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Periotest-analysis in penradicular surgery: preliminary results of a clinical-prospective study
Schweiz Monatsschr Zahnmed. 2005;115(10):903-8.
Cantelmi G, Frei C, von Arx T.
The two objectives of the present study were: to assess the healing after periradicular
surgery using the Periotest device, and to compare the recorded Periotest values with
the healing category determined after a one-year follow-up using radiographic and clinical
criteria. In 43 patients with periradicular surgery, Periotest values could be recorded
pre- and postoperatively, as well as after six and twelve months. Cases with a successful
healing, as determined at the one-year follow-up, demonstrated a continuous decrease of
the Periotest values over time, whereas one-year failures showed increasing Periotest
values over the study period. In control teeth, the Periotest values remained unchanged
for the whole study period. It appears that the Periotest measurements correlate with
the postoperative healing mode following periradicular surgery,
and therefore, allow an additional assessment of the healing outcome.
Effectiveness of computerized delivery of intrasulcular anesthetic in primary molars.
J Am Dent Assoc. 2005 Oct;136(10):1418-25.
Ashkenazi M, Blumer S, Eli I.
BACKGROUND: Pain measures associated with computerized delivery of intrasulcular anesthestic
have not been reported. The authors evaluated a computerized delivery system for intrasulcular
(CDS-IS) anesthesia in primary molars. METHODS; The study population consisted of children
aged 2 to 13 years who received CDS-IS injections, 159 in mandibular molars and 48 in
maxillary molars. Children were treated by one of three modes of behavioral management:
behavior modification (BM) only, inhalation of nitrous oxide (N2O) in addition to BM or
intrarectal sedation. Variables evaluated included the subjective perception of the child's
well-being before and after administration of the anesthetic, the child's pain behavior
during anesthetic administration, effectiveness of the anesthetic during dental treatment,
incidence of reported postoperative dental pain (PDP) and analgesic use after the CDS-IS
injections. RESULTS: The effectiveness of CDS-IS anesthesia in mandibular molars was 97
percent, 92 percent, 63 percent and 71 percent for restorations, preformed stainless steel
crowns, extractions and pulpal therapies, respectively (mean effectiveness, 89 percent).
The effectiveness of CDS-IS anesthesia in maxillary molars was 96 percent, 50 percent,
92 percent and 78 percent, respectively (mean effectiveness, 90 percent). CDS-IS was
less effective in children aged 2 to 4 years who received sedation than it was in older
children. The authors found no differences between children's subjective self-reports
of well-being before and after anesthetic administration, between the sexes and/or
between modes of behavioral management (that is, BM or N2O). Most children exhibited
low pain-related behavior during anesthetic administration, with no differences
between boys and girls. The overall incidence of PDP was 31.4 percent;
64.9 percent of these patients received pain-relieving medications as a result,
with no correlation to age, tooth treated, effectiveness of anesthesia or type
of treatment. CONCLUSIONS: CDS-IS is effective for anesthetizing primary molars, mainly for amalgam, resin-based composite and stainless steel
crown restorations.
Apicectomy with the Er:YAG laser or bur, followed by retrograde root filling with zinc oxide/eugenol or sealer 26.
Photomed Laser Surg. 2005 Aug;23(4):395-8.
Francischone CE, Padovan LA, Padovan LE, Duarte MA, Fraga Sde C, Curvello VP.
OBJECTIVE: This study evaluated the influence of root resection, by means of the use of
erbium:YAG laser in sealing two different materials, OZE and Sealer 26, in retrograde
obturations. BACKGROUND DATA: Few studies with sufficient data have been conducted in
this area. METHODS: Forty uniradicular teeth were used. They were biomechanically prepared
using the step-back technique and obturated using the lateral condensation technique. The
teeth were divided into two groups of 20 teeth, one group using the erbium:YAG laser
(350 mJ and 6 Hz) for the resection process and the other using the Zekrya Drill,
in high rotation. Then, the retrograde cavities were prepared using a micro
counter-angle with a number 2 spherical bur. After preparing the cavities,
the teeth were impermeabilized and divided into two subgroups. One subgroup
used the retrograde obturation technique with Sealer 26 cement, and the other
subgroup used OZE. After completing the retrograde obturation, the teeth were
immersed in 2% methylene blue for a 7-day period. Teeth were then removed from
the dye, washed, scraped, and sectioned in the vestibule-lingual direction.
