[Treatment plan in agenesis of lateral incisors].
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Bicuspid↗
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[Prosthetic closure of the traumatic space in the anterior teeth from the orthodontic viewpoint].
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Dental Arch↗
[The effect of the maxillary sinus floor on orthodontic tooth movement].
By superimposing 40 pre- und post-therapeutic orthopantomograms the degree of tipping and kind of movement of 87 teeth could be described quantitatively, dependent on configuration and extension of the basal maxillary sinus. It has been shown that, with a more vertical extension (VL = 1) in front of the tooth to be moved one can expect an obviously higher degree of tipping (about 10 degrees) as compared to teeth moved through a more horizontal maxillary sinus base (VL = 2). In the group of teeth VL = 1 a correlation between the depth of the maxillary sinus recessus and the degree of tipping could be found (p less than or equal to 0.05); i.e. the deeper the maxillary sinus recessus, the higher the degree of tipping. For VL = 2 this correlation is statistically not significant. In the group VL = 1 rather a tipping movement, in VL = 2 a translatory movement can be expected.
Adult↗
[Experimental bodily tooth movement through the bony floor of the nose--a pilot study].
Our experiment on animals was carried out in order to show to which degree the dog's bony nasal floor--taken as an equivalent of the recessus of the human maxillary sinus--is an obstacle to bodily tooth movement. The metric analysis showed that the movement of the upper teeth in comparison with the teeth of the lower jaw was markedly impaired by the basal cortical bone of the cavum nasi. Extended resorption of the basal bone of the nose was found histologically. The pressure side of the root surface too showed resorption lacunae which reached into the dentine deeply and were bordered by some osteoclasts.
Animals↗
[The therapeutic effects after the dentoalveolar compensation of skeletal open bite in adults. The skeletal and dental parameters].
In the following study 20 adult skeletal open-bite patients were analysed after they had undergone dental compensation to camouflage the underlying skeletal discrepancy. The initial and final cephalometric records were analysed to determine the factors that led to the desired goal. The results showed no significant difference in the skeletal relationship. Molar intrusion was not recorded. The open-bite was correct mostly by reclining the upper incisors and by changing their position. Significant differences existed between the obtained results and the mechano-therapy employed. The geometrical model developed on the of the above makes it possible to predict and predetermine the targeted vertical dimension. Furthermore the results show extrusion of the front teeth as another dominant factor.
Adolescent↗
Analgesic efficacy of an ibuprofen-codeine combination in patients with pain after removal of lower third molars.
A double-blind, randomised analgesic trial was carried out in 165 patients undergoing surgical removal of one impacted lower wisdom tooth. In a two-dose regimen, the analgesic efficacy of the combination ibuprofen-codeine 200 mg : 30 mg was compared with that of acetylsalicylic acid-codeine 500 mg : 30 mg and codeine 30 mg. Each dose was taken when the patient needed pain relief. The intensity of the pain was measured on a visual analogue scale during the 10-h period after the first dose. The mean pain reduction by Dose 1 in patients on ibuprofen-codeine, acetylsalicylic acid-codeine and codeine was 64%, 45% and 26%, respectively, and the mean duration of effect was 8.3, 6.3 and 5.6 h. According to the pain reduction, duration of effect and pain reduction index after Doses 1 and 1 + 2, there was a significant difference between ibuprofen-codeine and the other two drugs. The maximum pain reduction within 4 hours was 84% with ibuprofen-codeine. This was significantly different from the reduction achieved both with acetylsalicylic acid-codeine (64%) and codeine (35%). Seventeen patients reported adverse events: 5 on ibuprofen-codeine, 4 on acetylsalicylic acid-codeine and 8 on codeine. The most common events were tiredness and vertigo. It is concluded that the combination ibuprofen-codeine 200 mg : 30 mg had greater analgesic efficacy compared to the combination acetylsalicylic acid-codeine 500 mg : 30 or codeine 30 mg in patients with pain after removal of the lower third molars.
Adolescent↗
Anticholinergics improve fibreoptic intubating conditions during general anaesthesia.
