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PubMed1991

Cardiohemodynamic and serum catecholamine response to surgical removal of impacted mandibular third molars under local anesthesia: a randomized double-blind parallel group and crossover study.

The aim of this study was to differentiate between the extent to which surgical stress and the epinephrine in local anesthetic solutions influence serum catecholamine, cAMP, and potassium levels, and contribute to changes in cardiohemodynamic parameters. One hundred sixty mg of articaine hydrochloride (4.0 mL of a 4% articaine hydrochloride solution) with two different epinephrine doses was injected into outpatients prior to removal of an impacted mandibular third molar in a randomized, double-blind parallel group and crossover design. The results showed that the amount of epinephrine absorbed from the intraoral injection site predominantly determined the serum epinephrine concentration. The anesthetic-induced increase in the serum epinephrine level did not correlate with changes in the cardiohemodynamic parameters under study at any time during the operative procedure. The serum cAMP changes correlated with those of epinephrine, whereas the serum potassium levels remained unchanged. The procedure of tooth extraction was a stressful event when the 1:200,000 epinephrine-containing anesthetic solution was used, showing that the risk of inducing a cardiovascular incident during oral surgery seems to be higher the greater the extent of operation and the lower the epinephrine dose in the anesthetic solution.

Adult↗
PubMedDate not supplied

[Dental mutilation: rural workers' concepts of responsibility for tooth loss].

Brazilian oral hygiene institutions have promoted tooth extraction as a dental health practice. This article investigates the issue of dental loss within a rural drought area in the State of Bahia. Based on verbal information provided by local inhabitants, the author investigates dental extraction as perceived by the community, i.e., as a commonplace fact. The main goal is to analyze both representations of the oral cavity based on individual experiences and their associations with oral care practices, derived from the social reality in which they are immersed. The author considers the issues of both individual responsibility and that of government agencies and dentists.

Adult↗
PubMed2002

Oral surgical management of patients with mechanical circulatory support.

After the introduction of mechanical circulatory support (MCS) for treatment of patients with severe cardiogenic shock, the survival rate of these patients increased significantly. Temporary MCS may be applied over a period of several days up to months prior to heart transplantation (HTx). Oral surgical management of patients with MCS is seriously complicated by a combination of anticoagulant and antiaggregant medication. Moreover, contact of blood with artificial surfaces, i.e. polyurethane and silicone, may increase the risk of thromboembolic events and infections. A total of 32 patients with MCS (29 men and three women with a median age 48 years [range 27-60 years]) were examined for odontogenic foci, treatment needs and local and cardiovascular complications after oral surgical intervention. In 27 patients (84%) at least one potential focus was diagnosed. Following tooth extraction 4 out of 6 patients presented with local haemorrhage (n=3) and thromboembolic events (n=2). Generally MCS has to be considered a relative contraindication for elective oral surgical interventions.

Adult↗
PubMed2006

Immediate and early replacement implants and restorations.

UNLABELLED: There have been rapid developments in dental implant treatment protocols to reduce the time between implant placement and restoration. Implants may be placed immediately following tooth extraction or following a period of healing to allow resolution of residual infection or sufficient bone and soft tissue healing. Early restoration and loading of implants has to be carefully controlled to avoid increased failure and complications. Advantages and disadvantages of the various techniques are described. CLINICAL RELEVANCE: The clinician should adopt a treatment protocol that ensures a high success rate and a long-term functional and aesthetic implant restoration. Rapid treatment protocols can be considered when they do not compromise these goals, and the clinician is sufficiently experienced in their application.

Dental Implantation, Endosseous↗
PubMedDate not supplied

Ten-year incidence of tooth loss and dental caries in elderly Swedish individuals.

There has been a significant reduction in edentulism and the elderly retain more teeth into old age. The 10-year incidence of tooth loss, coronal and root caries was studied in a random sample of inhabitants of Göteborg, who were 55, 65 and 75 years old at baseline. Of the 208 persons examined at baseline, 102 (49%) participated in the follow-up examination: 56, 37 and 9, respectively, in the different age groups of 65, 75 and 85 years. In addition, for the purpose of time-trend comparisons, a new random sample of 98 individuals aged 55 years was examined. The mean numbers of remaining teeth were 24, 23, 17 and 14, respectively, in the age groups of 55, 65, 75 and 85. The corresponding mean numbers at baseline were 23, 19 and 17, respectively, in those subjects who were then 55, 65 and 75 years old. Forty-eight percent had lost no teeth during the 10-year period, while 13% had lost more than 2 teeth. The major reason for tooth extraction was dental caries and it was found in 60% of all cases. The incidence of coronal caries decreased, while that of root caries increased with age (p < 0.01). Comparing the same age groups, the frequency of root caries had decreased during the 10-year period. It could be concluded from this study that elderly people were determined to retain their teeth for as long as possible, but dental caries may be a problem among the very old.

