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PubMed2005

Early loading of interforaminal implants immediately installed after extraction of teeth presenting endodontic and periodontal lesions.

BACKGROUND: Infection in tooth extraction sites has traditionally been considered an indication to postpone implant insertion until the infection has been resolved. PURPOSE: The aim of this study was to evaluate the survival rate of early-loaded implants placed immediately after extraction of teeth with endodontic and periodontal lesions in the mandible. MATERIALS AND METHODS: Twenty patients in need of mandibular implant treatment and with teeth showing signs of infection in the interforaminal area were included in the study. The patients received four to six implants (Brånemark System, Nobel Biocare AB, Göteborg, Sweden) in or close to the fresh extraction sockets and received a provisional prosthesis within 3 days. Final prostheses were delivered after 3 to 12 months. The surgical protocol paid special attention to the preservation of high implant stability and control of the inflammatory response. The patients were followed up for 15 to 44 months. RESULTS: No implants were lost, resulting in a 100% survival rate. A mean marginal bone loss of 0.7 mm (SD 1.2 mm) was registered during the observation period. No signs of infection around the implants were detected at any follow-up visit. CONCLUSION: A high survival rate can be achieved for immediately placed and early-loaded implants in the mandible despite the presence of infection at the extracted teeth.

Aged↗
PubMed2004

Medical grade calcium sulfate hemihydrate in healing of human extraction sockets: clinical and histological observations at 3 months.

BACKGROUND: Following tooth extraction, remodeling and resorption of the alveolar bone at the extraction site characterize wound healing. This produces a reduction in ridge volume and difficulties in delayed placement of implants in an ideal position. Medical grade calcium sulfate hemihydrate (MGCSH) has been proposed as a graft material in extraction sockets to minimize the reduction in ridge volume. The aim of the present study was to investigate the influence of MGCSH on the histopathologic pattern of intrasocket regenerated bone and to evaluate histologically the healed MGCSH grafted extraction socket site 3 months postextraction METHODS: MGCSH was grafted in 10 fresh human extraction sockets in 10 patients. Five post-extraction sockets were used as controls. At 3 months a cylindrical tissue specimen, 2.5 mm in diameter, was trephined from the previously grafted site followed by implant placement. Non-decalcified specimens were sectioned at a cross-horizontal plane and stained with fast green, toluidine blue, and Van Kossa stains for histological and histomorphometrical examination. RESULTS: Histologically, MGCSH was not observed in most of the specimens. Newly formed bone with lamellar arrangements was identified in all the horizontal sections with no difference between apical, medium, and coronal areas. The mean trabecular area in the coronal sections was 58.6% +/- 9.2%; in the medium sections, 58.1% +/- 6.2%; and in the apical sections, 58.3% +/- 7.8%. The differences were not statistically significant. CONCLUSION: MGCSH seems to be an ideal graft material in extraction socket bone regeneration because it is almost completely resorbable, and it allows a new trabecular bone arrangement at 3 months.

Adult↗
PubMed1996

Blood pressure response during dental surgery.

To investigate blood pressure and pulse rate responses to dental surgery, 21 patients 18 to 73 years of age (mean age, 42 +/- 4 years) who visited our hospital for tooth extraction were studied. Before dental treatment, the patients underwent a mental arithmetic stress test, electrocardiography, and an anxiety evaluation with the State-Trait Anxiety Inventory. Baseline blood pressure and pulse rate were 118 +/- 4/70 +/- 3 mmHg and 69 +/- 2 beats/min, respectively. Blood pressure rose by 24 +/- 3/17 +/- 2 mmHg during the mental stress test, and the magnitude of the rise in systolic blood pressure was significantly correlated with age (r = 0.81, p < 0.001) and baseline blood pressure (r = 0.56, p < 0.01). After the topical injection of local anesthetic containing 1: 80,000 epinephrine, a transient increase in systolic blood pressure was observed. The maximum blood pressure and pulse rate increases during dental surgery were 24 +/- 4/13 +/- 2 mmHg and 17 +/- 3 beats/min, respectively. Similarly, the rate pressure product increased from 8,196 +/- 486 to 11,802 +/- 682. The magnitude of the blood pressure increase during dental surgery was not correlated with age, sex, family history of hypertension, baseline blood pressure, anxiety score, or response to mental stress. On the other hand, when the subjects were divided into two subgroups according to the blood pressure response during dental surgery, the larger response group (increase in mean blood pressure greater than 15 mmHg, n = 9) required a significantly larger dose of local anesthetic than did the smaller response group. The number of cases of pericoronitis of the third molar tended to be greater in the larger response group. These results indicate that an increase in blood pressure during dental surgery cannot be predicted on the basis of baseline blood pressure or the response to mental stress, but is related to the cause of tooth extraction and the volume of local anesthetics required to control the pain.

