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PubMed2003

[Experimental study on selecting optimal time of orthodontic tooth movement into extraction sites].

OBJECTIVE: The purpose of this study was to investigate the physiological process of healing after tooth extraction and the biological reaction of tooth movement into extraction sites with the aim of selecting optimal time of tooth movement into extraction sites clinically. METHODS: Extraction of upper first molars were performed on 30 male Sprague-Dawley rats which were divided equally into 5 groups. Orthodontic appliance was placed at different time after tooth extraction in order to move the maxillary second molars mesially into the extraction spaces. The animals were injected continuously with tetracycline and calcein for two days before appliance activation and animal sacrifice. Undecalcified mesio-distal specimans 65-100 microns of thickness were prepared. The quantification of bone remodeling parameters on tooth movement into extraction sites at different time was performed by histomorphometric measurements and computer image analysis. RESULTS: 1. The bone turnover had two bone modeling processes: resorption under pressure and formation in tension. 2. The bone resorption was more active on the mesial surface (pressure side) than that on the distal surface (tension side). While bone formation was more active on the distal surface (tension side) than that on the mesial surface (pressure side). 3. Both the resorptive parameters and the formative parameters across time were manifested by a peak at day 7 after tooth extraction. CONCLUSION: 1. Orthodontic retraction into extraction sites should be initiated at an early stage after tooth extraction, so that the advantage of bone remodeling in extraction sites was used. 2. The optimal time of tooth movement into extraction sites clinically was about a week after tooth extraction.

Animals↗
PubMedDate not supplied

A retrospective study of 1925 consecutively placed immediate implants from 1988 to 2004.

PURPOSE: The purpose of the present study was to evaluate implant survival rates with immediate implant placement (IIP) into fresh extraction sockets and to determine risk factors for implant failure. MATERIALS AND METHODS: A retrospective chart review was conducted of all patients in whom IIP was performed between January 1988 and December 31, 2004. Treatment required atraumatic tooth extraction, IIP, and mineralized freeze-dried bone allograft with an absorbable barrier to cover exposed implant threads. Implant failure was documented along with time of failure, age, gender, medical history, medications taken, postsurgical antibiotic usage, site of implant placement, and reason for implant failure. Statistical analysis was performed using chi-square and logistic regression analysis methods. RESULTS: A total of 1925 IIPs (1398 machined-surface and 527 rough-surface implants) occurred in 891 patients. Seventy-one implants failed to achieve integration; a total of 77 implants were lost in 68 patients. The overall implant survival rate was 96.0% with a failure rate of 3.7% prerestoration and 0.3% postrestoration. Machined-surface implants were twice as likely to fail as rough-surface implants (4.6% versus 2.3%). Men were 1.65 times more likely to experience implant failure. Implants placed in sites where teeth were removed for periodontal reasons were 2.3 times more likely to fail than implants placed in other sites. Patients unable to utilize postsurgical amoxicillin were 3.34 times as likely to experience implant failure as patients who received amoxicillin. CONCLUSIONS: With a 1- to 16-year survival rate of 96%, lIP following tooth extraction may be considered to be a predictable procedure. Factors such as the ability to use postsurgical amoxicillin and reason for tooth extraction should be considered when treatment planning for IIP.

Adolescent↗
PubMed2006

Immediate provisional restoration of postextraction implants for maxillary single-tooth replacement.

The timing of implant placement and loading following tooth extraction has recently undergone substantial reconsideration. The authors tested a protocol of immediate loading of single implants placed at the time of tooth extraction in a consecutive case series. Thirty-three patients received a single implant-supported crown to replace a maxillary anterior tooth at the time of extraction. Regular recalls were planned for the following 4 years. One implant did not integrate, and another became unstable secondary to facial trauma. Overall patient satisfaction and clinical and radiographic parameters were good.

Adult↗
PubMed2001

Treatment of replacement resorption with Emdogain--preliminary results after 10 months.