RESULTS: The results were analyzed with the aid of a magnifying lens, and
scores were attributed based on the magnitude of infiltration. The data were
then submitted to statistical analysis. CONCLUSIONS: No statistical difference
was noticed regarding the root resection methods; however, in comparing materials,
Sealer 26 was statistically superior to OZE. In the subgroup comparison,
a significant difference
was noticed in the Laser and Sealer 26 and the Laser and OZE and bur and OZE.
Chairside preparation of provisional restorations.
J Oral Maxillofac Surg. 2005 Sep;63(9 Suppl 2):80-8.
Moy PK, Parminter PE.
PURPOSE: Increasing demands are placed on the oral and maxillofacial surgeon to perform
early or immediate loading of dental implants due to demands and expectations of the
referring doctor and patients. In order to provide the patient with an immediately loaded,
functioning implant, the surgeon should consider incorporating the fabrication of the
temporary restoration as an additional service for their implant patients.
MATERIALS AND METHODS: The armamentarium necessary for the oral and maxillofacial
surgeon to deliver a temporary restoration will be described. The materials and
components needed to provide this service will be listed and a sequence of steps
to easily accomplish the fabrication of a temporary crown will be presented.
RESULTS: Temporary crowns cemented onto temporary or permanent implant
abutments are ideal for the management of gingival contours. Initial soft
tissue healing around the contours of the temporary crown, even with minimally
invasive techniques, provides many advantages for the patient. There is less
likelihood of gingival scarring, which minimizes the incidence of gingival
recession and the patient is restored to normal form and function immediately.
CONCLUSIONS: The fabrication of the temporary prosthesis by the oral and
maxillofacial surgeon provides benefits for the surgeon, restorative doctor,
as well as, the patient. By working closely with his or her restorative
colleagues, the surgeon will be able to provide his or her implant patients
with immediate return to form and function intraorally with minimum effort.
Overview of the SwissPlus Implant System.
J Oral Implantol. 2005;31(3):121-8.
Gunaseelan R, Rajan M.
Although many improvements have been made to implant dentistry during the last quarter
of a century, clinical challenges still remain. For the surgeon, achieving implant
stability in low-density bone can be difficult. For the restorative dentist, incompatibility
between implant systems and the increasing complexity of esthetic restorative options
frequently require special training in the selection and use of prosthetic components.
This article presents an overview of a 1-stage implant system with a textured surface
and osteocompressive surgical protocol designed to achieve stability in soft bone.
Self-tapping, double lead threads and a separate surgical protocol also enable the
implant to be placed in high-density bone. The implant is packaged on a fixture mount
that also functions as a transfer and transitional or definitive abutment for cemented
restorations. This implant is designed to help simplify restorative procedures by
eliminating many ancillary restorative components. For multiple-unit, screw-retained
restorations, the prosthesis can be splinted directly to the top of the implant
without an intermediate abutment. Overdenture attachments and straight,
angled, screw-receiving, and custom-cast abutments complete the restorative system.
A comparison of mucosal incisions made by scalpel, CO2 laser, electrocautery, and constant-voltage electrocautery.
Otolaryngol Head Neck Surg. 1997 Mar;116(3):379-85.
Liboon J, Funkhouser W, Terris DJ.
This study compares the histologic effects of scalpel, CO2 laser, electrosurgery, and
constant-voltage electrosurgery incisions on the mucosal tissue of swine.
