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PubMed2002

The palatal advanced flap: a pedicle flap for primary coverage of immediately placed implants.

The placement of implants immediately after tooth extraction has become a relatively common event. This approach has gained popularity because it reduces the time between tooth extraction and placement of the final prosthetic restoration. One problem that remains unresolved with this procedure, however, is that there is usually space left in the area surrounding the coronal portion of the implant. As none of the techniques published to date is completely satisfactory, we developed an approach that is a modification of the palatal pedicle flaps used for closure of oro-antral fistulas. This technique allows for precise rotational advancement of the palatal tissue in a coronal direction, thus facilitating complete coverage of the extraction site. The procedure was used on 38 patients treated for primary coverage of postextraction placed implants. Thirty-two of the patients required single tooth replacement, three patients received two implants each, and three patients received three implants each. In 27 of the cases, the procedure was performed in conjunction with barrier membranes; of the 38 cases, 25 patients required the use of DFDBA to fill the defect created by the extraction procedure. The average defect width was 4.70 +/- 0.2 mm. Complete primary coverage was obtained in all cases without any changes in the size or anatomy of the buccal vestibule; complete coverage was maintained over the entire healing period of 6-8 months (mean +/- SEM, 6.49 +/- 0.10 months). Even with guided tissue regeneration cases, there was no exposure of the barrier membrane or cover screw of the implant during healing. After a period of 1-5 years (mean +/- SEM, 39.35 +/- 2.69 months), none of the implants was lost. We conclude that the palatal advanced flap procedure is useful, fast, and easy to perform in cases of immediate implant placement after tooth extraction.

Adult↗
PubMed2005

[Socket healing after rat mandibular incisor extraction].

Prosthodontic treatment is difficult if the alveolar ridge is low or thin. To develop a method for alveolar ridge preservation after tooth extraction, we need an experimental model of a small animal, in which we can analyze the socket healing easily and quantitatively. The purpose of the present study was to establish such an experimental model. Ten weeks old male rats of Wistar strain were used. The edge of the right mandibular incisor was cut every three days three times and the incisor was extracted at three days after the final cut. The animals were sacrificed 0, 1, 2, 4, 8, 12 weeks after the extraction and the mandibles were dissected out. The length of the alveolar bone was measured on soft X-ray photographs and bone mineral content was measured with a dual energy X-ray absorptiometer (DEXA). Then, transverse sections of the alveolar bone were prepared. Periodic three-times cutting of the edge of the mandibular incisor made the extraction easy. Quantitative analyses of new bone formation in the socket and the resorption of the alveolar bone were possible with soft X-ray photography and DEXA. The histological findings corresponded well with the data from the soft X-ray photos and DEXA measurements. The present results demonstrated the possibility of simple and quantitative analyses of socket healing after the extraction of rat mandibular incisors. This experimental model would be useful for developing a method to prevent atrophy of the alveolar ridge after tooth extraction.

Animals↗
PubMed1983

A comparison of response profiles obtained on the McGill Pain Questionnaire and an adjective checklist.

The response profiles on the McGill Pain Questionnaire (MPQ) were compared with those obtained from a checklist format, consisting of the 78 MPQ words arranged in random order. Both forms were administered to 3 patient groups: (a) primiparae experiencing post-episiotomy pain (n = 60); (b) outpatients attending a rheumatology clinic wisdom tooth extraction (n = 60); and (c) inpatients having undergone wisdom tooth extraction (n = 60). The order of administration was balanced, so that within each patient group 40 patients received either one of the study forms and 20 both, yielding total sample sizes of 120 and 60 for further statistical analyses. Comparison of numbers of words checked in the two formats showed considerable similarity and so for purposes of further comparison, the MPQ structure was imposed on the checklist. This permitted comparison of summary scores, with no significant differences in mean level, with the sole exception of the evaluative subscale. Comparison of individual subgroup profiles on both forms also showed considerable similarity. A second objective was to compare the format in discriminating between patient groups. It was found that the MPQ offered a higher correct classification rate, although there was little in it, with MPQ subgroup scores rather than subscale scores showing marginally better results.

Adult↗
PubMed2006

Oral malodor associated with internal resorption.

