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Biomedical subjects

Thomas B Dodson

Publications and source records attributed to Thomas B Dodson.

At least 37 records · Page 2Linked to original sources
PubMed2004

Perioperative neurosensory changes associated with treatment of mandibular fractures.

PURPOSE: The purpose of this study was to document perioperative neurosensory changes in the inferior alveolar nerve (IAN) after mandibular fracture treatment and to identify risk factors associated with these changes. MATERIALS AND METHODS: This was a prospective cohort study composed of patients treated for mandibular fractures. The primary study variable was the change between the postinjury/pretreatment IAN neurosensory examination score and the score after fracture reduction. Risk factors were categorized as demographic, anatomic, and treatment. Appropriate descriptive, bivariate, and multivariate statistics were computed. RESULTS: The cohort was composed of 61 patients with 97 fractured sides. Forty-seven fractures (49%) were located between the lingula and mental foramen, and 50 fractures (51%) were located distal to the mental foramen. Thirty-nine fractures (41%) were displaced by 5 mm or more. Abnormal preoperative IAN neurosensory examinations were documented in 81% of the fractured sides. Fifty-three fractures (54%) were treated by closed reduction and 44 (46%) by open reduction and internal fixation. In 82 fractures (85%), the IAN neurosensory score was unchanged or improved after treatment. In a multivariate model, preoperative neurosensory score, displacement, and treatment were associated with a statistically significant risk (P < or =.05) for postoperative deterioration of IAN sensation. CONCLUSION: Open reduction and internal fixation, fracture displacement of 5 mm or more, and a normal preoperative IAN neurosensory examination were associated with an increased risk for deterioration of the IAN neurosensory score after treatment of mandibular fractures. Additional studies are indicated to determine long-term IAN neurosensory function after mandibular fracture treatment and the factors that affect prognosis.

Adult↗
PubMed2004

Dentoalveolar reconstructive procedures as a risk factor for implant failure.

PURPOSE: Dentoalveolar reconstructive procedures (DRPs) are commonly used to enhance deficient implant recipient sites. It is unclear, however, if these procedures are independent risk factors for implant failure. The specific aim of this study was to assess the use of DRPs as a risk factor for implant failure. MATERIALS AND METHODS: To address the research aim, we used a retrospective cohort study design and a study sample derived from the population of patients who had one or more implants inserted between May 1992 and July 2000. The main predictor variable was the use of DRPs, such as external or internal sinus lifts, onlay bone grafting, or guided-tissue regeneration with autogenous bone grafts or autogenous bone graft substitutes, to enhance the recipient sites before implant insertion. The major outcome variable was implant failure. Appropriate descriptive, bivariate, and multivariate statistics were computed. RESULTS: The study sample was composed of 677 patients who had 677 implants randomly selected (1 implant per patient) for analysis. The overall 1- and 5-year implant survival rates were 95.2% and 90.2%, respectively. Bivariate analyses revealed 4 factors statistically or nearly statistically associated with implant failure: current tobacco use, implant length, implant staging, and type of prosthesis (P <.15). In the multivariate model, patients with DRPs did not have a statistically significant increased risk for implant failure (odds ratio = 1.4, P =.3). CONCLUSIONS: The results of this study suggest that the use of DRPs to reconstruct deficient implant recipient sites was not an independent risk factor for implant failure in either the unadjusted or adjusted analyses.

Adolescent↗
PubMed2004

Mandibular third molars and angle fractures.

PURPOSE: The study purpose was to measure associations between mandibular third molar (M3) status/position and risk for angle fracture. MATERIALS AND METHODS: We designed a multicenter retrospective cohort study composed of patients who presented for operative management of mandible fractures. The primary predictor variable was M3 (present/absent). The secondary predictor variable was M3 position classified using the Pell and Gregory system. The outcome variable was angle fracture (present/absent). Appropriate univariate, bivariate, and multivariate logistic regression analyses were computed. The level of statistical significance was set at P </=.05. RESULTS: The study sample was composed of 1,450 subjects with a mean age of 30.6 +/- 10.4 years (range, 2 to 87 years). The risk of an angle fracture with and without M3s was 30.1% and 13.7%, respectively (adjusted odds ratio, 2.8; 95% confidence interval, 2.3 to 3.4; P <.001). Based on the Pell and Gregory classification, varying M3 position was associated with varying risks of angle fracture (P <.001). CONCLUSION: The presence of M3s was associated with a 2.8-fold increased risk for angle fractures. M3 position was associated with a variable risk for angle fracture. Notably, the deep impactions were not associated with an increased risk for fracture.