Tissue studies comparing the CO2 laser with the scalpel and electrosurgery have been done.
However, a gross and histologic comparison of the effects of all three techniques on oral
mucosal tissue has not been reported. A swine model of both tongue and buccal mucosa was
used to compare the scalpel, CO2 laser, electrosurgery unit, and constant-voltage
electrosurgery unit in an effort to assess their value in oral surgery. Tissue samples
of tongue and buccal mucosal incisions and excisions were histologically examined at
0, 3, 7, 14, 28, and 42 days after surgery to evaluate tissue damage and wound healing
properties induced by the four instruments. The instruments were also evaluated for
performance and ease of use. On subjective evaluation of ease of use, constant-voltage
electrosurgery scored highest (p < 0.05) on a scale of 0 to 4, followed by the CO2 laser. Speed of incisions and excisions, measured in seconds, was fastest with the scalpel (p < 0.001) and electrosurgery unit (p < 0.05). The amount of bleeding, as evaluated on a scale of 0 to 4, was least for electrosurgery (p < 0.001) and CO2 laser (p < 0.001). Histologic damage, as expected, was least with a scalpel. The extent of epithelial damage lateral to the wound edge and the extent of collagen denaturation were the lowest with the scalpel (p < 0.001), followed by constant-voltage electrosurgery. The wounds created by all four instruments displayed intact epithelium by 4 weeks, and granulation tissue peaked at 4 weeks with all methods except constant-voltage electrosurgery, where granulation tissue was still prevalent at week 6. Constant-voltage electrosurgery and the CO2 laser provided the best combination of ease of use, hemostasis, and lack of tissue injury among the instruments compared. Incisions and excisions made with constant-voltage electrosurgery required less time than those made with the laser, but constant-voltage electrosurgery wounds also had significantly more granulation
tissue in later weeks of the study, suggesting that wound healing may be delayed.
Microsurgical instruments for root-end cavity preparation following apicoectomy: a literature review.
Endod Dent Traumatol. 2000 Apr;16(2):47-62.
von Arx T, Walker WA 3rd.
Root-end cavities have traditionally been prepared by means of small round or inverted
cone burs in a micro-handpiece. Since sonically or ultrasonically driven microsurgical
retrotips became commercially available in the early 1990s, this new technique of retrograde
root canal instrumentation has been established as an essential adjunct in periradicular
surgery. At first glance, the most relevant clinical advantages are the enhanced access
to root ends in limited working space and the smaller osteotomy required for surgical
access because of the various angled designs and small size of the retrotips. However,
a number of experimental studies comparing root-end preparations made with microsurgical
tips to those made with burs have demonstrated other advantages of this new technique,
such as deeper cavities that follow the original path of the root canal more closely.
The more centered root-end preparation also lessens the risk of lateral perforation.
In addition, the geometry of the retrotip design does not require a beveled root-end
resection for surgical access thus decreasing the number of exposed dentinal tubules.
A controversial issue of sonic or ultrasonic root-end preparation is the formation
of cracks or microfractures, and its implication on healing success. The present
paper reviews experimental and clinical studies about the use of microsurgical
retrotips in periradicular surgery and discusses many issues raised in previous papers.
Computer-enhanced stereoscopic vision in a head-mounted display for oral implant surgery.
Clin Oral Implants Res. 2002 Dec;13(6):610-6.
Wanschitz F, Birkfellner W, Figl M, Patruta S, Wagner A, Watzinger F, Yerit K, Schicho K, Hanel R, Kainberger F, Imhof H, Bergmann H, Ewers R.
We developed a head-mounted display (HMD) with integrated computer-generated stereoscopic
projection of target structures and integrated it into visit, a specific oral implant
planning and navigation software. The HMD is equipped with two miniature computer monitors
that project computer-generated graphics stereoscopically into the optical path.
