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Localized osteomyelitis secondary to endodontic-implant pathosis. A case report.

This case report documents the placement of a single implant fixture in an incisor extraction socket, with the adjacent lateral incisor developing periapical pathosis within 2 weeks. This root-end inflammatory process proceeded to communicate with the surface of the implant fixture. Although endodontic therapy was performed within one week on the devitalized tooth, and extensive osteomyelitis developed around the implant. Three weeks after placement, the fixture had to be removed. The osteotomy site appeared to be healing uneventfully during the one month follow-up period. Seven possible causes for this occurrence are discussed.

Dental Implantation, Endosseous↗

Using 45S5 bioglass cones as endosseous ridge maintenance implants to prevent alveolar ridge resorption: a 5-year evaluation.

Bioglass cones acting as space fillers after removal of tooth roots delay the resorption of alveolar ridges. In 1987, 242 implants in 29 patients with a mean postimplantation interval of 19.9 months were reported by the authors. Bioglass cones had been fitted snugly at least 2 mm below the alveolar crest, and dentures were placed no sooner than 6 weeks following tooth removal; 2.9% had been lost and 3.7% developed dehiscences. The present report on 168 implants in 20 recalled patients (mean postimplantation interval of 63.2 months) revealed a loss of 14.3% of the implants and 7.7% of the implants requiring recontouring. Literature indicates highest survival rates for implants in the anterior mandible; however, the present data demonstrate a statistically significant retention rate in the anterior maxilla. With this high rate of Bioglass cone retention (85.7%) after 5 years, their placement into fresh sockets to maintain the alveolar ridge is recommended.

Adult↗

Effect of antimicrobial mouth rinses on the incidence of localized alveolitis and infection following mandibular third molar oral surgery.

Mandibular third molars were removed from 400 patients who were divided into four different preoperative and postoperative rinsing groups using either normal saline solution, chloramine-T, povidone iodine, or sodium bicarbonate. The overall incidence of localized alveolitis and infection was 4.5% and 1.7%, respectfully. The incidence of the two postoperative problems proved not to be statistically significant when the four groups were compared with each other. There seems to be no apparent advantage to the preoperative and postoperative use of an antimicrobial mouth rinse in place of normal saline solution in reducing the incidence of either localized alveolitis or postoperative infections.

Adolescent↗

A prospective study of complications related to mandibular third molar surgery.

A prospective study that evaluated the surgical and postsurgical problems of 9,574 patients of a wide range of ages who had had 16,127 third molars removed was performed. It was concluded that removal of mandibular third molar teeth during the teenage years resulted in decreased operative and postoperative morbidity.

Adolescent↗

Antibiotic therapy in impacted third molar surgery.

The use of routine antibiotic therapy in patients undergoing surgical third molar extraction is controversial. The efficacy of antibiotic therapy in preventing postoperative complications following surgical third molar extractions was evaluated in 141 patients. In the test group (66 patients), the protocol utilized a regimen of 2 g of amoxicillin orally daily for 5 d postoperatively, starting at the completion of surgery. In the control group (75 patients), no antibiotic therapy was given. No significant difference was found between the test group and the control group in the incidence of postoperative sequelae, i.e. fever, pain, swelling and alveolar osteitis. A statistically significant association between smoking, habitual drinking and increased postoperative pain and fever was found. Patient age > or = 18 yr was positively correlated with an increased incidence of alveolar osteitis. Swelling was found to be gender-related, in that female patients experienced more swelling than male patients. No correlation was found between the time required for surgery or difficulty of extraction and post-operative pain. In conclusion, no difference was found between patients receiving postoperative amoxicillin and the control group in the incidence of postoperative sequelae.

Adolescent↗

Relationship between the tooth eruption and regional blood flow in angiotensin II-induced hypertensive rats.

OBJECTIVE: The mechanism of action of vasoactive drugs on tooth movement is unknown. The purpose of the present study was to measure simultaneously the axial movement of the mandibular incisor, regional blood flow at the base of the incisor, and systemic arterial blood pressure in angiotensin II-induced hypertensive rats to determine the possible cause of tooth displacement. DESIGN: The measurements were made under artificial respiration with halothane anaesthesia. In the experimental animals, 2.5 microg of angiotensin II in 1 ml of Ringer's solution was infused at 0.83 ml/h for 12 h from the femoral vein. In the control animals, only Ringer's solution was infused. RESULTS: Angiotensin II caused an increase of the mean arterial blood pressure from 86 to 119 mm Hg, and decreases of the eruption rate from 667 to 494 microm/24 h and the regional blood flow from 262 to 214 mV. There was a positive correlation between the eruption rate and regional blood flow, and a negative correlation between the blood pressure and regional blood flow. CONCLUSION: These results suggest that angiotensin II caused constriction of the peripheral vascular smooth muscle resulting in an increase of arterial blood pressure and a decrease of regional blood flow, followed by a decrease of fluid volume and then a reduction of either the pressure within the socket or of the eruptive force. We assume that the regional vascular pressure within the socket plays an important role in determining the position of the rat incisor.