Adolescent↗
PubMed2004

Risk factors for third molar extraction difficulty.

PURPOSE: The purpose of this study was to measure the difficulty of third molar (M3) extractions and to identify demographic, anatomic, and operative variables associated with extraction difficulty. MATERIALS AND METHODS: To address the research purpose, we implemented a prospective cohort study and enrolled a sample composed of patients presenting for M3 removal. Predictor variables were categorized as demographic, anatomic, and operative. The primary outcome variable was difficulty of extraction, measured as extraction time per tooth. The secondary outcome variable was the surgeons postoperative estimate of M3 extraction difficulty, measured on a 100-mm visual analog scale (VAS). Appropriate univariate, bivariate, and multivariate statistics were computed. RESULTS: The sample was composed of 82 subjects, having 250 M3s (53.2% mandibular) extracted, with a mean age of 26.2 +/- 10.7 years; 57.3% were female, 72.0% were white. The mean operating time per M3 extraction was 6.9 +/- 7.6 minutes. The mean estimate of difficulty was 39.6 +/- 24.7 mm and was significantly correlated (r = 0.68) with extraction time (P < .01). Surgical experience, M3 location (maxillary versus mandibular), procedure type, tooth position, number of teeth extracted, and tooth morphology were statistically associated (P < or = .05) with extraction time in a multivariate model. CONCLUSION: Our model indicates that the difficulty of M3 extractions is governed primarily by anatomic and operative factors with minimal influence from demographic factors.

Adolescent↗
PubMed2004

Management of mandibular third molar extraction sites to prevent periodontal defects.

PURPOSE: Persistent periodontal defects on the distal aspect of the mandibular second molar (M2) is a reported complication of mandibular third molar (M3) extraction. The purpose of this study was to measure the efficacy of demineralized bone powder (DBP) or guided-tissue regeneration therapy (GTR therapy) in preventing periodontal defects on the distal aspect of the M2 following M3 extraction. MATERIALS AND METHODS: We implemented a single-blind, randomized, controlled clinical trial composed of a sample of subjects > or = 26 years of age who required extraction of bilateral M3s. The primary predictor variable was treatment group. Each subject was randomly assigned to receive either DBP or GTR therapy. Within subjects, 1 M3 site was randomly selected to be the experimental site and the opposite M3 served as a control and was permitted to heal without intervention. The primary outcome variable was the change in attachment levels (AL) and probing depths (PD) on the disto-buccal aspect of M2 between T 0 (immediate preoperatively) and T 4 (26 weeks postoperatively). Appropriate sample size estimates, descriptive, bivariate, and multivariate statistics were computed. RESULTS: Twelve subjects in the DBP group and 12 subjects in the GTR-therapy group completed the study. For both treatment and control sites, between T 0 and T 4, there were statistically significant improvements in AL (> or = 2.2 mm; P <.001) and PD (> or = 2.6 mm; P <.001). Within-subjects comparisons showed no significant differences in AL or PD between treatment and control M3 sites ( P > or =.3) at T 0 or T 4. CONCLUSION: The results of this study suggest that attachment levels and probing depths improve after M3 removal. In this sample, DBP or GTR therapy did not offer predictable benefit over no treatment.

Absorbable Implants↗
PubMed2003

Types, frequencies, and risk factors for complications after third molar extraction.