PURPOSE: To determine if anticholinergic agents improve fibreoptic intubating conditions and to compare the efficacy and side effects of glycopyrrolate and hyoscine. METHODS: Eighty ASA I adults undergoing elective wisdom tooth extraction were randomly allocated to receive 0.4 mg hyoscine hydrobromide po, 0.4 mg hyoscine hydrobromide im, 0.4 mg glycopyrrolate im or no anticholinergic, one hour pre-operatively. All underwent nasal fibreoptic intubation under general anaesthesia. The time taken to pass the fibreoptic scope was noted and visual analogue scores (VAS) were recorded for clarity of visual field and post-operative sore throat, dry mouth and nausea. RESULTS: The time to intubation was not different among the four groups (Kruschal-Wallis P = 0.07). The clarity of visual field was improved in all three anticholinergic groups (Kruschal-Wallis P = 0.006), but there was no difference among the three groups (median VAS control 6.4, glycopyrrolate 8.0, oral hyoscine 7.9, im hyoscine 7.7). There was no difference in post-operative side effects among any of the groups at both 30 min and four hours. CONCLUSION: The addition of an anticholinergic produced better visual conditions for intubation but had no effect on the incidence of post-operative sore throat, dry mouth and nausea.
Adult↗
[Life-threatening swelling of the tongue in antihypertensive therapy with ACE inhibitors].
Although generally showing a low incidence of side effects, inhibitors of angiotensin-converting enzyme (ACE) may in rare cases induce angioedemas, mainly located in the oro-facial area and larynx. The interval between the beginning of the ACE inhibitor therapy and the occurrence of such angioedemas may range from a few hours to a few years. Here, the case of a 53-year-old man with massive swelling of the tongue after dental surgery is presented who had started with ACE inhibitor therapy only 24 h before. At admission to the clinic, obstruction of the upper airway due to the tongue swelling had already progressed so far that fiberoptic intubation was necessary. Additionally, the patient was treated with corticosteroids, antihistaminics and epinephrine, avoiding any further administration of the ACE inhibitor. The swelling resolved within 48-72 h. Dentists and physicians should take into consideration this potential side effect in patients treated with ACE inhibitors.
Angioedema↗
Contactless measurement of canine retraction by digital macrophotogrammetry during hybrid retractor application.
A new contactless method for measuring tooth movements is presented. Digital macrophotogrammetry (DMP) enables the orthodontist to obtain information on the three-dimensional movement of a tooth at each session. Analysis of the DMP images provides information on the translation and toration of a tooth during treatment. It is conceivable that the introduction of DMP will make an important contribution to quality assurance.DMP application during canine retraction with the Hybrid Retractor((R)) has pave the way for the orthodontic appliance to be correctly adjusted at each session. Despite intra- and interindividual differences during canine movement, for which the anisotropy of the bone seems to be basically responsible, a movement velocity of ca 1.2 mm is to be expected over the entire treatment period. The preconditions for the three-dimensional orientation and description of canine movement are:1. The markers on the brackets and attachments must be clearly visible throughout the treatment.2. The teeth to which the scaling frame is fixed should not move during treatment.3. Four measuring points should be visible on each bracket.4. The control points on the frame must be positioned three-dimensionally, and it must be possible to determine their position with sufficient accuracy in advance. In vitro calibration of the photogrammetry presented here yielded a resolution of 1 micrometer for translation and of better than 1/10 degrees for rotation around the three spatial axes under optimal conditions.
Cuspid↗
[Brain abscesses after extracranial infections of the head and neck area].
