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PubMed1994

Altered bone remodeling pattern of the residual ridge in ovariectomized rats.

This study investigated the effect of estrogen deficiency on residual ridge remodeling after tooth extraction. Ovariectomy was performed on female Sprague-Dawley rats, and the plasma levels of estrogen and progesterone were monitored. The maxillary molars of the ovariectomized and control rats were extracted and the remodeling residual ridge tissues were harvested at 2, 4, and 8 weeks postextraction. The specimens were examined at the mesiodistal center point of the residual ridge by use of light and scanning electron microscopy. The surface of the residual ridge of the control animals showed a number of osteoclastic lacunae indicating bone resorption activity. In the ovariectomized animals, the surface of the residual alveolar bone was partially covered by a distinct calcified tissue. This tissue contained large cells and a mesh-like structure of thin calcified extracellular matrix consistent with the tissue characteristics of chondroid bone. The chondroid bone-like calcified tissue was found only in the ovariectomized animals throughout the experiment period. This study's data suggest that a systemic condition such as estrogen deficiency due to ovariectomy may alter the phenotypic expression of cells associated with the residual ridge and result in less osteoclastic activity and a different type of calcified tissue.

Alveolar Process↗
PubMed2000

Safety of dental treatment in patients with previously diagnosed acute myocardial infarction or unstable angina pectoris.

OBJECTIVE: The purpose of this study was to assess the safety of invasive dental treatments, such as tooth extraction and pulpectomy under local anesthesia, in patients with unstable angina pectoris and within 6 months after onset in patients who had experienced acute myocardial infarction. STUDY DESIGN: Cardiovascular complications during and after dental treatment and preoperative risk factors were explored in 63 patients who had experienced unstable angina pectoris or acute myocardial infarction. RESULTS: A total of 79 dental treatments were performed with no intraoperative complications. Chest pain occurred in 8 patients within 1 week after dental treatment. Risk factors for postoperative complications were identified as a history of chest pain within 2 weeks before the dental treatment and failure to clear the Master Test Single stress test. CONCLUSIONS: Many patients who had experienced unstable angina pectoris or acute myocardial infarction tolerated dental treatment when appropriate stress control measures were used. However, approximately 10% of the patients experienced postoperative problems. Acceptability of dental treatment should be determined on the basis of the comprehensive assessment of each patient.

Adult↗
PubMed1997

Resorption of mandibular canal wall in the edentulous aged population.

STATEMENT OF PROBLEM: The mandibular canal wall may be affected by the progress of residual ridge resorption after tooth extraction. Little knowledge is available regarding the relationship of specific systemic factors and the resorption of the mandibular canal wall. PURPOSE: The purpose of this study was to assess the status of the mandibular canal in the edentulous mandible and to determine whether there is any relationship between the resorption of the mandibular canal wall and selected health indices in the elderly. MATERIAL AND METHODS: The status of the mandibular canal was assessed from panoramic radiographs of 128 edentulous elderly subjects (32 men and 96 women). RESULTS: The superior border of the mandibular canal was more frequently resorbed in women (32.6%) than in men (9.8%). Resorption in the mandibular canal wall was significantly more prevalent in subjects with asthma (odds ratio: 6.0), with thyroid disease (odds ratio: 3.04), and with a cortical thickness at the mandibular angle less than 1 mm thick (odds ratio 2.74). CONCLUSION: The findings suggest that gender, asthma, and thyroid disease play important roles in resorption of the mandibular canal wall.

Aged↗
PubMed1994

The effects of mandibular hypofunction on the development of the mandibular disc in the rabbit.

The effect of a reduced functional dentition on the development of the mandibular disc in young rabbits was studied by measuring cell proliferation within the disc following tooth extraction. Maxillary and mandibular incisor teeth were extracted from 18 animals at 5 weeks of age. At 12 weeks the rabbits received 0.25 mg/kg vincristine sulphate. Groups of three animals were killed 1.5, 3, 6, 12, 24 and 48 h after the injection of vincristine and the mitotic rate determined across the anterior, intermediate and posterior bands of the disc. Eighteen age- and sex-matched control rabbits with intact dentitions were treated in parallel. In the absence of incisor teeth, reflex gnawing and incising failed to develop, resulting in altered jaw movements and muscle force requirements. The mitotic rate in the anterior band was reduced significantly (p = 0.0117); rates for the intermediate and posterior bands were not significantly affected. There was an associated reduction in alveolar bone mass and deformation of the developing craniomandibular complex. As the lateral pterygoid inserts into the anterior band of the mandibular disc, it is proposed that altered activity within this muscle, combined with a modified loading of the joints, both secondary to incisor removal, resulted in a reduced mitotic rate in the anterior band of the developing mandibular disc.

