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A double blind controlled randomised trial suggested that irrigation of third molar sockets with bupivacaine 0.75% produces significant reduction in pain scored on the first post-operative morning (p less than 0.01). However, this technique produces no significant reduction in opiate or oral analgesic consumption.
Impacted second molars refractory to orthodontic treatment are frequent problems. The family dentist and the orthodontist should be on the alert for them. A philosophy for their management and the authors' experience over the past 13 years are presented. The proper time for definitive treatment of these impactions is during early adolescence, generally in the 11- to 14-year range. Impaction of the second molar is usually a problem of arch length deficiency. There may be an associated problem with a third molar impaction. The alternatives for impacted second molar treatments are surgical repositioning with or without adjacent third molar removal, removal of the second molar allowing the third molar to erupt, and transplantation of the third molar to the second molar socket. In the authors' experience, surgical repositioning has provided the most promising results of the three choices. Technical aspects of surgical repositioning are discussed along with case selection criteria. Six cases are presented to demonstrate typical problems and their management. With proper timing and intervention, the prognosis is excellent for repositioning second molar impactions.
In a prospective study 1,106 impacted mandibular third molars were removed from 687 patients. Clinical, radiographic, and surgical factors were recorded. Postoperatively, we examined the modalities of common sensation in order to assess sensory deficit. The patients were followed up, until complete restitution occurred, or, if the sensibility failed to recover, for at least 6 months. A total of 3.6% of the operated sides demonstrated impairment of labial sensation, and 2.1% of lingual sensation. The vast majority of these disturbances subsided completely during the follow-up period. The incidence of persisting sensory diminution after 6 months was 0.91% for the inferior alveolar, and 0.37% for the lingual nerve. However, the degree of the persisting deficit was slight in most instances. The relationship between the recorded factors and the alteration of sensation was analysed by using the chi2 test. For the inferior alveolar nerve we found the patient's age, the development of the roots, the degree of impaction, and the radiographic position of the nerve canal to be significantly correlated to sensory deficit, as well as the surgical procedures in the depth of the socket and the intraoperative opening of the mandibular canal. As far as the lingual nerve is concerned, general anaesthesia and the individual operator were the main factors predictive of nerve damage.
A technique of surgically creating a socket and transplanting an autogenous root to provide a stable abutment for a fixed partial prosthesis was described. Radiographic evidence and the demonstration of physiologic mobility of the transplanted root at a three and a half year follow-up of one patient give an indication of the development of a periodontal ligament. One transplant has successfully served as an abutment for seven years.
Bone remodelling of post-extraction socket was studied in the past by various methods. In the present work, the process was studied with the scanning electron microscope (SEM). The SEM is essential for a three-dimensional description, particularly when hard tissues are involved. Initiation of healing on the first week was characterized by formation of delicate spongy bone. The trabeculae were distributed in a centrifugal pattern around the interradicular bone. Socket healing on the second week consisted of thickened, regularly distributed trabeculae. This was accompanied by resorption and flattening of the peri-socket sharp ridges. The third and fourth weeks were characterized by small bone marrow spaces and a gradual transformation of the trabecular bone to one of cortical-compact nature. The typical characteristics of resorbing, resting and forming surfaces were detected in all phases of socket healing. Two major patterns of ossification could be shown: Firstly, calcification of collagen bundles in osteoblastic lacunae. Concentrations of such lacunae were related to periosteal activity and were also found in areas most probably occupied previously by blood vessels. Another pattern of mineralization was in the form of globular calcospherites and is reminiscent of calcification of ground substance.
This investigation compared the results of 2 types of wound closure - primary closure technique with and without Penrose drains (Naturallatex) - after mandibular third Molar removal. In both the test group (n = 27) and control group (n = 25), the molar were removed using a buccal mucoperiosteal flap. The test group received a drain partially submerged into the socket to secure more drainage of woundsecrete. Examination were performed 1 day, 3 days and 7 days after surgery, and swelling, trismus, pain and analgetic consommation were recorded. Analysis of Variance indicated that there was significant difference between the 2 methods. The drain method appears to minimize postoperative edema, trismus, pain and analgetic consommation, and thus contributes to enhanced patient comfort.
Achieving an aesthetic implant-supported restoration is a constant challenge for the restorative dentist. Part I of this article, published in the March, 1994, issue of PP&A, presented a modified regenerative technique--the "socket seal surgery" (SSS). Part II presents a modified prosthetic technique--the "cervical contouring concept" (CCC). The clinical and laboratory prosthetic procedures are covered in four steps, reshaping of the gingival profile is discussed, and a case report is used to illustrate the procedures. The learning objective of this article is to supplement reader knowledge of methods and techniques in prosthodontic procedures.
