Panoramic radiographs are frequently used for routine follow-up of mandibular implants. The objective of this study was to determine whether measurement on a panoramic radiograph of the vertical dimension of the mandible near by an implant, using the known implant length as a reference, is a reliable method. In 11 patients, 2 permucosal implants were placed in the anterior part of the edentulous mandible. During the first year after implantation, 2 panoramic radiographs and 2 sets of standardized oblique lateral cephalometric radiographs were made. Oblique lateral cephalometric radiographs are the golden standard for measuring the vertical dimension of an edentulous mandible. The length of the implants and the vertical imension of the mandible dorsally to the implants were measured on all oblique lateral cephalometric radiographs. The measured and known implant length were used to calculate the image enlargement factor. This factor was used to calculate the real vertical dimension of the mandible. The same measurement procedures were performed on the panoramic radiographs. Using a paired t-test, the calculated values of the vertical dimensions of the mandibles found on panoramic radiographs were compared with the calculated values found on oblique lateral cephalometric radiographs. No tatistically significant differences were found. It was concluded that under the described circumstances, panoramic radiographs can be used for reliable measurement of the vertical dimension of the mandible near by permucosal implants.

In the Netherlands only patients with reduced defence mechanism are considered for antibiotic prophylaxis, and only in case of a total hip replacement. The extend to which the American indications will be applied in Europe, is at this moment unknown. It becomes more and more clear that the risk from providing prophylaxis is greater than the risk of a joint infection.

Treatment of extreme or pathological forms of dental anxiety requires specific skills. This paper is an attempt to formulate a number of treatment strategies, based on the available literature and effectiveness studies. It is suggested that based upon the assessment information three types of problem areas can be identified, namely, 1. a phobia of specific dental procedures or situations; 2. long overdue requiring acute dental treatment; and 3. intrusive or interfering psychiatric symptoms. In this article these problem situations are reviewed and several appropriate treatment options are discussed.

Combining clinical examination and panoramic, periapical or lateral cephalometric radiographs is generally sufficient in the pre- and post-operative investigation of most implant patients. Sometimes there is a need for more information needing computertomography (CT) as an additional diagnostic tool. The obtained CT data can be manipulated and reconstructed with software programs such as DentaScan. The resulting cross sections, that can be given in true proportions, are perpendicular to the course of the jaw. Interpretation of these processed images is much easier but not always more accurate than the original scans. Pre-operatively, CT/DentaScans can be used not only for the determination of bone quantity and quality, but also for the location of relevant anatomical structures. Post-operatively, the scans can be valuable in the diagnosis of unexplained problems that may be related to the placed implants. Three case reports illustrate the use and indication of CT/DentaScans in solving implant related maxillary pathology or neuralgic pain.

The NLM gateway is a Web based internet address, which offers the possibility to search simultaneously in multiple retrieval systems at the National Library of Medicine. In addition to MEDLINE and MEDLINEplus, one can search at least a dozen other medical databases. In this issue, an overview is presented of the topics of this ‘one-stop-shopping’ gateway to medical literature.