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Incidence of dry socket in surgical removal of impacted third molar.

In a search for dry socket five hundred and thirty six (536) impacted third molars were surgically removed among 435 patients. Each patient was examined clinically and radiographically before surgery. 108 impacted teeth were removed for prophylactic and 428 for therapeutic reasons. A standard operating procedure was performed for each case and pre-operative and post-operative regimens was employed. After surgery each case was followed to determine the absence or presence of signs and symptoms of dry socket. It was found that total incidence of alveolar osteitis (dry socket) was 10.26%.

Adolescent↗

Third molar surgery: current concepts and controversies. Part 2.

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.

Adrenal Cortex Hormones↗

[Intra-alveolar transplantation of tooth root].

In this article the technique and results of intra-alveolar transplantation are presented. The surgical technique consisted of extrusion of the root, lying under the gingival margins, within its own socket. By this technique the root was placed into the appropriate position required for the prosthodontic restoration.

Adult↗

[Alveolar bone resorption process in molar tooth region in calcium-deficient rats].

The present study was carried out to investigate the alveolar bone resorption in the molar tooth region in the rats fed a low calcium diet. Male Wistar rats (70-85g in body weight) were either fed a low calcium diet (0.05% Ca, 0.35% P) or a control diet (0.5% Ca, 0.35% P) by using a pair feeding technique. The rats were sacrificed at intervals of 3, 6, 9 and 20 days during the experimental period. Contact microradiograph of the second molar region of the mandible showed that the cancellus bone as well as the endosteal surface of the cortical bone were progressively resorbed soon after the start of low calcium feeding. At day 9, the amount of bone was reduced to about half of the control rats and 80% of the bone was diminished at day 20. In spite of the severe bone resorption, the alveolar bone proper that surrounds the molar sockets and a few cancellus bone were seen remaining and the occlusal function of the molar tooth seemed to be maintained. These results suggest that the alveolar bone quickly responded to the low calcium diet resulting in bone resorption and that the bone in the supporting tissues of the molar tooth seems to be not affected by the calcium deficiency.

Alveolar Bone Loss↗

Effect of chlorhexidine (0.12%) rinses on periodontal tissue healing after tooth extraction. (I). Clinical parameters.

The aim of the present study was to evaluate the effects of a 1-month period of chlorhexidine (CHX) rinses on the periodontal conditions of teeth adjacent to extraction sockets. 40 patients signed consent forms for this double blind trial and were randomly assigned to either the test group rinsing 2 x daily with 15 ml of a 0.12% CHX solution (Peridex) starting 2 days after tooth extraction or the control group rinsing with a placebo solution for 30 days. Clinical periodontal parameters were obtained from test sites located adjacent to as well as matched controls distant to the extraction sites. The measurements were performed at baseline before the extraction and 1, 2, 3 and 6 months thereafter. During the observation period, the patients were exposed to initial periodontal therapy. The test sites of the group rinsing with CHX demonstrated significantly reduced (p < 0.05) plaque indices, gingival indices and lower %s of sites bleeding on probing one month following the extraction. The test sites of the control group rinsing with the placebo demonstrated a tendency for loss of clinical attachment between 1 and 2 months after the tooth extraction. The mean pocket probing depth (PPD) at test sites of the CHX rinsing group was smaller than in the placebo rinsing group at the one month examination. Also, the mean PPD of the test sites in the CHX group was significantly smaller than at the control sites at 1 month. This difference was not observed in the control group rinsing with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Immediate transmucosal implants using the principle of guided tissue regeneration. I. Rationale, clinical procedures and 30-month results.

The installation of implants directly into extraction sockets offers considerable advantages over other treatment modalities for both practitioners and patients. Usually, immediate implants are placed and subsequently covered by mucosa allowing a submerged healing mode. This report presents the rationale, clinical procedures and results for immediate transmucosal implants. Following an intracrevicular incision and flap elevation, the tooth to be extracted is carefully luxated by means of small elevators to preserve the entire bony housing of the tooth. A titanium plasma-sprayed implant (ITI Bonefit) is then installed at the bottom or in the wall of the extraction socket. An expanded polytetrafluoroethylene barrier membrane (Gore-Tex GTAM) is tightly adapted around the implant post and over the bony margins of the alveolus. The flaps are then replaced, adapted around the neck of the implant and sutured. During nonsubmerged, transmucosal healing of the site, meticulous plaque control is performed by mechanical and chemical means. Membranes are removed after 5-7 months. Since infection was prevented, the implants obtained stability, healthy peri-implant mucosal tissues were observed and missing bone in the alveoli regenerated. Of 21 transmucosal implants placed into fresh extraction sockets, 20 yielded complete bone fill and coverage of the entire plasma-coated implants surface at the time of membrane removal. This documentation suggests that the immediate nonsubmerged installation of an implant into an extraction socket is a predictable treatment modality with good long-term prognosis.

