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PubMed2006

Successful use of recombinant factor VIII devoid of von Willebrand factor during multiple teeth extractions in a patient with type 3 von Willebrand disease.

We report a 55-year-old patient with type 3 von Willebrand disease who underwent multiple tooth extractions with successful hemostatic management using recombinant factor VIII. The patient was previously misdiagnosed and treated incorrectly then at 53 years old, he was diagnosed with type 3 von Willebrand disease. As he had avoided dental treatments for two decades due to severe bleeding after dental extraction, multiple severe caries and marginal periodontitis were revealed. The patient refused the use of blood products in hemostatic management because he was afraid of blood-borne diseases and development of anti-von Willebrand factor alloantibodies. After close consultation, we therefore decided to use recombinant factor VIII. Four teeth extraction procedures were executed twice. Before extraction, bolus recombinant factor VIII (50 IU/kg) was administered intravenously followed by continuous infusion (5-10 IU/kg per h) for approximately 48 h. The factor VIII:C level increased from about 1 to 20-32% 30 min after bolus infusion. During continuous infusion (10 IU/kg/h), factor VIII:C was maintained at more than 10%. Little bleeding occurred during and after the multiple teeth extractions and during suture removal. On frequent examinations during a 1-year follow-up, neither von Willebrand factor nor factor VIII inhibitors were detected.

Blood Loss, Surgical↗
PubMedDate not supplied

[The effect of radiation on the chronology of extraction wound healing. Histomorphologic study in rats].

The purpose of this study was to analyse histomorfologically the X-radiation influence on the chronology of wound healing of tooth extraction. Sixth young albino rats were used. After extracting the maxillary right incisors all the rats, three experimental groups were formed: the control (I) and the groups that received 1.25 Sv (II) and 1.75 Sv (III). The rats were killer at 3, 7, 14 and 28 post-operative days following the teeth extraction. The pieces obtained were submitted to routine laboratorial procedures until getting pieces stained with hematoxylin and eosin. It was concluted that: 1) there was a delay in the epithelial proliferation of the gengival mucosa o the animals submitted to X-rays, in a similar way in the two irradiated groups: 2) there was a considerable delay in the alveolar repair process in dental extraction wound; 3) this delay was more proeminent when the X-ray action was more intense.

Alveolar Process↗
PubMed1997

Orthodontic retraction into recent and healed extraction sites. A histologic study.

The aim of this experimental study was to assess the advantages of an early or delayed treatment start after tooth extraction on the basis of hard-tissue findings (density, maturity, osteodynamics) and of soft-tissue responses at the extraction site. Following bilateral extraction of the second incisors, reciprocal space closure was initiated in 3 foxhounds (age: 3.5 years): group 1 (6 teeth) 12 weeks after extraction, group 2 (6 teeth) immediately after extraction. After an 8-week bodily tooth movement period and a 2-month retention period, evaluation was undertaken on the basis of clinical/radiologic and histologic criteria (sequential polychromatic bone marking, light microscopy). Histologic analysis yielded the following findings in group 1 (delayed tooth movement): low bone density at the extraction site with more mature lamellar bone, pronounced horizontal atrophy of the alveolar process with periosteal bone apposition in direction of tooth movement, increased tendency towards gingival invagination. The findings in group 2 were characterized by: higher bone density with less maturity (bundle bone) at the extraction site, broader alveolar process, reduced tendency towards gingival invagination. No qualitative difference between the 2 groups was found with respect to root resorption. The histologic findings therefore indicate that orthodontic retraction into extraction sites should be initiated at an early stage.

Animals↗
PubMedDate not supplied

Guided tissue regeneration ensures osseointegration of dental implants placed into extraction sockets. An experimental study in monkeys.

The aim of the present study was to explore the possibility of achieving osseointegration of dental titanium implants, inserted into alveoli immediately after tooth extraction, by covering the recipient site with a teflon membrane. In each of 7 monkeys, mucoperiosteal flaps were raised on the buccal and palatal aspects of the maxillary molars in both sides of the jaw. The second molars were then extracted and self tapping titanium implants of the screw type (Astra Dental Implants) were inserted into the sockets of the largest roots. In the coronal portion of the sockets, a void was always present between the implant and the socket walls. In one side of the jaw, a membrane (Gore-Tex Augmentation Material) was adjusted to cover the implant. The implant in the other side of the jaw served as control and was only covered by the tissue flaps. Microscopic analysis after 3 months of healing revealed that soft tissue was facing the coronal portion of the implants to a varying degree in the control side, while osseointegration was consistently observed to the top of the membrane-covered implants which remained submerged throughout the experimental period. The results suggest that the membrane technique can secure complete osseointegration of implants inserted immediately into extraction sockets.

