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PubMed2005

Socket preservation followed by dental implant supported restorative treatment: a case report.

Implant-supported restorative treatment continues to revolutionize all aspects of dentistry. Any clinical procedure(s) with the potential to enhance and improve the success of implant-supported restorative treatment will gain favor with both practitioner and patient. Socket preservation following tooth extraction appears to offer several clinical advantages in preparing the ridge for future implant placement. A case report is presented describing treatment of a patient with evidence of root resorption of the maxillary central incisors, resulting in extraction and socket preservation followed by implant supported restorative treatment.

Adult↗
PubMed2005

Predisposing conditions for retrograde peri-implantitis, and treatment suggestions.

BACKGROUND: Recent case reports introduced the term retrograde peri-implantitis as a lesion (radiolucency) around the most apical part of an osseointegrated implant. It develops within the first months after insertion. This retrospective study aimed to find predisposing conditions for such peri-apical lesions and to evaluate treatment strategies. METHODS: All single implants (426 in the upper, 113 in the lower jaw, all Brånemark system type) placed at the department of Periodontology of the University Hospital (Catholic University Leuven) were included in this retrospective evaluation to check the incidence of retrograde peri-implantitis. Eventual predisposing factors such as patient characteristics (age, medical history), recipient site (local bone quality and quantity, cause of tooth loss), periodontal and endodontic conditions of neighboring teeth, implant characteristics (length, surface characteristics), and surgical aspects (guided bone regeneration, osseous fenestration, or dehiscency) were considered. Moreover, implants with retrograde peri-implantitis were followed longitudinally to verify their treatment outcome by means of different parameters (Periotest values (PTV), marginal bone level, radiological size of peri-apical defect). RESULTS: Seven implants in the upper (1.6%) and 3 in the lower jaw (2.7%) showed retrograde peri-implantitis, before or at abutment connection. In comparison with successful implants, such peri-apical lesions occurred preferably at sites with a history of an obvious endodontic pathology of the extracted tooth to be replaced. The incidence of retrograde peri-implantitis was significantly higher (P<0.0001) for TiUnite implants when compared with the machined implants (8/80 vs. 2/459). The machined implant surface, however, showed a higher failure rate (6.8%) than the TiUnite implants (2.5%). Failures with machined surfaces preferably occurred at extraction sites of teeth with a history of endodontic pathology or sites adjacent to teeth with an obvious endodontic pathology. No other predisposing factors could be identified. A curettage of the peri-apical lesions and the use of a bone substitute material prevented further progression of such lesions in the upper jaw (implants maintained their marginal bone and low PTV scores). A treatment in the lower jaw was less successful. CONCLUSIONS: Within the limitations of a retrospective study, these results seem to indicate that retrograde peri-implantitis is provoked by remaining scar or granulomatous tissue at the recipient site: endodontic pathology of extracted tooth (scar tissue-impacted tooth) or possible endodontic pathology from a neighboring tooth.

Causality↗
PubMed1996

Dental caries and tooth loss in adolescents with early-onset periodontitis.

The aim of this study was to assess the caries experience and tooth loss over 6 years in subjects with early-onset periodontitis as compared to their matched controls, and to describe the characteristics of teeth lost during this period. A multi-stage probability sample representing 8th to 12th grade U.S. schoolchildren were screened during the 1986/1987 school year to identify subjects with early-onset periodontitis (cases). The examination included measuring the clinical attachment level, presence of caries and dental restorations, and tooth loss. A random sample of controls without early-onset periodontitis were selected for a follow-up examination and were matched to cases on gender, race, age, and geographic location. A total of 266 subjects, with a mean age of 16 years at baseline, were examined during the 1992/1993 school year and were classified into localized (LJP) and generalized juvenile periodontitis (GJP), incidental attachment loss (IAL), and control groups. Whites had more caries experience than Blacks and Hispanics, but there were no significant differences in tooth loss between the ethnic groups. The LJP and the IAL groups, respectively, had higher and lower overall caries experience than the control group. The LJP group had a significantly higher number of missing teeth at follow-up, and exhibited more extensive tooth mortality during 6 years than the control group. The GJP group also showed more tooth loss than the control group, but the difference was not statistically significant. In the LJP, GJP, IAL, and control groups, respectively, 43%, 32%, 26%, and 18% of the subjects lost teeth over 6 years due to disease. The findings showed differences in caries activity between the early-onset periodontitis groups and a variation by race. The findings suggest that loss of periodontal support was the principal cause for tooth loss in the LJP and GJP groups, and that dental caries was the principal cause for tooth extraction in the IAL and the control groups.