Ankylosis of traumatized teeth in children and adolescents may inhibit further development and growth of the corresponding jawbone. Therefore, ankylosed teeth should be removed. As an alternative treatment option to autotransplantation of a premolar, intentional replantation using Emdogain may be considered, provided the ankylosis is detected at an early stage or has only affected a small area of the root. Eleven ankylosed teeth presenting with replacement resorption were treated as follows: after tooth extraction, the root canal was treated extraorally and obturated by retrograde insertion of a titanium post. Emdogain was applied to the root surface and into the extraction socket with subsequent replantation of the tooth. During a mean follow-up period of 6.3 months, no signs of recurrence of ankylosis were noted. The horizontally and vertically measured Periotest scores were identical to those obtained on the adjacent teeth. These results suggest that intentional replantation using Emdogain may prevent or delay ankylosis of these replanted teeth.

Adolescent↗
PubMed2004

Brain abscess after milk tooth self-extraction.

Brain abscesses are rare, especially in children, but they can be life-threatening infections. To date, dental pathology has been linked to only a small number of brain abscesses. To our best knowledge this is the first reported case of a brain abscess following self-extraction of a milk tooth. We are reporting on a 12-year-old previously healthy boy who developed a brain abscess in the vicinity of the left precentral gyrus. Clinical examination prior to surgery showed a severe right hemiparesis, more pronounced in his leg. We performed an ultrasonographically guided puncture and aspiration of the abscess through a small craniotomy. Immediately after the procedure he became hemiplegic. Bacteriological examination of the aspirated pus revealed Streptococcus intermedius, Streptococcus beta-haemolyticus group F, Fusobacterium species and gram-negative rods. The same species of microorganisms were identified in a smear from the vicinity of the extracted tooth. The patient was carefully screened for possible other sources of infection, but none was found. Following appropriate antimicrobial treatment he recovered completely and returned home without any neurological deficit.

Anti-Bacterial Agents↗
PubMed2004

Anxiety measurements in university students undergoing third molar extraction.

OBJECTIVE: This investigation was conducted to quantitate the anxiety associated with third molar extraction in university students, and to compare the measured anxiety before and after extraction and between men and women, first and second extraction, and impacted versus nonimpacted tooth extraction. STUDY DESIGN: The Japanese version of The State-Trait Anxiety Inventory (STAI), a psychological test, was given to 108 students undergoing third molar extraction. The students completed the test on the first examination (day 1), immediately before the extraction (day 2), and the day after the extraction (day 3). RESULTS: The state anxiety (STAI-S) score showed no significant difference between days 1 and 2, but the score on day 3 was lower than that on day 1, with a decrease in cases with a stage IV or V. Women showed more anxiety state on day 2 than men. The anxiety score on days 2 and 3 for the second extraction were significantly lower than those for the first extraction in 43 students who underwent third molar extractions twice. The change in the trait anxiety (STAI-T) stage was unremarkable among days 1, 2, and 3. No statistical difference was found in the anxiety between students undergoing impacted and nonimpacted third molar extraction. CONCLUSIONS: The anxiety status of students undergoing third molar extraction could be quantitatively evaluated using the STAI. The results of this investigation may provide oral maxillofacial surgeons with useful information about patients' anxiety throughout the tooth removal process.

Adolescent↗
PubMed2005

Treatment options following single-rooted tooth removal: a literature review and proposed hierarchy of treatment selection.

BACKGROUND: Alveolar bone changes following tooth extraction have been well documented and have given rise to a number of treatment approaches. Included in these approaches are placement of various grafting materials, immediate implant placement, and a combination of both. METHODS: A review of all pertinent literature discussing regenerative therapy at the time of tooth extraction or immediate implant placement with or without concomitant regenerative therapy was carried out. RESULTS: A clinically-based hierarchy of treatment selection following extraction of single rooted teeth is proposed, based upon the available literature and clinical experience. The role of patient phenotype is considered. CONCLUSION: Utilization of the proposed hierarchy of treatment selection affords a logical framework within which to predictably treat a variety of patients.

