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The three surgical techniques of simple tooth extraction and labial plate and intraseptal alveoloplasty were compared. The results were confirmed by statistical analysis. The conclusion of this study clearly indicated that simple tooth extraction is the best surgical approach to be followed to preserve as much of the residual alveolar ridge as possible.
A preliminary report of an "all-in-one' one-staged closure of all forms of cleft lip and palate during the first year of life. The one-stage repair of complete uni- and bilateral clefts includes the anatomical reconstruction of soft palate, hard palate closure in two layers, alveoloplasty with bone grafting and lip repair. This surgical technique is described and early results presented.
The authors report their experience in the treatment of cleft palate patients, with or without cleft lip, carried out without lateral release incisions. The surgical approach was as follows: the cleft palate only was closed in one step at the age of 10 to 12 months, while the cleft of lip and palate was closed in two steps: at 6 months of age the soft palate together with lip and nose repair and at 18 to 24 months the hard palate with gingivo-alveoloplasty. Out of the 147 patients treated from 1984 until 1992, 124 (73 cleft palate, 51 cleft lip and palate) were treated without lateral release incisions, allowing first intention healing in 122 cases. The failures observed involved 2 cases: in the first (a bilateral case with a wide cleft) an almost total dehiscence of the suture at the level of the hard palate occurred, while in the second (a cleft palate case) a small oronasal fistula developed (healed spontaneously in 2 weeks). Our results confirm that by performing the described surgical technique without lateral release incisions, a 98% success rate for closure of a cleft palate could be obtained. Of course, in very large clefts the lateral release incision should be considered however.
BACKGROUND: When planning oral surgery, dentists occasionally will have patients who first need to have their anticoagulation regimen altered. To minimize the side effects and not adversely affect the patient's health, therapeutic anticoagulation should be interrupted for as short a time as possible. Low-molecular-weight heparins, or LMWHs, recently have emerged as an alternative in the management of patients whose anticoagulant status should not be modified for lengthy periods. CASE DESCRIPTION: A 72-year-old man, who had a history of deep venous thrombosis, needed to have 19 teeth extracted and an alveoloplasty performed. An LMWH was substituted for warfarin a few days before surgery, and it was withheld from the patient for only a few hours the day of the surgery. CLINICAL IMPLICATIONS: LMWHs are administered on an outpatient basis and do not require hospitalization, as does unfractionated heparin. As a result, they are more cost-effective and offer greater convenience than heparin therapy. Depending on the procedure and the degree to which patients are medically compromised, dentists may not feel comfortable treating patients who continuously receive anticoagulation therapy. As a result, patients' physicians may prescribe LMWH injections to be administered by patients, family members or caregivers to more safely manage the patients' care during oral surgery. As part of the health care team, dentists must be familiar with LMWH and its use to help guide patients safely through treatment.
BACKGROUND: Sublingual hematoma during placement of mandibular endosseous dental implants is a rare, but potentially life-threatening, complication. The development of a sublingual hematoma during a dental procedure may result in the need for acute airway management, including intubation or even emergent tracheostomy. Dental implants are becoming a well-accepted treatment, and thousands of implants are placed every year by general practitioners and specialists, with few adverse sequelae. Clinicians rarely discuss this complication with patients before surgery, and no reports of death secondary to sublingual hematoma formation have been published. The incidence of this event is difficult to ascertain, and only, a few cases have been reported. CASE DESCRIPTION: A 56-year-old man with severe caries underwent multiple mandibular tooth extractions and alveoloplasty and received endosseous implants. During the surgical procedure, the patient developed a large sublingual hematoma that required hospitalization. CLINICAL IMPLICATIONS: Practitioners who perform implant surgery in the anterior mandible should notify patients of the potential risk of sublingual hematoma formation, and be able to manage acute airway issues that may result from this complication.
Failures of reconstructing alveoloplasty, which are known from the literature and confirmed by the author's personal experience, are attributed to the intolerance of the load-carrying denture support. For this reason, it is suggested to perform an extra-oral intervention on the maximally atrophied mandible to reinforce its crest with autogenous bone. A second intervention is necessary in the form of a combination of floor-of-the-mouth revision and vestibuloplasty (method of Rehrmann), the load-carrying support remaining intact at the level fo the alveolar process.