The authors report on 20 immunocompetent patients with brain abscess after 12 cases of middle ear, seven tooth and a single frontal sinus infection. The clinical aspects, hematochemical and microbiological data, the role of imaging diagnostics (CT, MR) and the type of treatment are analysed. Neurosurgery was performed on 17 patients (85%), eight of whom subsequently underwent evacuation of the primary source of infection (four mastoidectomies, two timpanoplasties, two tooth extractions). Mastoidectomy was eventually carried out on one of the three patients who did not undergo neurosurgery. Microbiological diagnosis was possible in nine patients through culture examination: Proteus mirabilis in three cases, Peptostreptococcus sp. in two, Micrococcus varians, Proteus vulgaris, Streptococcus sanguis and Streptococcus viridans not typed in single cases. The pus was sterile in eight patients (47.1% of those operated). An association of two antimicrobial agents was used in 18 patients, while in two cases monotherapy was preferred, based on the isolated bacteria. Treatment lasted on average 38 days. The most frequently used therapy regimen (75%) was the association of a beta-lactam drug with chloramphenicol or metronidazole. Therapy was successful in 19/20 patients; one patient died. There was no significant difference in prognostic terms with regard to sex, age, duration of symptoms prior to diagnosis, clinical picture at onset, number and size of abscesses or type of treatment. Recognising the first clinical signs and symptoms (headache, fever, alterations in consciousness, focal neurological deficit, epileptic seizures) is extremely important for prompt diagnosis of brain abscess.
Adolescent↗
[Ultrasound diagnosis in primary staging of head-neck tumors].
The radiologic imaging methods play an important role in the precise staging as basic requirement for an effective concept of tumor therapy. The accuracy of ultrasound in the primary staging according to the TNM-classification (UICC) was therefore prospectively investigated in 260 patients with head and neck tumors of the clinical stages T1N0 to T4N3. The clinically (C1) and sonographically (C2) evaluated pretherapeutic stages were compared to the postoperative histopathologic tumor classifications. The clinical staging was correct in 75.0%, high in 7.7%, low in 17.3%, the N-stages were correct in 59.2%, high in 17.7%, low in 23.1%. The sonographic staging was apparently superior with the T-classifications correct in 92.3%, high in 7.7%, low 0.0%. The N-stages were correct in 89.6%, high in 9.2%, low in 1.2%. The accuracy of combined TN classification rose from clinical 46.5% to 84.6% by sonography. Accompanying inflammations, foregoing biopsies and tooth extractions were the main reasons for incorrect staging. Therefore, the thorough sonographic investigation performed after the clinical examination and before invasive procedures, due to little patient discomfort, good availability and high accuracy, is an excellent sectional imaging method for staging, therapy-planning and follow up of tumors of the head and neck especially of the orofacial regions.
Adult↗
Fibroblastic osteosarcoma of the mandible.
Osteosarcoma of the mandible is a rare lesion. We report the case of a 16-year-old male who developed a fibroblastic osteosarcoma at the site of a wisdom tooth extraction. The lesion followed an aggressive course of recurrence and diffuse disseminated osteosarcomatosis. We speculate on the causal factors that resulted in this rapid course.
Adolescent↗
Prevalence of bisphosphonate associated osteonecrosis of the jaw within the field of osteonecrosis.
OBJECTIVES: Prevalence of bisphosphonate-associated osteonecrosis of the jaws within the catchment area of a university hospital maxillofacial unit and to review the outcome of treatment. METHODS: In a retrospective study, all patients with osteonecrosis, osteomyelitis and osteoradionecrosis treated in the period from January 2000 to March 2005 in the department for Maxillo Facial Surgery at the University of Mainz, Germany were analysed. RESULTS: Forty percent of the patients are grouped to odontogenic or surgically induced osteomyelitis. The second largest group (28%) were patients with osteoradionecrosis (ORN). Ten percent of all patients developed an osteonecrosis after treatment with bisphosphonates (BOJ). Eight percent showed osteomyelitis or sequester due to a trauma while 14% of all patients had osteomyelitis of unknown origin. All BOJ patients took bisphosphonates because of metastatic diseases of the bone (plasmocytoma, mamma carcinoma and prostate cancer) for up to 5 years. All had been administered a nitrogen-containing bisphosphonate (either pamidronat or zoledronat). Thirteen out of the 17 patients with BOJ and 14 of the 45 with ORN reported a possible trigger like previous tooth extraction, pressure denture sore or periodontal diseases. CONCLUSION: These findings support the association of bisphosphonate therapy and osteonecrosis of the jaw. The importance of this new disease is characterised by the growing number of patients. The role of dental trigger factors and the poor surgical outcome both seem to justify a prophylactic dental care concept in high-risk patients.