Alveolar Bone Loss↗
PubMed2005

Immediate implant placement: diagnosis, treatment planning and treatment steps/or successful outcomes.

Diagnosis and treatment planning are key factors in achieving successful outcomes after placing and restoring implants placed immediately after tooth extraction. The efficacy of immediate implant placement has been established and shown to be predictable if reasonable guidelines are followed. Some or all of the following suggestions, depending on individual circumstances should be considered when evaluating a patient for dental implants: thorough medical and dental histories, clinical photographs, study casts, periapical and panogram radiographs, as well as a linear tomography or computerized tomography of the proposed implant sites. Reasons for tooth extraction include, but are not limited to, insufficient crown to root ratios, remaining root length, periodontal attachment levels, periodontal health of teeth adjacent to the proposed implant sites, unrestorable caries, root fractures with large endodontic posts, root resorption, teeth with deep furcation invasions being considered as abutments for fixed partial dentures, and questionable teeth in need of endodontic retreatment. Teeth requiring root amputations, hemisections or advanced periodontal procedures may have a questionable prognosis, and patients should be given the implant option before these procedures are implemented. Similarly, nonvital teeth, fractured at the gingival margin with roots shorter than 13 mm should be considered for the implant option. This review will describe the steps for immediate implant placement at the time of extraction as well as the "gap" and socket preservation.

Animals↗
PubMed2002

Tooth extraction-induced internalization of the substance P receptor in trigeminal nucleus and spinal cord neurons: imaging the neurochemistry of dental pain.

Although pains arising from the craniofacial complex can be severe and debilitating, relatively little is known about the peripheral and central mechanisms that generate and maintain orofacial pain. To better understand the neurons in the trigeminal complex and spinal cord that are activated following nociceptive stimuli to the orofacial complex, we examined substance P (SP) induced internalization of substance P receptors (SPR) in neurons following dental extraction in the rat. Unilateral gingival reflection or surgical extraction of a rat maxillary incisor or molar was performed and tissues harvested at various time points post-extraction. Immunohistochemical analysis of brainstem and cervical spinal cord sections was performed using an anti-SPR antibody and confocal imaging. Both the number and location of neurons showing SPR internalization was dependent on the location and extent of tissue injury. Whereas extraction of the incisor induced internalization of SPR in neurons bilaterally in nucleus caudalis and the spinal cord, extraction of the molar induced strictly unilateral internalization of SPR-expressing neurons in the same brain structures. Minor tissue injury (retraction of the gingiva) activated SPR neurons located in lamina I whereas more extensive and severe tissue injury (incisor or molar extraction) induced extensive SPR internalization in neurons located in both laminae I and III-V. The rostrocaudal extent of the SPR internalization was also correlated with the extent of tissue injury. Thus, following relatively minor tissue injury (gingival reflection) neurons showing SPR internalization were confined to the nucleus caudalis while procedures which cause greater tissue injury (incisor or molar extraction), neurons showing SPR internalization extended from the interpolaris/caudalis transition zone through the C7 spinal level. Defining the population of neurons activated in orofacial pain and whether analgesics modify the activation of these neurons should provide insight into the mechanisms that generate and maintain acute and chronic orofacial pain.

Animals↗
PubMed2004

[Observation of the change of blood pressure in 835 patients during extraction of teeth].

PURPOSE: To observe the change of blood pressure during extraction of teeth. METHODS: Patients without hypertension who needed extraction were randomly selected, tooth extraction was carried out. The blood pressure and the patient's response to operation were observed and recorded during the procedure. RESULTS: The blood pressure in 825 patients increased significantly. The average increased blood pressure was 45/26 mmHg, 3 patients had arrhythmia, 5 patients had adverse reaction. CONCLUSION: The patient's blood pressure must be fewer than 140/90 mmHg, before a difficult extraction of teeth.

Adult↗
PubMedDate not supplied

Gingival degerming by povidone-iodine irrigation: bacteremia reduction in extraction procedures.

