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PubMed1994

Human immunodeficiency virus serostatus and the risk of postextraction complications.

Despite the increasing prevalence of human immunodeficiency virus (HIV) disease in the population and the increasing likelihood that HIV-positive (HIV+) patients may have an extraction, little is known about the risk of postoperative complications in this group. The goal of this investigation was to assess the risk of postoperative complications in HIV+ patients after tooth extraction. The study was designed as a retrospective cohort study with a sample consisting of 145 males who underwent tooth extraction. The patients' medical and dental records were reviewed to identify HIV serostatus, to document the frequency and type of postoperative complications, and to collect data on potential confounding variables. Forty-four patients were identified as HIV+. The postoperative complication rate in HIV+ patients was 20.9% and for HIV-negative (HIV-) patients 2.9% (relative risk = 7.0, 95% confidence interval = 2.0-25.0, P = 0.001). Furthermore, as the manifestations of the symptoms of HIV infection became more severe, the postextraction complication rate also increased (P = 0.008). The results of this study suggest that HIV+ patients have an increased risk of postextraction complications and as the level of HIV disease increases, the risk of complications also increases. While the findings of this study are consistent with studies based on case series, prospective cohort studies are required to confirm the findings.

AIDS-Related Complex↗
PubMed1993

Metastatic tumors to postextraction sites.

Review of the literature revealed 55 cases where tooth extraction preceded the discovery of metastases. The lung and breast were the most common sources of the metastasis, and the mandibular premolar area was the most common site. A soft tissue mass extruding from a recent extraction wound, and accompanied by pain, were the main symptoms in most patients. The mean time from discovery of the metastasis to death was 3.8 months. Tooth extraction appears to serve as a promoting factor in the metastatic process. A case of metastatic transitional cell carcinoma of the urinary bladder involving the area of a recently extracted mandibular third molar is reported.

Carcinoma, Transitional Cell↗
PubMed2003

Influence of body mass index and the time of edentulousness on the residual alveolar ridge resorption in complete denture wearers.

Alveolar bone loss (RRR) is a continuous process following tooth extraction, more pronounced during the first few months after the tooth extraction than later. The RRR in the mandible is twice that of the maxilla during a 1-year period and the mandibular: maxillary resorption ratio increases further to 4:1. So far, the etiology of RRR has not been elucidated. It has been speculated that both systemic and local factors contribute. The aim of this study was to analyse the rate of RRR in five different regions of both jaws on lateral cephalograms of 100 complete denture wearers during a one-year period and to compare the rate of RRR between patients being edentulous over a different period of time and between patients with different body mass index. The height of residual ridges was measured on 5 different sites at the delivery of the dentures and a year later using a calibrated grid. The results revealed significant RRR in a one year period. Body mass index had no significant influence on the rate of RRR on any of the five examined sites of the maxilla or the mandible (p > 0.05), while the period of edentulousness had a significantly higher rate of resorption in first 3 sites of measurement (anteriorly) in patients being edentulous less than 1 year than in patients being edentulous for 1-10 years or for over 10 years (ANOVA, p < 0.05).

Alveolar Bone Loss↗
PubMed1976

Comparing ridge resorption with various surgical techniques in immediate dentures.

The three surgical techniques of simple tooth extraction and labial plate and intraseptal alveoloplasty were compared. The results were confirmed by statistical analysis. The conclusion of this study clearly indicated that simple tooth extraction is the best surgical approach to be followed to preserve as much of the residual alveolar ridge as possible.

Alveolar Process↗
PubMed2003

[Logistic regression model analysis on Bolton ratio of orthodontic extraction model].