Alveolar Process↗
PubMed1993

Altered cartilage phenotype expressed during intramembranous bone formation.

The sequential phenotypic expression occurring during intramembranous bone formation was investigated using the tooth extraction socket created in rat alveolar bone in vivo. The differential expression of bone extracellular matrix genes, such as collagen I and osteocalcin, was confirmed by RNA transfer blot analysis and in situ hybridization during the active healing period of the bony socket. To clarify the possible involvement of the chondrogenic phenotype during the process of intramembranous bone formation, the expression of cartilage collagen II and IX was further examined in this model. It was found that both alpha 1(II) and alpha 1(IX) mRNAs were present, but the alpha 1(IX) mRNA was a transcript from the downstream start site/promoter, which is a different site in the alpha 1(IX) gene from that used in hyaline cartilage. In situ hybridization indicated that the alpha 1(IX) message was expressed by cells associated with bone matrix in the early formation stage. This finding led to the investigation of type IX collagen expression by osteogenic cells isolated from newborn rat calvariae, in which only the truncated form of alpha 1(IX) mRNA was indicated by RNA transfer analysis. The expression of collagen II and a truncated form of collagen IX may represent an early phenotypic feature of osteoblast differentiation.

Animals↗
PubMed1977

Transient bacteremia and endocarditis prophylaxis. A review.

Transient, usually asymptomatic bacteremia occurs in a wide variety of procedures and manipulations, particularly those associated with mucous membrane trauma. It may also occur with such daily functions as tooth brushing and bowel movements. These brief bacteremias are especially common in tooth extraction and other dental procedures. Although numerical risk is uncertain, these bacteremias can occasionally give rise to infective endocarditis in the susceptible patient. While no proof exists that antibiotics given prior to procedures causing bacteremia prevent endocarditis in humans, experimental evidence in rabbits supports their use. Therefore, in situations where bacteremia is highly predictable, it would seem wise to administer prophylactic antimicrobials. Procedures in the susceptible host where prophylactic antibiotics seem prudent include dental manipulations and urinary tract instrumentation. Whether patients with acquired valvular or congenital heart disease who are to undergo abdominal surgical procedures should routinely receive prophylactic antibiotics is unclear. However, until the incidence of transient bacteremia associated with various abdominal procedures is further defined, endocarditis-prone patients should probably receive prophylaxis. Furthermore, patients with prosthetic valves who are subjected to upper gastrointestinal endoscopy, sigmoidoscopy, liver biopsy, or barium enema should also probably have antibiotic pretreatment. For dental procedures and for upper gastrointestinal endoscopy in patients with prosthetic valves, a combination of penicillin and streptomycin or vancomycin alone is recommended. For urinary tract instrumentation in all patients and for sigmoidoscopy, liver biopsy, or barium enema in patients with prosthetic valves, prophylaxis should be with ampicillin and gentamicin or vancomycin and gentamicin.

Anti-Bacterial Agents↗
PubMed1979

Jawbone cavities and trigeminal and atypical facial neuralgias.

The possible role of dental and oral disease in the etiology of idiopathic trigeminal and atypical facial neuralgias has been examined. Among thirty-eight patients with idiopathic trigeminal neuralgia and twenty-three patients with atypical facial neuralgia, there was in nearly all instances a close relationship between pain experienced and the existence of cavities in alveolar bone and jawbone of the patients. The cavities were at the sites of previous tooth extractions and, although at times more than 1 cm. in a given diameter, were usually not detectable by x-rays. A new method for their detection and localization was developed empirically, based on the observation that peripheral infiltration of local anesthetic into or very close to the bone cavity rapidly abolished trigger and pain perception by patients during persistence of the anesthetic action. Histopathologic examination of bone removed from cavities by curettage revealed, in both idiopathic trigeminal and atypical facial neuralgias, a similar pattern characterized by a highly vascular abnormal healing response of bone. Some lesions presented a mild chronic inflammatory (lymphocytic) infiltration. Preliminary microbiologic studies of material from the walls of the cavities showed the existence within them of a complex, mixed polymicrobial aerobic and anaerobic flora. Treatment consisted of vigorous curettage of the bone cavities, repeated if necessary, plus administration of antibiotics to induce healing and filling-in of the cavities by new bone. Responses of patients to the above treatment consisted of marked to complete pain remissions, the longest of which has been for 9 years. Complete healing leads to complete and persistent pain remissions. It was concluded that in both idiopathic trigeminal and atypical facial neuralgias, dental and oral pathoses may be major etiologic factors.