Age Factors↗
PubMed2004

Rotated palatal flaps: A functional and aesthetic solution in endentulous sites.

Resorption of alveolar process generally occurs following tooth extraction, and this process may cause a variety of jaw deformities. Bone deformities in the aesthetic zone impair the appearance, quality, and prognosis of the definitive restoration. The rotated palatal flap is a surgical modality that can be used to reduce or prevent alveolar resorption and assist in the repairing of exisiting defects. This presentation demonstrates the application of the rotated palatal flap in a variety of clinical cases as a means of addressing such resorption.

Adult↗
PubMed1999

Autogenous masticatory mucosal grafts in extraction socket seal procedures: a comparison between sockets grafted with demineralized freeze-dried bone and deproteinized bovine bone mineral.

Successful preservation of the edentulous ridge after extractions may eliminate or reduce the need for ridge augmentation procedures. It has been claimed that grafting fresh extraction sockets and sealing them with autogenous soft tissue grafts promote ridge preservation after tooth extraction. In this study, the survival of free autogenous connective tissue grafts sealing extraction sites was evaluated. In 24 healthy patients, 42 maxillary anterior teeth were extracted. After socket debridement, soft tissue margins of the socket orifice were carefully cut to remove epithelial debris, Sockets were filled with either demineralized freeze-dried bone allografts (DFDBA) or deproteinized natural bovine bone mineral xenograft (DBBMX) to the level of the alveolar bone crest. Circular connective tissue grafts, slightly larger in diameter than the soft tissue socket orifice, were obtained and placed on top of the filler graft material sealing the sockets. Grafts were stabilized and secured by sutures and inspected weekly for the first month. The grafts were classified into 3 groups according to clinical parameters: vital, partially vital and non-vital. After 1 week, 18 grafts were vital, 13 partially vital and 11 non-vital. When only 1 sample unit (1 site per patient) was compared between DFDBA and DBBMX grafted sockets, no significant difference in graft vitality was shown (P = 0.34 for vital; P = 0.67 for vital plus partially vital). After 1 month, all socket orifices were sealed with mucosa. Based on the present observations, it seems that connective tissue grafts sealing fresh extraction sites are mainly dependent on underlying tissue vascularization and that sealing grafted fresh extraction sockets filled with bone substitute allograft or xenograft materials may be beneficial but an unpredictable procedure.

Adolescent↗
PubMed2004

Surgical removal of supernumerary teeth and the fate of incisor eruption.

AIM: The aims of this study were firstly to determine the fate of unerupted permanent maxillary incisor teeth following supernumerary tooth removal and secondly to make recommendations regarding the management of such incisor teeth following supernumerary tooth extraction. STUDY DESIGN: This is a retrospective study. METHODS: Records of children attending the Departments of Paediatric Dentistry, Edinburgh Dental Institute, Lothian Primary Care NHS Trust and Dundee Dental Hospital, Tayside University Hospitals Trust between 1995 and 2002 were examined with regard to non-eruption of one or both maxillary central incisors in association with supernumerary teeth requiring surgical removal. Subsequent permanent maxillary incisor eruption was recorded and in those cases of incisor non-eruption, further surgical interventions were noted. RESULTS: In all 118 sets of patient records were included in the study (87 males, 31 females) with a mean age at presentation of 8.8 years (range 5.3-11.6 years). Failure of eruption of the associated permanent maxillary central incisor teeth occurred in 27% of cases, in relation to both conical and tuberculate supernumerary teeth. All tuberculate supernumerary teeth associated with non-eruption cases were palatally placed and 59% were adjacent to maxillary incisors with near complete apex formation. To facilitate incisor eruption in these cases, 41% required surgical exposure of the non-erupted incisor tooth and 59% required surgical exposure with bonding of an orthodontic bracket and gold chain for orthodontic traction. CONCLUSION: Non-erupted permanent maxillary incisor teeth with near complete apical formation, associated with palatally placed, tuberculate-shaped supernumerary teeth, may benefit from having an orthodontic bracket and gold chain placed at the same time as the surgical procedure to remove the supernumerary tooth to facilitate future orthodontic traction.

Child↗
PubMed1999

Odontogenic sinusitis causing orbital cellulitis.

