Nasoendotracheal tube obstruction by a nasal polyp in emergency oral surgery: a case report.

World J Emerg Surg. 2007 Nov 22;2(1):31

Authors: Goranovic T, Milic M, Knezevic P

ABSTRACT: Nasal polyps can make nasoendotracheal intubation difficult. We present a case of complete obstruction of a nasoendotracheal tube by a nasal polyp during a blind nasoendotracheal intubation in emergency oral surgery.

PMID: 18034893 [PubMed - as supplied by publisher]

Extraction treatment of an adult patient with severe bimaxillary dentoalveolar protrusion using microscrew anchorage.

Chin Med J (Engl). 2007 Oct 5;120(19):1732-6

Authors: Ouyang L, Zhou YH, Fu MK, Ding P

PMID: 17935682 [PubMed - indexed for MEDLINE]

Mucoepidermoid carcinoma of the tongue.

Singapore Med J. 2007 Oct;48(10):e272-4

Authors: Leong SC, Pinder E, Sasae R, Mortimore S

We report a 27-year-old Congolese man with mucoepidermoid carcinoma (MEC) of the tongue base, which presented as spontaneous intraoral bleeding. Optimal treatment of tongue base MEC is unknown. To our knowledge, this is the first reported case treated with transoral excision with carbon dioxide laser and selective neck dissection. Although immunohistochemical studies have revolutionised understanding of the disease, little else is known of the natural history of MEC. The majority of MEC is considered low-grade, with an indolent course without recurrence or metastasis. Nonetheless, MEC requires surgical management, postoperative radiotherapy and close long-term follow-up.

PMID: 17909664 [PubMed - indexed for MEDLINE]

[Alveolar osteotomy and rapid orthodontic treatments]

Orthod Fr. 2007 Sep;78(3):217-25

Authors: Sebaoun JD, Ferguson DJ, Wilcko MT, Wilcko WM

When combined with orthodontics, selective periodontal decortication has been shown to be clinically effective in eliminating severe malocclusions three to four times more rapidly than conventional orthodontic treatment. Our technique combines surgical scarring of the cortical bone on both labial and lingual sides of the teeth to be moved, with an augmentation graft to increase alveolar volume. Alveolar spongiosa undergoes rapid transformation as the body attempts to heal the wounds to the cortices resulting in marked tissue turnover. The patient is seen every two weeks and most cases are completed within six months of orthodontic treatment. Moreover, this technique significantly expands the scope of treatment in resolving many skeletal problems such as openbites and severe maxillary constrictions, conditions typically relegated to orthognathic surgery. Clinical outcomes research has shown that the immediate post treatment results settle better during retention and that the long term results become more stable. These facts are likely due to the high tissue turnover induced by decortication as well as the thicker cortical bone resulting from the augmentation grafting.

PMID: 17878040 [PubMed - indexed for MEDLINE]

Dental trauma: restorative procedures using composite resin and mouthguards for prevention.

J Contemp Dent Pract. 2007;8(6):89-95

Authors: Santos Filho PC, Quagliatto PS, Simamoto PC, Soares CJ

AIM: The aim of this article is to describe a step-by-step protocol for emergency care of a patient with a dentoalveolar injury in the anterior region of the mouth as well as the fabrication of a mouthguard to prevent future trauma. BACKGROUND: Dental trauma is one of the most serious oral health problems in active children and adolescents. Care of traumatized patients requires immediate initial emergency treatment followed by integrated procedures to restore damaged oral structures along with a subsequent trauma prevention strategy. Dentoalveolar injuries in the anterior region of the mouth are often characterized by tooth avulsion and coronal fracture. They are managed using procedures such as dental splinting, endodontic therapy with its unique characteristics, and restorative techniques to re-establish function and esthetics as well as protective mouthguards. REPORT: A 16-year-old male presented with avulsion of his maxillary central incisors as a result of a direct, unintentional impact with an opponent during a basketball game. The teeth had been stored in physiological serum immediately following the injury and the patient received immediate care. On clinical examination, the right central incisor was fractured at the incisal third of the crown but no bone fractures were found. The teeth were reimplanted and splinted. The fractured right central incisor was restored following endodontic treatment and a mouthguard was fabricated for the patient. SUMMARY: The dentist must be knowledgeable about the most efficient and suitable treatment for each traumatic scenario in order to provide appropriate care for dental injuries. Coordinated multi-disciplinary action is fundamental in the successful treatment of these injuries. The dental mouthguard is an effective device for protecting the teeth and supportive structures during physical activities and must be part of the protective equipment used by athletes. It is the responsibility of the dental professional to make parents, trainers, and athletic associations aware of the risks associated with physical activities without orofacial protection; this should encourage the proper use of all protective devices to prevent dentoalveolar injuries that compromise oral functions, esthetics, and increase the cost of healthcare.

PMID: 17846676 [PubMed - indexed for MEDLINE]

A method of gauging dental radiographs during treatment planning for dental implants.

J Contemp Dent Pract. 2007;8(6):82-8

Authors: Anil S, Al-Ghamdi HS

AIM: The goal of pre-surgical dental implant treatment planning is to position the optimum number and size of implant fixtures to achieve the best restorative results. The purpose of this article is to describe the use of radiographic imaging software to calibrate and measure anatomical landmarks to overcome inherent distortions associated with dental radiographs. The procedure along with its potential use as an adjunct to radiographic interpretation in routine clinical implant practice is presented. BACKGROUND: Diagnostic imaging is an essential component of implant treatment planning, and a variety of advanced imaging modalities have been recommended to assist the dentist in assessing potential sites for implants. Although technological advances have resulted in new imaging innovations for implant dentistry, dental radiography remains the most widely used tool for determining the quantity and quality of alveolar bone as it is a non-invasive procedure. However, the unreliable magnification factor associated with conventional radiographs remains a major problem when estimating the amount of bone available at the implant site. SUMMARY: This image measurement technique is capable of assessing the bone quantity by measuring the height and width of the alveolar crest for a specified region in a two dimensional plane in any direction related to the visible landmarks in the oral cavity. These measurements can be used by the clinician to select the type of implant and its position. Since there is no additional equipment or cost involved, the technique can be used as an important adjunct in implant practice.

PMID: 17846675 [PubMed - indexed for MEDLINE]

Maxillary canine impactions related to impacted central incisors: two case reports.

J Contemp Dent Pract. 2007;8(6):72-81

Authors: Bayram M, Ozer M, Sener I

AIM: The purpose of this case report is to describe the combined surgical and orthodontic treatment of two cases with an impacted maxillary central incisor and canine in the same quadrant and to discuss the causal relationship between them. BACKGROUND: The most common causes of canine impactions are usually the result of one or more factors such as a long path of eruption, tooth size-arch length discrepancies, abnormal position of the tooth bud, prolonged retention or early loss of the deciduous canine, trauma, the presence of an alveolar cleft, ankylosis, cystic or neoplastic formation, dilaceration of the root, supernumerary teeth, and odontomas. Although impaction of the maxillary central incisor is almost as prevalent as impacted canines its etiology is different. The principal factors involved in causing the anomaly are supernumerary teeth, odontomas, and trauma. REPORTS: Case #1: A 10.5-year-old girl in the early mixed dentition stage presented with a chief complaint of the appearance of her anterior teeth. She had a Class I skeletal pattern and a history of trauma to the maxillary central incisors at age five with premature exfoliation. Radiographs revealed an impacted upper right central incisor in the region of the nasal floor, delayed eruption of the maxillary permanent central incisor, and the adjacent lateral incisor was inclined toward the edentulous space. Treatment was done in two stages consisting of surgical exposure and traction of the impacted central incisor and fixed orthodontic treatment. Case #2: An 11.5-year-old girl presented for orthodontic treatment with the chief complaint of an unerupted tooth and the appearance of her upper anterior teeth. She was in the late mixed dentition period with a Class III skeletal pattern along with an anterior cross-bite with some maxillary transverse deficiency. The maxillary right canine and central incisor were absent, but the maxillary right deciduous canine was still present. Treatment included arch expansion followed by surgical exposure and traction of the impacted teeth and fixed orthodontic treatment. SUMMARY: This case report provides some evidence of a significant environmental influence of an impacted maxillary central incisor on the path of eruption of the ipsilateral maxillary canine. When an impacted maxillary central incisor exists, the maxillary lateral incisor's root might be positioned distally into the path of eruption of the maxillary canine preventing its normal eruption. Ongoing assessment and early intervention might help to prevent such adverse situations from occurring.