The purpose of this study was to find out whether or not a certain mouth wash, i.e. povidone-iodine, will reduce the incidence of bacteremia following tooth extraction. The sample was composed of twenty-six patients who were given gingival sulcus irrigation and rinsing prior to tooth extraction. Thirteen patients used povidone-iodine mouthwash and the other 13 patients with an identically matched placebo. Prior to irrigation and rinse, first blood sample is drawn and first gingival sulcus sample is taken. To complete the whole procedure, the patient rinsed with 10-20 ml of assigned coded mouthwash for 30 seconds and then repeated the rinsing after 2 minutes followed by 60 second irrigation with 10-20 ml of the same coded mouthwash, administered in the gingival sulcus and surrounding mucosa of the tooth to be extracted. A second gingival sulcus sample is taken then extraction is performed. A second blood sample is drawn within 3 minutes of extraction. Growth and reduction in bacteremia were determined before, during and after extraction procedure. Results indicated significant reduction in incidence of post-operative bacteremia with povidone-iodine as compared with placebo (P = .01558) and significant reduction in growth of gingival cultures with povidone iodine as compared with placebo (= .65337). Povidone-iodine mouthwash used as a rinse and gingival sulcus irrigant reduced the growth of gingival cultures and the incidence of post-operative bacteremia in more specimen compared to the placebo.

Anti-Infective Agents, Local↗
PubMed2005

Randomized study evaluating recombinant human bone morphogenetic protein-2 for extraction socket augmentation.

BACKGROUND: Conventional dentoalveolar osseous reconstruction often involves the use of grafting materials with or without barrier membranes. The purpose of this study was to evaluate the efficacy of bone induction for the placement of dental implants by two concentrations of recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered on a bioabsorbable collagen sponge (ACS) compared to placebo (ACS alone) and no treatment in a human buccal wall defect model following tooth extraction. METHODS: Eighty patients requiring local alveolar ridge augmentation for buccal wall defects (> or =50% buccal bone loss of the extraction socket) of the maxillary teeth (bicuspids forward) immediately following tooth extraction were enrolled. Two sequential cohorts of 40 patients each were randomized in a double-masked manner to receive 0.75 mg/ml or 1.50 mg/ml rhBMP-2/ACS, placebo (ACS alone), or no treatment in a 2:1:1 ratio. Efficacy was assessed by evaluating the amount of bone induction, the adequacy of the alveolar bone volume to support an endosseous dental implant, and the need for a secondary augmentation. RESULTS: Assessment of the alveolar bone indicated that patients treated with 1.50 mg/ml rhBMP-2/ACS had significantly greater bone augmentation compared to controls (P < or =0.05). The adequacy of bone for the placement of a dental implant was approximately twice as great in the rhBMP-2/ACS groups compared to no treatment or placebo. In addition, bone density and histology revealed no differences between newly induced and native bone. CONCLUSION: The data from this randomized, masked, placebo-controlled multicenter clinical study demonstrated that the novel combination of rhBMP-2 and a commonly utilized collagen sponge had a striking effect on de novo osseous formation for the placement of dental implants.

Absorbable Implants↗
PubMedDate not supplied

A 3-arm study of early loading of rough-surfaced implants in the completely edentulous maxilla and in the edentulous posterior maxilla and mandible: results after 1 year of loading.