OBJECTIVES: The study objective was to identify the types, frequency, and risk factors for complications after third molar (M3) extractions. STUDY DESIGN: This retrospective cohort study consisted of patients who had 1 or more M3s removed between 1996 and 2001. Risk factors were grouped into demographic, general health, anatomic, and operative. Outcome variables were operative or inflammatory complications. Data were analyzed using descriptive, bivariate, and multivariate statistics. RESULTS: The study sample was composed of 583 patients (57.0% male) with a mean age of 26.4 +/- 8.4 years. The overall complication rate was 4.6%. Increasing age, a positive medical history, and the position of the M3 relative to the inferior alveolar nerve were associated with an increased risk for complications. CONCLUSION: While age, medical history, and M3 anatomy cannot be altered directly, these factors may be modified indirectly, resulting in a potential decrease for postoperative complications.

Adolescent↗
PubMed2003

A comparison of 2 consultation and treatment strategies to manage impacted third molars.

PURPOSE: This study compares the postoperative complication rates of 2 strategies for the evaluation and operative management (E&M) of patients with impacted third molars (M3s). MATERIALS AND METHODS: We used a retrospective cohort study design and a sample composed of patients who had M3s extracted between 1985 and 2000. The predictor variable was the E&M strategy defined as 1) same-day surgery (SDS) in which the consultation and procedure were performed on the same day and 2) consult prior to surgery (CPS) in which the consultation and procedure were separated in time by more than 24 hours. The outcome variable was postoperative complications. Descriptive and bivariate statistics were computed and a multivariate model was developed to measure the relationship between E&M strategies and postoperative complications. RESULTS: The sample was composed of 5,993 patients (mean age, 23.7 years; 61% female), and 1,556 patients (26%) were classified as having SDS. Overall, 36% of patients reported one or more postoperative complications. Variables included in the multivariate model were E&M strategy (SDS or CPS), age, gender, number of M3s removed, tobacco exposure, and type of anesthesia. Based on the results of the multivariate model, SDS was not associated with an increased risk for postoperative complications (P =.08). CONCLUSIONS: Optimal operative management of M3s would minimize the number of visits, maximize operator efficiency, and minimize morbidity. In comparison with CPS, SDS minimizes the number of patient visits without an increased risk for complications.

Adult↗
PubMed2003

Office-based ambulatory anesthesia: outcomes of clinical practice of oral and maxillofacial surgeons.

PURPOSE: The delivery of office-based ambulatory anesthesia services is an integral component of the daily practice of oral and maxillofacial surgeons (OMSs). The purpose of this report was to provide an overview of current anesthetic practices of OMSs in the office-based ambulatory setting. MATERIALS AND METHODS: To address the research purpose, we used a prospective cohort study design and a sample composed of patients undergoing procedures in the office-based ambulatory setting of OMSs practicing in the United States who received local anesthesia (LA), conscious sedation (CS), or deep sedation/general anesthesia (DS/GA). The predictor variables were categorized as demographic, anesthetic technique, staffing, adverse events, and patient-oriented outcomes. Appropriate descriptive and bivariate statistics were computed as indicated. Statistical significance was set at < or =.05. RESULTS: The sample was composed of 34,191 patients, of whom 71.9% received DS/GA, 15.5% received CS, and 12.6% received LA. The complication rate was 1.3 per 100 cases, and the complications were minor and self-limiting. Two patients had complications requiring hospitalization. Most patients (80.3%) reported some degree of anxiety before the procedure. After the procedure, 61.2% of patients reported having no anxiety about future operations. Overall, 94.3% of patients reported satisfaction with the anesthetic, and more than 94.7% of all patients would recommend the anesthetic technique to a loved one. CONCLUSION: The findings of this study show that the office-based administration of LA, CS, or DS/GA delivered via OMS anesthesia teams was safe and associated with a high level of patient satisfaction.

Adult↗
PubMed2003

Panoramic radiographic risk factors for inferior alveolar nerve injury after third molar extraction.