PMID: 17846674 [PubMed - indexed for MEDLINE]

Augmentation in two stages of atrophic alveolar bone prior to dental rehabilitation: a case report.

J Contemp Dent Pract. 2007;8(6):57-63

Authors: Zahrani AA

AIM: The aim of this report is to describe a significantly deficient case of alveolar bone that was managed by alveolar bone augmentation using a technique of distraction osteogensis and onlay bone grafting prior to dental implant placement. BACKGROUND: Injury to the teeth and alveolar ridge of the maxillary anterior region can cause a severe alveolar ridge deficiency resulting in ridge atrophy and maxillary retrognathism. The loss of these teeth and alveolar bone together with fibrotic scar formation can result in adverse changes of the interarch space, occlusal plane, arch relationship, and arch form which complicates rehabilitation and can compromise the esthetic outcome. While implant dentistry has become a new paradigm in oral reconstruction and replacement of missing teeth, ideal implant positioning can be compromised by inadequate alveolar bone in terms of bone height, width, and quality of the bone itself. Correction of osseous deficiencies with ridge augmentation allows ideal implant placement and creates a more natural soft tissue profile which influences crown anatomy and esthetics. REPORT: A 20-year-old female presented with a complaint of poor esthetics resulting from oral injuries incurred in a traffic accident six years previously. In addition to a mandibular parasymphyseal fracture, five maxillary anterior teeth and the most of the alveolar ridge were lost. Clinical examination revealed severe loss of bone in the maxillary anterior region, an absence of a labial sulcus, loss of upper lip support, and a slight over eruption of the mandibular anterior teeth. In preparation for dental implants a distraction osteogenesis surgical procedure was done to lengthen the height of the alveolar ridge. After a three-month healing period, the width of the residual ridge was found to be insufficient for implant placement. To correct this deficiency, a bone graft of a cortiocancellous block was harvested from the chin and fixed to the labial aspect of the ridge. To facilitate revascularization, small perforations were made in the cortical bone of the alveolar ridge at the recipient site before cancellous bone retrieved from the donor site was gently placed between the bone block and the ridge. The patient was then appropriately medicated and healing was uneventful. After three months, the width of the residual ridge was assessed to be adequate for endosseous implants. SUMMARY: The clinical result reported here has shown several procedures may be necessary for the rehabilitation of a trauma patient. Distraction osteogenesis per se may not always satisfactorily improve the anatomical alveolar anatomy but it has advantages over other methods of augmentation. It can improve the height and also expand the soft tissue for further bone grafting. Augmentation of the alveolar bone with an onlay bone graft often provides the desired gain of bone, allows for the ideal placement of dental implants, and improves any discrepancy between the upper and lower arches.

PMID: 17846672 [PubMed - indexed for MEDLINE]

Idiopathic thrombocytopenic purpura presenting as post-extraction hemorrhage.

J Contemp Dent Pract. 2007;8(6):43-9

Authors: Martini MZ, Lopez JS, Gendler JL, da Fonseca EV, Soares HA, Franzi SA

AIM: The aim of this article is to present a case of idiopathic thrombocytopenic purpura (ITP) in order to emphasize the importance of the clinical exam since the anamnesis leads to a diagnostic hypothesis of ITP. BACKGROUND: Acute ITP is considered an autoimmune disease characterized by the production of antibodies against platelets, antigens produced by a viral infection, or a platelet sparing drug combination. These antibodies adhere to platelets and are recognized and destroyed by the reticulo-endothelial system. Consequently, the platelet count gradually diminishes and is insufficient for the maintenance of primary hemostasis. REPORT: A 77-year-old woman presented with post-extraction intermittent bleeding. The physical examination revealed discoloration of the skin, multiple petechiae, hematomas, ecchymosis of the upper lip, bruises all over the body, gingiva that bled spontaneously, and a malformed blood clot at the extraction site of tooth #44. The hematological exams confirmed the hypothesis of ITP. The patient was immediately hospitalized in the Hematology Department of a local hospital and received platelet replacement, hydration, medication, and general care. After the spontaneous bleeding stopped, the malformed clot was removed using alveolar curettage along with a thorough cleaning of the extraction site with a 0.9% saline solution before suturing the wound and prescribing medication. After the sixth day of hospitalization, the patient presented with the following results: Hb: 12.3 mg/dL, Ht: 36.1%, and PC: 87,000 mm3. The patient was then discharged and was placed under outpatient follow-up care. SUMMARY: The importance of the clinical exam must be emphasized since the anamnesis leads to a diagnostic hypothesis of ITP and provides the dental surgeon with an opportunity to make important systemic alterations to improve the prognosis of a patient with ITP.

PMID: 17846670 [PubMed - indexed for MEDLINE]

Dental treatment of patients with coagulation factor alterations: an update.

Med Oral Patol Oral Cir Bucal. 2007 Sep;12(5):E380-7

Authors: Jover-Cerveró A, Poveda Roda R, Bagán JV, Jiménez Soriano Y

Hemostasia is a defense mechanism that protects vascular integrity, avoids blood loss, and maintains blood fluidity throughout the circulatory system. The biochemical processes leading to blood clot formation are complex, and alterations can appear at any point within the chain of events. While a range of alterations can affect the coagulation factors, some are more common than others in the general population, including congenital (hemophilia A and B, Von Willebrand's disease) and acquired disorders (anticoagulant drugs). Such diseases require special consideration in the context of dental treatment, and therefore must be known to dental professionals. Interconsultation with the hematologist will provide orientation on the characteristics of the disease and on the best approach to treatment, including the need for replacement therapy, the application of local hemostatic measures, the modification of anticoagulant therapy, etc. In any case, the most important concern is the prevention of bleeding complications by compiling a detailed clinical history, with adequate planning of treatment, and taking special care to avoid soft tissue damage during the dental treatment of such patients. The dental surgeon must enhance awareness among patients and their relatives of the importance of correct oral hygiene, which will help avoid the need for invasive dental treatments and will reduce the number of visits to the dentist.

PMID: 17767103 [PubMed - indexed for MEDLINE]

Pre-operative drilling simulation method for dental implant treatment.

Bull Tokyo Dent Coll. 2007 Feb;48(1):27-35

Authors: Arataki T, Furuya Y, Ito T, Miyashita Y, Shimamura I, Yajima Y

The position, depth and direction of implant placement are often planned based on evaluation of radiographs and study casts. Insertion planned in such a manner may not be adequate for precise and safe surgery in some cases due to inadequate working clearance in the oral cavity. In order to obtain high initial stability and ensure osseointegration at the implant-bone interface, careful and precise drilling must be performed at the implant placement site. Therefore, we propose the necessity of evaluating the operability of implant treatment-devices prior to surgery. The amount of handling space needed during implant placement surgery was determined. The results showed that for implants with a length of 7-18 mm, a vertical distance of as much as 50-60 mm was required, depending on the implant platform. These results suggest the necessity of pre-operative drilling simulation in each individual. Handling space was measured with angled heads and probes fabricated on a trial basis for pre-surgical drilling simulation in the oral cavity. We believe that these instruments may be clinically useful in estimating the amount of handling space required prior to surgery and ensuring precise implant placement. Evaluation of the intra-oral environment for handling of treatment devices should be included in the pre-surgical intra-oral evaluation of dental implant cases to avoid changes in treatment planning due to intra-oral interference during the course of surgery.

PMID: 17721064 [PubMed - indexed for MEDLINE]

Facemask therapy with miniplate implant anchorage in a patient with maxillary hypoplasia.

Chin Med J (Engl). 2007 Aug 5;120(15):1372-5

Authors: Zhou YH, Ding P, Lin Y, Qiu LX

PMID: 17711747 [PubMed - indexed for MEDLINE]

The application of microscopic surgery in dentistry.

Med Oral Patol Oral Cir Bucal. 2007 Aug;12(4):E311-6

Authors: García Calderín M, Torres Lagares D, Calles Vázquez C, Usón Gargallo J, Gutiérrez Pérez JL

The use of the microscope as a tool for practising Medicine, especially in surgical specialisations, has been established for decades. The microscope was first used in OdontologyDentistry back to the 1970s and 1980s, and was introduced more widely (although it was still far from being in general use) during 1990s. The purpose of this article is to describe the main applications of the microscope in OdontologyDentistry today, as well as providing odontologists and stomatologists, whether specialists or in general practice, with information about microscopic OdontologyDentistry for better patient care. This work also gives particular importance to matters needed to achieve the necessary manual dexterity to work in a magnified operating field using a surgical microscope (SM).