BACKGROUND: Odontogenic sinusitis is a well-recognized condition that usually is responsive to standard medical and surgical treatment. Current antibiotic therapy recommendations are directed against the usual odontogenic and sinus flora. CASE DESCRIPTION: The authors present a case of a patient with acute sinusitis initiated by a complicated tooth extraction that did not yield readily to standard treatment. The case was complicated by orbital extension of the sinusitis. The authors isolated methicillin-resistant Staphylococcus aureus, or MRSA, species from the affected sinus that usually is not encountered in uncomplicated acute nonnosocomial or odontogenic sinusitis. CLINICAL IMPLICATIONS: Though such forms of resistant microbial flora as MRSA are rare, they may be seen in patients who have a history of intravenous, or i.v., drug use and in immunocompromised patients. Management of patients with orbital extension of sinusitis requires hospitalization and i.v. antibiotic treatment.

Adult↗
PubMed2005

Clinical and radiographic performance of delayed-immediate single-tooth implant placement associated with peri-implant bone defects. A 2-year prospective, controlled, randomized follow-up report.

OBJECTIVES: The aim of the present study was to compare the delayed-immediate (Im) and the delayed (De) protocols for placement of single-tooth implants. MATERIAL AND METHODS: After allocation to the Im and De groups by random, 46 patients were treated with a single-tooth implant with acid etched surfaces (Osseotite) in the anterior or pre-molar region of the maxilla or the mandible on average 10 days (Im) or 3 months (De) following tooth extraction, respectively. Forty-one patients attended a follow-up visit 2 years after implant placement corresponding to 1(1/2) years of loading of the implant restorations. Peri-implant and prosthetic parameters were evaluated clinically and marginal bone levels measured on radiographs. RESULTS: Three implants were lost, all before mounting of the crown. None of the implant restorations had failed after 1(1/2) years of function. Probing pocket depths were reduced by up to 1.4 mm on average from the time of loading to the 2-year follow-up and at that time, no significant difference between the Im and De groups was found (4.2 versus 4.1 mm). A statistically significant radiographic marginal bone loss had occurred in the Im group (mean=0.8 mm) as well as in the De group (mean=0.7 mm) in the follow-up period. However, a mean marginal bone level of approx. 1.5 mm in both groups measured from the implant-abutment junction was found to be acceptable. It was demonstrated that probing pocket depths and marginal bone levels after 1(1/2) years of loading of the implant-retained crowns were not influenced by the presence of peri-implant bone defects immediately after implant placement. Furthermore, no severe prosthodontic complications, such as screw loosening or porcelain fractures, arose in this study material. CONCLUSION: High success rates of single-tooth implants after 1(1/2) years of function were achieved using the delayed-immediate and delayed implant placement techniques.

Alveolar Bone Loss↗
PubMed1997

Planning future general anaesthetic services in paediatric dentistry on the basis of evidence: an analysis of children treated in the Day Stay Centre at the Royal Hospitals NHS Trust, London, between 1985-95.

This study aimed to provide evidence for future planning of general anaesthetic services in Paediatric Dentistry. An audit was carried out on children (< or = 17 years) with special needs who were treated under general anaesthesia in the Day Stay Centre at The Royal Hospitals NHS Trust, London, between 1985-95. During these years, 586 child patients were treated, of which 350 had medical complications and/or mental disabilities. Although the number of peri-operative admissions were low (11 planned and 9 emergency), it highlighted the necessity for these patients to be treated in a hospital. Comprehensive dental treatments were carried out which included 1630 deciduous and 596 permanent tooth restorations, and 1382 deciduous and 261 permanent tooth extractions. These patients had follow-up preventive support in the Dental Institute and the readmission rate for further dental treatment under general anaesthesia was low (14 per cent). Comparing the results between 1985-87, 1988-91 and 1992-95 periods, there was a trend for more patients, travelling longer distances, to be treated in the latter periods. It is suggested that more centres with appropriate equipment and trained staff need to be established to meet the increased demand.

Adolescent↗
PubMed1997

Osseous regeneration in immediate postextraction implant placement: a literature review and clinical evaluation.

Immediate implant placement following tooth extraction in appropriately selected cases has been considered to be the optimal time for the procedure for the following reasons: The natural healing processes are mobilized to the maximum, no bone resorption has taken place as yet, drilling is avoided, the number of surgical stages are reduced, design and construction of the prosthesis is simplified, and the positive psychologic effect on the patient is immediate. The learning objective of this article is to discuss the results of immediate implant placement and guided osseous regeneration with membranes, as reported in the literature and as observed in the clinical practice by the authors. The findings of animal and human studies are presented, and the observations of the authors are compared with observations reported in the literature.

