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Some features in the pathogenesis of various forms of an inflammatory process were demonstrated by immunologic and microbiologic methods in patients with odontogenic infections. A close relationship has been revealed between microflora of an inflammatory focus, immune response type, and inflammation course in the maxillofacial area.
Minor oral surgery is an integral part of dentistry, whether performed by the generalist or the specialist. Procedures include those within the broad discipline of general oral surgery (such as routine and surgical extractions, impactions, preprosthetics, biopsy, and implants), periodontics (such as periodontal surgery, mucogingival plastic surgery, and implants), and endodontics (periapical surgery). There is considerable overlap among generalists and surgical specialists in terms of the treatment provider. Perhaps the most important consideration with regard to appropriateness and quality of care is not who does the surgery but how it is done. The ability to perform surgery according to sound surgical principles and to properly prescribe medications in association with that surgery is a necessary requisite for quality treatment. This article reviewed how various pharmacologic agents can be administered and how they influence surgical procedures. Whether or not they are used and the manner in which they are used are predicated on the discretion and clinical judgment of the clinician on a case-by-case basis. If used appropriately, these medications can be instrumental in mitigating morbidity and increasing tolerance and overall patient satisfaction with the surgical experience.
The outcome of third molar surgery is influenced by a variety of factors including among others, mucoperiosteal flap design and flap closure and the use of antibiotics and corticosteroids. This article discusses the special significance of modifying factors upon the incidence of perioperative complications associated with third molar surgery.
Analysis of the results of treatment of 150 alveolitis patients has demonstrated the advantages of the method using iruxol ointment (75 patients) as against the routine one (reference group--75 patients). Therapy with this ointment resulted in complete arrest of the painful syndrome in 2.11 +/- 0.15 days, whereas in the reference group it was attained in but 5.40 +/- 0.18 days. The temperature reaction normalized in all the test group patients within 3 days, whereas in the reference group such results were attained in only 74.36% of the patients. Inflammatory symptoms in the paramaxillary soft tissues were liquidated with iruxol ointment in 5.96 +/- 0.14 days, whereas in routine therapy this was observed in only 7.46 +/- 0.18 days.
Patients undergoing third molar extractions while under general anesthesia were given local anesthesia either before (group 1) or after (group 2) surgery. The medication intake and pain scores were studied for 7 days but showed no difference between the two groups. It is suggested that timing of local anesthesia alone may not prevent or reduce the postoperative pain experience.
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The records of 1,797 patients were retrospectively examined to analyze the possible relationships between postoperative complications following mandibular third molar extraction and parameters such as age, sex, indication for surgery, position of the molar, surgical experience, surgical technique, and postoperative care. Older patients tended to suffer more often from complications. Surgery performed while there were signs of pericoronal inflammation also resulted in more complications. There was no statistically significant difference in the mean complication rate arising from surgery performed by staff members and the rate when surgery was performed by residents. There seems to be no reason for patients to return routinely for removal of resorbable sutures or other postoperative care because this practice does not result in a decrease in postoperative symptoms.
Use of HTR (synthetic bone graft material) has been described to make tooth extraction a more controlled, regimented procedure. Strict adherence to surgical technique, with emphasis on appropriate suturing, is necessary to produce consistently successful results. A variation of an interrupted suture technique, the double-mattress stitch, is described in detail to achieve these results. This suturing method is replicable and applicable to most areas of the mouth. This technique is more challenging (but not impossible) to perform in areas that are difficult to access, such as in maxillary third molar regions. This stitch is essential for closing the extraction site and containing the graft material during initial healing. An ideal bone graft material should prevent postextraction osteitis, and maintain bone in the extraction area and proximal to this site. HTR satisfied these requirements.
Following the removal of mandibular teeth, especially third molars nowadays, a post-operative complication may occur, namely alveolitis. This article reviews the pertinent literature concerning this condition and discusses its etiology, symptoms and treatment.
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In a survey of military dentists to examine use of antimicrobial agents in the management of third molars, questions addressed use of antibiotics and an antimicrobial rinse in treating pericoronitis and third molar extractions. Results were compared with information from a literature review. According to the survey, a majority of clinicians use antibiotics to treat pericoronitis but not surgical extraction of asymptomatic dental impactions. About 60 percent of respondents use a preoperative rinse with chlorhexidine in treating the third molar conditions discussed. A postoperative rinse with chlorhexidine was used less frequently. Half the respondents listed medicolegal factors in their decisions.
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Analysis of liberation of medical substances from dressing for treatment of dry tooth-socket proved that this process proceeds simultaneously to two receiving compartments. Liberation to saliva proceeds as in vitro conditions, whereas liberation to tissue of the tooth-socket is limited by the absorption rate. Based on measurements carried out in vitro one can predict the period of effectiveness of the dressings in vivo. It is evident that results of measurements in vitro can be correlated with those in vivo.