The functioning of a complete lower denture is determined by a series of clinico-anatomical characters of the edentulous mandible. These are commented upon to establish the limits of indication of preprosthetical-surgical techniques. The reflections point to the necessity for paying more attention to really reconstructing alveoloplasties.
A 2-implant-retained mandibular overdenture is considered by some to be the standard of care for mandibular edentulism. Compared to a conventional complete denture, an implant-retained overdenture requires more thorough planning. Careful consideration is necessary regarding the 3-dimensional orientation of the implants to ensure adequate horizontal and vertical space for prosthetic components. This clinical report describes a patient with a compromised mandibular overdenture in whom the position of the existing implants yielded insufficient space for prosthetic components. This report describes the concepts for treatment planning prior to fabricating a new mandibular overdenture, including considerations for the surgical removal of the existing implants, alveoloplasty to create the necessary space for prosthetic components, and placement of the new implants to ensure an esthetic and functional prosthesis.
This case report describes repair of a gingival cleft located on the labial aspect of the maxillary left canine tooth in a client-owned dog. Multiple procedures were performed including elevation of a pedicle flap, granulation tissue removal, alveoloplasty and root planing, and placement of an osteoconductive bone graft material. The surgical site was closed with a laterally repositioned flap. Postoperative examinations were performed at 2 and 3-weeks without chemical restraint and at 3 and 10-months postoperatively under general anesthesia. At the 10-month postoperative examination, a broad band of gingiva surrounded the maxillary left canine tooth, and probing revealed absence of periodontal pockets. Intraoral dental radiographs indicated maintenance of alveolar bone height and incorporation of the bone graft material into alveolar bone.
The use of epsilon-aminocaproic acid has proved to be an efficient and practical method for treating hemophiliacs who require dental work. In the past, patients requiring extractions were admitted to a hospital for approximately ten days and received replacement infusions every 12 hours during their stay. This resulted in a large expense because of the cost of the material and the hospitalization itself, not to mention the trauma sustained by the patient both physically and psychologically. Also, by decreasing the number of factor infusions, the risk of complications such as the transmission of hepatitis, allergic reaction, or inhibitor formation decreased. The same protocol using a single infusion of the appropriate factor replacement with supplementary epsilon-aminocaproic acid can be used for the management of patients with other coagulation disorders such as factor IX deficiency (Christman disease), factor XI deficiency, and von Willebrand's disease. Since this paper was submitted, seven more patients have been treated using this protocol. An additional seven odontectomies, 33 extractions, operative dentistry in 18 quadrants, and alveoloplasties in two full arches have been performed. This brings the total to 23 treatment sesions with 18 patients undergoing 124 procedures. One additional minor bleeding episode occurred, resulting in a total rate of four bleeding episodes in 23 treatment sessions and 124 procedures. Our incidence of complications secondary to epsilon-aminocaproic acid specifically remains zero.
Results from this study of 16 patients who underwent extractions and alveoloplasty indicate that cephalexin effectively penetrates alveolar bone. After cephalexin had been administered, 500 mg four times a day for 48 hours, the average concentration in bone exceeded the average minimal inhibitory concentration of six organisms commonly encountered in infections and bacteremias of dental origin. These data and the current knowledge of cephalexin suggest that cephalosporins may have a unique use in dental infections or potentially harmful bacteremias caused by susceptible organisms.
OBJECTIVE: Compare 5-year-old dental arch relationships of patients from three centers with differing primary protocols. DESIGN: Retrospective study of treatment outcomes using blinded evaluation of dental study casts. SETTING: Three major cleft-craniofacial centers; one (center A) is a free-standing institution, and two (centers B and C) are university hospitals. PATIENTS: 118 (A = 41; B = 33; C = 44) consecutively treated 5-year-old patients with complete, nonsyndromic unilateral cleft lip and palate. INTERVENTIONS: Centers A and C completed primary repair without presurgical orthopedics by 18 months (center A in three surgeries and center C in two surgeries). Center B used passive presurgical orthopedics with lip/soft palate repair at 6 months and gingivo-alveoloplasty/hard palate repair at 18 to 36 months. MAIN OUTCOME MEASURE: Averaged ratings of dental casts using the 5-year yardstick were computed for each patient. The Wilcoxon two-sample test was used to compare means; a chi-square test was used to compare distributions. RESULTS: Intra- and interexaminer reliability tests showed excellent reliability (>.90). Mean scores were not significantly different. Distribution of scores differed significantly. Center A had the highest percentage of good scores and the lowest percentage of poor scores (72% versus 6.5%), followed by center B (63% versus 6.6%) and center C (59% versus 16.3%). CONCLUSIONS: Centers A and B had comparable scores and completely different protocols in surgical technique, timing, sequencing, and nonuse/use of appliances. Center C's results were slightly lower than those of 1 and 3, but the center had the protocol with the least burden of treatment (only two surgeries, without use of appliances).