Animals↗
PubMed2002

Simplified technique for immediate implant insertion into extraction sockets: report of technique and preliminary results.

A technique is presented for placement of implants at the time of tooth extraction in the precisely desired positions, regardless of extraction socket morphology. To date, 162 implants have been placed utilizing this technique. One was mobile at uncovery and removed. The other implants have been successfully in function, as defined by the Albrektsson Criteria, for up to 7 years, yielding a cumulative success rate of 99.4%.

Bone Regeneration↗
PubMed2003

[Influence of bone remodeling in extraction sites on tooth movement].

OBJECTIVE: To investigate the influence of bone remodeling in extraction sites and orthodontic forces on tooth movement with the aim of providing a basis for selecting optimal orthodontic forces, time of tooth movement and reducing the time for tooth moving into extraction sites. METHODS: Extraction of upper first molars were performed on 36 male Sprague-Dawley rats which were divided equally into 3 groups. A method for quantification of orthodontic tooth movement in the rats was presented. Orthodontic appliance was placed at different time after tooth extraction. Different forces were used to move the maxillary second molars mesially into the extraction spaces. X-ray was taken before appliance activation and after 1, 3, 5, 7, 10, 14 days since appliance activation. Tooth movement was measured cephalometrically by Imagine Analysis Technique, adjusting for magnification by using the known digitized length of the broach. RESULTS: 1. The tooth on the recent extraction side moved faster than that on the healed side. 2. Tooth movement at all time points on the 0.30 N curve differed from those on the higher force curves (P < 0.01), either moving into recent extraction sites or healing sites. Comparison between 0.60 N and 1.36 N indicated that mesial molar movement did not differ from each other after day 5. 3. The classical tooth movement curve had three parts that represent distinctly different processes: early movement; delay; later movement. CONCLUSION: 1. The tooth on the recent extraction side moved faster than that on the healed side. 2. Moderate force maybe was the optimal orthodontic force. It could be overloaded, but resulted in no further enhancement of tooth movement.

Animals↗
PubMed1998

Distribution of periodontal disease in a Swedish adult population 1973, 1983 and 1993.

The aim of this study was to compare changes in periodontal status in a Swedish population over a period of 20 years. Cross-sectional studies were carried out in Jönköping County in 1973, 1983, and 1993. Individuals were randomly selected from the following age groups: 20, 30, 40, 50, 60, and 70 years. A total of 600 individuals were examined in 1973, 597 in 1983, and 584 in 1993. The number of dentate individuals was 537 in 1973, 550 in 1983, and 552 in 1993. Based on clinical data and full mouth intra-oral radiographs, all individuals were classified into 5 groups according to the severity of the periodontal disease experience. Individuals were classified as having a healthy periodontium (group 1), gingivitis without signs of alveolar bone loss (group 2), moderate alveolar bone loss not exceeding 1/3 of the normal alveolar bone height (group 3), severe alveolar bone loss ranging between 1/3 and 2/3 of the normal alveolar bone height (group 4), or alveolar bone loss exceeding 2/3 of the normal bone height and angular bony defects and/or furcation defects (group 5). During these 20 years, the number of individuals in groups 1 and 2 increased from 49% in 1973 to 60% in 1993. In addition, there was a decrease in the number of individuals in group 3, the group with moderate periodontal bone loss. Groups 4 and 5 comprised 13% of the population and showed no change in general between 1983 and 1993. The individuals comprising these groups in 1993, however, had more teeth than those who comprised these groups in 1983; on the average, the individuals in disease group 4 had 4 more teeth and those in disease group 5, 2 more teeth per subject. In 1973, these 2 groups were considerably smaller, probably because of wider indications for tooth extractions and fewer possibilities for periodontal care which meant that many of these individuals had become edentulous and were not placed in a group. Individuals in groups 3, 4, and 5 were subdivided according to the number of surfaces (%) with gingivitis and periodontal pockets (> or =4 mm). In 1993, 20%, 42%. and 67% of the individuals in groups 3, 4, and 5 respectively were classified as diseased and in need of periodontal therapy with >20% bleeding sites and >10% sites with periodontal pockets > or =4 mm. In conclusion, an increase in the number of individuals with no marginal bone loss and a decrease in the number of individuals with moderate alveolar bone loss can be seen. The prevalence of individuals in the severe periodontal disease groups (4, 5) was unchanged during the last 10 years; however, the number of teeth per subject increased.

Adult↗
PubMed1979

Role of pain in placebo analgesia.

