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The effect of a single dose of 1500 R on early postextraction socket healing was studied in jaws of rats. A severe delay in healing was found in animals irradiated 2 weeks prior to extraction. Retardation of healing to a lesser degree was demonstrated in sockets irradiated immediately after exodontia.
A surgical technique with the objective of obtaining and maintaining soft tissue closure over membranes used for guided bone regeneration is described. This procedure achieves primary closure in extraction sockets or in association with immediate implants without creating mucogingival problems around adjacent teeth.
TEN PATIENTS WHO REQUIRED two or more anterior teeth extractions were utilized in this study. Extraction procedures were carried out with a full thickness surgical flap approach. After flap reflection, teeth were removed with a minimum of trauma to the surrounding bone. Following extraction silicone-based impression techniques were used to produce a model of the alveolar process and small metal pins were placed in the alveolus to be used as fixed points to make measurements of ridge dimensions. One socket was covered with an expanded polytetrafluoroethylene (ePTFE) barrier membrane (experimental site); the other socket was a conventional control. The soft tissue flaps were then mobilized using periosteal releasing incision and the wound closed with ePTFE mattress sutures. Six months following extraction, patients were treated with flap surgery to expose both extractions sites to remove the ePTFE membranes and to measure ridge dimensions using the pins as fixed points. Clinical and model measurements have shown statistically significant better ridge dimensions at experimental sites than at control (P < or = 0.05). Three patients with exposed membranes had similar dimensional changes as controls. Results from this study suggested that this improved technique offers a predictable alveolar ridge maintenance enhancing the bone quality for dental implant procedures and esthetic restorative dentistry.
The effect of splinting upon periodontal and pulpal healing after autotransplantation of teeth with complete and incomplete root formation was studied in 16 green Vervet monkeys (Cercopithecus aethiops). 2 maxillary incisors were extracted in each monkey and autotransplanted to the contralateral socket. One of these teeth was stabilized with an acrylic splint for either 2 or 6 weeks, while the other incisor was non-splinted. The animals were sacrificed 8 weeks after autotransplantation and the autotransplanted teeth were examined histologically. The following histologic parameters were registered for each tooth: surface resorption, inflammatory resorption, replacement resorption (ankylosis), downgrowth of pocket epithelium, periapical inflammatory changes and extent of pulp necrosis. The histometric analysis demonstrated that splinting increased the extent of pulp necrosis and inflammatory root resorption compared to non-splinting. Furthermore, the extent of normal periodontium was decreased among the splinted teeth, when compared to the non-splinted teeth. It is concluded that splinting not only failed to improve healing but apparently exerted a harmful effect upon periodontal and pulpal healing after autotransplantation.
The purpose of this study is to present new flap designs for the prevention of postoperative gingival recession adjacent to maxillary anterior sites that received dental implants. Nine patients received 10 implants in the maxillary anterior region. Gingival morphotypes and smile lines were evaluated prior to implant placement. Gingival probing depths, clinical attachment levels, and recession were recorded at teeth adjacent to implant sites at the initial exam and 3 months after implant restoration. A minimum of 5 mm of crestal bone width was required for implant placement. The labial flaps for healed ridges and implants placed into sockets were extended to or within 1 to 3 mm beyond the alveolar crest. In two sites, transfer of the implant relationships was made to provide the patients with provisional restorations at the time of second-stage surgery. Four patients had implants placed at the time of tooth removal. In these patients, expanded polytetrafluoroethylene barrier membranes were modified, removing the outer rim of material. The inner portion of the material was placed over the implant and the flaps were sutured, leaving the center part of the material exposed. The purpose of using the barrier in this manner was to protect the clot and subsequent granulation tissue formation during the first 2 weeks of healing. The material was removed 2 weeks after surgery. Six implants were placed into edentulous sites. At second stage surgery, flaps were reflected to the alveolar crest, thereby minimizing the potential for gingival recession. Provisional restorations placed at the time of implant uncovering appeared to support the repositioned gingiva. Changes in probing depth, clinical attachment levels, and recession were not statistically or clinically significant. Results of this pilot project suggest that flap designs minimized recession at teeth next to implant sites.