We report a case of oral malodor associated with internal resorption. A 39-year-old male attended our hospital complaining of oral malodor. Utilizing organoleptic measurement, the halimeter test and gas chromatography, it was diagnosed as a strong halitosis caused by oral origin. The pocket probing depth of tooth 21 was 10 mm, and X-ray examination revealed a vertical bone loss around this tooth. The patient had received periodontal treatment at two dental offices previously, but the periodontal conditions and oral malodor persisted. We performed an initial periodontal preparation, however a deep pocket remained. We therefore performed a surgical inspection including flap reflection, and found that the tooth had a large perforating defect in the distal surface. The extracted tooth had multiple perforating defects covered with granulation tissues on all root surfaces including the root apex. Taking into consideration the anamnesis and X-ray examination of the extracted tooth, internal absorption was considered to have been the cause of the multiple perforating defects. After extraction of the causative tooth, oral malodor dramatically decreased. To our knowledge, this is the first report of an oral malodor associated with internal resorption.

Adult↗
PubMed2002

Relationship between bleeding time test and postextraction bleeding in a healthy control population.

OBJECTIVE: We sought to determine whether cutaneous bleeding time (BT) is related to bleeding outcome measures after a single tooth extraction. STUDY DESIGN: This was a prospective clinical pilot study of 30 subjects. Cutaneous BT was evaluated before a single tooth extraction. After extraction, an oral BT was determined. Subjects were contacted 3 to 7 hours and 2 days after extraction to assess further postoperative bleeding. RESULTS: The mean cutaneous BT was 5.9 minutes (range 1.5-10.0 minutes). The mean oral BT was 7.5 minutes (range 0-20 minutes). Cutaneous BT did not correlate with oral BT or any of our measures of postoperative bleeding. However, the oral BT correlated with the number of hours of bleeding after surgery (R(s) = 0.54, P =.03). The time necessary to perform the extraction correlated with the extraction site bleeding 3 to 7 hours after surgery (R(s) = 0.67, P =.0006). CONCLUSION: Cutaneous BT did not correlate with measures of postoperative bleeding in the present study, but oral BT immediately after extraction correlated with the duration of subsequent postoperative bleeding.

Adult↗
PubMed2001

Lack of association between QT dispersion and blood pressure response during dental surgery.

1. It is well known that dental surgery induces increases in blood pressure. However, the factors influencing this increase are not yet fully understood. We have determined the relationship between QTc (= QT/RR(1/2), with RR being the R-R interval in seconds) dispersion, measured with a 12-lead surface electrocardiogram, and changes in blood pressure during tooth extraction. 2. Both QTc dispersion and the power spectrum of R-R variability were determined before the dental surgery was undertaken. The low-frequency (LF; 0.041-0.140 Hz), high- frequency (HF; 0.140-0.500 Hz) and total spectral powers (TF; 0.000-4.000 Hz) were calculated and the ratio of LF to HF and the percentage of HF relative to TF (%HF; HF/TF x 100) were used as indices of sympathovagal balance and parasympathetic activities, respectively. 3. In the present study, QTc dispersion failed to correlate with LF/HF and %HF. Systolic blood pressure and pulse rate increased significantly during tooth extraction; however, changes in these variables failed to correlate with QTc dispersion. 4. These results suggest that QTc dispersion is not associated with the power spectrum of R-R variability and that it does not affect the blood pressure response during tooth extraction.

Adult↗
PubMed1989

[Enhancement of enamel crystallinity with gel method during orthodontic treatment. The 1st report: Application of electron probe X-ray microanalyser].