PURPOSE: The purpose of this study was to estimate the association between specific panoramic radiographic signs and inferior alveolar nerve (IAN) injury during mandibular third molar removal. PATIENTS AND METHODS: A case-control study design was used; the sample consisted of patients who underwent removal of impacted mandibular third molars. Cases were defined as patients with confirmed IAN injury after third molar extraction, whereas controls were defined as patients without nerve injury. Five surgeons, who were blinded to injury status, independently assessed the preoperative panoramic radiographs for the presence of high-risk radiographic signs. Bivariate analyses were completed to assess the relationship between radiographic findings and IAN injury. The sensitivity, specificity, and positive and negative predictive values were computed for each radiographic sign. RESULTS: The sample was composed of 8 cases and 17 controls. Positive radiographic signs were statistically associated with an IAN injury (P <.0001). The presence of radiographic sign(s) had positive predictive values that ranged from 1.4% to 2.7%, representing a 40% or greater increase over the baseline likelihood of injury (1%) for the individual patient. Absence of these radiographic findings had a strong negative (>99%) predictive value. CONCLUSIONS: This study confirms previous analyses showing that panoramic findings of diversion of the inferior alveolar canal, darkening of the third molar root, and interruption of the cortical white line are statistically associated with IAN injury. Based on the estimated predictive values, the absence of positive radiographic findings was associated with a minimal risk of nerve injury, whereas, the presence of one or more of these findings was associated with an increased risk for nerve injury.

Adult↗
PubMed2003

Patient satisfaction after trigeminal nerve repair.

OBJECTIVE: The purpose of this study was to measure patient satisfaction and to evaluate the factors influencing patients' perceptions of the outcome of inferior alveolar nerve or lingual nerve repair. STUDY DESIGN: We used a retrospective cohort study design and a sample of patients who underwent repair of inferior alveolar nerve or lingual nerve injuries. The major outcome variable was the patient's overall satisfaction with treatment. The patient's satisfaction was rated as either good to excellent (group A) or fair to poor (group B). RESULTS: The study sample was composed of 46 patients with a mean age of 28 +/- 12 years; 76% were female. Fifty-five percent of the sample reported their overall satisfaction to be good to excellent. No individual predictor factors were statistically associated with patient satisfaction. Among the outcome variables, the measures of taste, pronunciation, self-consciousness, and function were statistically significantly different (P <.05) between the 2 groups. CONCLUSIONS: After nerve repair, more than half of the patients rated their overall satisfaction with the operative results to be good to excellent.

Adult↗
PubMed2002

Do mandibular third molars alter the risk of angle fracture?

PURPOSE: In this study, we measured the relationship between the presence of mandibular third molars (M3s) and angle fractures. In addition, the study examined the relationship between M3 impaction level and angle fracture susceptibility. PATIENTS AND METHODS: We used a multicenter retrospective cohort study design and a sample composed of patients treated for mandibular fractures. The predictor variables were 1) the presence of an M3 and 2) the position of an M3 classified according to the Pell and Gregory system. The outcome variable was the presence or absence of an angle fracture. RESULTS: The study sample was composed of 1,210 patients. Patients with M3s present had a 2.1 times greater chance of an angle fracture than did patients without M3s (P <.001). There was a statistically significant variation in the risk for an angle fracture depending on M3 position (P <.001). CONCLUSIONS: In patients who sustain a mandible fracture, the presence of M3s significantly increases the likelihood of an angle fracture. In addition, the risk for an angle fracture depends on M3 position.

Adult↗
PubMed2002

Antiangiogenic therapy with interferon alpha for giant cell lesions of the jaws.

PURPOSE: Giant cell tumors are classified and treated based on their biologic behavior. We hypothesize that they are proliferative vascular lesions and would be expected to respond to antiangiogenic therapy. The purpose of this report is to present a treatment protocol consisting of enucleation, with preservation of vital structures, followed by subcutaneous interferon alpha. MATERIALS AND METHODS: Patients with a biopsy-confirmed giant cell lesion satisfying criteria for "aggressive giant cell tumor" were included. Instead of wide en bloc resection, lesions were enucleated and the patients started on interferon alpha-2 or beta (3,000,000 units/m(2)) 48 to 72 hours postoperatively. The subjects were followed by clinical examination and radiography, immediately after surgery and every 3 months until the bone cavity completely healed. Thereafter, follow-up was every 6 months. RESULTS: Eight patients (7 females), with a mean age of 18.7 +/- 11.1 years, have been enrolled. Six tumors were in the posterior mandible, and 2 were in the anterior maxilla. The mean size was 29.0 mm (range, 15 to 70 mm). All patients underwent enucleation. There were no postoperative complications, and all patients tolerated interferon. There was no evidence of tumor growth during treatment. Seven of 8 patients have completed interferon therapy, and there have been no recurrences during 1 to 6 years of follow-up. The other patient continues on treatment with no evidence of disease. CONCLUSION: Antiangiogenic therapy, in combination with curettage, is a promising strategy for treatment of aggressive giant cell tumors. Combined treatment results in a high rate of tumor control with decreased operative morbidity compared with conventional treatment.