OBJECTIVE: The purpose of this study was to evaluate the role of Angle's class, overall ratio and anterior ratio in the creation of tooth size discrepancies, and to determine whether any tooth extraction combinations create more severe discrepancies. METHODS: 166 dental casts of orthodontic patients were selected randomly. These models were classified according to angle's criterion. Mesio-distal dimensions of mandibular and maxillary teeth were measured before treatment, and subjected to Bolton's analysis. Hypothetical tooth extraction by the following combinations: all the first premolars, all the second premolars, upper first and lower second premolars, and upper second and lower first premolars, was performed on each patient. The measurement results were again subjected to Bolton's analysis to see whether any tooth-size discrepancy had been created. The results were evaluated statistically by means of Logistic regression model. RESULTS: Overall ratio, anterior ratio and extraction models affected mesio-distal tooth size ratio of both maxillary and mandibular teeth in the final stage of orthodontic treatment, Whereas, the results showed no significant difference among these groups of malocclusion. CONCLUSION: The results suggested that dentists should always keep in mind that each patient should be treated individually and should be aware of that other factors also played important roles in determining what teeth, if any, should be removed and the Bolton analyses of all kinds of extraction models should be carried out, as well as the general Bolton analysis.

Adolescent↗
PubMed1994

The effect of occlusal loss on normal and pathological temporomandibular joints: an animal study.

The effect of unilateral posterior malocclusion on temporomandibular joint intra-articular pathology was studied in sheep. In Group I, osteoarthritic changes were induced in the left temporomandibular joint by gentle scraping of the articular surface (Ishimaru and Goss, 1992). Group II had the same procedures as Group I, with concurrent extraction of all the left maxillary posterior teeth. Group III had a different osteoarthritic precondition in the left temporomandibular joint, allowing synovial fluid to contact the condylar marrow (Ishimaru et al., 1992). Group IV had the same procedure as Group III, with concurrent extraction of all the left maxillary posterior teeth. Group V had unilateral maxillary molar teeth extraction in the left side. At 3 months, the animals were sacrificed and the joints examined histologically. There were no significant differences between normal control joints and those with unilateral tooth extraction (Group V). Similarly the degree of osteoarthritic change was the same between Groups I and II. Significant differences (p < 0.05) were seen between Groups III and IV with tooth extraction increasing the osteoarthritic effects. Hence it was concluded that in sheep, malocclusion had no effect on the normal temporomandibular joint and on one type of experimental osteoarthritis, but accelerated osteoarthritic change in another model.

Alveolectomy↗
PubMed1996

[Oral surgical procedures during anticoagulant therapy].

Minor oral surgery, in patients being treated with anticoagulant therapy, constitutes a problem for the oral and maxillofacial surgeon. 77 patients getting coumarin underwent 168 oral surgical procedures (tooth extraction, apicoectomy, crown-lengthening, excision of lesions) without lowering the dose of anticoagulant. Local hemostasis was achieved in all cases by silk suture. For tooth extraction gelfoam was used as well. In 12 patients who presented with postoperative bleeding, it was controlled in all by gauze pressure with tranexamic acid and/or biologic glue and/or surgical splinting. Postoperative bleeding was not correlated with the international normalized ratio (INR), but with degree of local inflammation. The study shows that interruption of anticoagulant therapy in such cases is not justified, and the use of tranexamic acid or biological glue can control bleeding.

Adult↗
PubMed2005

Prospective evaluation of the systemic inflammatory marker C-reactive protein in patients with end-stage periodontitis getting teeth replaced with dental implants: a pilot investigation.

OBJECTIVES: Serum C-reactive protein (CRP) has been shown to be a risk predictor for cardiovascular disease. Periodontal treatment reduces elevated CRP levels. The aim of this pilot investigation was to evaluate if dental implants placed after extractions in patients with end-stage periodontitis affect the serum CRP levels. MATERIAL AND METHODS: Serum CRP levels in 10 subjects with end-stage periodontitis were measured prior to tooth extraction and placement of dental implants, and at 3-month intervals for a year post-operatively. Univariate repeated measures analysis of variance was used to estimate and test the changes in CRP levels over time. RESULTS: Mean CRP levels decreased significantly following tooth extraction and replacement with dental implants from 3.45 to 1.55 mg/dl after 12 months (P < 0.01). Six-, 9-, and 12-month post-implant placement mean CRP values were statistically significantly different from the mean pre-operative CRP value (P < 0.01). CONCLUSIONS: The pilot data suggest that extraction of advanced periodontally involved teeth and their replacement with dental implants lead to a decrease in CRP levels, and dental implant placement does not change the lowered CRP levels over a 12-month period.