Concentrations of clindamycin in the mandible were determined in 17 dogs and 13 cats with severe plaque, gingivitis/periodontitis, and calculus that were treated orally with clindamycin (11 mg/kg) once daily for 5 days prior to professional teeth cleaning and extractions. The animals were patients at the Dental Department of the Clinic for Surgery and Ophthalmology of the University of Veterinary Medicine in Vienna, Austria. Clindamycin levels were determined during postextractional alveoloplasty. Approximately 1 to 3 mm3 of mandible was removed from the intraradicular septum in multirooted teeth and from the protruding labial/buccal alveolar rim with a small rongeur. The mean concentration of clindamycin was 8.18 microg/g in dogs (range=3.16 to 24.08 microg/g) and 17.43 microg/g in cats (range=2.45 to 51.60 microg/g). The concentration of clindamycin in the mandibles of dogs and cats may be useful to combat infections after periodontal procedures, tooth extractions, or injuries to the mandible.
The author has studied on the various diseases occurring in the oral and maxillofacial region for the year of 1987 at the Department of Oral & Maxillofacial Surgery, Seoul National University Hospital. The diseases diagnosed and treated have been analyzed according to each disease such as inflammatory, traumatic, cyst, tumor, neoplastic, deformities and so on, in order to get accurate information on the diseases of the oral & maxillofacial region and the information might be helpful to plan the education programmes for students, and interns and residents. The results obtained are as follows; 1. The sex distinction and the percentage of occurrence rate as follow Male 2090 (49.6%) Female 2127 (50.4%) 2. To study compare with the age, both male and female patients showed the highest ratio at the 20-29 age group, and the percentage of the 20-49 age group is 64.1% and the percentage of geriatric patients over 60 years old is 10.2%. 3. To study compare with the month (the patient came first time), August was most abundant in a year. 4. To study compare with the disease, dental-periodontal disease, impacted tooth and eruption abnormality are the most prevalent (51.2%), and next is odontogenic infection (22.4%), cyst & tumor (7.6%), traumatic injury (7.5%), and anomaly or deformity (3.8%). The number of medically compromised patients with oral surgery problems is 183 (4.3%). 5. Classifying the treatments according to the operator group, 1) For students(senior class), simple extraction showed the highest ratio, next is surgical extraction. 2) For interns, simple extraction showed the highest ratio, next is surgical extraction, pre-prosthetic surgery (alveoloplasty and vestibuloplasty).(ABSTRACT TRUNCATED AT 250 WORDS)
We have described our technique for general anesthesia for outpatients using a mixture of nitrous oxide, oxygen, and enflurane with spontaneous ventilation through a Bain anesthetic circuit. In our experience, surgical excision of impacted teeth, multiple extractions and alveoloplasty, enucleation of simple cysts, excision of benign tumors, and other similar operations have been done efficiently with these anesthetic techniques. More than 500 such cases have been managed without significant complication. The concepts of selection and preparation of patients, airway security and protection during surgery performed in the upper airway on an unconscious patient who is breathing spontaneously, continuous monitoring of vital functions, and rapid induction and recovery all combine to make this technique consistent with standards for excellence in anesthesia.
Trauma and neoplasms may be responsible for ablative procedures performed in the anterior mandibular region. This surgery, as well as alveoloplasty, ridge augmentation, and placement of subperiosteal implants, may be responsible for the anterior malpositioning of the floor of the mouth along with its adnexa, which brings Wharton's carunculae directly over the crest of the ridge. A technique has been devised to correct this problem.
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