Adolescent↗
PubMed2002

Risk factors affecting dental implant survival.

Given the predictability of dental implant success, the attention of the scientific community is moving from descriptions of implant success toward a more detailed analysis of factors associated with implant failure. The purposes of this study were (1) to estimate the 1- and 5-year survival of Bicon dental implants and (2) to identify risk factors associated with implant failure in an objective, statistically valid manner. To address the research purposes, we used a retrospective cohort study design and a study sample composed of patients who had one or more implants placed. The predictor variables were grouped into the following categories: demographic, health status, anatomic, implant fixture-specific, prosthetic, perioperative, and ancillary variables. The major outcome variable of interest was implant failure defined as implant removal. Overall implant survival was estimated using the Kaplan-Meier analysis. Risk factors for implant failure were identified using the Cox proportional hazard regression models. The study sample was composed of 677 patients who had 677 implants randomly selected for analysis. The overall 1- and 5-year survival of the Bicon implant system was 95.2% and 90.2%, respectively. After adjusting for other covariates in a multivariate model, both tobacco use (P = .0004) and single-stage implant placement (P = .01) were statistically associated with an increased risk for failure. The results of these analyses suggest that the overall survival of the Bicon dental implant is comparable with other current implant systems. In addition, after controlling for covariates, we identified 2 exposures associated with implant survival, tobacco use and implant staging. Of interest, both of these exposures are under the clinician's control.

Adolescent↗
PubMed2002

Strategies for managing anticoagulated patients requiring dental extractions: an exercise in evidence-based clinical practice.

Evidence-based clinical practice requires the development and refinement of literature searching, appraisal skills, and clinical experience. Answering clinical questions using evidence-based methods can be time-intensive, but as one becomes more familiar with the methods, it becomes a fairly straightforward process. For example, it took less than an hour to complete the initial steps of this exercise and arrive at an initial recommendation for Ms. J. Oftentimes, the clinician does not have an hour to find an answer. Fortunately, there are more and more resources available that summarize reviews of clinical questions, so individual practitioners can rapidly access the information they need. Recently, I saw a patient who presented with a preauricular mass. During the visit, a pathologist performed a fine needle aspiration (FNA) to obtain a specimen for diagnosis. Much to our surprise, the FNA results suggested a diagnosis of melanoma. Not being a melanoma expert, I signed on to the computer, went to Up To Date, searched using the keyword "melanoma," and found the information I needed in under a minute. Before the patient left our office, he was scheduled for all the tests and imaging studies needed to maximize his initial appointment with the melanoma specialist. Central to evidence-based clinical practice is the explicit enumeration and balancing of risks and benefits. Evidence is never enough for making clinical decisions. We need to integrate our clinical values and preferences with the patient's values and preferences to render compassionate, informed treatment decisions.

Anticoagulants↗
PubMedDate not supplied

Complications of dental implants: identification, frequency, and associated risk factors.