PMID: 17664918 [PubMed - indexed for MEDLINE]

Peripheral neurological damage following lower third molar removal. A preliminary clinical study.

Minerva Stomatol. 2007 Jun;56(6):319-26

Authors: Visintini E, Angerame D, Costantinides F, Maglione M

AIM: Type of impaction and site of nerve are important risk factors of neurological damage following the lower third molar removal. The purpose of this study was to evaluate the peripheral damage of lingual and lower alveolar nerves in relation to tooth angulation and radiographic proximity to the alveolar canal. METHODS: Sixty-seven consecutive patients (41 women and 26 men, mean age 29.97+/-14.35 years) underwent lower wisdom teeth extraction and were clinically evaluated over a one year period, checking any evidence of peripheral damage of the lower alveolar or lingual nerves. Tooth angulation and presence or absence of spongy bone between the mandibular canal and the root apex were considered; so, the patients were assigned twice to two groups: G1A (third molar in axis); G2A (third molar angulated); G1B (third molar apex adjacent to the mandibular canal); G2B (spongy bone between root apex and canal). The extraction was carried out according to a standardised technique without raising and retracting of a lingual flap. The follow-up checks were at one week, 1, 3, 6, 12 months and until any problem was solved. Statistical analysis was carried out using chi2 test. RESULTS: A total of two cases of temporary damage to the lingual nerve (1 case in G1A and 1 in G2A; 2 cases in G2B) and 3 cases to the lower alveolar nerve (3 cases in G2A; 1 in G1B and 2 in G2B) were discovered. No statistical differences were found. Symptoms cleared up within a maximum period of 5 months. CONCLUSION: Tooth angulation and proximity to lower alveolar canal were not related to alveolar or lingual damage; the conservative surgical technique seems to be an important factor in preventing neurological complications.

PMID: 17625489 [PubMed - indexed for MEDLINE]

Dens invaginatus on a geminated tooth: a case report.

J Contemp Dent Pract. 2007;8(5):99-105

Authors: Canger EM, Celenk P, Sezgin OS

AIM: To present a case of a concomitant occurrence of dens invaginatus (DI) and gemination in a mandibular left lateral incisor. BACKGROUND: DI is a developmental anomaly resulting from the invagination of a portion of a crown in the enamel organ stage of odontogenesis. It is commonly found in the maxillary lateral incisors but also occurs in the central incisors, premolars, canines, and molars in descending order of frequency. The occurrence of DI in the mandible is extremely rare. Gemination results from one tooth bud attempting to split into two. Geminated teeth present with a single root structure and rarely occur in mandibular teeth. REPORT: A 13-year-old girl presented with a chief complaint of spontaneous nocturnal pain in the mandibular left lateral incisor tooth. Intraoral examination revealed the tooth was enlarged with a notch on the incisal edge extending to the coronal 1/3 of the crown. The radiological examination revealed a Type 2 DI in a Type I geminated mandibular left lateral incisor. SUMMARY: DI is clinically significant due to the possibility of the pulpal involvement; pulpitis, necrotic pulps, and chronic periapical lesions are often associated with this anomaly without clinical symptoms. Clinicians should be mindful of the possibility of DI when a tooth presents pulpitis without history of trauma or caries and examine the suspicious tooth and the periodontium radiographically.

PMID: 17618336 [PubMed - indexed for MEDLINE]

Maxillary corticotomy and extraoral orthopedic traction in mature teenage patients: a case report.

J Contemp Dent Pract. 2007;8(5):76-84

Authors: Pelo S, Boniello R, Gasparini G, Longobardi G

AIM: The authors' propose to combine the reverse pull headgear with a Delaire type face mask and a maxillary corticotomy to treat a Class III non-growing patient with maxillary retrusion. The aim of this report is to present two cases in which this treatment strategy was successful. BACKGROUND: Several studies suggest the majority of Class III dento-skeletal malocclusions have components of maxillary retrusion. Early treatment of these patients with maxillary protraction devices have shown promising results. Facemask therapy has some important limits. Most important is the optimal timing of treatment between the ages of six to ten years. Closure of the maxillary suture occurs as a child ages which results in an increase of maxillary resistance to protraction. REPORT: A proposed therapy carried out in orthodontic and surgical phases was used in the treatment of two young patients. They were both beyond the optimal age range for the application of the orthopedic device (a girl 15 years old and a boy 16 years old), however, they had not reached the necessary skeletal maturity for orthognathic surgery. SUMMARY: The described technique has the advantage of being quick and easy to perform with a low surgical risk yielding satisfactory results after 15-20 days of therapy instead of the six to nine months associated with traditional procedures.

PMID: 17618333 [PubMed - indexed for MEDLINE]

Surgical management of accidentally displaced mandibular third molar into the pterygomandibular space: a case report.

Kaohsiung J Med Sci. 2007 Jul;23(7):370-4

Authors: Huang IY, Chen CM, Chang SW, Yang CF, Chen CH, Chen CM

Surgical removal of the mandibular third molar is a regular surgical procedure in dental clinics, and like all operations, it may have some complications, such as infection, bleeding, nerve injuries, trismus and so on. An accidentally displaced lower third molar is a relatively rare complication, but may cause severe tissue injury and medicolegal problems. As few papers and cases have been published on this topic, we report this case to remind dentists on ways to prevent and manage this complication. The patient, a 28-year-old male, had his right lower mandibular third molar extraction in January 2006. The dentist resected the crown and attempted to remove the root but found that it had suddenly disappeared from the socket. Assuming that the root had been suctioned out he closed the wound. The patient was not followed up regularly because he studied abroad. About 3 months later, the patient felt a foreign body sensation over his right throat, and visited a local hospital in Australia. He was told after a computed tomography (CT) scan that there was a root-like radio-opaque image in the pterygomandibular space. The patient came to our hospital for further examination and management in June 2006. We rechecked with both Panorex and CT and confirmed the location of the displaced root. Surgery for retrieving the displaced root was performed under general anesthesia by conventional method without difficulty, and the wound healed uneventfully except for a temporary numbness of the right tongue. This case reminds us that the best way to prevent a displaced mandibular third molar is to evaluate the condition of the tooth carefully preoperatively, select adequate instruments and technique, and take good care during extraction. If an accident does occur, dentists should decide whether to retrieve it immediately by themselves or refer the case to an oral and maxillofacial surgeon, and should not try to remove the displaced root without proper assurance. Localization with images and proper surgical methods are the keys to retrieving the displaced fragment successfully. When immediate retrieval is decided on, Panorex and occlusal view are useful in localizing the displaced fragment. When the fragment moves into a deeper space or the retrieval has been delayed for months, three-dimensional CT seems to be a better choice.

PMID: 17606433 [PubMed - indexed for MEDLINE]

Illinois dental anesthesia and sedation survey for 2006.

Anesth Prog. 2007;54(2):52-8

Authors: Flick WG, Katsnelson A, Alstrom H

This is a 10-year follow-up survey of a 1996 study of all dentists in Illinois holding a permit to administer sedation or general anesthesia. The survey describes the scope of sedation and anesthesia services provided in dental offices in Illinois. A mail survey was sent to 471 dentists who were registered with the department of professional regulation to administer sedation or general anesthesia. Classification by specialty area of practice showed: 63% (84% in 1996) are oral and maxillofacial surgeons, 20% (11% in 1996) general dentists, 6% (5% in 1996) periodontists, 9% (0% in 1996) pediatric dentists, 1% (less than 1% in 1996) dentist anesthesiologists. Advanced cardiovascular life support (ACLS) training was reported by 90% (85% in 1996) of the respondents. The total number of sedations and general anesthetics administered for the year was 115,940. Two mortalities and two cases of long-term morbidity were reported for the 10-year period. Respondents reported that 30 patients required transfer to a hospital but suffered no long-term morbidity. Other practice characteristics were detailed.

PMID: 17579504 [PubMed - indexed for MEDLINE]

Effects of local and whole body irradiation on appearance of osteoclasts during wound healing of tooth extraction sockets in rats.