Aged↗
[Root growth after wisdom tooth transposition. Case documentation with proposal for a radiologic method to quantify growth].
OBJECTIVES: To introduce a method for assessment of root growth on panoramic radiographs exemplified by a case report on an autotransplanted lower third molar. MATERIAL AND METHODS: A lower left third molar (T) with incomplete root formation was transplanted for replacement of the lower left first molar in an 18-year-old woman. T was monitored clinically and, together with its neighboring lower second molar (37) with constant root length, also radiographically by means of two panoramic radiographs (OPGs) produced 12 days and 20 months postoperatively. A method for calculation of the root length as a multiple of the crown length is introduced, using accurately reproducible landmarks defining the coronal and apical endpoints of the examined tooth in all OPGs of the series. This method minimizes error due to different magnifications within the set of radiographs. RESULTS: Using the method introduced, the root length of the constant tooth 37 varied at 2.7% within the set of OPGs, whereas it revealed a 5.6% variation when the evaluation was based on direct measurement. Based on the described method, T revealed a postoperative root growth of approximately one-third of its final length and showed clinically no pathological findings during the observation period. CONCLUSIONS: Our results indicate that with the described method root growth assessment on panoramic radiographs is more accurate than with direct measurement.
Adolescent↗
[Intraoperative adverse events in minor oral surgery. Risk analysis].
AIM OF THE STUDY: The aim of this prospective study was to evaluate oral surgical procedures performed as day surgery under local anesthesia. We examined patients' general condition, and besides checking for intraoperative complications we analyzed postoperative bleeding in patients with hemostatic disorders. PATIENTS: The patient population consisted of 1540 patients (797 female, 743 male), who underwent a total of 2055 minor oral surgical procedures over a 5-year period (1998-2002). Before the treatment started a data file was made for each patient, which contained information on his or her past medical history, concomitant medication, why the operation was indicated, premedication, anesthetic and surgical techniques applied, and postoperative treatment. RESULTS: Systemic pathologies influencing surgical decisions were found in 316 patients (20.5%), affecting 676 interventions (32.9%). In 109 patients (5.3% of the 2055) altered hemostasis was found. The surgical procedures recorded were: (operative) tooth extraction (n=394), interventions for surgical conservation of teeth (n=272), treatment for cysts (n=140), surgical revisions (n=46) and preprosthetic surgery (n=19). Passing complications, mostly systemic in nature, occurred during 27 sessions of local anesthesia (1.3%). There were 87 adverse events intraoperatively (4,2%), most of which were confined to the surgical field; specifically 15% of these complications took the form of hemorrhage. We observed no significant correlation between the occurrence of intraoperative complications and patients' gender, predisposing systemic pathologies including bleeding disorders, or age. Postoperative hemorrhage was observed significantly more frequently in patients with impaired hemostasis and required admission to hospital for inpatient treatment in 2 cases. CONCLUSION: According to our investigation, oral surgery can be performed in patients with compromised general condition with as few intraoperative complications as in patients with no general medical problems. However, in individual cases specific risk factors can be present and oral surgery may be temporarily contraindicated, at least as day surgery.
Adult↗
[Bisphosphonate-associated osteonecrosis of the jaw].