Adolescent↗
PubMed1999

Five-year follow-up of successful intentional replantation.

Intentional replantation has been practised for many years as a treatment modality for pulpless teeth. Although the success ratio for intentional replantation is far below that for routine or surgical endodontics, one should consider this procedure as an alternative to tooth extraction. Two cases of mandibular second molars which were treated with intentional replantation and retrograde fillings are reported in this article. At the 5-year recall visit, the radiographs showed no evidence of pathological changes.

Adult↗
PubMed1999

Prosthetic concerns about atrophic alveolar ridges.

Recently, research has provided much insight into the problem of residual ridge resorption. It has become clear that ridge maintenance and preservation dramatically improves the quality of restorative dentistry provided, in addition to lessening the complexity of the treatment plan for the dentist. This article discusses the concerns, difficulties, and prosthetic challenges that must be addressed when restoring a patient with residual ridge resorption to acceptable function and esthetics. While patients can expect to lose a significant portion of their residual ridge as a result of normal physiologic activity, frequently resorption is the result of tooth extraction. The importance of postextraction grafting with calcium phosphates and the complexity of the prosthodontic rehabilitation needed to restore residual ridge resorption patients is also reviewed.

Alveolar Process↗
PubMed1980

Clinical efficacy of mild analgesics in pain following gynaecological or dental surgery: report on multicentre studies.

1 Dipyrone 1.0 g, paracetamol 1.0 g and placebo were compared in a double-blind parallel group study in patients with episiotomy pain. 2 Patients were stratified according to severity of initial pain (severe or moderate) and the three treatments were randomized for each of these two groups. 3 Two-hundred and sixty-four patients entered the study: five patients were excluded from analysis; 127 patients had 'severe' pain, 132 'moderate' pain. 4 Both drugs were more effective than placebo, and dipyrone was significantly more effective than paracetamol, particularly where initial pain was severe. 5 The efficacy of dipyrone 1.0 g was compared with paracetamol 1.0 g in relieving pain after tooth extraction. 6 Ninety patients entered the study and 87 were analyzed without stratification according to initial pain severity. 7 Dipyrone was consistently and significantly more effective than paracetamol at every assessment.

Acetaminophen↗
PubMed1997

The reasons for tooth loss in geriatric patients attending two surgical clinics in Jerusalem, Israel.

OBJECTIVES: Numerous studies around the world have been conducted in order to understand the reasons for tooth extractions in various age groups. Most studies have dealt with the general adult population but little attention has been paid to the elderly population. In Israel, as in most of the western countries, the elderly population is growing rapidly and thus demands for its dental needs are also increasing. In order to meet the dental requirements of the geriatric population, data on the main reasons of tooth mortality have been collected. DESIGN: Retrospective analysis of reasons for extraction divided into three categories: caries, periodontal disease and "other". SUBJECTS: The files of 302 consecutive elderly patients aged 65-95 years attending for extraction. The cause for tooth extraction was gathered from the written diagnosis described by the operator as well as from radiographs. Setting Two surgical clinics in Jerusalem serving low income residents. Results Results indicated that 30% of the extractions were due to caries, 65% were due to periodontal disease and only 6.4% related to "other" reasons. In both, males and females, periodontal disease was the major cause for tooth loss yet, females exhibited more extractions due to caries than males (35% vs 23% respectively). A relatively high incidence of tooth loss was documented for the 85+ age group. Of the teeth that were extracted, incisors and molars were equally the most frequent (29%) followed by premolars (26%) and canines (17%). Premolars were the teeth most frequently extracted out of the teeth removed due to caries (32%) whereas incisors were the most frequently removed within the group of teeth extracted due to periodontal disease (31%). CONCLUSIONS: The results of this study point to the importance of prevention and treatment of dental diseases, particularly periodontal disease, in adults aged 0 years and above in order to prevent tooth loss in their later years.

Aged↗
PubMed1999

Evaluation of porous collagen membrane in guided tissue regeneration.

