Objective A study which examined the morbidity experienced by patients who underwent iliac crest bone graft procedures. Design A post-operative questionnaire was forwarded to patients who underwent iliac crest bone graft procedures at a single centre. Subjects One hundred and fourteen patients underwent iliac crest bone grafts for intra-oral augmentation. Results Ninety-eight patients (80%) returned post-operative questionnaires. Eighty of the 98 (81.6%) patients suffered postoperative pain with 70% of patients being pain-free after four weeks. However, 10% of patients experienced pain for more than 16 weeks. Eighty-five (86.7%) patients were able to walk without any difficulties six weeks post-operatively. Gait disturbance was not related with age, however there was a significant association between pain and disturbance of gait (P< 0.001). Twenty two patients required the use of a walking stick and the use of such aids varied from 0.5 to 26 weeks. Women used walking aids for longer periods than men (P< 0.05). Twenty five patients had altered sensation with about half of them experiencing altered sensation in the distribution of the lateral femoral cutaneous nerve. Other morbidities included deformity at the hip site (2.4%), haematoma (2.4%), infection (3.2%), stress fracture (4.1%) and meralgia paraesthetica in one patient. Despite the above morbidities, 82 patients were willing to undergo the same procedure again and 89 patients would recommend the procedure to their relatives and friends. Conclusion This study demonstrates considerable morbidity following anterior iliac crest bone harvest for intra-oral augmentation. Clinicians referring patients for such bone graft procedures must be aware of the above morbidities so that any patients referred for such procedures are fully informed.Teeth are usually lost as a result of disease or trauma but some patients may have congenitally missing teeth. One of the key elements involved in successful prosthetic rehabilitation is the

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We report the novel finding of matrix-rich "fibrin" cuffs in chronic nonspecific oral ulceration and propose a possible role for these lesions. Pericapillary cuffs are typically found in chronic venous ulceration. Vascular cuffs, which form in the base and margins of leg ulcers, have been reported to contain fibrin, laminin, fibronectin, tenascin, and types I and III collagen. Histologically identical vascular cuffs are present in oral ulcers of unusually prolonged chronicity and their occurrence in the oral cavity suggests that chronic venous insufficiency and back pressure are not essential to their formation. It is proposed that the matrix-rich pericapillary cuffs may act as a scaffold for angiogenesis in ulceration of prolonged duration.

Objective To compare the effectiveness of direct access referrals with standard letter referrals, and also assess the impact of the direct access system on the primary care provider, secondary sector and from the patients perspective. Design Surgical and anaesthetic guidelines were agreed and 12 general dental practitioners were recruited to participate in the study. Each practitioner was given 100 envelopes which contained randomly allocated 50 direct and 50 standard referrals. For direct referrals, GDPs completed a pre-operative assessment and obtained an operation date by telephone from the day case unit while the patient was in the surgery. The clinical history sheet was faxed to the day unit and the radiographs posted. The only contact the patient had with the hospital was on the day of surgery. Standard referral patients were referred in the traditional way with a referral letter being sent to an out-patient clinic. Evaluation of the effectiveness of the direct referral system versus standard letter method were made via completion of questionnaires by the patients, dental practitioners, hospital clinicians, day case anaesthetist and co-ordinator. Setting The study was carried out over 2 years commencing in 1997 at the Oral Surgery Day Case Unit at Manchester Royal Infirmary. Results A greater number of direct access referrals (409; 90%) were treated in comparison with (312; 75%) standard referrals (P < 0.001). Eighty nine per cent of direct access records were adequate pre-operatively. More than 70% of dentists and hospital clinicians preferred the direct access referral method. Sixty-three per cent of standard letter patients were satisfied with their mode of referral compared with 87% of direct access patients. Conclusions Given appropriate guidelines dental practitioners are able to refer directly to oral surgery day case operation lists. This has proved to be the favoured method of referral for dental practitioners, the secondary sector and patients.

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