of roots or root canals. Clinical significance A thorough knowledge of the complexities and variations of the root canal system would help in avoiding some of the common iatrogenic access opening errors like perforations and excessive tooth removal caused during the search for the missing or extracanal. How to cite this article Nayak G, Dahiya S, Singh I, Mohammad FH. Endodontic Management of an Unusual Maxillary First Molar with a Single Buccal Root. J Contemp Dent Pract 2014;15(3):367-371.