Porous collagen membrane was prepared with collagen protein, which was extracted from bovine tendon by enzyme digestion, by freeze-drying method. The animal, clinical experiments of the membrane used in artificial dental implant system were studied. In the animal experiments, pure titanium spiral implants, which were prepared according to Adell etc. method, were implanted in the mandibular dental alveus of adult hybrid dog and covered with collagen membrane. Then the animals were killed after 4, 18 weeks individually. In the clinical research, the implants (phi 3.3 mm) were used in 33 patients of different age groups. The implant was put on the buccal lateral deficiency of implantation cavity wall, and covered with collagen membrane on the buccal lateral, then observed after 3, 6 months individually. The results of animal experiments proved the collagen membrane could guide osseous tissue regeneration around the bone integral implant which was implanted in the fresh tooth extraction fossa, be helpful to repair the fissural bone deficiency produced when implanted the implant, increase the bone content around the implant significantly, and improve the structure of new bone to a certain extent. The results of clinical research proved that collagen membrane was used in the patients with density deficiency, irregularity of alveolar ridge, or artificial dental of shorter tooth extraction, could significantly improved the bone density of artificial implant's shoulder.

Adult↗
PubMed2006

A comparison between in vivo radiographic working length determination and measurement after extraction.

The purpose of this study was to compare the difference between the in vivo working length established by viewing a periapical radiograph and the in vitro measurement from the file tip to the apical foramen of the extracted tooth. Twenty-six canals from teeth that had been treatment planned for extraction were accessed under rubber dam isolation. The coronal portion of each canal was flared using Gates Glidden drills, and a K-type file was inserted down the canal until an electronic apex locator indicated that the file had reached the apex. A size 20 K-type file was locked into place with glass ionomer cement at this position. A radiograph was exposed and the tooth was extracted. Each tooth was viewed using a videomicroscope at 30x original magnification, and the distance from the file tip to the most coronal aspect of the major foramen was measured. Six examiners viewed each radiograph and assessed the working length of each canal. Chi(2) analysis of the data revealed a significant difference (p < 0.01) between the estimation of working lengths and the microscopic measurements. The examiners overestimated the distance between the file tip and the apical foramen of the tooth when the file was placed short, and underestimated the distance when the file was placed long. In conclusion, when the file is short it is actually closer to the apical foramen than it appears radiographically; when it is long it is actually longer than it appears radiographically.

Adolescent↗
PubMed2000

Rotated palatal flap in immediate implant procedures. Clinical evaluation of 26 consecutive cases.

Immediate implant placement after tooth extraction is a successful treatment modality. Primary flap closure is important for satisfactory final results in these procedures. The purpose of this article was to evaluate a surgical approach that would enable predictable primary soft tissue closure over implants placed into fresh extraction sockets. In 24 patients, 26 consecutive implants were placed immediately following extraction of one anterior or premolar maxillary tooth. Primary closure was achieved by a surgical technique based on a rotated palatal flap (RPF), covering the implant. Deproteinized bovine bone was used as grafting material. The apicocoronal distance between the buccal alveolar crestal bone and the coronal aspect of the implant body was measured at time of implant placement (mean 2.6 mm, SD 1.72) and at second stage surgery (mean 0.6 mm, SD 0.70). The difference between both records was calculated. The mean gain in crestal bone was 2.0 mm (SD 1.69, P < 0.001). In 1 patient, where the implant cover screw became exposed early, crestal bone loss was noted. This technique offers a predictable valuable treatment approach to achieve and maintain primary soft tissue coverage and crestal bone regeneration over implants immediately placed within a bony envelope, after extracting maxillary teeth, without the use of barrier membranes.

Adult↗
PubMed2005

A clinical staging system and treatment guidelines for maxillary osteoradionecrosis in irradiated nasopharyngeal carcinoma patients.

PURPOSE: To develop a clinical staging system for maxillary osteoradionecrosis (ORN) in irradiated nasopharyngeal carcinoma (NPC) patients. METHODS AND MATERIALS: The data of maxillary ORN cases among 1,758 irradiated NPC patients were analyzed. A staging system based on the degrees of bone exposure (E), infection (I), and bleeding (B) was developed. Correlations between various clinical parameters and stages of maxillary ORN and relationships between treatment modalities and outcomes at each stage were evaluated. Cumulative success of treatment and risk factors that affect treatment outcomes were analyzed. RESULTS: The incidence of maxillary ORN was 2.7% (48/1,758). TNM stage of NPC (p < 0.001), radiation dose (p = 0.029), and tooth extraction (p < 0.001) appeared to have significant influences on disease severity. Success rates between conservative therapy and surgical treatment were not significantly different for Stage I ORN but differed significantly for Stage II (p = 0.013) and Stage III (p = 0.008) lesions. Grade 3 infection and bleeding significantly jeopardized treatment success (p = 0.043 and 0.015, respectively). The risk ratios of treatment failure for Grade 3 infection and bleeding were 2.523 (p = 0.034) and 3.141 (p = 0.027), respectively. CONCLUSIONS: More serious maxillary ORN tended to occur in cases with more advanced NPC, higher radiation dose, and history of tooth extraction. Surgical treatment was usually required in Stage II and III ORN. The grades of infection and bleeding are important factors in guidance of treatment and prediction of outcomes.