This paper is to review the gel method of strengthening tooth enamel substance around bonded brackets and morphological observations and elemental analyses of the chopped cross section of the three below-mentioned groups were carried out by electron probe X-ray microanalyser (EPMA) for a relative review. Group I: bracket-bonded extracted tooth enamel in application of the silica-hydro gel method. Group II: bracket-bonded extracted tooth enamel in application of the gelatin gel method. Group III: bracket-bonded extracted tooth enamel in application of neither method. The results obtained were as follows: 1) As a result of making morphological observations through secondary electron image and back scattered electron image, the adhesive condition of the brackets and the state of the chopped cross sections were favorable and these combined observation proved effective as a supplementary method of elemental analysis. 2) Through qualitative analyses, Ca, P, F, O, Na, Mg and Cl were recognized as content elements on the experimental side (the non-bracket side) as well as on the control side (the bracket side) from group I through III. 3) In making ultrahigh-speed wide-area surface analyses (elemental concentration map), the incorporation of F was recognized from enamel cuticle to approximately 200 microns in group I and to 50-100 microns in group II, and the distribution of Ca was totally consistent, and P showed the slight downward trend from enamel cuticle to dentoenamel junction. 4) The incorporation of F was acknowledged to be until 150-200 microns on the experimental side of group I and to be until 80 microns on the experimental side of group II by line analyses. 5) As regards F on the experimental and the control side in group I as well as in group II through a quantitative analysis, the experimental side clearly revealed a high concentration of F and acknowledged 1% level to be a significant distinction. From the foregoing results through the electron probe X-ray microanalyser, strengthening tooth enamel substance in vitro by application of the gel method proved to be effective, and the silica-hydro gel method was indicated to be superior to the gelatin gel method.

Dental Bonding↗
PubMed2001

Bone volume collected from dental implant sites during osteotomy.

PURPOSE: Little research has been done to determine the amount of bone harvested from implant site preparations using an inline bone collector. This study looked at the amount of bone that can be harvested from common dental implant osteotomies. PATIENTS AND METHODS: A total of 24 implants were placed in 9 patients over a 3-month period. Implant size ranged from 3.75 x 13 mm to 4.75 x 13 mm. Nine implants were placed in the maxilla, and 15 implants were placed in the mandible. Seven patients were female, and 2 patients were male. The patient age ranged from 27 to 72 years. Four patients had implants placed within 5 years after tooth extraction, and 5 patients had implants placed 5 years after tooth extraction: an analysis of variance was used to determine if there were statistical differences between maxilla versus mandible, male versus female, and edentulism less than or greater than 5 years. RESULTS: The average bone volume from the 24 osteotomies was 0.195 +/- 0.099 mL. The average osteotomy site measured 4.02 x 12.90 mm. There were no statistical differences noted among maxilla and mandible, gender, or time of edentulism. CONCLUSIONS: When using an inline bone collector to harvest implant osteotomy sites, an average of 0.195 mL of bone can be obtained from a site approximately 4.0 x 13 mm. This bone can often be combined with a xenograft or alloplastic material to provide extra bulk to fill peri-implant defects. When multiple implant sites are prepared, often sufficient bone can be obtained with the bone collector alone.

Adult↗
PubMed2002

Histological comparison of healing extraction sockets implanted with bioactive glass or demineralized freeze-dried bone allograft: a pilot study.

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.

Adult↗
PubMed2001

Cardiovascular and sympathetic responses to dental surgery with local anesthesia.

We investigated changes in blood pressure and blood variables, including plasma catecholamines, serum glucose and insulin concentrations, during dental surgery. The study included 11 normotensive patients (age, 22.5+/-0.7 years) who underwent tooth extraction at Kyushu Dental College Hospital. Three to 7 days prior to dental surgery, blood pressure, pulse rate, and heart rate variability were measured every 30 min over 24 h. The low frequency (LF: 0.05 to 0.15 Hz) and high frequency (HF: 0.15 to 0.40 Hz) powers were calculated, and the ratio of LF to HF (LF/HF) and HF were used as indexes of sympathetic and parasympathetic activities, respectively. Lidocaine, 2% with epinephrine (1:80,000), was used as the local anesthetic for all patients. Systolic blood pressures significantly increased during dental surgery (+10.8+/-3.5 mmHg); however, this increase failed to correlate not only with baseline systolic blood pressure but with 24-h averaged blood pressures, LF/HF or HF. On the other hand, plasma epinephrine and norepinephrine concentrations increased during dental surgery, and peak values of these variables were obtained after local anesthesia and during tooth extraction, respectively. Serum glucose level increased after local anesthesia (control vs. local anesthesia: 5.16+/-0.11 vs. 5.62+/-0.10 mmol/l; p<0.01); however, plasma insulin concentrations did not change significantly. These results suggest that 1) ambulatory measurements of blood pressure and heart rate variability over 24 h cannot predict the responses of blood pressure during dental surgery, and that 2) administration of local anesthetic and tooth extraction activate sympathoadrenal outflow, resulting in an increase in serum glucose level in normotensive subjects.