INTRODUCTION: We performed a retrospective study of tooth removal for patients with coagulation disorders. MATERIAL AND METHOD: The study included 67 patients divided into 3 groups according to their coagulation disorder. The first group included 31 patients with a congenital disorder, the second 19 patients receiving anticoagulant therapy, and the third 16 patients with an acquired disorder. The same surgical procedure was used for all patients: alveoli regulation, socket preparation with resorbable oxycellulose dressing, and sutures with separate stitches. Biological glue and celluloid splints were not used. Depending on the severity of the coagulation disorder, factor VIII or concentrated von Willebrand factor or Desmopressine was administered for patients in the first group. If possible, low-molecular-weight heparin replaced oral anticoagulation for patients in the second group. Platelet concentrates were administered for 2 of the patients in the third group. RESULTS: Postoperative bleeding was noted in 4 patients in the first group, 2 in the second and 2 in the third. DISCUSSION: We have abandoned the use of biological glue and celluloid splints. The rate of bleeding in the first and second group was similar to that reported in the literature. We were unable to find any comparable report for the third group.
A fluoroalkyl cyanoacrylate is shown to be a very effective hemostatic agent in routine extractions in rhesus monkeys. Clinical and histologic observations of the healing sockets at selected intervals revealed uneventful healing, even when the tissue adhesive was placed directly against the alveolar bone within the extraction socket. The quantity, quality, and rate of bone replacement were not different between the experimental and control groups. When polymerized cyanoacrylate is entrapped within the connective tissue above the healing socket, it is effectively removed by normal tissue phagocytes.
Osseointegrated dental implants have proven to be predictably successful when appropriate guidelines are followed. The technique as outlined by bränemark includes a post-extraction period of up to 12 months in order to allow for bone healing. This delay, combined with ridge resorption following extraction, may contribute to several problems. Insufficient available bone for ideal implant placement and prolonged treatment time are two common difficulties. Recently, several investigators have reported immediate placement of dental implants into extraction sockets achieving excellent results while, at the same time, minimizing or eliminating the above-mentioned difficulties. This paper will discuss the technique of immediate placement of osseointegrated dental implants into extraction sockets and its potential advantages. A future article will detail surgically-related difficulties with this technique.
OBJECTIVE: The purpose of this study was to identify factors associated with an increased risk for post-tooth-extraction complications in a sample of HIV-positive patients. STUDY DESIGN: A cohort of HIV-positive patients who required the extraction of one or more teeth was enrolled. The predictor variables were grouped into the following sets: demographics; medical and social history; preoperative clinical findings; preoperative laboratory measures (hematologic, immunologic, and nutritional); and treatment. The outcome variable was defined as the presence or absence of a complication following tooth extraction. Logistic regression techniques were used to identify variables associated with an increased risk for complications following tooth extraction. RESULTS: During the enrollment period, 76 HIV-positive patients were enrolled into the study cohort. Seventeen patients (22.4%) had postoperative complications. Based on the bivariate statistical analyses, variables associated with the presence of postoperative complications were red blood cell count, CD8 count, total number of positive sites tested using cell-mediated immunity skin tests, and extraction technique (p < or = 0.05). Using a stepwise logistic regression technique, the variable identified as being predictive of postoperative complications was the CD8 count (p = 0.02). The post-tooth-extraction complication rate of the HIV-positive patients in this study sample was greater than the rate reported in most other studies (22% vs. 3%-5%). The complications, however, were minor and easily treated. The variable consistently identified with an increased risk for complications was the CD8 count: the lower the CD8 count, the higher the risk for complications. The CD8 count, however, had poor predictive value. CONCLUSION: In acute clinical situations--for example, in cases of patients with significant dental pain--the results suggest that delaying treatment to obtain laboratory studies may be of little clinical value. It may be appropriate to proceed with suitable, definitive procedure(s) to alleviate symptoms.