Female↗
PubMed2006

Clinical evaluation of recombinant factor VIII preparation (Kogenate) in previously treated patients with hemophilia A: descriptive meta-analysis of post-marketing study data.

The safety and efficacy of Kogenate, a recombinant factor VIII (rFVIII) preparation for the treatment of bleeding episodes, were studied in a 123-patient meta-analysis population of previously treated patients (PTPs), including 15 enrolled in the registration Phase III trial (PTP-I group), 93 from the post-marketing special investigation (PTP-II group), and 15 from short-term special investigations in surgery or tooth extraction (SI group). These patients (82 severe, 31 moderate, 9 mild, and 1 unknown), aged 11 months to 72 years, were enrolled in 28 centers in Japan. Blood samples taken at the baseline and at 3, 6, 9, 12, 18, and 24 months after the introduction of Kogenate were evaluated for FVIII inhibitor antibodies, antibodies formed against trace proteins derived from the rFVIII production process, and for general changes in laboratory test results. Mean exposure to Kogenate was 1103 days in PTP-I, 86 days in PTP-II, 27 days in patients in surgery, and 2 days in patients with tooth extraction. Assessment of FVIII inhibitor activity was conducted in 115 of the 123 patients by means of the Bethesda assay. Twelve patients were found to have a low titer of FVIII inhibitor (0.5-3.0 BU/mL) prior to any administration of Kogenate, and 103 were inhibitor-negative at the baseline. Among this latter group, 3 patients (2.9%) tested inhibitor-positive, with titers ranging from 1.2 to 2.1 BU/mL, with 4 patients below 1.0 BU/mL. One patient in the 11 PTPs investigated (PTP-I) developed antibodies against baby hamster kidney protein and mouse immunoglobulin G, but these findings were transient and asymptomatic. Hemostasis was achieved (markedly effective or effective) in 3666 of the 3855 bleeding episodes (95.1%) observed in 108 patients. Only 1 infusion was necessary in 3790 (98.3%) of these episodes. These data indicate that Kogenate is safe and very effective for the treatment of bleeding in PTPs with hemophilia A.

Adolescent↗
PubMed2006

Bleeding in carriers of hemophilia.

A wide range of factor VIII and IX levels is observed in heterozygous carriers of hemophilia as well as in noncarriers. In female carriers, extreme lyonization may lead to low clotting factor levels. We studied the effect of heterozygous hemophilia carriership on the occurrence of bleeding symptoms. A postal survey was performed among most of the women who were tested for carriership of hemophilia in the Netherlands before 2001. The questionnaire included items on personal characteristics, characteristics of hemophilia in the affected family members, and carrier testing and history of bleeding problems such as bleeding after tooth extraction, bleeding after tonsillectomy, and other operations. Information on clotting factor levels was obtained from the hospital charts. Logistic regression was used to assess the relation of carrier status and clotting factor levels with the occurrence of hemorrhagic events. In 2004, 766 questionnaires were sent, and 546 women responded (80%). Of these, 274 were carriers of hemophilia A or B. The median clotting factor level of carriers was 0.60 IU/mL (range, 0.05-2.19 IU/mL) compared with 1.02 IU/mL (range, 0.45-3.28 IU/mL) in noncarriers. Clotting factor levels from 0.60 to 0.05 IU/mL were increasingly associated with prolonged bleeding from small wounds and prolonged bleeding after tooth extraction, tonsillectomy, and operations. Carriers of hemophilia bleed more than other women, especially after medical interventions. Our findings suggest that not only clotting factor levels at the extreme of the distribution, resembling mild hemophilia, but also mildly reduced clotting factor levels between 0.41 and 0.60 IU/mL are associated with bleeding.

Adolescent↗
PubMed1999

The impact of the ART approach on the treatment profile in a mobile dental system (MDS) in South Africa.