J Radiat Res (Tokyo). 2007 Jul;48(4):273-80

Authors: Hosokawa Y, Sakakura Y, Tanaka L, Okumura K, Yajima T, Kaneko M

We examined effects of local and whole body irradiation before tooth extraction on appearance and differentiation of osteoclasts in the alveolar bone of rat maxillary first molars. Wistar rats weighting 100 g were divided into three groups: non-irradiation group, local irradiation group, and whole body irradiation group. In the local irradiation group, a field made with lead blocks was placed over the maxillary left first molar tooth. In the whole body irradiation group, the animals were irradiated in cages. Both groups were irradiated at 8 Gy. The number of osteoclasts around the interradicular alveolar bone showed chronological changes common to non-irradiated and irradiated animals. Several osteoclasts appeared one day after tooth extraction, and the maximal peak was observed 3 days after extraction. Local irradiation had no difference from non-irradiated controls. In animals receiving whole body irradiation, tooth extraction one day after irradiation caused smaller number of osteoclasts than that 7 day after irradiation during the experimental period. Whole body-irradiated rats had small osteoclasts with only a few nuclei and narrow resorption lacunae, indicating deficiency of radioresistant osteoclast precursor cells. Injection of intact bone marrow cells to whole body-irradiated animals immediately after tooth extraction recovered to some content the number of osteoclasts. These findings suggest that bone resorption in the wound healing of alveolar socket requires radioresistant, postmitotic osteoclast precursor cells from hematopoietic organs, but not from local sources around the alveolar socket, at the initial phase of wound healing.

PMID: 17538234 [PubMed - indexed for MEDLINE]

Brain abscess following dental procedures. Case report.

Minerva Stomatol. 2007 May;56(5):303-5

Authors: Ulivieri S, Oliveri G, Filosomi G

There have been a number of reports of brain abscess suggesting an odontogenic etiology after dental treatment procedures or oral infections, but the diagnosis was mainly by exclusion rather than based on evidence. We present a case of a brain abscess due to Strepto-coccus constellatus in a 27-year-old-immunocompetent woman who underwent extraction of the primary molar and eradication of a radicular cyst some weeks before.

PMID: 17529917 [PubMed - indexed for MEDLINE]

Electronic dental anaesthesia for third inferior molar surgery.

Minerva Stomatol. 2007 May;56(5):267-79

Authors: Zanette G, Facco E, Bazzato MF, Berengo M, Buin F, Mariuzzi ML, Mazzuchin M, Rigo L, Sivolella S, Viscioni A, Manani G

AIM: The aim of this study was to evaluate the efficacy of Electronic Dental Anaesthesia (EDA) for third molar surgery. METHODS: Third molar extraction under regional anaesthesia (inferior alveolar and buccal nerve blocks) was performed in 2 groups of 30 patients each: group 1 = controls, group 2 = EDA treatment. Anxiety and pain level were reported by means of Visual Analogue Scale, postoperative pain description with the McGill Pain Questionnaire. A postoperative phone interview to all patients was made. Computerized randomization was performed; values expressed as mean+/-SD, data comparison evaluated by means of ANOVA and chi squared, statistical significance indicated by P values <0.05. RESULTS: Features of the patients and surgical interventions were similar. EDA has determined lower pain level; moreover, the control patients has shown higher values of blood pressure and heart frequency. Phone interview has reported no amnesia about the perioperative events. A smaller number of EDA treated patients has reported pain during needle prick and/or intraoperatively; 80% of the EDA treated patients has reported a good opinion about the treatment, 93% of the patients would repeat the treatment, if needed. CONCLUSION: EDA is a complementary analgesic technique for dental surgery. Cardiovascular changes, frequently observed during third molar extraction, were not present in the EDA treated patients. These data confirm that EDA is able to modify the physiologic responses to stressful events, blunting the adrenergic upset, maybe by means of an analgesic action on A, fiber and an increase of endorphins' central level. These results underline that the complementary use of EDA in the third molar extraction may be better than regional anaesthesia alone.

PMID: 17529914 [PubMed - indexed for MEDLINE]

Healing of periodontal flaps when closed with silk sutures and N-butyl cyanoacrylate: a clinical and histological study.

Indian J Dent Res. 2007 Apr-Jun;18(2):72-7

Authors: Kulkarni S, Dodwad V, Chava V

BACKGROUND: The closure of the periodontal flaps post-surgery is a necessity for attainment of a primary union between the flap margins and the establishment of a healthy dentogingival junction. N-butyl cyanoacrylate is a tissue adhesive, which can be used for the closure of the incised wounds to overcome the problems associated with conventional suture materials like silk. OBJECTIVE: The present study was carried out to assess the healing of the periodontal flaps when closed with the conventional silk sutures and N-butyl cyanoacrylate. MATERIALS AND METHODS: The study was carried out on 24 patients who needed flap surgical procedure for pocket therapy. RESULTS: It was found that healing with the cyanoacrylate is associated with less amount of inflammation during the first week when compared with silk. However, over a period of 21 days to 6 weeks, the sites treated with both the materials showed similar healing patterns. CONCLUSION: It can be concluded that cyanoacrylate aids in early initial healing.

PMID: 17502712 [PubMed - indexed for MEDLINE]

Osteochondroma of the mandibular condyle: literature review and report of a case.

J Contemp Dent Pract. 2007;8(4):52-9

Authors: Ribas Mde O, Martins WD, de Sousa MH, Zanferrari FL, Lanzoni T

AIM: The intent of this report is to present a brief review of the literature on osteochondroma and to present a case involving the surgical removal and replacement of a major portion of the condyle and angle of the mandible using free autogenous mandibular bone. BACKGROUND: While osteochondroma is the most common tumor of skeletal bones, it is relatively uncommon in the jaws occurring at the condyle or the tip of the coronoid process. This benign cartilage-capped growth is usually discovered incidentally on radiographic examination or on palpation of a protruding mass in the affected area. Malocclusion and progressive facial asymmetry are common findings in most cases of condylar osteochondroma. REPORT: A case of a 29-year-old woman with an osteochondroma of the mandibular condyle is presented. Surgical treatment was tumor resection, grafting, and reshaping of the mandibular angle and ramus. As this lesion is usually asymptomatic and discovered incidentally on radiographic examination, the general practitioner usually is the first professional to make the diagnosis. SUMMARY: Condylectomy cannot be recommended as routine in all cases.37 Common surgical treatments include condylectomy and reconstruction.24 If the tumor involves only a limited area of the condylar surface, then preservation of the remaining portion of the condyle and reshaping should be done. Reasons for not taking such a conservative approach are the possibilities of malignancy and the risk of recurrence. In this case report the extraoral vertical ramus osteotomy, associated with free autogenous mandibular bone, presented several advantages.

PMID: 17486187 [PubMed - indexed for MEDLINE]

Severe life threatening maxillofacial infection in pregnancy presented as Ludwig's angina.

Infect Dis Obstet Gynecol. 2006;2006:51931

Authors: Abramowicz S, Abramowicz JS, Dolwick MF

BACKGROUND: Ludwig's angina is a rapidly spreading cellulitis that may produce upper airway obstruction often leading to death. There is very little published information regarding this condition in the pregnant patient. CASE: A 24-year old black female was admitted at 26 weeks gestation with tooth pain, submandibular swelling, severe trismus, and dysphagea, consistent with Ludwig's angina. Her treatment included emergent tracheostomy, incision and drainage of associated spaces, teeth extraction, and antibiotic therapy. CONCLUSIONS: During a life threatening infectious situation such as the one described, risks of maternal and fetal morbidity include both septicemia and asphyxia. Furthermore, the healthcare provider must consider the risks that the condition and the possible treatments may cause the mother and her unborn child.

PMID: 17485803 [PubMed - indexed for MEDLINE]

Rehabilitation of severely resorbed maxillae with zygomatic implants: an update.

Med Oral Patol Oral Cir Bucal. 2007 May;12(3):E216-20

Authors: Gal&#xE1;n Gil S, Peñarrocha Diago M, Balaguer Martínez J, Marti Bowen E

Studies highlight the zygomatic bone as a suitable anatomical structure for implant placements since they cross four corticals. Zygomatic implants were described by Branemark in 1988, since then zygomatic implants are indicated in maxillae with atrophy of the posterior area. They have been used in systemic diseases associated with bone loss in this area, and in patients who have suffered radical surgery for maxillofacial tumors. Computed tomography is recommended before placement in order to discount any pathology of the maxillary sinus. The surgical technique has been slightly modified since its description with procedures such as the sinus slot technique. The success rate obtained by different authors varies between 82% and 100%, indicating this technique as a valid treatment option. The objective of this study was to revise the literature with the aim of updating the subject.

PMID: 17468718 [PubMed - indexed for MEDLINE]

Anesthetic management of the trigeminocardiac reflex during mesiodens removal-a case report.