Adult↗
PubMed1998

The application of deproteinized bovine bone mineral for ridge preservation prior to implantation. Clinical and histological observations in a case report.

Alveolar ridge preservation following tooth extraction is important when implant-supported oral rehabilitation is considered. The ability to maintain the ridge allows implant placement in an ideal position, fulfilling both functional and esthetic demands. A deproteinized bovine bone mineral (DBBM) was used as a socket site filler material to maintain ridge configuration, without applying an occlusive membrane. The material was grafted and packed onto the socket sites immediately after extractions, and subsequently primary soft tissue closure was attempted. The ridge healed for 9 months before the second surgical procedure, in which the implant was placed. New bone formation was observed in all histological specimens. DBBM particles adhered to a highly osteocyte-rich woven and lamellar-type bone. Clinically and histologically, this report demonstrated DBBM particles to be an effective biocompatible filler agent in extraction sockets for ridge preservation prior to titanium fixture implantation. Randomized controlled clinical trials are needed to fully evaluate the usefulness of this material in ridge preservation after tooth extraction.

Adult↗
PubMed1990

Factor VII deficiency first observed at preoperative routine clotting test.

Factor VII deficiency was first observed in a 24-year-old female in the routine clotting test for tooth extraction. Her factor VII was 22%, mildly below normal limits. Factor IX complex was not administered as replacement therapy when her impacted tooth was extracted. There was no sign of abnormal postoperative bleeding. As this disease was a rare disorder, the minimum safe level of factor VII for tooth extraction was unknown. We had a opportunity to study a patient with this disorder observed in the preoperative routine clotting test for tooth extractions.

Adult↗
PubMed2004

Assessment of NICE guidance on two surgical procedures.

The National Institute of Excellence (NICE) released its first guidance in 2000 on clinical procedures and technologies in England and Wales. Using hospital activity data, we looked at the effect of NICE guidance on wisdom tooth extraction and primary total hip replacement in the UK National Health Service. We selected hospitals that submitted their activity continuously between 1997 and 2002. Analysis of wisdom tooth extraction showed that NICE guidance was not the primary reason for the downward trend in extractions (p=0.8287); this trend was more likely to be attributable to previous guidance. For total hip replacement there was no significant change in behaviour away from use of non-cemented hip prostheses. Therefore, NICE guidance has had little effect on behaviour for these two procedures.

Arthroplasty, Replacement, Hip↗
PubMed1995

Salivary cortisol response to dental treatment of varying stress.

The physiologic stress of various dental procedures (dental examination, dental prophylaxis, restoration, root canal therapy, and tooth extraction) was measured in 50 nonsmoking healthy men between the ages of 18 and 55 years (mean 34.6 years, range 21 to 53 years) with a salivary cortisol assay. Expectorated saliva was collected at four time points: 10 minutes before the start of the procedure, 15 minutes after the patient was seated, at the end of the procedure, and 1 hour after the completion of the procedure. Of the 196 samples included for analysis, mean cortisol values ranged from 0.1 to 3.8 micrograms/dl with a recovery of 100% +/- 8.4%. The mean cortisol value for the extraction group (1.09 +/- 0.42 microgram/dl) was significantly different (p < 0.05) from the mean values of the examination (0.46 +/- 0.10 microgram/dl), prophylaxis (0.64 +/- 0.64 microgram/dl), root canal (0.49 +/- 0.07 microgram/dl), and restorative (0.60 +/- 0.04 microgram/dl) groups as determined by the Duncan's multiple range test. Cortisol levels decreased from the initial reading to the end of the procedure by about 15% for patients undergoing an examination, root canal, and restorative procedure. Cortisol levels at the end of the procedure were elevated in the prophylaxis (55%) and extraction (148%) groups compared with the baseline cortisol recording. A minority of patients in the prophylaxis group had elevated cortisol levels throughout dental treatment, whereas cortisol levels were elevated during treatment in 80% of patients undergoing extraction. These data suggest that the adrenal stress response associated with tooth extraction(s) is greater than that associated with other routine dental procedures.