PURPOSE: The aim of the present prospective study was to evaluate the concept of early loading of rough-surfaced implants in the completely edentulous maxilla and in the edentulous posterior mandible and maxilla. MATERIALS AND METHODS: Fifty-four consecutive patients were treated. Twenty patients were completely edentulous in the maxilla (group A), 19 patients were edentulous in the posterior left and/or right maxilla (group B), and 15 patients were edentulous in the posterior left and/or right mandible (group C). One patient in group B and 5 in group C were bilaterally treated. Two hundred thirty-four solid screw-type, sandblasted, large-grit, acid-etched (SLA) ITI implants were placed, 58 (25%) immediately after tooth extraction. Mean placement torque and standard deviations were measured at all sites. Sixty fixed prostheses were delivered after a mean delay of 9 days (range, 4 to 22 days). Mean marginal bone reduction was measured after 1 year of loading. RESULTS: Two implants were lost (0.9%), 1 before functional loading and 1 after 1 year. All other implants were clinically stable, with a mean marginal bone loss of 0.75 mm (+/-1.3 mm). Marginal bone loss ranged from 0 to 3.5 mm. Mean placement torque on implants placed in healed bone or immediately after tooth extraction ranged from 29.1+/-9.3 Ncm to 35.5+/-5.8 Ncm. No statistical difference was found (P > .05) between implants placed in healed bone and those placed immediately after tooth extraction. DISCUSSION: There is little documentation for immediate or early loading in the areas studied. However, in this study, favorable results were obtained in 54 consecutive patients in these regions. CONCLUSION: In this study population, early loading protocols can be applied with predictable results using rough-surfaced implants for rehabilitation of the completely edentulous maxilla, posterior maxilla, and posterior mandible.

Adult↗
PubMed2006

Interventions for replacing missing teeth: dental implants in fresh extraction sockets (immediate, immediate-delayed and delayed implants).

BACKGROUND: Dental implants can be placed in fresh sockets just after tooth extraction. These are called 'immediate' implants. 'Immediate-delayed' implants are those implants inserted after weeks up to about a couple of months to allow for soft tissue healing. 'Delayed' implants are those placed thereafter in partially or completely healed bone. The advantages of immediate implants are that treatment time can be shortened and that bone height might be maintained thus possibly improving the aesthetic results. The potential disadvantages are an increased risk of infection and failures of the immediately placed implants. OBJECTIVES: To evaluate success, function, complications and patient satisfaction between 'immediate', 'immediate-delayed' and 'delayed' implants. SEARCH STRATEGY: The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. Several dental journals were handsearched. The bibliographies of review articles were checked, and personal references were searched. More than 55 implant manufacturing companies were also contacted. Last electronic search was conducted on 7 August 2006. SELECTION CRITERIA: Randomised controlled trials (RCTs) and preference RCT evaluating immediate, immediate-delayed, and delayed implants, reporting the outcome of the interventions to at least 1 year after functional loading. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CIs). The statistical unit of the analysis was the patient. MAIN RESULTS: Two RCTs were included. One RCT compared immediate implants placed in periapical infected sites versus delayed implants in 50 patients and after 1 year found no statistically significant differences. The second RCT compared immediate-delayed versus immediate implants in 46 patients. After 1 year and a half there were no statistically significant differences for prosthesis and implant failures, complications, aesthetics assessed by the patient and the papilla height assessed by the dentist. However, patients in the delayed group perceiving the period between tooth extraction and insertion of the crown significantly longer than patients in the immediate-delayed group, mean difference of VAS -20.30 (95% CI -33.36 to -7.24). There was also statistically significantly higher patient satisfaction in the immediate-delayed group, mean difference (VAS) -6.51 (95% CI -12.63 to -0.39). An independent blinded assessor judged the level of the perimplant marginal mucosa in relation to that of the adjacent teeth as more appropriate in the immediate-delayed group, with risk ratio (RR) 1.68 (95% CI 1.04 to 2.72). AUTHORS' CONCLUSIONS: Despite that the evidence is derived from only two RCTs with a limited number of patients, it is possible to suggest that immediate implants and immediate-delayed implants may offer some advantages over conventional implants in healed sites in terms of patient satisfaction and aesthetics possibly by preserving alveolar bone. Immediate implants can work and are able to shorten treatment periods, however properly designed RCTs are still needed to fully evaluate the potential advantages and risks of this treatment modality since more complications and failures may occur.

Dental Implantation, Endosseous↗
PubMed1989

[Incidence of bacteremia following extractions--a double blind study on local disinfection using chlorhexidine].