Adult↗
PubMed1993

Tissue response to Bioglass endosseous ridge maintenance implants.

Conical devices placed in the alveolar ridge after tooth extraction have been used clinically for several years to maintain the ridge morphology. In this way, the bone atrophy which occurs after extractions is minimized, and denture fit and function are enhanced. A system using such cones made from Bioglass (registered trademark of the University of Florida) and matching burs has been developed and tested clinically. Average four-year data show a retention rate of over 90%, which compares favorably with other systems using other materials (see Hench et al., 1991). Stanley et al. (to be published), in a review of the four-year clinical data, point out that a few of the cones, although firmly positioned within the alveolar ridge, have a radiolucent zone around the implant. In a clinical study, it is not possible to determine whether this radiolucent zone represents areas of fibrous capsule which are not attached to the implant and therefore compromise its long-term stability, or whether the soft tissue is adherent to the implant and thus contributes to its long-term stability. In a recent study, conical implants identical to those in the clinical trial were placed in the alveolar ridges of dogs and evaluated for up to two years. The adhesion of bone and soft tissue was measured and the development and stabilization of the reactive gel layer monitored. The findings in this animal study support the clinical observations and contribute to an explanation of the success of the Bioglass system in patients.

Alveolar Bone Loss↗
PubMed1998

Changes in blood pressure and heart rate variability during dental surgery.

The objective of the present study was to determine the changes in blood pressure, pulse rate, and heart rate variability during dental surgery. The study included 40 patients, 19 to 74 years of age (mean age: 42.7+/-3.0 years), who underwent tooth extraction at our hospital. Holter electrocardiographic monitoring was used to determine the power spectrum of R-R variability before and during dental surgery. The low frequency (LF: 0.041 to 0.140 Hz), high frequency (HF: 0.140 to 0.500 Hz), and total spectral powers (TF; 0.000 to 4.000 Hz) were calculated, and the ratio of LF to HF and percentage of HF relative to TF (%HF: HF/TF x 100) were used as indices of sympathetic and parasympathetic activities, respectively. The baseline blood pressure and pulse rate were 121+/-3/70+/-2 mm Hg and 70+/-1 beats/min, respectively. After the administration of local anesthetic (2% lidocaine) containing 1:80,000 epinephrine, both the blood pressure and pulse rate increased. During dental surgery, blood pressure increased further to 132+/-3/73+/-2 mm Hg. The increase in blood pressure was greater in middle-aged and older patients (> or =40 years old). In young patients (<40 years old), the %HF decreased and the LF/HF increased during local anesthesia. In contrast, in middle-aged and older patients, the LF/HF decreased during local anesthesia. These results suggest 1) that middle-aged and older patients have a greater increase in blood pressure during dental surgery than younger patients, and 2) that the regulation of the autonomic nervous system during dental surgery differs between younger and older patients.

Adult↗
PubMedDate not supplied

Quality of life of patients with maxillofacial defects after treatment for malignancy.

PURPOSE: The purpose of the study was to investigate how cancer patients with maxillofacial defects evaluate their quality of life after prosthodontic therapy, complemented by a retrospective interview for judging the various therapy steps. The results were compared with a nontumor control group (multiple tooth extractions) and with population-based norm data. MATERIALS AND METHODS: A total of 34 patients were included in the study, 17 in each group. Patients first filled in a questionnaire and then answered additional questions in a standardized interview. RESULTS: At the time of investigation, tumor patients did not significantly differ from nontumor patients regarding global quality of life. However, tumor patients had significantly less favorable values regarding role functioning, speech, mouth opening, and dry mouth, as well as pain and swallowing. In comparison with the reference data of the German population, tumor patients had considerable deficits (> 20 points) regarding role functioning, dyspnea, and financial difficulties. Other deficits (> 10 points) became apparent in global quality of life, fatigue, insomnia, and appetite. When reflecting the course of disease and recovery, tumor patients rated the diagnosis as the most stressful event and reported that the family was most instrumental in the recovery process. CONCLUSION: Patients with maxillofacial defects after treatment for malignancy suffer from numerous clearly definable quality of life-related symptoms and problems, even after prosthodontic treatment. These patients need psychologic care at the time of diagnosis to alleviate the burden of the cancer diagnosis and prepare for the demanding treatment. After completion of the prosthodontic treatment, therapy options for pain or speech problems should be offered.