Adolescent↗
PubMed1999

Factors predictive of anxiety before oral surgery: efficacy of various subject screening measures.

Recruiting anxious people for analgesic and anxiolytic studies allows greater opportunities to study the positive effects of anxiolytic medication. The purpose of this study is to describe a population recruited for a study of anxiolytic medication using the third molar model and to evaluate the relative efficacy of different measures of dental anxiety as recruitment tools. A concerted effort was made to recruit anxious subjects. The following measures were tested: Corah's Dental Anxiety Scale (DAS), Kleinknecht's Dental Fear Survey (DFS), Litt's Oral Surgery Confidence Questionnaire (OSCQ), and Spielberger's State-Trait Anxiety Inventory. The influence of prior experience with tooth extractions on anxiety was also assessed. Subjects who had previously experienced tooth extraction reported higher anxiety before oral surgery than did subjects without such experience. DAS, DFS and state anxiety scores correlated with anxiety reported before oral surgery. However, OSCQ scores and trait anxiety were not related to anxiety reported before surgery. Linear regression indicated that the DFS predicted anxiety before oral surgery best of all measures that were used. Kleinknecht's DFS is thus recommended for use as a tool for recruiting anxious patients.

Adolescent↗
PubMed2001

Pott's puffy tumor and epidural abscess arising from dental sepsis: a case report.

OBJECTIVE: To present an unusual case of two uncommon cranial complications of frontal sinusitis: Pott's puffy tumor and epidural abscess arising from frontal sinusitis of dental origin, and also two systemic complications of sinusitis: septicemia and empyema, all occurring in an immunocompetent patient. STUDY DESIGN: A 21-year-old man presented with a scalp swelling and epidural abscess. Magnetic resonance imaging and computed tomographic scans revealed unilateral opacification of the frontal sinus and an epidural abscess with a direct connection to the scalp abscess. Further history revealed that his symptoms occurred coincidentally with a tooth extraction 2 months before, and he was hospitalized soon after the tooth extraction for sepsis and a lung abscess. METHODS: A combined neurosurgical and otolaryngologic approach was required to treat the sinusitis and the associated epidural and scalp abscess. RESULTS: Cultures returned as Streptococcus intermedius from all three sites. The patient was free of disease at the 3-month follow-up. CONCLUSIONS: Odontogenic maxillary sinusitis is well documented; however, there is little reported of frontal sinusitis arising from dental disease. The prevalence of sinusitis of dental origin will be reviewed, including the microbiology of this particularly virulent organism that persisted despite earlier treatment with ampicillin. Also, the current thoughts on management of these cases will be discussed with particular reference to local therapy for sinusitis in addition to systemic treatment with antibiotics.

Abscess↗
PubMed2005

Factors influencing referral of children for dental extractions under general and local anaesthesia.

OBJECTIVE: To investigate the relative importance of a range of explanatory variables concerning why child patients in Scotland enter pathways for tooth extractions under either Dental General Anaesthesia (DGA) or local anaesthesia (LA). BASIC RESEARCH DESIGN: A cross-sectional study was carried out involving DGA centres across Scotland. Data collected related to demographic characteristics of child DGA patients, reported anxiety and dental attendance levels of patients and parents, reasons given by referring practitioners for requesting DGA, number and type of teeth extracted and parental beliefs and attitudes to DGA. Similar data were collected relating to children having teeth extracted in primary care under LA. Multivariate analysis was performed to determine which factors were the best predictors of anaesthetic choice. RESULTS: 425 and 121 children having dental extractions under DGA and LA respectively participated. Ninety-six percent of DGA cases and 48% of LA patients had extractions for caries. For DGA cases, the mean age was 6.7 years, an average of 5.3 teeth were extracted and dental anxiety levels were higher than population norms. Multivariate analysis found the number of teeth extracted was the major predictor of anaesthetic type. On removing this variable, age became the most important factor, with 99% of children under 5.5 years receiving a DGA. Among DGA patients, 25% were reported to have had a previous DGA for tooth extraction. CONCLUSIONS: Future reductions in DGA numbers will be dependent on decreasing the number of young children presenting with advanced caries in multiple teeth. Consequently, guidelines are required concerning the prevention and appropriate management of caries in the primary dentition.

Adolescent↗