BACKGROUND: Bisphosphonates (BP) are widely used in patients with osteoporosis or malignant tumors with bony metastases such as breast cancer and plasmocytoma because of their potency to affect osteoclasts and bone resorption. Osteonecrosis of the jaw (ONJ) has been described as a potential side effect since 2003. After a review of the literature we present results of a questionnaire, which was sent to departments of oral and maxillofacial surgery (OMFS) in German-speaking countries. MATERIAL AND METHODS: We present 349 patients from the literature, 54 patients from the departments of OMFS and 19 cases from our own department. These patients ware analyzed depending on their disease, their medication, localization of the affected area, histological signs and therapeutic outcome. RESULTS: Of 73 patients, 68 (93%) were treated with pamidronate or zoledronate; 69 (94%) patients suffered from malignant diseases, 3 (5%) had osteoporosis, and 1 (1%) had Paget's disease. In 57 (78%) patients the ONJ affected the mandible, in 12 (16%) the maxilla and in 4 (5%) both jaws. A previous tooth extraction was reported in 38 (52%) patients, and in 35 (48%) ONJ occurred spontaneously. Histological findings were similar to osteomyelitis with a high number of actinomyces colonies. Nine (12%) patients received non-surgical treatment only, 52 (71%) patients underwent minor surgical procedures (e. g. decortication) and 19 (26%) patients underwent marginal or segmental resection of the jaw. Considering all treatment modalities, healing was achieved in 55; the most effective was marginal and segmental resection (88%). DISCUSSION: Though millions of patients receive BP treatment only a few suffer from ONJ. The incidence in cancer patients with pamidronate and zoledronate therapy is 4%-10%. Because of the similarity to "phossy jaw", seen in patients dealing with white phosphorus in the nineteenth century, some authors call the new entity "bis-phossy jaw". As the pathogenesis of ONJ is not clear we recommend that the descriptive term bisphosphonate-associated osteonecrosis should be used. Bone resection and safe soft tissue closure is the treatment of choice. We recommend systematic dental care for patients receiving BP medication. Information exchange between oncologists, oral and maxillofacial surgeons and dentists is important.
Aged↗
[Quantitative vascular analysis in the marginal periodontium using PECAM-1].
BACKGROUND: Systemic sclerosis (SSc) is a generalized disorder of the interstitial tissues and vasculature with distinct abnormalities in three systems, immune and autoimmune, vascular and microvascular, and mesenchymal extracellular matrix (ECM), that lead to exuberant fibrosis. The aim of this study was to compare the number of blood vessel profiles in the marginal gingiva between SSc patients and patients with periodontitis but without SSc by using biopsies. METHODS: Marginal gingiva and gingival papilla were obtained from 13 scleroderma patients and 8 patients with periodontitis after routine tooth extraction and gingival curettage. On the histological sections, immunohistochemical investigations were performed using the avidin-biotin complex method (ABC) and the monoclonal antibody CD 31/Clone JC70A (platelet endothelial cell adhesion molecule-1). Blood vessels were identified by light microscopy (original magnification x400) and counted within 0.3615 mm2. Medians of blood vessel profiles were compared by Mann-Whitney U-test. RESULTS: There is no statistical difference between the median of blood vessel profiles in the marginal gingiva of SSc patients as compared to the median of blood vessel profiles in the marginal gingiva of patients with periodontitis (P = 0.665). We did not discover avascular areas in the subepithelial connective tissue. DISCUSSION: The pathological changes in the microvasculature in the dermis of SSc patients are not transferable to the marginal periodont, as intraindividual histological examinations of dermis and oral mucosa in relation to the degree of the disease are not available yet.
Adult↗
Incidence of deep fascial space infection after surgical removal of the mandibular third molars.
Nine hundred and ninety-three patients who underwent surgical removal of the mandibular third molars with oral antibiotic prophylaxis were examined to determine the incidence of postoperative deep fascial space infection and its background factors. Postoperative deep fascial space infection was observed in 8 of the patients (0.8%; 4 males and 4 females), and submandibular spaces were involved in all infected patients. Only 1 of these 8 patients was an immune compromised host. Patients aged 30 years or more had a significantly higher incidence of deep fascial space infection than those aged under 30. Five patients had partial bony impactions and 3 had complete bony impactions. However, the incidence of infection according to the molar positions was not significantly different between partial bony impaction and complete bony impaction. The 8 patients had not had pericoronitis preoperatively. The clinical courses of all were favorable after antibiotics were administered intravenously. In conclusion, the incidence of deep fascial space infection after removal of the mandibular third molars was low, at 0.8%. However, it may be desirable to remove the molars, if applicable, at a younger age because of the higher incidence of infection in patients aged over 30. The results of this study also offer information that will be useful as a basis for obtaining informed consent from patients whose mandibular third molars are to be removed.
Adolescent↗