Adolescent↗
PubMed2005

Multidisciplinary treatment approach for enhancement of implant esthetics.

A "team approach" that includes different specialties from the initial stages of implant treatment is important to achieve predictable and esthetically pleasing outcomes in compromised dental replacement cases. This report describes a severely compromised case that was properly managed by the combined efforts of a team of specialists. Briefly, prior to tooth extraction, orthodontic forced eruption was applied to coronally displace the attachment apparatus (i.e., hard and soft tissues). Then, atraumatic tooth extraction together with immediate implant placement was performed. The "sandwich bone augmentation" technique was used to augment the deficient buccal alveolar ridge. A second stage surgery was performed 6 months after healing, revealing 100% of bone fill/augmentation. This technique allowed fabrication of a final restoration that respected the proportions of the natural dentition in a case that would otherwise result in a poor esthetic outcome.

Adult↗
PubMedDate not supplied

Medial-grade calcium sulfate hemihydrate (surgiplaster) in healing of a human extraction socket--histologic observation at 3 months: a case report.

PURPOSE: Following tooth extraction, wound healing is characterized by remodeling and resorption of the alveolar bone at the extraction site. This produces reduction in ridge volume. Medical-grade calcium sulfate hemihydrate (MGCSH) has been proposed as a graft material for extraction sockets to minimize the reduction in ridge volume. The aim of this study was to investigate the influence of MGCSH on the histopathologic pattern of intrasocket regenerated bone and to evaluate histologically the healed MGCSH-grafted extraction socket site at 3 months postextraction. MATERIALS AND METHODS: MGCSH was grafted in a fresh human extraction socket, and at 3 months a cylindric tissue specimen, 2.5 mm in diameter, was trephined from the previously grafted site and an implant was placed. Non-decalcified specimens were sectioned at a horizontal plane and stained for histologic and histomorphometric evaluation. RESULTS: The mean trabecular area was 58.6% +/- 9.2% in the coronal sections, 58.1% +/- 6.2% in the middle sections, and 58.3% +/- 7.8% in the apical sections. The differences in mean trabecular area between sections were not statistically significant. DISCUSSION: It is significant that the MGCSH underwent complete resorption and replacement by newly formed bone because the most important negative attribute of other graft materials is the resorption time. Moreover, calcium sulfate shows great potential for guided bone regeneration in surgical sites. CONCLUSION: MGCSH seems to be an acceptable graft material for extraction socket bone regeneration because it is completely resorbable and allows new trabecular bone arrangement in a limited 3-month period.

Alveolar Bone Loss↗
PubMedDate not supplied

Correction of malocclusion secondary to maxillary impaction fractures using a mandibular symphyseal realignment in eight cats.

Eight cats with stable impaction fractures of the maxilla, sufficient to cause malocclusion, were treated by mandibular symphyseal realignment. The mandibular symphyseal realignment allowed occlusion to be restored with a minimal amount of dental work (e.g., enameloplasty, endodontics, or tooth extraction) in a majority of the cases. Enameloplasties were performed in two cats, one of which had a vital pulpotomy. Tooth extractions (range, two to five teeth; mean, 3.3 teeth) were performed in four cats. All cats were doing well at the time of in-hospital follow-up at one month to four years (mean, 2.1 yrs) postoperatively. Further telephone follow-up was obtained, from 1.5 to five years (mean, 3.4 yrs) after surgery, from all but one owner, with no change from the in-hospital evaluations. All owners contacted were pleased with the long-term outcome.

Animals↗
PubMed1995

[Corono-radicular amputation of mandibular molars: indication, technic and prosthetic utilization. Apropos of a clinical case].

Lesions to the radicular bifurcation generally entail the removal of the tooth in question. This leads to the need to create a prosthetic bridge to compensate for the absence of the extracted tooth. This solution is not readily accepted by the patient who wishes to avoid involving other teeth. In these cases rhizectomy and the execution of an inlay on an adjacent tooth may satisfy the patient and resolve the clinical symptoms. The authors report a case of rhizectomy and prosthetic reconstruction of a tooth using inlay.

Dental Prosthesis↗
PubMed1996

New directions in surgical endodontics; immediate implantation into an extraction site.

Endodontic surgical procedures may reveal compromising factors that indicate a modification of the treatment (e.g. tooth extraction, root amputation, etc.). To take advantage of the osseous height and width, as well as the natural tooth angulation, immediate placement of implants after extraction is a reasonable alternative treatment. In this study, 32 titanium alloy implants were inserted immediately after extraction of teeth diagnosed during endodontic surgery as having root fractures, perforations, or endodontic-periodontal complications. After 4 to 6 months of osseointegration, only one implant failed to integrate, and the remaining implants were prosthetically restored. Sixteen months after occlusal loading, bone loss was approximately 1.5 mm for the 31 implants remaining. It seems that the immediate placement of implants following tooth extraction due to endodontic complications is a reliable procedure.