Anesth Prog. 2007;54(1):7-8

Authors: Webb MD, Unkel JH

We describe a case in which reflection of a palatal flap for removal of a mesiodens is presented as the triggering factor for bradycardia caused by stimulation of the trigeminocardiac reflex. The management of the case, as well as the reflex arc, is discussed.

PMID: 17352528 [PubMed - indexed for MEDLINE]

Severe hemorrhage during an incisional biopsy: a report of a case.

J Contemp Dent Pract. 2007;8(3):97-103

Authors: Cheng CK, Gaia BF, de Oliveira Neto HG, Martini MZ, Aburad A, Shinohara EH

BACKGROUND: Surgical procedures under local anesthesia are routinely employed by the dentist and are susceptible to significant complications which demand immediate care from the dental professional. REPORT: This report presents a case of severe arterial hemorrhage during a simple removal of a lesion during an incisional biopsy. SUMMARY: In the event of severe arterial hemorrhage in a conventional dental office, manual compression for containing the hemorrhage and use of an adequate light source to correctly visualize the origin of the bleeding is recommended. If visible, the dental surgeon must attempt to perform vascular ligature or an occlusive suture. If the hemorrhage cannot be controlled after these measures, the patient must be transported to a hospital while continuing local compression during transit.

PMID: 17351687 [PubMed - indexed for MEDLINE]

Hematoma following periodontal surgery with a torus reduction: a case report.

J Contemp Dent Pract. 2007;8(3):72-80

Authors: Mantzikos K, Segelnick SL, Schoor R

BACKGROUND: There are no published case reports that hematomas occur on the floor of the mouth as a result of periodontal surgery. REPORT: These three case reports document post surgical hematoma formation on the floor of the mouth that pose problems with the diagnosis, prognosis, and patient management. All cases involved periodontal surgery where extensive reduction of tori and bony exostoses were required. Two cases resulted in hematomas in the floor of the mouth. However, a change in the post surgical management for a third case demonstrated possible prevention of hematoma formation. SUMMARY: Hematomas in the floor of the mouth can be a resolving post surgical phenomenon or a serious vascular insult to this region of the oral cavity. This report clarifies the diagnosis, prognosis, and the best management protocol through the presentation of three cases.

PMID: 17351684 [PubMed - indexed for MEDLINE]

Prevalence, clinical picture, and risk factors of dry socket in a Jordanian dental teaching center.

J Contemp Dent Pract. 2007;8(3):53-63

Authors: Nusair YM, Younis MH

AIMS: The aims of this study were to determine the prevalence, clinical picture, and risk factors of dry socket at the Dental Teaching Center of Jordan University of Science and Technology (DTC/JUST). METHODS AND MATERIALS: Two specially designed questionnaires were completed over a four-month period. One questionnaire was completed for every patient who had one or more permanent teeth extracted in the Oral Surgery Clinic. The other questionnaire was completed for every patient who returned for a post-operative visit and was diagnosed with dry socket during the study period. RESULTS: There were 838 dental extractions carried out in 469 patients. The overall prevalence of dry socket was 4.8%. There was no statistically significant association between the development of dry socket and age, sex, medical history, medications taken by the patient, indications for the extraction, extraction site, operator experience, or the amount of local anesthesia and administration technique used. The prevalence of dry socket following non-surgical extractions was 3.2%, while the prevalence following surgical extractions was 20.1% (P< 0.002). The prevalence of dry socket following surgical and non-surgical extractions was significantly higher in smokers (9.1%) than in non-smokers (3%) (P = 0.001), and a direct linear trend was observed between the amount of smoking and the prevalence of dry socket (P = 0.034). The prevalence of dry socket was significantly higher in the single extraction cases (7.3%) than in the multiple extraction cases (3.4%) (P = 0.018). The clinical picture and management of dry socket at DTC/JUST were similar to previous reports in the literature. The prevalence of dry socket, its clinical picture, and management at DTC/JUST are similar to those reported in the literature. CONCLUSION: Smoking and surgical trauma are associated with an increased incidence of dry socket. Moreover, patients who had single extractions were more likely to develop dry socket than those who had multiple extractions in the same visit.

PMID: 17351682 [PubMed - indexed for MEDLINE]

Histological comparison of bone to implant contact in two types of dental implant surfaces: a single case study.

J Contemp Dent Pract. 2007;8(3):29-36

Authors: Shibli JA, Feres M, de Figueiredo LC, Iezzi G, Piattelli A

AIM: The purpose of this single case study was to evaluate the influence of different implant surfaces on human bone and osseointegration. METHODS AND MATERIALS: A 47-year-old partially edentulous woman received two experimental implants along with conventional implant therapy. Experimental implants placed in the mandibular ramus consisted of machined and anodized surfaces, respectively. After three months of healing, the experimental implants were removed and prepared for ground sectioning and histological analysis. RESULTS: The data demonstrate anodized implant surfaces present a higher percentage of osseointegration when compared to a machined surface in cortical human bone after a healing period of three months. CONCLUSION: This single case study suggests an anodized implant surface results in a higher percentage of bone to implant contact when compared to machined surfaced implants when placed in dense bone tissue. However, further investigations should be conducted.

PMID: 17351679 [PubMed - indexed for MEDLINE]

Comparison of morbidity following the removal of mandibular third molar by lingual split, surgical bur and simplified split bone technique.

Indian J Dent Res. 2007 Jan-Mar;18(1):15-8

Authors: Praveen G, Rajesh P, Neelakandan RS, Nandagopal CM

BACKGROUND: The methods frequently used for surgical removal of impacted third molars are bur technique, lingual split and simplified split bone technique. The morbidity rates following the use of these different surgical techniques are not completely resolved. The use of a surgical method with minimum postoperative complication is needed. AIM: This study was conducted to compare the morbidity rates of the three different surgical techniques and their efficacy with regard to postoperative pain, swelling, labial and lingual sensation. MATERIALS AND METHODS: Ninety patients with a symptomatic impacted mandibular third molar with the age range of 14-62 years were divided into three groups of 30 patients each for surgical bur technique, lingual split technique and simplified split bone technique. All patients were operated by the same surgeon under local anesthesia (2% lignocaine) in the dental chair. The severity of pain and swelling was recorded on a visual analogue scale and the presence or absence of sensory disturbance at 6, 24, 48 hours and seven days after operation. The pain was scored according to a visual analogue 4-point scale. Patients were asked to indicate which side was more swollen and to record this assessment on the swelling scale. RESULTS: Lingual split technique was more painful than the other two techniques. Surgical bur technique had more swelling than the other two techniques. Labial and lingual sensations were not altered in all the techniques. CONCLUSION: The simplified split bone technique had the least morbidity than the lingual split and surgical bur technique.

PMID: 17347539 [PubMed - indexed for MEDLINE]

Positional vertigo afterwards maxillary dental implant surgery with bone regeneration.

Med Oral Patol Oral Cir Bucal. 2007 Mar;12(2):E151-3

Authors: Rodr&#xED;guez Gutiérrez C, Rodríguez Gómez E

Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo. It is caused by loose otoconia from the utricle which, in certain positions, displaced the cupula of the posterior semicircular canal. BPPV most often is a result of aging. It also can occur after a blow to the head. Less common causes include a prolonged positioning on the back (supine) during some surgical procedures. Additionally one can include in this ethiopathogenesis the positioning required during the maxillary dental implant surgery with bone regeneration related to a forced head positioning and inner ear trauma induced by dental turbine noise working in the maxillary bone. Two cases of patients who suffered BPPV after undergoing maxillary dental implant with bone regeneration procedures are reported. Diagnosis and treatment are also described.

PMID: 17322805 [PubMed - indexed for MEDLINE]

Comparative study of the anesthetic efficacy of 4% articaine versus 2% lidocaine in inferior alveolar nerve block during surgical extraction of impacted lower third molars.