Angiotensin II↗

Tooth eruption through autogenous and xenogenous bone transplants: a histological and radiographic evaluation in beagle dogs.

The effect of implanting autogenous and xenogenous (Bio-Oss) bone transplants into metabolically active sites within beagle dog mandibles during permanent premolar tooth eruption was examined. Ten 14-week-old beagles were used. Before commencing the radiographic experiments, metal bone markers were placed in the caudal margin of the mandible at the age of 10 weeks. The deciduous first and third molar teeth were extracted and their sockets over the permanent second and fourth premolars were implanted with autogenous particulate enchondral iliac crest bone, autogenous particulate membraneous mandibular body bone, xenogenous bovine anorganic bone mineral spongiosa granules (1-2mm3) (Bio-Oss, Geistlich Pharma, Switzerland) of left empty. The third premolar served as control site. Standardized oblique lateral radiographs were taken once a week. A number of coordinates of defined points and structures were determined by means of a coordinate digitizing system. Animals were killed 4, 10 and 16 weeks after bone transplantation for histological examination of the transplantation sites. All premolars showed no delay in eruption or disruption of crown and root development. On histology, the Bio-Oss particles were not resorbed or integrated in the alveolar bone but were pushed forward into the gingiva. We have demonstrated that there is on difference in the eruption curve of the permanent premolars in the four groups (ANOVA P > 0.5) and that bone transplantation has no inhibitory effect on eruption (ANOVA P > 0.3) and crown development of the underlying permanent premolar but that Bio-Oss does not have the same resorbable or integrating capability as autogenous bone grafts.

Alveolar Process↗

Tissue reaction to submerged ceramic tooth root implants. An experimental study in monkeys.

Tooth root replica implants made from alumina ceramic material of solid structure coated with a porous layer, were used as dental implants in monkeys. The porous coating was 1/2 mm thick and had pore sizes within 50--200 microns range, with a 30% degrees of porosity. Tne implants were inserted into prepared sockets in the mandible of 5 Cercopithecus monkeys. After submerged implantation periods varying from 5 to 15 weeks, a perforating steel post was introduced through the covering gingiva into the artificial root canal of the implants. The animals were sacrificed after 6 weeks, 2, 3 and 4 months. Three out of the total number of 10 implants were lost. The remaining 7 specimens were retrieved for histologic and microradiographic examination. Fibrous and mineralized tissue ingrowth of the porous layer of the implants was found. No adverse reactions of the adjacent bone were demonstrable. The implants became anchored to the host and no epithelial downgrowth along the ceramic was found.

Aluminum Oxide↗

A comparison of various methods of soft tissue management following the immediate placement of implants into extraction sockets.

Various techniques of soft tissue management following the immediate placement of implants into extraction sockets are evaluated; the merits of the Rehrman-plasty, the free mucosal graft, the pedicled island flap, and membranes to seal the socket are discussed as are the esthetic effects of various surgical techniques used at abutment connection. Two treatment strategies are suggested. Presently, the treatment of choice seems to be to close the extraction socket after implant placement by means of either a pedicled island flap or a thin cortical bone membrane. In addition, a new excisional technique is described for use at abutment connection. If a flap has to be raised to extract the tooth, the implant should be covered by means of either a Rehrman-plasty or a cortical bone membrane. If a Rehrman-plasty is chosen, the apically repositioned flap should be used at abutment connection.

Bone Transplantation↗

[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↗

Dental extractions in hemophilia: reflections on 10 years' experience.

During the past ten years we have witnessed a remarkable reduction in complications following dental extractions in patients with hemophilia. Thirty-six of 100 patients experienced delayed bleeding during the first half of this period; fourteen of 112 patients had a hemorrhagic problem after extraction during the second half. From a major undertaking involving hospitalization and general anesthesia, it has become a simple procedure in the outpatient office. During the entire period, no changes were made in the transfusion policy or in the oral administration of antifibrinolytic agents. Factors contributing to the favorable evolution have been the increasing experience of the oral surgeon, the improving dental status of our hemophilia patients, prophylactic measures to reduce gingival inflammation, and changes in the composition and amount of material used to pack the dental sockets.

Aminocaproic Acid↗

Alveolar osteitis after surgical removal of impacted mandibular third molars. Identification of the patient at risk.