Aged↗
PubMed2003

Litigation and the lingual nerve.

PURPOSE: A "malpractice crisis" exists in the United States. Litigation analysis helps to understand the causes and may be useful in prevention of suits. This study reviews litigation regarding the lingual nerve. MATERIALS AND METHODS: Jury verdict reports were obtained from a computerized legal database for the years 1987 through 2000. The study reviews all state and federal civil trials in the United States. Reviews compile information on plaintiffs and defendants, allegations of wrong-doing, reasons for litigation, anatomic sites of injuries, specialties of expert witnesses, verdict results, and awards received. RESULTS: Thirty-three suits from 12 states were obtained. Dentists or oral surgeons were involved in 87%, and otolaryngologists were involved in 13% of suits. Tooth extractions were involved in 79%, and 50% of these resulted in financial awards. Lack of informed consent was alleged in 52% of suits overall and in 46% of tooth extraction suits. Expert witnesses were of the same specialty for both sides in 81%. Inadequate training and selection of the wrong surgical approach were alleged in 18% and 15%, respectively. Anatomic variations were thought to be present in 15%. CONCLUSIONS: Surgeons must be aware of anatomic variations and regions in which injury to the lingual nerve frequently occurs. Written informed consent may help decrease litigation in known risk regions.

Compensation and Redress↗
PubMed1989

[Cardiotoxicity of local anesthetics: dynamic electrocardiogram study].

Twenty-two cardiopathic patients (mean age 54.4 +/- 9.9 years) underwent dynamic electrocardiography during tooth extraction under local anesthesia (mepivacaine hydrochloride 2% plus adrenalin 1:200.000). Heart rate (p less than 0.001), systolic and diastolic blood pressure (p less than 0.001) significantly increased during tooth extraction returning to values near to basal level in the recovery period. No patients showed significant changes in ST segment. One patient with chronic atrial fibrillation presented an increase in ventricular rate (180 beats/min) and appearance of premature ventricular beats, spontaneously regressed. In conclusion, in cardiopathic patients dental operations by local anesthesia with vessel constriction it is possible, provided estimated clinical conditions of patients.

Adult↗
PubMed2001

Freestanding and tooth-implant connected prostheses in the treatment of partially edentulous patients. Part I: An up to 15-years clinical evaluation.

In 123 patients, 339 implants were connected to 313 teeth by means of fixed partial prostheses (test) and followed up for 1.5-15 years (mean: 6.5). In another ad random selected 123 patients, 329 implants were connected to each other by means of 123 freestanding fixed partial prostheses (control) and were followed up for 1.3-14.5 years (mean: 6.2). The aim of this study was to compare both treatment modalities with each other based on implant, tooth and prosthesis complications. The cumulative implant success, based on implant immobility and/or lack of implant fractures after loading, in the test and control groups amounted to 95% and 98.5%, respectively. Although in the test group 10 implants versus only 1 in the control group failed, a regression analysis of the survival data, based on the cox proportional hazards model, revealed no significant difference. In the test group periapical lesions (3.5%), tooth fracture (0.6%) and tooth extraction due to fatal decay or periodontitis (1%) were observed, besides tooth intrusion (3.4%) and crown cement failure (8%). Framework fracture occurred in 3 patients. In the control group, only 2 abutment screws fractured. The treatment of partial edentulism by means of oral implants was beneficial for our patients. Because of a clear tendency of more implant failures (mobility or fractures) and tooth complications in the tooth-implant connected prostheses, the freestanding solution is the primary option to be considered. To avoid intrusion of abutment teeth, the connection, if made, should be completely rigid.

Adult↗
PubMed1993

Is phantom tooth pain a deafferentation (neuropathic) syndrome? Part I: Evidence derived from pathophysiology and treatment.