Adult↗
PubMed2004

Treatment options of untreatable traumatized anterior maxillary teeth for future use of dental implantation.

The anterior maxilla is the most traumatized region during childhood. Posttraumatic complications occasionally lead to tooth loss as well as the need for future implants. Unfortunately, it is contraindicated to place dental implants during childhood. A waiting period of approximately 8 to 10 years before completion of growth is required. For this patient to become a candidate for future dental implants, it is necessary to ensure the continuous growth and to preserve the dimensions of the alveolar process until growth has ceased from time of injury until joint maturation. To achieve these goals, it is essential to coordinate the treatment sequence at the time of trauma. After loss of a traumatized anterior permanent maxillary incisor in young adults, treatment options are limited: orthodontic closure of the gap and reshaping the adjacent teeth, or tooth extraction and maintaining the gap with a temporary restoration. Orthdontic space closure has limited indications and requires prosthetic restoration of at least 2 teeth. Extraction and temporary restoration will usually lead to bone augmentation before implantation. Other possible treatment options include orthodontic extrusion of the root remnant (in cases of untreatable root fracture or complicated crown-root fracture) and a temporary crown to serve the patient until the completion of growth and development, autogenous tooth transplantation, intentional extraction and immediate tooth replantation, distraction osteogenesis, and decoronation. Because general rules do not apply, individual treatment plans are necessary.

Adolescent↗
PubMed1998

[Mining and dentistry].

Major Norwegian 19th-century mines had their own company physicians. Some of their reports and the mine sick-lists have been kept. From the Modum Blue Colour Works we have more than 80 such reports or sick-lists (each covering a four-week mining period) from 1823 to 1839. Of a total of 8,798 patients, 67 (0.8%) were diagnosed as suffering from odontalgia. The treatment was extraction or medication. Patients who underwent tooth extraction had fewer subsequent sick-days than those who were only given medication. Other registrated dental or oral disorders included dental abscess, caries, dental cancer with growth on the gums, thrush, dentition, dental fever and scorbutus.

History of Dentistry↗
PubMed1996

Periodontal reasons for tooth loss in an Asian population.

This study analysed data on periodontal reasons for tooth extractions, obtained from 52 dentists practising general dentistry in Singapore. The results revealed that, out of 2172 teeth extracted from 1276 patients, 35.8% were lost due to periodontal disease and 35.4% due to caries. Extraction due to periodontal problems increased with age, were more conspicuous in the Indian ethnic group and were frequently associated with pocketing and tooth mobility.

Adolescent↗
PubMed2000

[Delayed root canal therapy. Data on the frequency and complications].

This retrospective study of 118 teeth receiving root canal treatment was conducted to determine the frequence and complications of delayed root canal treatment. Teeth were categorised into prompt treatment group and delayed treatment group according to the length time of treatment; prompt treatment group was defined as a group where root canal treatment was achieved within a period of 4 months or less, and delayed treatments group, a group where period of treatment was greater than 4 months or where canals were never obturated. Two types of complications were studied: postobturation pain and fracture involving tooth extration. The results of this study have shown that 34.5% of treatments were delayed. In this group we found also a higher rate of fractures involving tooth extraction, but the difference was not significant. The results have also shown that disappearance of pain was the essential factors in the frequence of delayed treatment, but the dental chair breakdown had some responsability. As well as in the two groups, the first reason of extractions was fracture and not pain. These results emphasize the necessity of focusing the patient's motivation on the risk of losing the tooth.

Adolescent↗
PubMed2006

20-year follow-up of patients receiving high-cost dental care within the Swedish Dental Insurance System: 1977-1978 to 1998-2000.

The objective was to perform a long-term follow-up study of patients that had received high cost dental care within the Swedish National Dental Insurance System in 1977-1978 with special focus on remaining teeth, periodontal disease progression, change in the prevalence of root-filled teeth and teeth with apical periodontitis as well as the survival of fixed prosthetic reconstructions. All 262 patients who had had their treatment plans sent for approval for high-cost dental care in 4 local health insurance districts and who were sampled for base-line studies in 1977-1978, were offered a free clinical examination including radiographs in 1998. 177 patients (68 % of the original sample) could be reached for telephone interview and 104 of them (40 % of the original sample) were examined clinically and radiographically. Comparisons were made with records and radiographs from 1977-1978. The analyses were performed with the individual patient as the studied unit. The low progression of severe periodontal disease during the 20-23 year follow-up period and the decrease in number of teeth with apical periodontitis among a majority of the patients examined, indicated that the dental care received resulted in a limitation of dental disease on the individual level. Furthermore 63 % of the patients had the fixed prosthetic reconstructions, received after approval 1977-1978, in full extention after 20-23 years. However, more tooth losses were observed among the patients in this study than in similar studies in Swedish general populations over the same decades. Furthermore multiple tooth extractions were significantly more frequent in patients with severe periodontitis at baseline and in patients with less apical periodontitis at follow-up in this study. Thus it seems that tooth extraction not seldom was a treatment choice for teeth with severe periodontitis and apical periodontitis among the patients examined clinically in this study.