Adult↗
PubMed2005

Changes in the distribution of laminin-5 during peri-implant epithelium formation after immediate titanium implantation in rats.

Laminin-5 (Ln-5), a component of the basement membrane (BM), regulates epithelial cell migration and adhesion. This study used anti-Ln-5 (gamma2chain) antibody to investigate the distribution of Ln-5 during the formation of peri-implant epithelium (PIE) in rats, and compared it to the distribution of Ln-5 during oral mucosa formation after tooth extraction. One day after extraction, the junctional epithelium (JE) had disappeared. After 3 days, new epithelium formed from the oral sulcular epithelium (OSE) and extended horizontally over the wound with Ln-5-positive cells at the leading edge. After 5 days, the epithelium extending from the OSE on each side of the wound joined and formed additional new epithelium. The new epithelium expressed Ln-5 in the BM. After 1-2 weeks, the oral epithelium (OE) extending from the sides of the wound joined in the center. Thereafter, OSE and new epithelium disappeared, and only OE remained covering the wound. Three days after implantation (titanium), no JE remained. New epithelium formed from the keratinized OSE extending apically with Ln-5-positive cells. After 1-2 weeks, the new epithelium became the PIE and spread further apically facing the implant surface. Ln-5 was expressed at the PIE-connective tissue interface, but not at the implant-PIE interface. Finally, after 4 weeks, Ln-5 was expressed at the implant-PIE interface, and the PIE was non-keratinized epithelium. These findings suggest that Ln-5 induces cell migration during PIE formation, and that PIE originates from OSE. Furthermore, they support the hypothesis that Ln-5 contributes to the attachment of PIE to titanium, regardless of the delay in the synthesis and deposition of Ln-5 at the titanium-PIE interface.

Animals↗
PubMedDate not supplied

Low-dosage intravenous immunoglobulin in the management of a patient with acquired von Willebrand syndrome associated with monoclonal gammopathy of undetermined significance.

We report herein the case of a 69-year-old Japanese man with acquired von Willebrand syndrome associated with monoclonal gammopathy of undetermined significance who developed IgG1-kappa antibodies against von Willebrand factor (VWF). The patient was urged to undergo tooth extractions because of alveolar pyorrhea, and a low-dosage intravenous immunoglobulin (IV-Ig) therapy (0.3 g of IgG/kg/day for 3 days) was chosen for him. On the 4th day after the infusion, VWF antigen and VWF ristocetin cofactor increased to 40 and 78% of the control, respectively, and dental extractions were performed successfully. On the 7th day, these values reached a maximum, i.e. 95 and 160% of the control, respectively. Then, they quickly decreased to 35 and 75% on the 10th day, and 6 months later, they became 16 and <3% of the control, respectively. Upon analysis of plasma VWF multimers (VWFMs) in this patient, those with large to medium molecular masses more selectively disappeared before the IV-Ig infusion than did those with small molecular masses. On the 4th day, the pattern of VWFMs was completely normalized and appeared to persist until the 10th day. Six months later, a small amount of large to medium-sized VWFMs was still present, but at 7-8 months, the pattern of VWFMs became almost the same as that before infusion. Throughout the patient's clinical course, the activity of plasma VWF-cleaving protease, which specifically cleaves the Tyr842-Met843 bond of the subunit and reduces its multimeric sizes, was quite normal (95-119%). These results provided consistent evidence that the selective absence of VWFMs with large to medium molecular masses in this patient is caused by the heightened clearance of a complex of IgG inhibitor and VWFMs from the circulation, presumably through IgG binding to the Fc receptor of macrophages. Furthermore, these results also indicated that a low-dosage IV-Ig therapy is effective enough for hemostatic management for programmed surgery.

ADAM Proteins↗
PubMed1996

[Recovery from descending necrotizing mediastinitis and multiple organic failure after seven months of mechanical ventilation].