In a randomised double-blind study the incidence of bacteremia after two minutes mouth rinsing with chlorhexidine 0.1% followed by tooth extractions was registered. A significant reduction of bacteremia could not be observed in comparison with mouth rinsing with physiological saline solution. Tooth extractions always require the preventive administration of antibiotics to patients known with high risk of endocarditis.

Chlorhexidine↗
PubMed1996

Bone regeneration in extraction sites after immediate placement of an e-PTFE membrane with or without a biomaterial. A report on 12 consecutive cases.

The efficacy in restoring a buccal dehiscence after tooth extraction has been studied in 12 consecutive cases using guided bone regeneration with (6 patients) or without (6 patients) a biomaterial (DFDBA or Bio Oss) beneath an e-PTFE membrane. A correlation between the clinical impression of density at drilling time and the histological signs of bone formation has been evaluated too. The membrane was removed after 6 or 9 months and a biopsy was performed. Clinically, GBR was highly predictable for regeneration of the alveolar bone after tooth extraction with buccal dehiscence. The histology fully confirmed the clinical and radiographical results, showing bone formation in all cases with individual variations in the amount of bone formed. 6-month biopsies from the membrane sites had lamellar bone with large medullary spaces, while a good bone density was observed at 9 months. The membrane/biomaterial sites demonstrated mineralization and large amounts of allograft at 6 months. Thus, bone regeneration seems to take more time when grafting material is used.

Alveolar Bone Loss↗
PubMed1997

The effect of premolar extractions on tooth-size discrepancy.

The purpose of this study is to investigate whether the extraction of four premolars as a requirement of orthodontic therapy is a factor in the creation of tooth size discrepancies, and to determine whether any tooth extraction combinations create more severe discrepancies. The study is carried out on the pretreatment dental casts of 50 patients with malocclusions. The dental casts were selected according to the main criteria. No tooth-size discrepancy between the mandibular and maxillary dental arches should exist before treatment. Pretreatment mesiodistal dimensions of mandibular and maxillary teeth were measured, recorded on a computer program, and subjected to Bolton's analysis. Hypothetical tooth extractions were performed on each patient by the following combinations: all first premolars, all second premolars, upper first and lower second premolars, and upper second and lower first premolars. The resultant measurements were again subjected to Bolton's analysis to see whether a tooth-size discrepancy had been created. The results were evaluated statistically by the use of paired samples t test. The difference between the pretreatment and postextraction Bolton values was found statistically significant for the first premolar extraction and insignificant for the others. The removal of the four first premolars created the most severe tooth-size discrepancy, whereas the extraction of all four second premolars created fewer discrepancies and the smallest range in the size of discrepancies. The results of this study indicate a new point of view to the question of which teeth to extract when evaluated for tooth size aspect only.

Bicuspid↗
PubMed2006

Clinical impact of oral health indexes in dental extraction of hemophilic patients.

PURPOSE: Periodontal disease in patients with hemorrhagic disorders may lead to severe bleeding during dental treatment. This study evaluated the clinical impact of oral health indexes in hemophilic patients undergoing tooth extraction. PATIENTS AND METHODS: Thirty-one hemophilic patients underwent teeth extractions using autologous fibrin glue and an oral antifibrinolytic drug (epsilon-aminocaproic acid). Oral health indexes (plaque, PI; gingival, GI; and decay-missing-filling-teeth, DMFT index) were evaluated before tooth extraction. RESULTS: Postsurgical bleeding episodes were observed in 6 hemophilic patients (1 severe, 3 moderate, and 2 mild type). The PI and GI index in the bleeding group were 1.8 and 1.7, respectively, and 1.8 for both of the non-bleeding groups (PI, P = .8; GI, P = .56). The global DMFT index was 18 in the bleeding group and 19.6 in the non-bleeding group (P = .67). CONCLUSION: The status of oral health did not interfere with bleeding caused by dental extraction of hemophilic patients.

Adolescent↗