Phantom tooth pain is a syndrome of persistent pain or paresthesia in teeth and other oral tissues that may follow dental or surgical procedures such as pulp extirpation, apicoectomy, tooth extractions, or exenteration of the contents of the maxillary antrum. It can also occur when nerves are injured after trauma to the face or even after routine inferior alveolar nerve blocks if the needle pierces the nerve sheath. In the case of tooth extraction, the pain is found in the edentate area. After periodontal surgery, pain or paresthesia is located in the gingiva. The incidence of phantom tooth pain after extirpation may be as high as 3% of cases. Clinically, phantom tooth pain is similar in many essential characteristics to deafferentation pain syndromes also known as phantom pain syndromes. A limitation to this taxonomy is the lack of definitive information with respect to the pathophysiology of deafferentation pain in the trigeminal nerve. This article amplifies previous clinical descriptions of phantom tooth pain. Current concepts in the pathophysiology of neuropathic pain are reviewed as they pertain to phantom tooth pain. Treatments are described that use three routes of drug administration: oral, nerve blocks by injections, and intranasal applications. Reasons are discussed for the high rates of morbidity after dental and neurosurgery in attempts to treat phantom tooth pain.

Afferent Pathways↗
PubMed1984

Connective tissue reattachment as related to presence or absence of alveolar bone.

The present study was designed to examine if alveolar bone, located adjacent to a root surface deprived of its periodontal ligament and cementum layer, can stimulate the reformation of a connective tissue attachment. The maxillary and mandibular incisors in 3 monkeys were extracted. Immediately after tooth extraction, the buccal root surfaces of the incisors from the left side of the jaws were planed by means of curettes to a level corresponding to half the root length. All teeth were then reimplanted into their original sockets. However, before tooth reimplantation, the buccal alveolar bone plate was removed in 2 of the monkeys to a level corresponding to half the depth of the sockets. The animals were sacrificed 6 months after the reimplantation procedure. The jaws were removed and histological sections of the experimental teeth and adjacent periodontal tissues were produced. The sections were analyzed in the microscope and subjected to histometric measurements. The results demonstrated that, irrespective of the presence or absence of alveolar bone, a fibrous reattachment failed to form on that part of the reimplanted teeth which had been deprived of their periodontal ligament. This indicates that alveolar bone located adjacent to a root surface may have limited influence on the biological conditions which determine whether periodontal healing results in connective tissue reattachment or new attachment.

Alveolar Process↗
PubMed2005

Incidence and bacteriology of bacteremia associated with various oral and maxillofacial surgical procedures.

OBJECTIVE: The aim of this study was to determine the incidence and bacteriology of bacteremia associated with various oral and maxillofacial surgical procedures. METHODS: A total of 237 patients who underwent oral and maxillofacial surgery were included in this study. Blood samples were obtained for bacteriological examination immediately after the essential steps of the surgical procedure had been performed. RESULTS: Bacteremia was detected in patients who underwent surgery for tumor, infection and trauma, and surgical reconstruction of jaw. In particular, decortication for osteomyelitis and tooth extraction resulted in a higher incidence of bacteremia compared with other surgical procedures. The incidence of bacteremia was not affected by oral hygiene, gingival inflammation, blood loss, and duration of surgery. Furthermore, concerning tooth extraction, there was no statistical difference in the incidence of bacteremia with respect to the number of teeth extracted and the method of extraction. Extraction of teeth with odontogenic infection (periodontitis, periapical infection, and pericoronitis) did however produce a significantly increased incidence of bacteremia compared with infection-free teeth (P < .01). Viridans streptococci were the predominant group of bacteria isolated from the bacteremias. CONCLUSION: Oral and maxillofacial surgery involving transoral incision produces bacteremia, regardless of the extent and degree of surgical invasion. In particular, surgical procedure at infected sites is more likely to result in bacteremia compared with infection-free sites.

Adult↗
PubMed1991

[Tissue response after preparation of implant cavity].

UNLABELLED: The purpose of this study is to discuss the structural changes of the surrounding tissue around the implant cavity when the influence of tooth extraction is still remaining. At 3 months after the extraction of the dog lower teeth, implant cavities were prepared. Histological examinations were performed on the specimens at 30 minutes, 2 days, 5 days and 10 days. RESULTS: 1) At 3 months after the tooth extraction, enhanced bone remodeling looks like a typical one in the compact bone area. 2) The bones formed after the extraction, by alternate resorption and formation with time, were replaced by higher differentiated ones. 3) At 5 days, by the implant cavity formation, bone addition is seen on the inner and outer surfaces of the compact bone. 4) Inside the extraction socket, the changes in the shape and structure of the trabeculae, which are influenced by the implant cavity preparation, are seen near the deep zone of the implant cavity and gradually with time they could be seen in the shallow zone and away from the implant cavity. 5) The newly formed trabeculae inside the implant cavity are mainly type I and on a part of the surface there is the addition of type II.