Alveolar Process↗
PubMed1989

[Histopathological observation of periodontal tissue by tipping movement toward the hydroxyapatite-packed socket].

Tipping movement in orthodontic therapy, which is often performed even in the absence of the adjacent tooth, is represented by the movement following tooth extraction. Such tipping movement in the absence of the adjacent tooth depends not only upon the magnitude of orthodontic force as classified into Stoner 4D, but also upon the condition of the extracted wounds. To evaluate the clinical applicability of HAp-packing used in combination with tipping movement, histopathological investigation was performed in the periodontal tissue with tipping movement toward the adjacent to HAp-packed socket. HAp packing into the extracted wound cavity produced no significant changes in quantitative tipping movement compared with non-HAp packing. HAp packing into the extracted wound cavity, followed by tipping movement, produced compressed sides not only for the moved tooth but also for the anchor tooth. Resorption and disappearance of alveolar septum were observed on the compressed sides of both these teeth for all experimental sides. HAp in an amount enough to meet the narrowing of the extracted wound cavity, associated with tipping movement was discharged from the suture surface. In the same region, fibrous connective tissue lay between the dental root and the HAp mass, which were not adjacent to each other. The fibrous connective tissue presented temporal bone regeneration so as to surround the tooth. Apart from the moving distance, the tissue change showed no essential difference either for a weak force or for a strong force. The above results revealed the usefulness of HAp packing into the extracted wound cavity for tipping movement of the adjacent tooth in the direction of the wound cavity and immediate move ability after extraction.

Durapatite↗
PubMed1989

Osteoradionecrosis of the jaws.

In 431 patients treated for malignant tumors 21 osteoradionecroses (ORN) were diagnosed in 19 patients. The relation of ORN to radiotherapeutic factors and surgical as well as extraction schemes were studied. There was a clear relation to high dose, high CRE and superfraction. Six ORN developed in connection with tooth extraction. The importance of atraumatic extraction is stressed.

Aged↗
PubMedDate not supplied

Pain management in school-aged children by private and public clinic practice dentists.

A mail survey of 198 Seattle dentists who treat children assessed their beliefs about pain control in school-aged children and examined the relationship of those beliefs to pain management behaviors. The survey population of general dentists and pediatric dentists in clinics and private practice had a response rate of 89.6%. Two of three dentists always use local anesthetic when doing restorations or extractions and also provide more anesthetic at the child's request. One in three dentists never provides postoperative medication following tooth extractions. Ten percent regularly deny child pain and many do not believe child pain reports are valid. Dentists who work in private practice are more likely to provide local anesthetic than are dentists who work in clinics. Dentists who desire more control over a child are less likely to provide local anesthetic. Dentists who question children about comfort are more likely to provide additional anesthetic based on a child's report of discomfort and to provide postoperative medication if the dentist perceives a dental procedure to be painful.

Adolescent↗
PubMed1986

Dental extraction in congenital hemorrhagic patients.

125 dental extractions were performed in patients with hemophilia A, B, von Willebrand disease and rare coagulopathies. The missing factor was brought to a level of 15-40% according to the degree of surgical trauma. In the majority of cases a single pre-extraction administration of concentrate was sufficient. Antifibrinolytics were administered to the patients (tranexamic acid, 60 mg/kg/day) for 8-10 days. After tooth extraction, a fibrin sponge was positioned using anti-traumatic cross suture. In 90% of cases there was no bleeding, in the others modest easily controllable hemorrhagic episodes. Our results show that it is sufficient in hemophilia A and B to use low doses of antihemophilic concentrate (10-20 U/kg) and frequently a single pre-extraction administration. In rare coagulopathies the hemostatic procedure and dental management have also to be similar to those used in hemophilia A and B.

Adult↗
PubMed1993

Effect of calcium phosphate ceramic particle insertion on tooth eruption.