This study describes the precise determination of the extrusive force in the rat mandibular incisor measured for a relatively longer period of time under artificial respiration with halothane anaesthesia. Following restraint of the eruptive movement of the incisor for a period of 20 h, the pushing force increased gradually and was maintained as an extremely gentle slope toward the end of the experimental period. The maximum pushing forces were estimated to be 9.1 +/- 2.5 (SD) mN in impeded incisors and 9.8 +/- 2.3 mN in unimpeded incisors. When force was converted to pressure, values were 30 +/- 8 (SD)mmHg and 32 +/- 8 mmHg, respectively; the difference was not significant. The maximum pushing force decreased rapidly--almost in parallel--with the fall of systemic arterial blood pressure after death of the animals; the amounts of reduction were 7.2 +/- 1.8 mN (24 +/- 6 mmHg) in impeded incisors and 7.0 +/- 2.0 mN (23 +/- 7 mmHg) in unimpeded incisors. Residual pushing forces were 1.7 +/- 1.0 mN (5.6 +/- 3.3 mmHg) in impeded incisors and 2.5 +/- 0.6 mN (8.2 +/- 2.0 mmHg) in unimpeded incisors; the difference was significant (P < 0.05). These results suggest that, under these experimental conditions, the pushing force of the rat incisor originates primarily from localized blood pressure within the incisor socket and, in part, from tissue growth.
Dental implants have become an accepted form of permanent tooth replacement. Nearly all implants currently being placed are of the osseointegrated type. These typically consist of three parts: a fixture, an abutment, and a screw or threaded rod. The fixture, usually composed of titanium, can be placed in either a surgically created site in the alveolar ridge or a fresh extraction socket. Diagnostic imaging can play an important role in evaluating patients with such implants. Useful imaging studies include plain panoramic radiography, computed tomography, and computer-reformatted cross-sectional, panoramic, and three-dimensional imaging. Advanced imaging studies can be used to determine the suitability of implant placement, appropriate sites for implant placement, the size of the implant that can be placed, and the need for preimplantation ridge surgery. Postoperatively, advanced imaging studies can show failure of an endosseous implant to osseointegrate, improper placement of an implant, and violation of important structures.
A technique that facilitates the removal of teeth or retained root fragments without traumatizing the alveolar bone of the socket is described. This technique may be employed whenever such extractions are envisaged, but it is particularly important when the subsequent placement of dental implants is planned.
BACKGROUND: On the basis of an anatomo-surgical classification adopted in our Department, that divides impacted lower third molars into (1) ectopic, (2) dystopic and (3) in the proper anatomical site, and the latter into Class A (complete bone impaction without pathology of the second molar), Class B (mucosal impaction with pathology of the second molar: Subclass B1, if the mucosa distal to the second molar is of a normal amount; Subclass B2, if the retromolar mucosa is plentiful), and Class C (mucosal semi-impaction), the authors carried out a comparative study on 20 patients who underwent extraction of both Class C lower third molars. METHODS: These operations were performed, in each patient, on one side raising an Archer's flap and on the other introducing a modification of the incision lines using Z-plasty for flap design. The patients were examined from the first postoperative hours up to the 7th day following a protocol aimed at monitoring the postoperative variables pain, edema, trismus, infection and healing time. RESULTS AND CONCLUSIONS: The preliminary results, analyzed by Student's "t"-test, are statistically significant (p < 0.05), and favour the hypothesis that the technical modification proposed for the flap, by permitting a better closure of the socket, involves a lesser incidence of postoperative complications and in any case a more comfortable postoperative course.