Adult↗

Recrudescence of herpes simplex virus type 1 in latently infected rats after trauma to oral tissues.

Tooth extraction in rats was used to trigger a latent HSV-1 infection. HSV-1 was inoculated unilaterally in the rat palates. Eight weeks later two molars were removed bilaterally. The trigeminal ganglia were co-cultivated and HSV-1 was isolated from 63% of the ganglia on the infected sides but from only 11% on control sides. The immune response pattern was analysed by immunoblotting of rat serum, and strong reactivity to HSV-1 specific cell polypeptides and glycoproteins (ICP6, gC, pgC, gD) was seen after reactivation. The extraction sockets were histopathologically evaluated and showed healing on the infected side in 26% compared to 63% in contralateral control sockets. The effect of acyclovir (ACV) treatment was elucidated and was found to influence the subsequent development of antibodies and to promote healing of the sockets. Vesiculation in intra- and subepithelial tissue was present on the infected side in 58% but in only 12% of ACV-treated animals. The present study in rats has shown that a latent HSV-1 infection can be established and reactivated by tooth extraction. Reactivation resulted in delayed healing of sockets on the latently infected side but not on the contralateral control side. HSV-1 reactivation was demonstrated serologically by immunoblotting. Healing was significantly promoted by administration of ACV, which also supports the contention that HSV-1 interferes with the healing process.

Acyclovir↗

Human ex vivo bone tissue strains around natural teeth vs. immediate oral implants.

PURPOSE: To compare ex vivo bone tissue strains around natural teeth with immediate implants supporting unsplinted and splinted fixed prostheses. MATERIAL AND METHODS: Six linear strain gauges were bonded on the labial marginal bone of bilateral maxillary anterior teeth in two fresh-frozen human cadavers. The natural teeth were loaded in centric occlusion via an occlusal splint with integrated miniature load cells. Strain measurements were performed at a sample rate of 10 kHz and under a maximum load of 100 N, simultaneously monitored from a computer connected to data acquisition system. Upon extraction of the anterior teeth, Ø 4.1 mm and Ø 4.8 mm ITI dental implants were placed into sockets of incisors and canines, respectively. Installation torque value (ITV) of each implant was measured by a custom-made torque wrench and resonance frequency analyses (RFA) were also undertaken. Strain measurements were performed for (1) single-tooth implant restorations, (2) unilateral splinted anterior implants, and (3) bilateral splinted anterior implants. Finally, an autopolymerizing acrylic resin was injected into the implant sockets for simulation of osseointegration and strain measurements were performed. RESULTS: Microstrains of all groups were statistically comparable (P>0.05), although lower strains were elicited for implants in sockets of incisors in comparison with natural teeth. Microstrains around canine implants were comparable or higher than those induced around natural canines. For all groups, microstrains around canines were higher than those around lateral (P<0.05) and central incisors (P<0.01), which had similar strain levels (P>0.05). The RFA values of implants were comparable. The ITVs of implants in sockets of lateral incisors and canines were similar and were higher than those of implants in central incisor regions. CONCLUSION: The labial marginal bone having no contact with immediate implants may experience strain gradients within physiologic levels due to deformation of bone under load. Although one prosthetic design does not seem to have clear advantages over another, splinting of implants may be considered as a safety measure for immediately loaded immediate implants, if possible.

Adult↗

Effect of experimental tooth movement on the mechanical strength of the periodontium in the rat mandibular first molar.

A 474 microns thick latex elastic band was inserted between the mandibular first and second molars to cause tooth movement. The mechanical strength of the periodontium was measured by extracting the first molar from the socket in the dissected jaw. From the 1st to the 4th day, the ultimate extraction loads decreased markedly, while the inter-dental spaces remained about 300 microns. About 5 min after the elastic insertion, the ultimate load was not significantly changed and the inter-dental space was 61 microns. Restoration of the mechanical strength of the periodontium occurred gradually after the removal of the band. On the 4th day, recovery was complete. Restoration of the original inter-dental space was most marked in the initial 24 h. The forces exerted on the teeth by the bands were of the order of several tens of newtons initially and became reduced to a few newtons after the tooth movements. It is suggested that decreases in the ultimate extraction loads were caused by changes in constitution of the periodontal collagen, by the disorganization of the periodontium and by the loosening of the attachment of the periodontal fibres to the bone.