Med Oral Patol Oral Cir Bucal. 2007 Mar;12(2):E139-44

Authors: Sierra Rebolledo A, Delgado Molina E, Berini Aytís L, Gay Escoda C

BACKGROUND: A comparative study is made of the anesthetic efficacy of 4% articaine versus 2% lidocaine, both with epinephrine 1:100,000, in truncal block of the inferior alveolar nerve during the surgical extraction of impacted lower third molars. STUDY DESIGN: A randomized double-blind clinical trial was conducted of 30 patients programmed for the bilateral surgical extraction of symmetrical lower third molars in the context of the Master of Oral Surgery and Implantology (University of Barcelona, Barcelona, Spain). Following the obtainment of informed consent, two operators performed surgery on an extemporaneous basis, using as local anesthetic 4% articaine or 2% lidocaine with the same concentration of vasoconstrictor (epinephrine 1:100,000). The study variables for each anesthetic were: latency (time to action) and duration of anesthetic effect, the amount of anesthetic solution used, and the need of re-anesthetize the surgical zone. A visual analog scale was used to assess pain during surgery, and thus subjectively evaluate the anesthetic efficacy of the two solutions. RESULTS: Statistically significant differences (p = 0.003) were observed in the mean duration of anesthetic effect (220.86 min. for 4% articaine vs. 168.20 min. for 2% lidocaine). Latency, the amount of anesthetic solution and the need to re-anesthetize the surgical field showed clinical differences in favor of articaine, though statistical significance was not reached. The pain scores indicated similar anesthetic efficacy with both solutions. CONCLUSIONS: The results obtained suggest that 4% articaine offers better clinical performance than 2% lidocaine, particularly in terms of latency and duration of the anesthetic effect. However, no statistically significant differences in anesthetic efficacy were recorded between the two solutions.

PMID: 17322803 [PubMed - indexed for MEDLINE]

Physiological features of periodontal regeneration and approaches for periodontal tissue engineering utilizing periodontal ligament cells.

J Biosci Bioeng. 2007 Jan;103(1):1-6

Authors: Benatti BB, Silvério KG, Casati MZ, Sallum EA, Nociti FH

Experimental studies have shown that the potential of periodontal regeneration seems to be limited by the regenerative capacity of the cells involved. The regeneration of damaged periodontal tissues is mediated by various periodontal cells and is regulated by a vast array of extracellular matrix informational molecules that induce both selective and nonselective responses in different cell lineages and their precursors. In this paper, we first review periodontal ligament tissue and its different cell subpopulations including fibroblasts and paravascular stem cells, and their functions during the development and homeostasis of periodontal tissues. Because conventional periodontal regeneration methods remain insufficient to obtain a complete and reliable periodontal regeneration, the concept of periodontal tissue engineering has been based on the generation of the conditions necessary to improve the healing of periodontal tissues. Additionally, the potential of periodontal ligament cells for use in periodontal tissue engineering to overcome the limitations of conventional periodontal regenerative therapies is discussed, followed by an update of the recent progress and future directions of research utilizing periodontal ligament cells for predictable periodontal regeneration.

PMID: 17298893 [PubMed - indexed for MEDLINE]

Retrieval of blade implants with piezosurgery: two clinical cases.

Minerva Stomatol. 2007 Jan-Feb;56(1-2):53-61

Authors: Sivolella S, Berengo M, Fiorot M, Mazzuchin M

In this work an ultrasound device was used to perform an ostectomy for the removal of blade implants in order to save as much bone tissue as possible, so that root form implants might later be inserted. Two patients underwent surgery for the removal of two blade implants (one maxillary, the other mandibular) that were no longer functional. The peri-implant ostectomy was carried out with a piezoelectric surgery device. The instrument demonstrated to be effective and precise during ostectomy, providing an extremely thin cutting line. During the course of the operation and at controls after 7 and 30 days, patients did not show any relevant complications and both still had sufficient alveolar bone to be treated with root form implants. The piezosurgery device proved to be an effective instrument in interventions requiring a significant saving of bone tissue, extreme precision in cutting, and respect of soft tissues.

PMID: 17287707 [PubMed - indexed for MEDLINE]

Esthetics and implantology: medico-legal aspects.

Minerva Stomatol. 2007 Jan-Feb;56(1-2):45-51

Authors: Santoro V, De Donno A, Dell'Erba A, Introna F

In recent years the high number of malpractice lawsuits in dentistry has attracted closer attention of dental practitioners to its medico-legal aspects. Implantology, in particular, presents many points of medico-legal concern connected with the difficulties inherent to dental procedures and objectives (both functional and esthetic), as well as full patient collaboration as an essential part of successful treatment. An accurate assessment of each case by the clinician is fundamental, especially in circumstances where esthetic considerations are preponderant as, for instance, in the frontal sectors. In such cases, the options of implantology or of a traditional fixed prosthesis need to be carefully weighed in light of the patient's anatomic condition. The patient should therefore receive complete information and be made fully aware of the risk of treatment failure, as well as possible complications, limits to the procedures, and the fact that successful outcome will also depend on her/his scrupulous observance of the practitioner's instructions. In short, the aim is to make the patient an active ''accomplice'' in treatment. To this end, the use of an extremely detailed information leaflet is strongly advised; after careful clarification of any doubts the patient may have, the patient's written informed consent should be obtained. Nevertheless, there is the risk that excessive intrusion of bureaucracy into medical procedures in defence of the practitioner against malpractice suits may hinder the principal aim of traditional medicine, i.e. to provide the best care for the patient through mutual trust fostered within the doctor-patient relationship.

PMID: 17287706 [PubMed - indexed for MEDLINE]

Augmentation of keratinized gingiva through bilaminar connective tissue grafts: a comparison between two techniques.

Minerva Stomatol. 2007 Jan-Feb;56(1-2):3-20

Authors: Bertoldi C, Bencivenni D, Lucchi A, Consolo U

AIM: A mucogingival deficiency is considered a potential risk factor for periodontal disease. In particular, mucogingival deficiency can lead to gingival recession, which is a pathological entity per se, due to the increased risk for dental hypersensitivity and root caries. The aim of this study was to evaluate and compare 2 bilaminar grafting techniques normally employed to achieve root coverage. METHODS: Thirty-five patients were divided into 2 groups. Group 1 included 19 patients with 49 gingival recessions treated by Nelson technique (as modified by Harris), while group 2 included 15 patients with 40 recessions treated by Langer technique. Clinical evaluation was performed at preoperative level (T0), after 1 month (T1) and after 1 year (T2). Statistical analysis was performed by means of Friedmann and Wilcoxon test and U-Mann-Whitney test. RESULTS: The statistical analysis did not reveal any significant difference between groups, both in terms of percentage of root coverage and of width of keratinizaed gingiva gain. A significant difference was only observed within each group, for the amount of keratinized gingiva at T1 vs T0 and at T2 vs T1. CONCLUSIONS: This study did not show any statistical difference between the Nelson and the Langer technique as to root coverage and gain in keratinized gingiva.

PMID: 17287702 [PubMed - indexed for MEDLINE]

Use of low-molecular-weight heparin during dental extractions in a medicaid population.

J Manag Care Pharm. 2007 Jan-Feb;13(1):53-8

Authors: Pettinger TK, Owens CT

BACKGROUND: Evidence-based guidelines recommend against discontinuation of oral anticoagulation therapy during most dental procedures because severe bleeding complications are rare and there is an increased risk for thromboembolic events in patients for whom warfarin therapy is interrupted. Although interruption of oral anticoagulation and bridge therapy with low-molecular- weight heparin (LMWH) may be indicated for high-risk individuals undergoing certain procedures, the use of LMWH in tooth extractions is expensive and often unnecessary. OBJECTIVE: The purpose of this review was to identify and characterize procedural use of LMWH for dental extractions with respect to current consensus recommendations. METHODS: The Idaho Medicaid pharmacy and medical claims database was queried to identify patients with a tooth extraction procedure between February 1, 1998, and January 31, 2005. Patients on warfarin therapy for 2 months before tooth extraction were identified as were claims for LMWH within 30 days before the procedure or 5 days after. Patient profiles were reviewed to determine number of extractions, rate of LMWH use, indication for anticoagulation, and associated drug costs. RESULTS: Of 55,260 Medicaid patients who had a tooth extraction, 518 (0.9%) had received warfarin for at least 2 consecutive months before the tooth extraction procedure. Of these, 31 patients (6%) received LMWH therapy at the time of extraction for a total of 35 procedures. All procedures selected for review carried a low bleeding risk, with an average of 1.3 teeth extracted per procedure. The indications for anticoagulation included 16 procedures (45.7%) involving patients with a history of a thromboembolic event more than 90 days before the procedure, 10 procedures (28.5%) involving patients with a prosthetic valve, 4 procedures (11.4%) involving anticoagulated patients with atrial fibrillation, and 5 procedures (14.2%) involving patients with a history of thromboembolism fewer than 3 months before the procedure. LMWH costs for these 35 extractions totaled $22,294, or an average of $637 per procedure or $474 per extracted tooth. Enoxaparin was used in all but 1 of the procedures, with an average 5-day supply (average 8 enoxaparin units) dispensed per procedure. The costs associated with the required additional drug monitoring, e.g., INR monitoring, were not included in this analysis. CONCLUSION: Although the overall number of dental procedures in anticoagulated patients using LMWH was small in our review, this inappropriate use resulted in avoidable costs to this Medicaid program.