One hundred thirty-eight impacted mandibular third molars were surgically removed. A prospective study of risk factors associated with the development of alveolar osteitis (dry socket) postoperatively was undertaken. Two surgeons, one experienced and one inexperienced, removed the teeth. Patients were controlled for age, sex, use of oral contraceptives, radiographic difficulty of the extraction, and tobacco use. Patients treated by the inexperienced surgeon and those using tobacco had a significantly greater incidence of alveolar osteitis. Previously identified risk factors of increased age, female sex, oral contraceptive use, and increased surgical time were not associated with an increased incidence of dry socket. Recommendations are made regarding prevention of alveolar osteitis in those patients identified as being at high risk.

Adolescent↗

Evaluation of topical viscous 2% lidocaine jelly as an adjunct during the management of alveolar osteitis.

PURPOSE: This study evaluated the efficacy of topical viscous 2% lidocaine jelly for the alleviation of pain experienced during the instrumentation of mandibular third molar extraction sites diagnosed with alveolar osteitis and for pain relief during the postinstrumentation period. PATIENTS AND METHODS: Thirty adult patients with a diagnosis of alveolar osteitis in a mandibular third molar extraction site were included in this prospective, double-blind study. Each patient had their sutures removed, the socket irrigated, and 2% lidocaine jelly placed on the tip and side of the tongue to blind the patient against the test substances. The subjects were then randomly distributed into two groups. Group 1 had a nonactive jelly base placed into the socket 2 minutes prior to the placement of a standard obtundant dressing. Group 2 had viscous 2% lidocaine jelly placed into the socket in the same manner. Patients subjectively quantified their pain intensity pretreatment, during instrumentation, immediately postmanipulation, at 5-minute intervals to 30 minutes, and at 45 and 60 minutes. They also subjectively quantified their pain relief at each of the time intervals following instrumentation. RESULTS: There was no statistical difference between the pretreatment pain experienced by both groups. The use of 2% lidocaine jelly had a measurable (P = .056), but not statistically significant, effect on pain due to instrumentation. At every time interval thereafter, the use of 2% lidocaine jelly elicited a statistically significant (P < .05) decrease in pain perception, and a statistically significant increase in pain relief when compared with the inactive jelly. CONCLUSION: Topical viscous 2% lidocaine jelly is a useful adjunct during the treatment of alveolar osteitis, especially in the early (< or = 60 minutes) postinstrumentation period.

Adult↗

Perioperative use of 0.12% chlorhexidine gluconate for the prevention of alveolar osteitis: efficacy and risk factor analysis.

OBJECTIVES: The purposes of this study were to evaluate the use of 0.12% chlorhexidine gluconate as a prophylactic therapy for the prevention of alveolar osteitis and to further examine subject-based risk factors associated with alveolar osteitis. STUDY DESIGN: The trial was a randomized, double-blind, placebo-controlled, parallel-group study conducted among 279 subjects, each of whom required oral surgery for the removal of a minimum of one impacted mandibular third molar. Subjects were instructed to rinse twice daily with 15 ml of chlorhexidine or placebo mouthrinse for 30 seconds for 1 week before and 1 week after the surgical extractions. This regimen included a supervised presurgical rinse. Alveolar osteitis diagnosis was based on the subjective finding of increasing postoperative pain at the surgical site that was not relieved with mild analgesics, supported by clinical evidence of one or more of the following: loss of blood clot, necrosis of blood clot, and exposed alveolar bone. RESULTS: In comparison with use of the placebo mouthrinse, prophylactic use of the chlorhexidine mouthrinse resulted in statistically significant (p < 0.05) reductions in the incidence of alveolar osteitis. With chlorhexidine therapy, the subject- and extraction-based incidences of alveolar osteitis in the evaluable subset (271 subjects) were reduced, relative to placebo, by 38% and 44%, respectively. The corresponding odds ratios that describe the increased odds of experiencing alveolar osteitis in the placebo group were 1.87 and 2.05 for subject- and extraction-based analyses, respectively. In comparison with nonuse of oral contraceptives, the use of oral contraceptives in female subjects was related to a statistically significant increase in the incidence of alveolar osteitis (odds ratio = 1.92, p = 0.035). Relative to male subjects, the observed incidence of alveolar osteitis for female subjects not using oral contraceptives was not statistically significant (odds ratio = 1.18, p = 0.64). Smoking did not increase the incidence of alveolar osteitis relative to not smoking (odds ratio = 1.20, p = 0.33). CONCLUSIONS: These data confirm that the prophylactic use of 0.12% chlorhexidine gluconate mouthrinse results in a significant reduction in the incidence of alveolar osteitis after the extraction of impacted mandibular third molars. In addition, oral contraceptive use in females was confirmed to be a risk factor for the development of alveolar osteitis.

Adolescent↗