BACKGROUND: Various materials have been used immediately following tooth extraction to fill and/or cover the socket in an attempt to limit or prevent ridge resorption. The purpose of the present pilot study was to establish a reliable model to investigate the effect of various bone graft and bone replacement materials on extraction socket healing. This study also compared healing extraction sockets 6 to 8 months postimplantation of a bioactive glass (BG) or demineralized freeze-dried bone allograft (DFDBA) to an unfilled socket control (C). METHODS: Following tooth extraction, a total of 30 sockets in 19 patients were randomly divided into 3 treatment groups: 10 sockets received BG, 10 sockets DFDBA, and 10 sockets served as unfilled controls. Primary coverage was achieved by flap advancement over each socket. Six to 8 months postextraction at time of implant placement, histological cores of the treatment sites were obtained. These cores were processed, undecalcified sections prepared and stained with Stevenel blue/van Gieson's picric fuchsin, and histomorphometrically analyzed. Vital bone, connective tissue and marrow, and residual graft particles were reported as a percentage of the total core. RESULTS: A model system was described in humans and used to evaluate the healing response in the 3 treatment groups. Results concluded that mean vital bone present was 59.5% for BG-, 34.7% for DFDBA-, and 32.4% for C-treated sites. These differences were not statistically significant. However, the residual implant material was significantly higher in DFDBA-treated (13.5%) versus BG-treated sockets (5.5%). CONCLUSIONS: Although the differences in percent vital bone were not statistically significant among the 3 treatment groups in this pilot study, BG material was observed to act as an osteoconductive material which had a positive effect on socket healing at 6 to 8 months postextraction. Further research following implant placement in treated and control sockets is warranted to determine if bone implant contact is improved in BG-filled versus unfilled sockets.
OBJECTIVES: To calibrate and validate a digital subtraction radiography system using scanned images for quantification of alveolar bone changes by means of computer-assisted densitometric image analysis (CADIA) in vitro. MATERIALS AND METHODS: Noise levels were determined using 10 standardized periapical radiographs of the same lower molar region in a human dry skull. For validation of the system, radiographs were taken before and after bovine bone particles in measures with increments of 2 mg weighing from 2 to 20 mg were added into each socket of three dry skulls. Radiographs were developed and scanned into a computer with a flatbed scanner. After digitization, the images were subjected to alignment, normalization and subtraction. Appropriate regions of interest (ROIs) were selected and their CADIA values were calculated for the determination of noise levels, and correlations between the CADIA values and the actual bone mass were performed. RESULTS: When the threshold value was 7, the percentage of pixels deviating from the set threshold value was small (0-11.3%). There were statistically significant correlations between the actual bone mass and the CADIA value for anterior sockets (p<0.001, r2=0.89) and posterior sockets (p<0.001, r2=0.9). For pooled data of both anterior and posterior sockets, the correlation was also statistically significant (p<0.001, r2=0.88). CONCLUSIONS: A high and statistically significant correlation between the actual bone mass and CADIA value was obtained, which suggests that the system could be suitable for the detection of small alveolar bone changes.
The purpose of this study was to compare bone promotion around implants which were augmented with ePTFE membranes alone or in combination with cortical demineralized freeze-dried bone (DFDB) or the combination of platelet derived growth factor-BB (PDGF) and insulin like growth factor I (PDGF/IGF-I). Membranes were placed over titanium implants which had been inserted into fresh extraction sockets with large buccal dehiscences. Twenty-four implants were placed in 4 dogs. At 18 weeks clinical bone height measurements were taken, the animals were sacrificed, and all specimens retrieved for histologic evaluation. Clinically, a significant gain in bone levels was present in both the ePTFE membrane alone group (P < 0.005) and PTFE plus PDGF/IGF-I group (P < 0.01), but not in the PTFE plus DFDB group. Results from histometric measurements revealed an approximately 2-fold increase in the percentage of implant surface in contact with bone, area of bone adjacent to the implant surface, and in the total length of the implant surface in contact with bone in the dehiscence defects treated with ePTFE plus PDGF/IGF-I compared to the defects receiving ePTFE membranes alone (each P < 0.05). The response to the DFDB was highly variable and it did not significantly improve the efficacy of the PTFE membranes for any parameter measured. The distance from the outer surface of the new bone to the implant surface was statistically significant for ePTFE membranes alone and membranes plus PDGF/IGF-I. The results demonstrated that clinically, ePTFE membranes alone or ePTFE membranes with PDGF/IGF-I were equally effective in promoting bone growth around the implants. Histologic measurements demonstrated that sites treated with ePTFE membranes plus PDGF/IGF-I had the highest bone density compared with sites which received ePTFE membranes alone or with ePTFE membranes and DFDB. The results of this study question the use of DFDB and support the use of ePTFE membranes alone or with PDG-F-BB/IGF-I as potential methods of promoting bone formation around dental implants.
Some hydrogel dressings have been investigated to determine their utility for the treatment of painful dry tooth-socket (Alveolitis sicca dolorosa). As drugs mefenamic acid and Nipagin P have been applied. Hydrophilized methylcellulose, 5-15% glycerol or 5-20% PEG 200 were the filling and gel building material. It has been found, that the properties of the dressings depend on the content of the hydrophilizers. The half liberation time of the drugs under study ranges from 0.5 to 11 h, the swelling degree amounts to 366-400%, the washing out time runs to 80-140 min and the period of activity of the dressings inside the tooth-socket amounts to 24-48 h. The dressings show thixotropic properties and a high flow limit.