A prospective randomized crossover, within-patient, controlled study was performed in 26 healthy patients to test the effect of the prophylactic local use of gauze drain impregnated with chlortetracycline (Aureomycin 3%, Lederle) ointment on postoperative alveolitis formation after surgical removal of 52 bilaterally impacted mandibular third molars. The teeth were removed on two separate occasions; on one side drain was inserted in the socket, and on the other side no drain treatment was used for control. The influence on postoperative pain, swelling, and mouth opening ability was investigated. The results indicated a statistically significant reduction (P = 0.02) in the incidence of postoperative inflammatory complications, defined as postoperative alveolitis, from 35% in the no-drain group to 4% in the drain group. No statistically significant difference was found between the two treatment methods with regard to pain and mouth opening reduction. There was a significant difference between the drain and no-drain treatment with regard to swelling on the 1st postoperative day in favor of the no-drain method. It is concluded that insertion of a chlortetracycline-impregnated drain may be an effective method for reducing postoperative alveolitis formation but has no beneficial effect on pain, swelling, and mouth opening reduction after impacted mandibular third-molar surgery.
A double-blind, randomized trial was carried out in 90 patients to compare the analgesic and anti-inflammatory efficacy of 500 mg diflunisal twice daily with that of 25 mg codeine phosphate 4-times daily and placebo in relieving pain and swelling after surgical removal of impacted third molars. Diflunisal was found to be superior to codeine and placebo on the first post-operative day, but the difference in efficacy of the drugs had diminished by the third post-operative day. In the diflunisal group of 30 patients, 10 (33%) developed 'dry socket' or alveolitis sicca dolorosa. Only 2 patients in the codeine group and 1 patient in the placebo group developed this very painful condition. The possible explanation of 'dry socket' is discussed.
Nhe symptoms after surgical removal of 379 mandibular wisdom teeth when Xylocain-Exadrin 2% and Citanest-Octopressin 3% were used, were evaluated according to a three grade scale. The severity of the symptoms, which were mild and normal in 53% and severe in 47%, did not demonstrably vary with the type of anaesthetic agent used. The symptoms were, on the average, more severe among the women than among the men. The symptoms were correlated with the duration of the operation, which was most obvious in the men. For the men the frequency of symptoms also increased with age. In the men there was also a tendency to a correlation between dry socket and long duration of operation. It thus appeared as if only the men reacted in the way expected from a biologic point of view. The investigation also showed that Xylocain-Exadrin had a better anaesthetic and ischemic effect.
Removal of third molars is the most common procedure in oral surgery. It may be associated with complications, such as sensory damage , dry socket, infection and iatrogenic damage. A case of mandibular angle fracture during third molar extraction in a 37-year-old female is reported. Literature review on the possible etiologies and ways of prevention were recorded. The reason is believed to be multifactorial and include: age, gender, degree of impaction, relative volume of the tooth in the jaw, preexisting infection or bone lesions, failure to maintain a soft diet in the early postoperative period and the surgical technique. It is possible to reduce the risk of this complication by adoption of preventive measures.
A histologic study was done to observe the influence of occlusal hypofunction on periodontal tissues and the physiologic drift process, and to elucidate the origin of periodontal ligament narrowing. Twenty-four Wistar rats were used. Hypofunction was induced by extracting the right maxillary molars. Histologic observations were reported on the right lower jaws which were fixed, decalcified, sectioned and stained according to classical histologic methods. Two groups of five animals each were used for a complementary study study using sequential fluorescent labeling in order to evaluate the bone formation rate. After 15 days of hypofunction, the periodontal ligament was obviously narrowed and its structure was disorganized. Woven-bone formation was noted at the top of the interradicular septa, at the bottom of the sockets and along their modeling sides. At 30 days and at intervals up to 3 months, the periodontal ligament remained disorganized and narrowed. The newly-formed bone was engaged in a maturation process. Nevertheless, osteoporosis was also observed at the inferior part of the interradicular septa. Fluorescent labeling confirmed the histologic findings and showed that the induced bone formation is related to periodontal ligament narrowing and the supra-eruption process.