PMID: 17269837 [PubMed - indexed for MEDLINE]

Dental management of low socioeconomic level patients before radiotherapy of the head and neck with special emphasis on the prevention of osteoradionecrosis.

Braz Dent J. 2006;17(4):336-42

Authors: Bonan PR, Lopes MA, Pires FR, Almeida OP

Head and neck cancer patients need to receive dental care previously to radiotherapy. Even patients who regularly visit dental offices need special attention including prophylactic and curative treatments. The purposes of this study were to evaluate the dental status of Brazilian head and neck squamous cell carcinoma patients with low socioeconomic level as well as to discuss the dental treatment performed and the oral side effects of radiotherapy. Forty patients with head and neck squamous cell carcinoma received dental care and dental extractions prior to radiotherapy and were were followed up for a mean period of 28.7 months after the cancer treatment. Before radiotherapy, 28 patients were dentulous and 12 edentulous, and all of them had poor oral health and hygiene. The most common treatment performed were dental extraction and 23 patients had 8.6 teeth extracted on average. One out of 9 (11.1%) patients developed radiation caries and 5 out of 23 cases (21.3% - Group I) developed osteoradionecrosis, being only 1 case associated with previous dental extraction. Brazilian low-socioeconomic level patients with head and neck cancer were submitted to multiple dental extractions due to poor dental conditions and inadequate oral care. The dental treatment did not prevent osteoradionecrosis, which presumably presented a multifactorial etiology in most cases.

PMID: 17262149 [PubMed - indexed for MEDLINE]

Sealer penetration and marginal permeability after apicoectomy varying retrocavity preparation and retrofilling material.

Braz Dent J. 2006;17(4):323-7

Authors: Winik R, Araki AT, Negr&#xE3;o JA, Bello-Silva MS, Lage-Marques JL

Apicoectomy failure is generally related to inappropriate marginal sealing of the retrocavity, which allows percolation of microorganisms and their products from root canal system to periapex. This study evaluated tubular penetration of canal sealers and marginal permeability after retrocavity irradiation with Er;Cr:YSGG laser and retrofilling with MTA or cyanoacrylate. Twenty-two single-rooted teeth were decoronated and endodontically treated, their apical 3 mm were resected and the root ends were retroprepared with a low-speed bur. Twenty roots were randomly assigned to 4 groups (n=5): GI and GII--retrofilling with MTA and cyanoacrylate, respectively; GIII and GIV--retrocavity irradiation with Er;Cr:YSGG laser (2.78 microm, 4 W, 20 Hz, 70.8 J/cm(2)) and retrofilling with MTA and cyanoacrylate, respectively. The remaining 2 roots served as positive and negative controls. The analysis of rhodamine B dye infiltration (p=0.05) demonstrated that laser irradiation and MTA retrofilling presented significantly higher permeability rates (p<0.05). Retrofilling with cyanoacrylate showed significantly lower permeability, either when laser was used or not on retrocavity. SEM analysis depicted more cyanoacrylate penetration through dentinal tubules when compared to MTA, suggesting a more efficient marginal sealing. Based on these results, it may be concluded that cyanoacrylate provided a less permeable retrofilling regardless of the retropreparation method, suggesting a more favorable condition to the establishment of the periapical healing.

PMID: 17262147 [PubMed - indexed for MEDLINE]

Retention of radicular posts varying the application technique of the adhesive system and luting agent.

Braz Oral Res. 2006 Oct-Dec;20(4):347-52

Authors: Fonseca TS, Alfredo E, Vansan LP, Silva RG, Sousa YT, Saquy PC, Sousa-Neto MD

This study evaluated in vitro the retention of intracanal cast posts cemented with dual-cure resin varying the application method of the primer/adhesive solution and luting agent in the prosthetic space prepared to receive the posts. Sixty endodontically treated maxillary canines had their crowns discarded, and their roots were embedded in acrylic resin. The prosthetic spaces were prepared with Largo burs mounted on a low-speed handpiece coupled to a parallelometer in order to maintain length and diameter of intraradicular posts constant and to guarantee that the preparations were parallel after casting. Two groups (n = 30) were randomly formed according to the device used to apply the adhesive system: microbrush or standard bristle brush (control). Each group was divided into 3 subgroups (n = 10) according to the technique used to place the luting agent into the root canal: using only a lentulo spiral before setting the post, applying it onto the post surface, or combining both methods. After 72 hours, the tensile force required to dislodge each post was determined by a universal testing machine (Instron 4444) set at a speed of 1 mm/min. The results indicated that the use of the microbrush yielded higher bond strength values (0.1740 +/- 0.04 kN) than those recorded for the bristle brush tip (0.1369 +/- 0.04 kN, p < 0.001). Bonferroni's test demonstrated a higher retention (p < 0.001) in radicular post cemented with the technique that combined both methods (lentulo + post: 0.1787 +/- 0.03 kN) than that obtained with lentulo (0.1461 +/- 0.065 kN) or post (0.1416 +/- 0.03 kN) alone. The interactions between the adhesive system and luting agent application techniques presented statistical difference (p < 0.001). It was concluded that the best performance in terms of tensile strength among the tested conditions was obtained when the adhesive system was applied with a microbrush and the luting agent was taken into the root canal with lentulo spirals alone (0.1961 +/- 0.04 kN) and combining both methods (lentulo + post: 0.1911 +/- 0.02 kN).

PMID: 17242797 [PubMed - indexed for MEDLINE]

Length determination of zygomatic implants using tridimensional computed tomography.

Braz Oral Res. 2006 Oct-Dec;20(4):331-6

Authors: Koser LR, Campos PS, Mendes CM

Considering the potential of tridimensional computed tomography (3D-CT) as a predictor of real bone dimensions, nine dried human skulls with maxillary edentulism were evaluated using images obtained by 3D-CT, prior to the installation of zygomatic implants, in order to obtain the measurements of the implants. In the analysis of correlation between the two 3D-CT examiners, a 75% agreement was found, and no correlation was found between them and the surgical measurement. The worst result was the surgical one, possibly because an inaccurate probe was used. Based on the obtained data, we concluded that the probe used is inaccurate, suggesting that the surgical probe be changed in its measurement scale. Agreement between surgeon and radiologist could possibly be obtained by using insertion guides, since what might have possibly caused the discrepancy in the results is the fact that the 3D-CT examiners and the surgeon used different implant insertion points. It is also possible that a larger sample might produce a more accurate evaluation, thus improving the results.

PMID: 17242794 [PubMed - indexed for MEDLINE]

Densitometric analysis of the autogenous demineralized dentin matrix on the dental socket wound healing process in humans.

Braz Oral Res. 2006 Oct-Dec;20(4):324-30

Authors: Gomes MF, Abreu PP, Morosolli AR, Ara&#xFA;jo MM, Goulart MG

The aim of this study was to evaluate the effects of the autogenous demineralized dentin matrix (ADDM) on the third molar socket wound healing process in humans, using the guided bone regeneration technique and a polytetrafluoroethylene barrier (PTFE). Twenty-seven dental sockets were divided into three groups: dental socket (Control), dental socket with PTFE barrier (PTFE), and dental socket with ADDM slices associated to PTFE barrier (ADDM + PTFE). The dental sockets were submitted to radiographic bone densitometry analysis and statistical analysis on the 15th, 30th, 60th and 90th days using analysis of variance (ANOVA) and Tukey's test (p < or = 0.05). The radiographic analysis of the ADDM + PTFE group showed greater homogeneity of bone radiopacity than the Control group and the PTFE group, during all the observation times. The dentin matrix gradually disappeared from the dental socket during the course of the repair process, suggesting its resorption during the bone remodeling process. It was concluded that the radiographic bone density of the dental sockets treated with ADDM was similar to that of the surrounding normal bone on the 90th day. The ADDM was biocompatible with the bone tissue of the surgical wounds of human dental sockets. The radiographic analysis revealed that the repair process was discreetly faster in the ADDM + PTFE group than in the Control and PTFE groups, although the difference was not statistically significant. In addition, the radiographic image of the ADDM + PTFE group suggested that its bone architecture was better than that of the Control and PFTE groups.