Its position is tracked by the navigation system's optical tracker and target structures
are displayed in their true position over the operation site. In order to test this
system's accuracy and spatial perception of the viewer, five interforaminal implants
in three dry human mandibles were planned with visit and executed using the
stereoscopic projection through the HMD. The deviation between planned and
achieved position of the implants was measured on corresponding computed tomography
(CT) scan images recorded post-operatively. The deviation between planned and
achieved implant position at the jaw crest was 0.57 +/- 0.49 mm measured from
the lingual, and 0.58 +/- 0.4 mm measured from the buccal cortex. At the tip of
the implants the deviation was 0.77 +/- 0.63 mm at the lingual and 0.79 +/- 0.71
mm at the buccal cortex. The mean angular deviation between planned and executed
implant position was 3.55 +/- 2.07 degrees. The present in vitro experiment
indicates that the concept of preoperative planning and transfer to the operative
field by an HMD allows us to achieve an average precision within 1 mm
(range up to 3 mm) of the implant position and within 3 degrees deviation
for the implant inclination (range up to 10 degrees ). Control during the
drilling procedure is significantly improved by stereoscopic
vision through the HMD resulting in a more accurate inclination of the implants.
Acceptance and side effects of nitrous oxide oxygen sedation for oral surgical procedures.
Acta Odontol Scand. 1999 Aug;57(4):201-6.
Berge TI.
Two hundred and forty-one treatment sessions with nitrous oxide oxygen sedation
were performed in 194 patients undergoing ambulatory oral surgery procedures.
Removal of mesiodentes and tooth transplants were the most frequent procedures
in age groups under 13 years, while removal of impacted teeth was predominant
in older age groups. Local anesthesia was used in addition to inhalation sedation
in 238 sessions. Median gas volume rate was 10 l/min, median concentration 50%
and median duration of procedures 31 min. In 10 sessions (4.1%) sedation was not
accepted, while in 25 (10.4%) sessions the procedure could be completed with some
difficulty. No potentially dangerous complications were noted. Side effects occurred
in 18 sessions in 16 patients. All side effects were minor and easily handled.
Logistic regression analysis revealed that failure, defined as poor acceptance
and/or presence of side effects, was associated with ASA class 2 and general
apprehension, especially based on previous negative experience with medical
or dental treatment. Nitrous oxide oxygen sedation is a reliable, efficient
and safe adjunct to local anesthesia
in both healthy children and adults undergoing ambulatory oral surgery
Malpractice claims for permanent nerve injuries related to third molar removals.
Acta Odontol Scand. 1998 Aug;56(4):193-6.
Venta I, Lindqvist C, Ylipaavalniemi P.
On the basis of the register of the Finnish Patient Insurance Association, the aim
of this study was to examine malpractice claims for nerve injuries associated with
third molar removals and determine whether they are concentrated among specialists,
among less experienced dentists, or in certain geographic areas. During 1987-93 there
were 139 claims for permanent sensory or motor disturbances related to removal of lower
third molars in Finland. The lingual nerve was injured in 54% and the inferior alveolar
nerve in 41% of the claims. In 91% of the cases the injury occurred in relation to
surgical removal of the tooth and in 6% in relation to simple extraction. The claims
were distributed among 123 dentists, of whom 78% were dental surgeons, 15% specialists
in oral and maxillofacial surgery, and 7% other specialists. These figures represented
2% of the dental surgeons and 26% of the oral surgeons in Finland (P< 0.01). More
than half the claims were associated with dentists with less than 10 years' experience.
Claims originated more often from the eastern and northern (rural) areas of
Finland than from urban areas (3.8 claims versus 2.4 claims per 100,000 inhabitants,
P < 0.05). Compensation was paid to the patients in two-thirds of the cases,
indicating that the dentists authorized to decide claims very often considered
these injuries avoidable. Therefore, proper diagnosis, treatment planning, surgical
techniques, and detailed patient information must be emphasized.
In cases where risks are obvious, referral to an oral surgeon is recommended.
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