The hypothesis that perceived pain intensity can influence placebo analgesia was tested. One hundred and seven subjects rated their pain from from 0 to 10 on a visual analog scale after a standard wisdom tooth extraction. The expected course of such postoperative pain in the absence of therapy or placebo is a steady increase; this was confirmed by blind administration of the placebo. When placebos were given intravenously in view of the patients, some (placebo nonresponders) reported that their pain increased, whereas others (placebo responders) reported that their pain either decreased or remained the same over the next 60 min. A placebo response was more likely to occur if the pain rating 5 min prior to placebo administration (initial pain) was greater than 2.6. Furthermore, placebo responders with initial pain above this 2.6 level reported significantly greater mean analgesia than those with lower initial pain. Indeed, responders with initial pain less than 2.6 reported no change in pain during the 60 min after administration of a placebo. When their initial pain level was greater than 2.6, they reported a steady decline in pain over this period. However, above the 2.6 level there was no obvious relationship between the magnitude of the placebo analgesia and the initial pain.

Analgesia↗
PubMed2003

Immediate implants covered with connective tissue membranes: human biopsies.

BACKGROUND: Osseointegration has been shown to occur around implants placed immediately after tooth extraction in humans. To date, such osseointegration has been achieved only with titanium plasma-sprayed (TPS) implants placed in extraction sockets with a bone-to-implant distance of less than 2 mm. In a previous report, when this horizontal defect dimension (HDD) exceeded 2 mm, the resulting percentage of bone-to-implant contact was reduced, indicating that the immediate technique would be limited in most cases to non-molar teeth. In an attempt to improve the bone-to-implant contact and the initial bone-to-implant contact in a vertical dimension, the implant surface, the type of membrane, and the method of membrane placement used in a previous study by our group were modified. METHODS: Ten large-grit sandblasted, acid-attacked (SLA) titanium implants were placed into immediate extraction sites in 5 patients. HDDs of 0.0 to 1.5 mm (controls), 1.5 to 4.0 mm, and >4.0 mm were used. Following insertion, implants were completely covered with a connective tissue membrane. This was in contrast to the use of an expanded polytetrafluoroethylene (ePTFE) membrane penetrated by the neck of the implant in our previous report. Primary closure of soft tissue flaps was achieved in each case. Six months after placement, 7 of the implants were histologically examined. RESULTS: Osseointegration occurred across all HDDs, with the percentage of bone-to-implant contact in the 0.0 to 1.5 mm HDDs similar to that seen in the >4.0 mm HDDs. The first bone-to-implant contact measured vertically was similar in both the smaller and larger HDDs. CONCLUSIONS: Osseointegration was successful in immediate implant placement sites with horizontal defect dimensions wider than 4 mm in humans when SLA titanium implants were completely covered with connective tissue membranes. It remains undetermined whether the different type of membrane, placement of the membrane, type of implant surface, or a combination of these 3 factors were responsible for the improved osseointegration in HDDs >4 mm. Further study is needed.

Alveolar Process↗
PubMed2006

Clinical and anatomical study of retromolar foramen and canal.

PURPOSE: The retromolar canal is a rare anatomic variation of the mandible. The neurovascular content of the mandibular retromolar canal is very important for surgical procedures involving the retromolar area and there has been a lack of information on this subject. This study consists of anatomic research of the retromolar foramen and canal, planned after an impacted third molar tooth extraction operation in which we encountered a retromolar neurovascular bundle. MATERIALS AND METHODS: Eighty sides of 40 mandibles were evaluated and the presence of the retromolar foramen and its relation to the last teeth, the transverse and sagittal distances of the retromolar trigone, and the distance of the retromolar foramen to the last socket of the arch were measured. RESULTS: The neurovascular bundle includes striated muscle fibers, thin myelinated nerve fibers, numerous venules and a muscular artery. Of the 40 mandibles included in this study, retromolar foramens were found in 10 (25%). The presence of the retromolar foramen is not dependent on the last teeth of the arch. The dimensions of the retromolar trigone were measured and the presence of the retromolar foramen was found to be nonrelevant to the dimensions of the retromolar trigone. Retromolar foramen distance from the distal edge of the last socket of the arch was found to be 11.91 +/- 6.71 mm and 4.23 +/- 2.30 mm, respectively, from the second and third molars. CONCLUSIONS: This study therefore clearly establishes the incidence and importance of the retromolar canal. This study shows that the retromolar foramen and canal can be seen occasionally in routine dental surgery. Due to the neurovascular bundle passing through it, the retromolar canal and foramen must be kept in mind in all anesthetic and surgical approaches regarding the retromolar area and mandible.

Adult↗