PMID: 17242793 [PubMed - indexed for MEDLINE]

Evaluation of the quality of life of patients with oral cancer in Brazil.

Braz Oral Res. 2006 Oct-Dec;20(4):290-6

Authors: Andrade FP, Antunes JL, Durazzo MD

This study performed a field trial of a Portuguese version of the University of Washington quality of life questionnaire (UW-QOL, 3rd version), aiming at appraising its ability to identify different patterns of health-related quality of life of patients with oral cancer in Brazil. Patients (N = 100) were interviewed as they were undergoing treatment for oral squamous cell carcinoma at a large Brazilian hospital ("Hospital das Clínicas", School of Medicine, University of São Paulo). The results were compared based on categories of socio-demographic and clinical characteristics of the patients. At a one-year follow-up, 20 patients had died, and 24 were considered dropouts. The remaining patients accounted for the longitudinal assessment of modifications in the self report of quality of life. Patients with larger tumours and neoplasms in the posterior part of the mouth presented significantly (p < 0.05) poorer indications of quality of life. Chewing was the poorest rated domain (35.0/100.0), and presented the highest proportion of complaints both at the baseline and at the follow-up assessments. The questionnaire allowed the identification of important contrasts (while comparing clinical characteristics) and similarities (while comparing socio-demographic status) among subsets of respondents, and it can contribute to reduce the impact of treatments and improve subsequent patient management.

PMID: 17242787 [PubMed - indexed for MEDLINE]

Long-term uncontrolled hereditary gingival fibromatosis: a case report.

J Contemp Dent Pract. 2007 Jan 1;8(1):90-6

Authors: Sengün D, Hatipoğlu H, Hatipoğlu MG

Hereditary gingival fibromatosis (HGF) is a rare condition characterized by varying degrees of gingival hyperplasia. Gingival fibromatosis usually occurs as an isolated disorder or can be associated with a variety of other syndromes. A 33-year-old male patient who had a generalized severe gingival overgrowth covering two thirds of almost all maxillary and mandibular teeth is reported. A mucoperiosteal flap was performed using interdental and crevicular incisions to remove excess gingival tissues and an internal bevel incision to reflect flaps. The patient was treated 15 years ago in the same clinical facility using the same treatment strategy. There was no recurrence one year following the most recent surgery.

PMID: 17211510 [PubMed - indexed for MEDLINE]

Influence of trans-operative complications on socket healing following dental extractions.

J Contemp Dent Pract. 2007 Jan 1;8(1):52-9

Authors: Adeyemo WL, Ladeinde AL, Ogunlewe MO

AIM: Extraction healing complications have been attributed to several factors. The influence of trans-operative complications on an extraction site wound healing was the focus of this investigation. METHODS AND MATERIALS: This prospective study was conducted at the Oral Surgery Clinic of the Department of Oral and Maxillofacial Surgery of the Lagos University Teaching Hospital (LUTH) in Nigeria . Subjects selected were those referred for one or two adjacent extractions and who satisfied the inclusion criteria for the study. The relevant pre-operative information recorded for each patient were age and sex of patient, indications for extraction, time taken to extract the tooth, tooth/teeth removed, and any trans-operative complications. Extractions were performed with dental forceps, elevators, or both under local anaesthesia. Patients were blindly evaluated on the third and seventh post-operative day for socket healing assessment without reference to pre-operative information on the patients. RESULTS: Seventy-three (24.25%) of 301 teeth considered for socket healing assessment had various trans-operative complications due to accidental crown, root, or alveolar bone fractures. Of the 73 extractions with trans-operative complications during extraction, 18 developed a socket healing complication, while 17 of the 228 extractions without trans-operative complications developed socket healing complications (p = .000). The mean (SD) time taken to extract teeth developing healing complications was also found to be significantly longer than those without healing complications (p < .01). CONCLUSIONS: The study demonstrated the combination of tooth/bone fragments in the socket and increased time of extraction due to trans-operative complications and accidents predispose to the development of extraction site wound healing disturbance.

PMID: 17211505 [PubMed - indexed for MEDLINE]

Short-term success of osseointegrated dental implants in HIV-positive individuals: a prospective study.

J Contemp Dent Pract. 2007 Jan 1;8(1):1-10

Authors: Stevenson GC, Riano PC, Moretti AJ, Nichols CM, Engelmeier RL, Flaitz CM

PURPOSE: Except for the occasional case report, there are no studies evaluating the success rate of osseointegrated dental implants in individuals infected with the human immunodeficiency virus (HIV). This study investigated the short-term clinical outcome of implant placement in a group of HIV-positive and HIV-negative individuals who required complete dentures. METHODS AND MATERIALS: Edentulous subjects were recruited from an HIV-dedicated clinic and a dental school clinic. Two BioHorizons dental implants were placed in the anterior mandible to support an overdenture opposing a maxillary denture. Outcome measurements obtained six months after activation of implants were presence of pain, mobility, soft tissue status, and radiographic bone level. Descriptive statistics were used. RESULTS: Twenty-nine edentulous adults, including 20 HIV-positive subjects (test) and nine HIV-negative subjects (control), participated. The test group had six females, 14 males; 13 Whites, four African-Americans, and three Hispanics with a mean age of 48.9 years (range: 35-59). The mean CD4 count was 467 cells/mm3 (range: 132-948). The control group had six females, three males; seven Whites, and two Hispanics with a mean age of 65.3 years (range: 50-82). Short-term success rate was 100% for both groups. No difference in clinical outcome was found between the groups. CONCLUSION: This study demonstrated dental implants are well tolerated and have predictable outcomes for HIV-infected individuals for the duration of the study and probably over an even longer term.

PMID: 17211499 [PubMed - indexed for MEDLINE]

Subcutaneous emphysema secondary to dental treatment: case report.

Med Oral Patol Oral Cir Bucal. 2007 Jan;12(1):E76-8

Authors: Gamboa Vidal CA, Vega Pizarro CA, Almeida Arriagada A

Subcutaneous emphysema is a relatively rare complication of dental treatment, although increasingly due to the use of high pressure air instruments. Many cases go unrecognized or are misdiagnosed. Majority of patients with this complication resolve spontaneously after 5 to 10 days, however some can advance to potentially life-threatening complications. A case of subcutaneous emphysema during restorative procedure in a 52-year-old woman was treated in the Docent Odontological Clinic of the Frontera University is presented. The differential diagnosis and management of this condition is discussed. Our purpose is not to add one more case of emphysema to literature, but to show dentists that in simple restorative procedures using air pressure instruments, they could be exposed to this complication.

PMID: 17195836 [PubMed - indexed for MEDLINE]

Iatrogenic mandibular fracture associated with third molar removal. Can it be prevented?

Med Oral Patol Oral Cir Bucal. 2007 Jan;12(1):E70-2

Authors: Woldenberg Y, Gatot I, Bodner L

Removal of third molars is the most common procedure in oral surgery. It may be associated with complications, such as sensory damage , dry socket, infection and iatrogenic damage. A case of mandibular angle fracture during third molar extraction in a 37-year-old female is reported. Literature review on the possible etiologies and ways of prevention were recorded. The reason is believed to be multifactorial and include: age, gender, degree of impaction, relative volume of the tooth in the jaw, preexisting infection or bone lesions, failure to maintain a soft diet in the early postoperative period and the surgical technique. It is possible to reduce the risk of this complication by adoption of preventive measures.

PMID: 17195834 [PubMed - indexed for MEDLINE]

Evaluation of lidocaine and mepivacaine for inferior third molar surgery.

Med Oral Patol Oral Cir Bucal. 2007 Jan;12(1):E60-4

Authors: Porto GG, Vasconcelos BC, Gomes AC, Albert D

OBJECTIVE: The aim of this study was to compare 2% lidocaine and 2% mepivacaine with 1:100,000 epinephrine for postoperative pain control. STUDY DESIGN: A group of 35 patients, both genders were recruited, whose had ages ranged from 13 to 27 years-old and had two inferior third molars in similar positions to be extracted. The cartridges were distributed to the patients according to a randomised pattern, where lidocaine was in the control group and mepivacaine in the experimental group. RESULTS: Results showed no significant association between the anesthetics and postoperative pain, pulp sensibility after one hour, gender, tooth position and duration of the surgical procedure. CONCLUSIONS: It was shown that lidocaine and mepivacaine have similar time of anesthesia, they are adequate for surgical procedures that last one hour, and there was no difference between the two anesthetics in relation to the severety of post-operative pain.

PMID: 17195831 [PubMed - indexed for MEDLINE]