Adult↗
PubMed2000

Influence of previous restoration of the tooth on prognosis of crowns with dowels.

Due to extensive loss of tooth substance the restoration of endodontically treated tooth requires intracanal dowels to give an efficient strength for the crown. The aim of our study was to investigate whether the previous type of restoration of the tooth, i.e. composite restoration with screw post versus one-piece dowel crown, has an effect on the prognosis of crowns with dowels. The material consisted of 111 single crowns and as a previous restoration there were 83 composite restorations with screw posts and 28 one-piece dowel crowns. The mean follow-up time was 78 months (range 6--163 months). The cumulative survival was 87% for one-piece dowel crowns and 84% for composite resins with screw posts. There were six root fractures, four losses of cement retention and one tooth extraction due to caries in crowns with previous composite resin with screw posts. In one-piece dowel crowns as a previous restoration there were two root fractures and one tooth extraction for periodontal reasons. In conclusion, it seems that the previous restoration has no marked effect on the prognosis of crowns with dowels when studying a composite resin restoration with screw post and a one-piece dowel crown.

Adult↗
PubMed1990

[A microbiologic study on anaerobic bacteremia after dental extraction].

It has been known for many years that tooth extraction can cause bacterial dissemination into blood stream, that is, bacteremia. Besides endocarditis--causing bacteria, alpha-hemolytic streptococci, anaerobes are involved in the post- extraction bacteremia. They are of clinical importance because they can cause abscesses in the various parenchymatous organs such as the liver, lung, and brain through anachoresis. The purpose of this study is to establish the types of species of anaerobes associated with post--extraction bacteremia, and to give the baseline to the succeeding study of sensitivity tests of various antibiotics, thus clinicians can chose the right ones. 10ml of blood was sampled pre- and post- operatively from 32 patients and incubated in anaerobic chamber. The followings are the results of this study. 1. All the preoperative blood samples showed negative culture. 2. Postoperative blood samples from 8 out of 10 patients (80%) in group 1, from 1 out of 15 (73.3%) in group 2, and 2 out of 7 (28.6%) in group 3 yielded anaerobic and facultative species. 3. Organisms detected were species belonging to the genera Streptococcus, Bacteroides, Actinomyces, Staphylococcus, Peptostreptococcus, Peptococcus, Propionebacterium, Fusobacterium, nonenterococcus, and Corynebacterium.

Bacteria, Anaerobic↗
PubMed1997

Blood loss following extraction of deciduous teeth under general anaesthetic.

The potential for significant blood loss following deciduous tooth extractions has been a factor in treatment planning in dental care for children. This paper reports the results of a study which aimed to quantify normal blood loss following extraction of deciduous teeth from medically fit children under general anaesthetic. Blood loss from a group of 50 children aged 3 to 5 years, having at least one molar tooth removed, was determined by comparing the amount of haemoglobin in a sample of the patient's whole blood with a known dilution of blood collected during surgery and recovery. Total blood loss ranged from 2.5 to 57 mL, with the maximum corresponding to deciduous clearance of (the removal of all deciduous teeth from) the upper arch together with the lower molars for a 3-year-old child. Clinical judgement would suggest that the maximum potential blood loss resulting from a complete dental clearance (20 teeth) from an otherwise fit child in this age group is unlikely to be greater than 100 mL. It is concluded that the risk of inducing hypovolaemic shock from this procedure is much lower than the risks of using repeated administrations of general anaesthesia to facilitate a staged dental clearance.

Anesthesia, General↗
PubMedDate not supplied

Aesthetic ridge and extraction site augmentation for anterior implant placement without barrier membrane.

Augmentation of the alveolar ridge to facilitate implant placement in a single tooth extraction site or a completely edentulous arch is currently a well-accepted and routinely performed therapeutic procedure. This article describes a method for augmenting extraction sites and ridges, without primary closure or the use of barrier membranes over bone grafts. The technique retains or enhances gingival architecture while creating bone for placement of an implant in the most optimal position. The tooth is extracted, demineralized freeze-dried bone allograft or another augmentation material of choice is placed, and a provisional mucoadhesion partial denture is delivered. When the implant is uncovered and the healing abutment is placed, a flap design is utilized to create papillae and proper labial contour. The learning objective is familiarity with this technique, which is particularly useful for maxillary anterior implant placement. A case report is used to document the clinical procedure.

Adult↗