Structural changes that occurred when unerupted developing permanent teeth in dogs were transferred to other bony crypts or surgically prepared sockets were assessed histologically. The enamel epithelium and pieces of enamel matrix were often displaced from the developing teeth and contained within the dental sac. The epithelium underwent metaplasia, cysts frequently developed, and cementum was formed in moderate quantities when enamel matrix was directly in contact with connective tissues. Development of the crowns did not continue normally, and the teeth did not erupt.
The aim of this paper is to present the post mortem dental evidence and dental health of the victims exhumed throughout the territories of Croatia that was temporarily occupied during the war. A total number of 62,432 teeth out of 1,253 human bodies exhumed from 5 different counties were analyzed. The majority of victims inhabited those areas before 1991. Post mortem dental characteristics were analyzed according to the American Board of Forensic Odontology and WHO methodology. The results show the highest level of the dental health before 1991 in the Vukovarsko-Srijemska County. The decayed (D), missing (M), filling (F), teeth (T), DMFT of that County was at the lowest level i.e. at 5.2. In all of the other counties, it was always between 6 and 12. The material most frequently used for the dental fillings was amalgam. Its highest frequency level was recorded in the County 4 (8%) and lowest in the County 1 (1.5%), p<0.001. The most frequent prosthodontic appliances were acrylic dentures. Their frequency was lowest in the County 5 (1.3%) and highest in the County 3 (11.6%), p<0.001. Determination of sex and dental age showed that victims were mostly men (79%) of middle and elderly age (89%). Teeth were useful also for monitoring of the quality of exhumations--taking into consideration number of empty dental sockets. The highest number of empty dental sockets was recorded in the County 3 (40.4%) and lowest in the County 1 (13.5%), p<0.001. Even after many years in the soil, teeth proved to be the most preserved human organs and valuable indicators of identity as well as of the way of life before death.
The availability of inert materials like dense, pure Al2O3-ceramic or titanium allows the study of purely biomechanical influences of surface modulations or lacune on the osseo-integration of implants at different locations of the skeleton. The discovery of the "load-line-shadow" phenomenon in lacune of dental implants and the observation of the same effect in the grooves of hip sockets (Lindenhof type) indicate the general validity of the rules controlling the remodelling ability of bony tissue. Their application to the problems concerned with load transmission via surfaces which are mainly loaded by shear can contribute to achieve a well defined anchorage of implants.
A total of sixty-two patients with head and neck malignancy who had teeth extracted prior to irradiation therapy were studied. Only one in this group of sixty-two patients developed posttherapy necrosis, and this instance was in no way related to the pre-irradiation extractions. Our experience with patients who have undergone extractions prior to radiotherapy indicates that exodontia may not be, within itself, associated with increased serious postirradiation sequelae. The incidence of osteoradionecrosis in these patients is extremely low. Further, our data do not indicate a critical time period for healing of extraction sockets prior to initiation of radiotherapy. When the state of the underlying disease allows, a healing time of 10 to 14 days should be granted when teeth are extracted prior to irradiation. This recommended interval is only a guideline, since a shorter healing time does not entail a significantly greater risk and should therefore not be arbitrarily classified as inappropriate.
Previous studies have shown that the mechanical strength of the periodontal ligament decreased markedly after application of an orthodontic force to the rat molars. However, an analysis of stress-strain curves obtained from transverse sections of the rat molars has not been made. The present study analyzed the stress-strain curves obtained from the mesial root of the rat mandibular first molar to evaluate the changes of the mechanical properties of the ligament after application of an orthodontic force. An elastic band was inserted between the mandibular first and second molars for 7 days. The maximum shear stress, elastic stiffness, and failure strain energy density were significantly less in the experimental group than in the control group, but the maximum strain was significantly greater. Histologic examinations of the transverse section after mechanical testing showed that the area of the ligament adhering to the mesial surface (compression side) of the socket bone was significantly less in the experimental group. It is suggested that orthodontic forces may cause changes in the constitution of the periodontal collagen, in osteoclastic activity in alveolar bone, and in mineralization patterns of Sharpey's fibers followed by reductions of the mechanical strength of the ligament, particularly on the compression side of alveolar bone.