A 61-year-old man with a history of hypertension and diabetes mellitus had a tooth extracted. Nine days later, he was admitted to the hospital with complaints of high fever, dyspnea, and anterior chest pain. Physical examination revealed a drowsy man with a fever of 38.2 degrees C, blood pressure of 66/44 mmHg, and marked redness and swelling from the neck to anterior part of the chest. Laboratory examination indicated severe infection and multiple organ failure, consisting of cardiac, respiratory, renal, and hepatic failure, with disseminated intravascular coagulation. Chest X-ray and CT-scan films showed abscesses extending from the neck to the mediastinum, and bilateral pleural effusion. Immediately, he was treated with catecholamines, furosemide, mechanical ventilation with a high concentration of oxygen, continuous drainage, repeated skin incisions, and broad-spectrum antibiotics. In addition, steroid pulse therapy was administered for persistent respiratory failure. On the 28th hospital day, a fistula developed between the trachea and the mediastinum, and an intratracheal tube had to be inserted through the fistula. On the 212 th hospital day, after intravenous hyperalimentation, continuous intravenous insulin infusion, and administration of broad-spectrum antibiotics, catecholamines, and furosemide, the patient was weaned from mechanical ventilation. A restrictive ventilatory defect due to ankylosis and atrophy of underused muscles was noted after weaning, but the PaO2 was high with a low dose of oxygen (1 to 2 l/min), and 21 months later, the blood gases were normal while the patient was breathing room air. As of January, 1996, he was undergoing rehabilitation to promote his recovery from ankylosis, muscle atrophy, and speech dysfunction.

Catecholamines↗
PubMed2003

The dental care pathway of welfare recipients in Quebec.

IN Quebec (Canada), the utilization of dental care services varies greatly from one social class to another: whereas the well-to-do visit the dentist often for check-ups, those most in need demonstrate a "wait-and-see" attitude. The objective of our research was to describe the dental care pathway of the underprivileged when confronted with symptoms, and to understand how this pathway might be interrupted and possibly lead to tooth extractions. We arranged 16 one-on-one interviews with adult Montrealers who had experienced a dental problem during the 12 months preceding the interview. These participants, 9 women and 7 men aged between 30 and 48, lived in great poverty: all were welfare recipients, and as such, enjoyed the benefits of a government programme that entitled them to free basic dental care. During the interviews, the interviewers asked the participants to describe their latest dental problem and their subsequent behaviour. The dental care pathway of our participants was characterized by a strategy of adapting to the symptoms. This process of adapting, which can last several months, is essentially an individual process in which the individuals often resort to self-medication to soothe their pain. They decide to visit a dentist when the pain is too great and self-medication is no longer effective. Once this decision is made, their dental care pathway may nevertheless be interrupted in two ways: first, in the failure to find a dentist, and second, later, in the failure to complete treatments that are not covered by the welfare program, such as endodontic treatment. The fragmented character of these dental care pathways refers us to two features of accessibility: financial accessibility and acceptability. With regard to financial accessibility, our study shows that the public coverage intended for welfare recipients presents major gaps. As for acceptability, our participants are strongly critical of the dental profession, and develop a culture of rejection of it.

Adult↗
PubMed2004

Measurements of soft tissue volume in association with single-implant restorations: a 1-year comparative study after abutment connection surgery.

BACKGROUND: Patients with buccal defects due to tooth extraction seem to regain some of the contour at the time of abutment surgery and connection of single-implant crown restorations. It can then be assumed that different abutment systems could restore the buccal contour to different degrees. PURPOSE: To measure changes in buccal tissue volume after placing restorations with single-implant crowns using two different abutment systems and to measure soft tissue change during the 1 year after single-implant treatment. MATERIALS AND METHODS: Eighteen patients were provided with single-implant restorations in the central incisor area. Nine patients in each group were treated with single-implant crowns supported by either CeraOne abutments (Nobel Biocare AB, Göteborg, Sweden) or customized Procera ceramic abutments (Nobel Biocare AB). Study casts were made before abutment connection, at crown placement, and after 1 year. After the casts were scanned, they were analyzed with a computer, using the model before abutment as a reference. In the area of the single implant, sagittal projections provided images of the models that allowed measurements between the contours at the different situations. Radiography and photography for measuring papillary volume were also performed. RESULTS: All patients exhibited increased "buccal volume" after abutment connection and crown placement (p < .01). A trend to greater increase was observed for the Procera group. Both groups also showed a reduction of buccal tissue 1 year later (p < .05-.01), leaving on average more volume in the Procera group. The papillae recovered spontaneously, and no relationship was observed between the presence of papilla and underlying bone support (p > .05). CONCLUSIONS: The buccal tissue increased significantly after placement of the abutment cylinder and the implant crown. This increase of buccal contour was reduced after 1 year. Furthermore, no relationship was established between the presence of papillae and the distance between the contact point and the underlying bone crest.

Adolescent↗