The effects of calcium phosphate ceramic implants on tooth eruption were investigated radiographically and histologically in 20 3-month-old dogs. Four kinds of ceramic particles were used: dense and porous hydroxyapatite particles, and dense and porous tricalcium phosphate particles. These particles were implanted in the sockets after deciduous tooth extraction. The four types of calcium phosphate ceramic particles produced similar radiographic and histologic findings. There was no delay of tooth eruption, no dysplasia, and no resorption of dental hard tissue.

Animals↗
PubMed1992

An evaluation of the behaviour of children undergoing dental extraction under general anaesthesia.

The cooperation of a random sample of 190 children with an average age of 5 years (range 1-17 years), presenting with a dental emergency requiring tooth extraction under general anaesthesia, was evaluated using the Frankl Behaviour Scale. The results showed that 60% of the children cooperated in the operating theatre. Furthermore, removal of only one or two teeth per patient accounted for 40% of the cases. This survey has identified a group of child dental patients who might benefit from conscious sedation and local anaesthetic techniques.

Adolescent↗
PubMed1994

[Lesions of the lingual nerve during extraction of the mandibular wisdom teeth. Consequences--etiopathogenesis--prevention--prognosis--legal medical aspects].

A brief review of the lingual nerve anatomy is followed by an examination of the consequences of injury to the lingual nerve during mandibular wisdom tooth extraction on sensibility and sensorial activities. The circumstances of such injury are described as a function of the position of the tooth together with means of prevention. The clinical course of injury to the lingual nerve is unpredictable and varies over time and in quality of recovery. No prognosis can be made before a reasonable delay of 18 months to 2 years. Prevention remains the best treatment and consists of using a flexible bar to protect the nerve during the operation. Rate of legal disability compensation is estimated at 2 to 5%.

Cranial Nerve Diseases↗
PubMed1991

Nonhealing extraction site due to Actinomyces naeslundii in patient with AIDS.

There are many oral complications of human immunodeficiency virus infection. One of the infectious sequelae is contamination and delayed healing of the tooth extraction site. We report a case of a nonhealing extraction site in a patient with the acquired immunodeficiency syndrome. Histologic and microbiologic evaluation determined the causative species of bacterium to be Actinomyces naeslundii. Diagnosis and treatment are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Identifying acute pulpalgia as a factor in TMD pain.

An acute pulpalgia and temporomandibular disorders can produce many of the same symptoms. To illustrate identification of an acute pulpalgia as a component in TMD, the authors review the evaluation of 11 patients at a clinic that specializes in TMD treatment. During the evaluation, thermal testing and periodontal ligament anesthesia were used to identify the offending tooth. After receiving endodontic treatment or having the tooth extracted, patients reported either complete or partial relief of TMD symptoms. The authors provide questions that may help practitioners identify a tooth with an acute pulpalgia as a contributing factor to TMD symptoms and suggest a technique to confirm this diagnosis.

Acute Disease↗
PubMed1994

Short-term effect of full-mouth extraction on periodontal pathogens colonizing the oral mucous membranes.

In this study, we investigate the prevalence of selected periodontal pathogens on the oral mucous membranes before and after full-mouth tooth extractions in patients with severe periodontitis. 8 patients were microbiologically examined 2 x before and 2 x after extraction; several locations on the oral mucous membranes, saliva, supra- and subgingival plaque, were sampled. Besides their presence in subgingival plaque, we detected before extraction on the mucous membranes Actinobacillus actinomycetemcomitans in 2 patients (mean 0.03%), Porphyromonas gingivalis in 6 patients (mean 9%), and Prevotella intermedia (mean 2%) and other Prevotella species (mean 7%) in all patients. At 1 and 3 months after extraction, A. actinomycetemcomitans and P. gingivalis could not be detected in any of these patients on the oral mucous membranes and in saliva, while from all patients still P. intermedia (mean 3%) and the other blackpigmented Prevotella species (mean 4%) could be isolated. These results indicate that the preferable habitat for A. actinomycetemcomitans and P. gingivalis is dental plaque in subgingival lesions. P. intermedia and the other blackpigmented Prevotella species can colonize the oral mucous membranes of edentulous patients irrespective of the presence of a subgingival microflora. We speculate that in periodontal patients the colonization of mucous membranes with P. gingivalis and A. actinomycetemcomitans is transient in nature and most likely the result of dissemination from the subgingival microflora. Thus it seems unlikely that edentulous patients constitute a reservoir of infection of P. gingivalis A. actinomycetemcomitans.