One hundred and forty eight patients with bilateral symmetrically impacted lower third molars entered a clinical crossover trial to compare the effects on postoperative recovery of a Bismuth Iodoform Paraffin Paste (BIPP) socket dressing, primary closure using a resorbable suture (Softgut) and to ascertain if prophylactic metronidazole influenced the outcome. The results reaffirm the surgical principle that contaminated surgical wounds such as third molar sockets are best kept open with a dressing. Attempts at primary closure should be resisted if there is no intention to prescribe antibiotic cover. However, if a suitable antibiotic is taken then primary closure using a resorbable suture can be carried out with confidence. This may reduce the need for outpatient follow up.
Optimal implant placement can be achieved only if the ridge maintains its dimensions and the quality of bone. To prevent the resorption of the ridge and to enhance the quality of regenerated bone, two main approaches have been suggested. Part I of this article presents a modified regenerative technique-the "socket seal surgery" (SSS). Part II will present a modified prosthetic technique--the "cervical contouring concept" (CCC)--and it will be published in the May, 1994, issue of PP&A. The learning objective of this article is to supplement reader knowledge of methods and techniques for prevention of ridge resorption and enhancement of bone regeneration.
Clinicians have always had difficulty finding the apex of the lower central incisor on a lateral cephalometric radiograph. This study was undertaken to define the radiographic anatomy surrounding the true apex. Standard cephalograms were taken of 38 skulls with metallic markers in the socket apex of 1 lower central incisor. Similar cephalograms were taken with the lower central incisor apex positioned in the central ray of the x-ray source. The comparison of the marked apices in the complete skulls and their separate mandibles showed that there was no distortion. Measurements from the markers to the lingual and labial symphyseal borders located the apices labial of center.
The Polymer Expansion Implant System, which is a system for the substitution of missing dental roots in natural or surgical alveolus, has been developed by the author. The polymer used is poly (methyl methacrylate) (PMMA). A material is sought that has three of the basic physical and mechanical qualities of human dentine: low modulus of elasticity, thermal and electrical passiveness, and ideal porosity. In addition it should be resistant, easily worked, biocompatible, and of low cost. Of the biomedical polymers, PMMA has these qualities, and it can be used as a substitute for dental roots. The design of bodies to be implanted as substitutes for dental roots requires: anatomical measurements of the maxilla and sockets; methods of retention by the bone tissue; and methods of insertion. The formation of lamina dura around an implanted body is a reply of the organism to the forces acting on it and a demonstration of the good interaction of the porosity of the material, the peri-implant collagenous fibers and bone. X-rays that demonstrate the behavior of bone to a PMMA implant are shown.
A 71-year-old man was admitted to an emergency room because of postextraction hemorrhage and died of asphyxia caused by airway obstruction. About 40 days earlier, he had had 11 carious teeth removed without postextraction bleeding. At autopsy, liver cirrhosis was found, but examination of his previous extractions and postmortem external findings did not show a general hemorrhagic tendency. The surgical incision in the gingiva had been sutured, and no damage to the bony socket or large vasculature was found. We could not determine the etiologic source of the decedent's rapidly increasing hematoma. Postextraction hemorrhage or hematoma is a common complication in routine dental extraction, but marked hematoma formation around the airway may cause critical respiratory problems in the short run. In such cases, the maintenance of the airway, including control of hemorrhage, is necessary at an early stage.
The present study was designed to compare the process of structural changes which appeared in the alveolar bone and cortical bone of the frontal maxilla and mandible after extraction of the incisors. Twelve adult dogs whose upper and lower incisors on the same side were extracted at the same time were kept for 29-181 days. The dogs were injected continuously with tetracycline during the first half of the experimental period and with calcein during the latter half. Labio-palatal and labio-lingual longitudinal ground sections were first micro-radiographed and, then, examined by fluorescence microscopy. From a montage of fluorescence micrograms, color tracings of the labelling sites were made on thin plastic sheets. The two images of the control and experimental sides were precisely compared The structural changes which appeared in all the parts of the alveolar bone and cortical bone after extraction of the incisors were more prominent in the maxilla than in the mandible. New bone formation in the extraction socket appeared and was completed earlier in the maxilla than in the mandible. Secondary internal remodelling of the alveolar bone proper and the newly formed bone in the extraction socket progressed more quickly in the maxilla than in the mandible. The remodelling of cortical bone and the resorption of the alveolar crest was made very actively in the upper labial side, whereas these process very slight in the upper palatal side and in the lower labial and lingual sides, so that the contour of the frontal maxilla, especially in its labial side, was more prominently deformed than the mandible.