Animals↗

[The nonhealing of the buccal mucosa after tooth extraction. Apropos a case of histiocytosis X].

We report a case of eosinophilic granuloma falsely diagnosed as a radicular cyst in a 28-year-old patient. Between August 1996 and June 1997, successful extraction [correction of avulsion] of teeth 36 and 37 was followed by non-healing of the mucosa in the corresponding sockets. Three bone biopsies were needed to establish the diagnosis of histiocytosis X. In case of non-healing of the intraoral mucosa after tooth extraction [correction of avulsion], the first step is to rule out a malignant tumor. A clinical and radiographic work-up as well as biopsy are needed. Less common conditions such as tuberculosis or histiocytosis X requiring specific treatment can be diagnosed by pathology.

Adult↗

A clinical evaluation of dry socket in a Nigerian teaching hospital.

PURPOSE: We sought to determine the incidence of dry socket in a Nigerian teaching hospital and to evaluate the patients' demographic pattern, predisposing factors, the treatment given, and treatment outcome. PATIENTS AND METHODS: A retrospective review of records of dental extractions complicated by dry socket in Obafemi Awolowo University Teaching Hospital, Ile-Ife, between January 1996 and December 2000 was undertaken. Information retrieved included patient sociodemographic data, indications for extraction, tooth extracted, status of attending surgeon, onset of symptoms, relevant findings of the examining clinician, interval before presentation, treatment given, and its outcome. RESULTS: Of the 3,319 dental extractions performed in 3,008 patients, 136 (4.1%) were complicated by dry socket. The patients' mean age was 33.4 (15.4) years and a peak age incidence of 21 to 30 years was found. A slight female preponderance (1.4:1) was observed. The majority of patients were in the low-income group, and presentation in the hospital was prompt in the high-income group. Mandibular teeth were affected 3 times more than maxillary teeth (P =.00080). Most cases of dry socket resulted from extractions performed by undergraduates and house officers. Various underlying systemic conditions were found in 11.0% of cases, none of which included use of oral contraceptives. Treatment was usually the use of zinc oxide eugenol dressing in an irrigated socket, combined with antibiotic therapy in 45.3% of cases. No adverse reaction to zinc oxide eugenol was observed. CONCLUSION: The incidence of dry socket in our hospital is 4.1%. The mandible was involved 3 times more than the maxilla. With the use of zinc oxide eugenol dressing, 70.6% of patients completed treatment satisfactorily and 29.2% were lost to follow-up.

Adult↗

Autogenous transplantation of teeth with complete root formation: two case reports.

AIM: Autotransplantation is an alternative treatment for replacing lost teeth when suitable donor teeth are available. This paper presents two cases of successful autogenous tooth transplantation. SUMMARY: Two third molars with complete root development were autogenously transplanted from their original sockets into new recipient sites on the same side of the mouth, one in the maxilla and one in the mandible. In both cases, the third molars were transplanted immediately after the first molar extractions. To provide better adaptation of the donor teeth, the recipient alveolar sites were remodelled using surgical burs. Semi-rigid splints were maintained for 45 and 15 days, respectively. Root canal treatment commenced one a week after transplantation and the canals were medicated with a calcium hydroxide paste before they were filled. Clinical and radiographic findings after 5 and 3 years of follow-up, respectively, are discussed in relation to the literature. KEY LEARNING POINTS: Autogenous transplantation of teeth with complete root formation may be considered as a viable treatment option to conventional prosthetic and implant rehabilitation for both therapeutic and economic reasons. Careful surgical and endodontic procedure, together with careful case selection may lead to satisfactory aesthetic and functional outcomes.

Adult↗

Osseointegrated fixture placement with simultaneous tooth extraction.

Three cases are presented that illustrate the potential for accelerating the healing phase with fixture-based treatment. Depending on the clinical circumstances, techniques may include radical alveolectomy, the use of fresh extraction sockets, and fixture placement in inter-radicular bone.

Adult↗