Adolescent↗
PubMed1976

Premolar enucleation.

A study was made on 27 cases where enucleation of four first premolars was performed simultaneously without introduction of mechanical devices to influence space closure. The results suggested that: 1. Enucleation of premolars can be used to minimize the severity of crowding in arch-length deficiency cases. 2. There is no damage to the remaining teeth and alveolar process when enucleation is accomplished with good surgical technique. 3. The average amount of lingual tipping of the mandibular incisors in approximately four years subsequent to the enucleation procedure was 4.1 degrees. 4. This amount of lingual tipping compares quite favorably with the amount of lower incisor uprighting experienced during growth and could not be considered excessive. 5. The mandible does tend to rotate in a counterclockwise manner following enucleation of four first premolars without appliance therapy. This rotation was considered significant in comparison with the amount of rotation that could be expected from an untreated sample. 6. If orthodontic treatment is planned, the enucleation of the manddibular second premolars in borderline extraction cases to avoid excessive lingual tipping of the mandibular incisors would seem to be questionable. 7. Various combinations of enucleation and tooth extraction may be helpful in treatment planning. 8. With judicious timing the enucleation of four first premolars can minimize the severity of the malocclusion simplifying appliance therapy if proper diagnosis and good surgical technique are employed. 9. Although conventional serial extraction may accomplish similar ends, it would appear that enucleation would offer some advantages in terms of autonomous adjustment of the mandibular incisors and root positioning of mandibular cuspids. 10. Enucleation cases usually require fewer traumatic surgical procedures and less supervision by the orthodontist. 11. The parents should be informed that serial extraction procedures including enucleation may simplify but will not eliminate the need for appliance therapy.

Bicuspid↗
PubMed1992

Oral myiasis caused by sarcophagidae in an extraction wound.

Oral myiasis (infestation by the larvae of Diptera flies) has only rarely been reported in the English-language literature. This article records a case of wound myiasis caused by flies of the family Sarcophagidae that affected a tooth-extraction site, and was a painful complication of the extraction.

Adult↗
PubMed2001

The reasons for the extraction of various tooth types in Scotland: a 15-year follow up.

OBJECTIVES: The aim of this survey was to investigate the reasons for extraction of the various tooth types in Scotland. This study replicated one which was undertaken 15 years earlier. A further aim, therefore, was to identify any changes in the frequency of extraction of each tooth type in the 15 years between the two studies. METHODS: The names of every fourth dentist on the list of the Scottish Dental Practice Board were obtained. Four hundred and twenty-five general dental practitioners were asked to record permanent tooth extractions for 1 week. Data requested for each extraction were: the patient's age, gender and dental attendance pattern, the type of tooth removed and the reason for the extraction. RESULTS: Three hundred and fifty-two dentists participated (a response rate of 82.8%). There were 25% fewer teeth extracted per patient and 30% fewer per dentist than in the 1984 study. In 1999, more teeth of most types were extracted from regular attenders whereas, in 1984, more teeth of all types were extracted from irregular attenders. Premolars and first and second molars were the tooth types most frequently extracted in both surveys. In 1999 premolars were the teeth most commonly removed below 21 years of age, accounting for 57.5% of extractions in this age range. Molars accounted for 33.8% of extractions in this age range compared with 52% in 1984. Overall, caries was found to be the principal reason for loss of all tooth types apart from lower incisors which were extracted mainly for periodontal reasons. However, below 21 years, 84.5% of premolar extractions were performed for orthodontic purposes. CONCLUSIONS: Over the last 15 years, the overall number of extractions has reduced and the proportion of extractions from regular attenders has increased. Proportionately more premolars and fewer molars were extracted from under-21-year-olds. This observation can be explained by an increase in orthodontic extractions or a decline in extractions for caries in this age group. However, when extractions from the population as a whole are considered, caries and its sequelae remains the principal reason for loss of all tooth types other than lower incisors which are extracted mainly for periodontal reasons.

Adolescent↗