The changing profile of oral care rendered through the Mobile Dental System (MDS), after the introduction of the Atraumatic Restorative Treatment (ART) approach is described. During the first year of introduction of ART, the percentages of amalgam restorations and tooth extractions decreased significantly (P < 0.0001). This is partly ascribed to a change in choice of treatment by dental operators in favour of ART and also due to an increase in acceptance by patients because of the reduced fear, and the patient-friendly nature of the ART approach. The reduction in amalgam restorations was 16.0 per cent for permanent and 1.4 per cent for primary posterior teeth. Extraction of posterior teeth was reduced by 17.4 per cent in the permanent and 35.7 per cent in the primary dentitions. The restorative component of oral care increased by 33.4 per cent in the permanent and 37.1 per cent in primary posterior teeth. The one-year survival of one-surface ART restorations using Fuji IX and KetacMolar was 93.6 per cent. Full and partial (more than 90 per cent) retention of the sealant part of the ART restoration was obtained in 75 per cent of the cases after one-year. During the one-year period, infection control was made more simple and this facilitated easier maintenance of mobile dental equipment. The introduction of the ART approach reduced extraction, restored more teeth and made oral care in the MDS more preventive, less threatening and thus more patient-friendly.

Child↗
PubMed2000

The Royal London Space Planning: an integration of space analysis and treatment planning: Part II: The effect of other treatment procedures on space.

The Royal London Space Planning process is carried out in 2 stages. The first stage, assessing the space required to attain the treatment objectives, was described in Part I of this report, published earlier. In Part II, the process of integrating space analysis with treatment planning continues with consideration of the effects other treatment procedures have on space. These procedures include tooth enlargement or reduction, tooth extraction, the creation of space for prosthetic replacement, and mesial and distal molar movement. The effects of favorable and unfavorable growth are also considered. A brief case report is presented to demonstrate use of the Royal London Space Planning.

Cephalometry↗
PubMed2004

Dental treatment needs of children in a rural subcounty of Uganda.

OBJECTIVES: To describe normative dental treatment needs of 5-7 and 12-year-olds in a rural sub county of Uganda and devise a strategy to improve oral health. DESIGN: Clinical survey. SETTING: Primary schools in the subcounty. SAMPLE AND METHODS: School-based random cluster sample of 236 5-7-year-olds and 202 12-year-olds. Dental status and treatment need data were collected according to WHO Oral Health Surveys Basic Methods. Additional data for 12-year-olds included dental fluorosis using the Thylstrup and Fejerskov index (TFI), oral hygiene procedures and experience of oral pain in the previous month. RESULTS: In the 5-7-year-olds, mean dmft was 1.47 (50.8% dmft = 0). A total of 52.5% needed fillings and almost one third needed a tooth extracted. Among the 12-year-olds, mean DMFT was 0.64 (65.8% DMFT = 0), 28.5% had dental fluorosis and 6.7% had TFI > 2. Toothache in the previous four weeks was reported by 36.5%, 30.2% needed a filling and 6.4% needed one or more teeth extracted. CONCLUSIONS: Dental disease is a significant public health problem in this population. An efficient way to meet the needs of the children would be to increase the availability of fluoride toothpaste and to develop a service to provide treatment using Atraumatic Restorative Technique.

Adolescent↗
PubMed2004

Sublingual hematoma formation during immediate placement of mandibular endosseous implants.

BACKGROUND: Sublingual hematoma during placement of mandibular endosseous dental implants is a rare, but potentially life-threatening, complication. The development of a sublingual hematoma during a dental procedure may result in the need for acute airway management, including intubation or even emergent tracheostomy. Dental implants are becoming a well-accepted treatment, and thousands of implants are placed every year by general practitioners and specialists, with few adverse sequelae. Clinicians rarely discuss this complication with patients before surgery, and no reports of death secondary to sublingual hematoma formation have been published. The incidence of this event is difficult to ascertain, and only, a few cases have been reported. CASE DESCRIPTION: A 56-year-old man with severe caries underwent multiple mandibular tooth extractions and alveoloplasty and received endosseous implants. During the surgical procedure, the patient developed a large sublingual hematoma that required hospitalization. CLINICAL IMPLICATIONS: Practitioners who perform implant surgery in the anterior mandible should notify patients of the potential risk of sublingual hematoma formation, and be able to manage acute airway issues that may result from this complication.

Airway Obstruction↗