Animals↗
PubMed2005

Long-term survival of endodontically treated molars without crown coverage: a retrospective cohort study.

STATEMENT OF PROBLEM: Teeth are weakened after endodontic treatment and should, ideally, be crowned, especially posterior teeth. However, this is not always possible. Information about the longevity of endodontically treated teeth without crown coverage may assist in selecting appropriate treatment modalities. PURPOSE: The aims of this cohort study were to evaluate the survival rate for endodontically treated molars without crown coverage and to identify possible related factors. MATERIAL AND METHODS: A total of 220 endodontically treated permanent molar teeth in 203 subjects on a waiting list for fixed prosthodontic treatment at the Faculty of Dentistry-Mahidol University, Thailand, were included. Follow-up data were derived from a clinical examination and review of the dental record and radiographs. Subjects were not included in the study if teeth had provisional crowns, definitive restorations with cuspal coverage, or with dowel and core and/or crown restorations. The outcome evaluated was defined as a failure if there were negative findings in the condition of a tooth that required a restoration, tooth repair, or extraction. Tooth loss due to endodontic and periodontal reasons was excluded. The independent variables assessed were patient age, gender, location (maxilla or mandible), the existence of an opposing dentition and adjacent teeth, remaining tooth structure, and types of restorative material. Kaplan-Meier analysis with a 95% confidence level was used to calculate the survival probability, and a log-rank test was used to determine whether significant differences existed. RESULTS: Overall survival rates of endodontically treated molars without crowns at 1, 2, and 5 years were 96%, 88%, and 36%, respectively. With greater amounts of coronal tooth structure remaining, the survival probability increased. Molar teeth with maximum tooth structure remaining after endodontic treatment had a survival rate of 78% at 5 years. Restorations with direct composite had a better survival rate than conventional amalgam and reinforced zinc oxide and eugenol with polymethacrylate restorations. CONCLUSION: Within the limitations of this study, the amount of remaining tooth structure and types of restorative material have significant association with the longevity of endodontically treated molars without crown coverage.

Acrylic Resins↗
PubMed2005

Anxiety may enhance pain during dental treatment.

The purpose of this study was to clarify the effects of anxiety about dental treatment on pain during treatment. Subjects consisted of 57 consenting sixth-grade students at Tokyo Dental College (male: 32, female: 25), all of whom participated in this study during their clinical training program. They knew how third molars were extracted and all had experience of assisting in tooth extraction. Prior to the study, trait anxiety in the subjects was evaluated according to the State-Trait Anxiety Inventory (STAI, Japanese version). The students were asked to read one of two scenarios describing a scene in which a third molar was extracted while imagining themselves to be the patient. Scene 1 is set in an "environment where the patient feels safe and comfortable," and the Scene 2 is set in an "environment where the patient feels strong anxiety". The subjects were asked to imagine the anxiety and pain in that scenario and evaluate that pain according to a visual analogue scale (VAS). Two scenarios were randomly shown to the subjects in a crossover manner. No significant correlation between trait anxiety and preoperative anxiety was observed. There was no difference in level of preoperative anxiety for Scene 1 and Scene 2 between the high- and low-trait anxiety groups. This suggests that there was no relationship between sensitivity to anxiety as a characteristic of the subject and amplitude of anxiety immediately prior to treatment. Scene 2 elicited significantly higher anxiety before injection of regional anesthesia, significantly higher pain during insertion of the needle, and significantly higher pain during extraction of the tooth than Scene 1. This difference suggests that patients feel stronger pain if anxiety in the treatment environment is high and that it is, therefore, important to reduce anxiety during treatment to reduce pain.

Anesthesia, Local↗