AN EXPERIMENTAL STUDY OF THE EFFECT OF GROWTH HORMONE, THYROTROPIN AND THYROXIN ON BONE CHANGES IN THE ALVEOLAR SOCKET AND ITS SURROUNDINGS.
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Our aim was to investigate the occurrence of bacteremia associated with removal of a semirigid osteosynthesis plate and an adjacent third molar. Ten patients with fixed mandibular angle fracture were bacteriologically sampled from the second molar's distal gingival pocket, from the third molar's extraction socket and from the osteosynthesis plate. Blood samples from the ante-cubital vein were taken 10 times until 30 min postoperatively. Established culture, isolation and identification methods for the bacterial species were used. Bacteremia was detected in 60% of the subjects, most frequently 1.5 min after removal of the plate (20%) and 1.5 and 5 min after extraction of the tooth (20%), but also 10 min (10%) and 30 min (10%) postoperatively. 13 different bacterial species or groups were isolated, mean 2.5 +/- 1.9 per bacteremia-positive subject. The majority (85%) were anaerobes with Actinomyces, Campylobacter and Lactobacillus species predominating. In all the blood culture-positive cases the corresponding species was also recovered from one or more of the oral samples. These results show that oral surgical procedures are associated with a high frequency of longstanding anaerobic bacteremia, which could be harmful in patients at risk.
The search for a biodegradable material which may be placed in a fresh extraction socket to facilitate healing and prevent localized osteitis is a project which continues to hold much interest for oral surgeons. Polylactic acid is a biodegradable material which appears to have some promise in this area. The present study was devised to compare polylactic acid with two commonly used biodegradable substances and natural healing in order to determine the tissue response and suitability of polylactic acid as a treatment modality in fresh extraction sites. The over-all results were very satisfactory. The polylactic acid was well tolerated and did not interfere with the healing process.
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PURPOSE: The purpose of this study is to identify surgical outcomes in third molar surgery when no sutures are used for primary closure. PATIENTS AND METHODS: A total of 1,280 third molars were removed from 366 patients in an outpatient setting using intravenous sedation and local anesthesia. A small V-shaped flap was raised in all cases and no sutures were placed over a 2-year period (2001 to 2003). All people were contacted by a registered nurse within 24 hr. All records were reviewed by a medical investigator and IRB approval was obtained. RESULTS: The mean age was 22.14 years, males 39%, females 61%, white 75%, African American 22%, and Asian 3%. Ninety-three people of 366 experienced at least 1 complaint. Alveolar osteitis was 2.81% for the total teeth extracted and 10.7% for the mandibular Class IV impactions. A total of 652 mandibular third molars were removed (Class III, n= 113; Class IV, n= 522). Forty-eight of 366 patients (13.1%) had postoperative diagnosis of alveolar osteitis. CONCLUSIONS: Small flap third molar surgery without sutures is less invasive and saves time. Delayed healing in oral surgery is not new. The outcome of 1,280 extractions demonstrates good results.
A double-blind, placebo-controlled trial was carried out to study the value of cones containing sulfanilamide and sulfathiazole in the healing of third molar sockets. On the seventh postoperative day, 94 patients were examined regarding pain, swelling and the overall effect of the operation. Trials were run to compare sulfa cones directly with a placebo: in addition, the placebo and sulfa drugs were each compared with the effects of no medication. Pairs were made of the left and right mandibular third molars in the same patient and the results assessed by sequential analysis. It was found that although sulfa cones were better than the placebo, they themselves were no better or worse than leaving the socket alone.
Eight volunteer patients free of any systamic disease underwent extraction of two teeth on the same day. One extraction socket was packed with Alvogyl, the other served as a control wound. Biopsies for histological assessment were taken from both sockets 1 and 2 weeks after extraction. Histological study revealed the normal sequence of wound healing in the sockets allowed to heal spontaneously. On the other hand, the signs of retarded wound healing (acute inflammatory infiltrate, persistent granulation tissue, failure to form connective tissue scar and frequent foreign bodies/foreign body giant cells) were encountered in the sockets packed with Alvogyl. On the basis of these preliminary results, it seems warranted to state that the systematic use of Alvogyl as a preventive and curative treatment for postextraction alveolar infections cannot be advocated.
OBJECTIVE: The purpose of this study was to evaluate whether immediate placement of medicated dry socket packing would decrease the incidence of alveolar osteitis (dry socket) with lower third molar extractions. STUDY DESIGN: In 100 patients, 200 lower third molars were extracted. One half of the sockets were packed to the crest of the alveolar ridge with a one-quarter-inch radiograph-detectable filament gauze that contained 9% eugenol, 36% balsam of Peru, and 55% petroleum jelly. The medicated packing was removed 1 week after surgery. None of the patients were taking antibiotics. Patients were instructed to increase their oral hygiene before and after surgery and were to use 0.12% chlorhexidine gluconate 2 days before and 3 days after surgery. RESULTS; Two hundred bilateral lower third molars of varying difficulty were extracted. The overall alveolar osteitis rate was 34 (17%). The immediately packed lower third molar sites had an alveolar osteitis rate of 8 (8%). The sockets that were not packed with medicated packing the day of surgery had an alveolar osteitis rate of 26 (26%). The difference was statistically significant (P =.001). CONCLUSION: The results of this study suggest that placement of medicated dry socket packing immediately after lower third molar extraction decreases the alveolar osteitis rate.
Post-procedural complications were assessed for 331 patients with AIDS after a wide range of outpatient dental procedures. Only patients with a CD4+ cell count < or = 200 cells/mm3 were included. Patients' charts were reviewed retrospectively by the treating dentist. The overall complication rate was 0.9 percent.
Anti-inflammatory drugs should impair wound healing, which may explain why they have been used to only a limited extent to relieve pain. If they are to have maximal effect they must be started before the operation. In the present study, single doses of the non-steroidal anti-inflammatory agent diclofenac or of diclofenac and the corticosteroid methylprednisolone were given before operation, and the effects on wound healing after operative extraction of third molars were recorded. Patients developed 18 postoperative complications (5%), the most common of which was alveolar osteitis (n = 14), followed by bleeding (n = 3) and infection (n = 1). Pretreatment with diclofenac alone or in combination with methylprednisolone did not result in a notable increase in the incidence of complications as compared to placebo.
A buccal plate destroyed by the inflammatory process as a result of a longitudinal root fracture was completely restored by the combined use of an IMZ implant placed in the alveolus of the fractured maxillary central incisor and the principles of guided tissue regeneration. A Gengiflex membrane was used to cover the implant, and porous hydroxyapatite was used as grafting material. At the 6-month reentry, the defect around the implant was completely filled by mineralized tissue.
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