PURPOSE: This study sought to identify the types, frequencies, and risk factors associated with complications following placement of dental implants. It was hypothesized that one or more factors could be identified that are associated with an increased risk for complications and may be modified by the clinician to enhance outcome. MATERIALS AND METHODS: A retrospective cohort study design was used that included patients who received Bicon implants (Bicon, Boston, MA) between 1992 and 2000. Predictor variables were grouped into demographic, medical history, implant-specific, anatomic, prosthetic, and reconstructive categories. Complications were grouped into inflammatory, prosthetic, operative, and major or minor categories. Cox proportional hazards regression models were developed to identify risk factors for complications. RESULTS: The sample was composed of 677 patients. The overall frequency of implant complications was 13.9% (10.2% inflammatory, 2.7% prosthetic, 1.0% operative), of which 53% were minor. The multivariate Cox model revealed that smoking, use of 1-stage implants, and reconstructive procedures were statistically associated with an increased risk for overall complications (P < or = .05). The median duration of follow-up was 13.1 months (range 0 to 85.6 months). DISCUSSION: A lower frequency of complications was found compared to mean frequencies calculated from past reports. Investigations examining the influence of smoking and reconstructive procedures on implant complications are recommended. CONCLUSION: Of the 3 factors associated with an increased risk for complications, tobacco use and implant staging may be modified by the clinician to enhance outcome.

Adolescent↗
PubMedDate not supplied

Survival estimates and risk factors for failure with 6 x 5.7-mm implants.

PURPOSE: Short dental implants facilitate prosthetic restoration in the setting of limited alveolar bone height. The study objectives were to (1) estimate the 1-year survival of Bicon 6 x 5.7-mm implants, (2) compare the 1-year survival of 6 x 5.7-mm implants with that of non-6 x 5.7-mm implants, and (3) identify risk factors associated with implant failure. MATERIALS AND METHODS: A retrospective cohort study design was used. The sample was composed of patients who had received at least one 6 x 5.7-mm implant. Predictor variables were categorized as demographic, health status, anatomic, implant-specific, prosthetic, perioperative, and reconstructive. The outcome variable was implant failure, defined as explantation. Appropriate descriptive, bivariate, and multivariate survival statistics were computed. RESULTS: The sample was composed of 35 patients in whom 172 implants had been placed (45 of which were 6 x 5.7-mm). The 1-year survival rates for 6 x 5.7-mm and non-6 x 5.7-mm implants were 92.2% and 95.2%, respectively (P = .76). After adjusting for covariates in a multivariate model, implant size was not associated with failure (P = .95). DISCUSSION: The comparable survival estimates for 6 x 5.7-mm implants and non-6 x 5.7-mm implants in this study suggested that 6 x 5.7-mm implants can become osseointegrated and bear a functional load after placement. CONCLUSIONS: The survival of 6 x 5.7-mm implants was comparable to that of non-6 x 5.7-mm implants.

Dental Implants↗
PubMedDate not supplied

Changes in crestal bone levels for immediately loaded implants.

PURPOSE: The authors' objective was to measure crestal bone level change in subjects with immediately loaded implants and to identify risk factors associated with changes in bone level. MATERIALS AND METHODS: A retrospective cohort study design was used. The sample comprised subjects who had had endosseous implants placed and immediately loaded between July 2001 and July 2003. Demographic, health status-related, anatomic, implant-specific, prosthetic, and surgical variables were examined. The primary outcome variable was change in crestal bone level over time. Appropriate uni-, bi-, and multivariate statistics were computed. RESULTS: The sample comprised 174 subjects who received 347 immediately loaded implants. The mean duration of radiographic follow-up was 6.9 +/- 4.0 months, respectively. Mean changes in radiographic bone level were -0.5 mm and -0.6 mm on the mesial and distal surfaces, respectively, after a mean of 6.9 months of radiographic follow-up. Using least squares methods, it was estimated that radiographic bone levels would be -1.0 mm and -0.8 mm on the mesial and distal surfaces, respectively, at 12 months. The multivariate model revealed that radiolucency at or adjacent to implant site was associated with an increased risk of crestal bone loss (odds ratio, 1.88; 95% CI, 1.00 to 3.60). Twelve months after placement, 92.5% of implants had had < or = 1.5 mm of crestal bone loss. DISCUSSION: The results of this study were comparable to the results of other studies comparing immediate loading to delayed loading. Further research to estimate long-term changes in crestal bone loss and to identify risk factors for bone loss with immediate loading is recommended. CONCLUSION: This study suggests that crestal bone level changes with immediately loaded implants were within the recommended range for 92.5% of the evaluated implants. The mandible showed a higher risk for crestal bone loss compared to the maxilla.

Adolescent↗