A clinical study on unfavorable cases of dental implant

The clinical analysis of 462 patients (154 men and 308 women) with problems of implant therapy done at other clinics is reported. They visited the clinic for oral implant of the Tokyo Medical and Dental University Hospital during the period from January 1996 to March 2002. The results were as follows: 1) The majority of the patients (76.6%) were 40 to 69 years of age. 2) Of the total patients, 26.8% had been referred from the other outpatient clinics in our hospital, 14.7% from private dental offices and 2.6% from attending doctors. 3) There were 361 patients with complications related to the implant therapy. Seventy-six patients asked for second opinions concerned about a diagnosis or treatment recommendation. Thirty patients required maintenance of the implants. 4) The most common complications observed were peri-implantitis (184 cases). Prosthodontic complications (72 cases) included framework/resin/veneering material fractures, screw loosening and fractures. There were implant fractures in 21 cases, sensory disturbance in 20 cases, problems related to sinus in 13 cases, problems of connected teeth in 30 cases and phonetic/esthetic complications in 10 cases. 5) The types of problem implants were osseointegrated implants (196 cases), alumina-ceramic implants (74 cases), metallic blade-type implants (35 cases), pin-type implants (10 cases), subperiosteal implants (6 cases) and other implants.     

A self-administered questionnaire--an aid in managing complete denture patients.

A written self-administered questionnaire aids in treating edentulous patients and greatly reduces the possibility of patient dissatisfaction and medicolegal complications. Twenty-two questions have been presented which are to be answered in writing by the edentulous patient prior to the interview and examination. Such a questionnaire has several advantages31: (1) It saves time for the dentist and reduces the cost of treatment. (2) It quickly identifies problem areas. (3) It provides background information on the patient which is useful during the oral interview. (4) It identifies patients who write more intelligently and openly than they speak. (5) It evaluates neuromuscular coordination through handwriting review. (6) It serves as a reference for postinsertion problems. (7) It has legal merit when properly dated and signed and indicates that maximum diagnostic and therapeutic efforts are intended.     

Quadruple salivary duct diversion for drooling in cerebral palsy

Drooling complicates many neurologic disorders including cerebral palsy. It is socially debilitating for the patient and very tedious for the caregiver. Surgical treatment consists mainly of ablative (excision/ligation) or physiological (diversion) methods; combined techniques have also been proposed. We have applied bilateral diversion of both submandibular and parotid ducts in 12 cerebral palsy patients (age range, 7-15 years). Preoperative drooling severity was grade 4/5 in 10 cases and grade 5/5 in 2 of the cases. All patients underwent physiotherapy for a minimum of 6 months and were consulted with a dentist, otolaryngologist, and a speech therapist before surgery. No bleeding, hematoma, or infection has been observed in any of the patients. Two patients had early postoperative tongue edema that regressed with conservative treatment. All patients except one regressed to grade 2/5 drooling by the first postoperative month. In 1 patient who had previously been classified as grade 5/5, surgery provided limited improvement with only 1 grade of step-down. Satisfactory results for the patients and their families could be achieved and sustained for a median 18 months (7-20 months) of follow-up. In conclusion, the quadruple duct diversion method is an effective physiological surgical method in the control of drooling in cerebral palsy.     

The effect of preemptive and/or postoperative ibuprofen therapy for orthodontic pain.

The control of pain during orthodontic treatment is of vital interest to both clinicians and patients. Surprisingly, there has been limited research into the control of orthodontic pain, and there is no standard of care for controlling this discomfort. The purpose of this study was to compare the effectiveness of preemptive ibuprofen therapy, postoperative ibuprofen therapy, and a combination of the 2 therapies. Forty-one orthodontic patients aged 9 years 3 months to 16 years 11 months who were to undergo separator placement were enrolled in this prospective study. Patients were randomly assigned to 1 of 3 experimental conditions: (1) 400 mg ibuprofen taken orally 1 hour before separator placement and 400 mg ibuprofen taken orally 6 hours after the initial dose, (2) 400 mg ibuprofen taken orally 1 hour before separator placement and a lactose capsule taken orally 6 hours after the initial dose, or (3) a lactose capsule taken orally 1 hour before separator placement and 400 mg ibuprofen taken 6 hours after the initial placebo. The results revealed that preemptive ibuprofen therapy significantly decreased pain that was experienced 2 hours after separator placement and at bedtime. Beginning on day 2, there was a trend for patients who had taken both preemptive and postoperative ibuprofen doses to have lower pain scores compared with the other 2 groups. In conclusion, these data indicate that ibuprofen taken 60 minutes before separator placement alleviates pain at 2 hours and at bedtime after treatment. Further study with the use of additional postoperative doses is warranted.     

Gene therapy in the management of oral cancer: review of the literature

Gene therapy essentially consists of introducing specific genetic material into target cells without producing toxic effects on surrounding tissue. Advances over recent decades in the surgical, radiotherapeutic and chemotherapeutic treatment of oral cancer patients have not produced a significant improvement in patient survival. Increasing interest is being shown in developing novel therapies to reverse oral epithelial dysplastic lesions. This review provides an update on transfer techniques, therapeutic strategies, and the clinical applications and limitations of gene therapy in the management of oral cancer and precancer. We highlight the combination of gene therapy with chemotherapy (e.g., 5-Fluoracil) and immunotherapy, given the promising results obtained in the use of adenovirus to act at altered gene level (e.g., p53). Other techniques such as suicide gene therapy, use of oncolytic viruses or the use of antisense RNA have shown positive although very preliminary results. Therefore, further research into these promising gene therapy techniques is required to assess their true efficacy and safety in the management of these lesions.     

Application of intermaxillary fixation screws in maxillofacial trauma.

PURPOSE: The use of intermaxillary fixation (IMF) in the treatment of maxillofacial trauma represents the cornerstone of fracture reduction and immobilization. Many modalities of IMF have been described; recently IMF screws have been introduced into clinical practice, however, hardware failure can occur. We performed a retrospective study evaluating hardware-associated complications for self-drilling/tapping IMF screws. MATERIALS AND METHODS: A retrospective study on 49 patients requiring IMF was performed. The diagnosis, duration of IMF, screw site, use of elastic or wire fixation, and associated complications were recorded. IMF screws were used to adjunct open reduction techniques, for definitive closed reduction, or fracture prevention following dentoalveolar surgery. Follow-up examinations were performed until fracture healing was complete (6 to 8 weeks). RESULTS: A single adverse event occurred in 19 patients (39%) while 4 patients (8%) had more than 1 complication. The most common event was screw loosening; 29% of patients had at least 1 screw dislodged in the treatment period. Of the total number of screws placed (229), 15 (6.5%) became loose, and were equally distributed among the mandible and maxilla. The remaining complications noted were root fracture, 4% (2 of 49); loosened wires, 6% (3 of 49); screw shear, 2% (1 of 49); malocclusion, 2% (1 of 49); and ingested hardware, 2% (1 of 49). CONCLUSIONS: Overall the IMF self-drilling/tapping screws have been shown to be a useful modality to establish maxillomandibular fixation. It is a safe, and time-sparing technique; however, it is not without limitations or potential consequences which the surgeon must be aware of in order to provide safe and effective treatment.     

In vitro two-body wear of polymeric veneering materials

The various methods to accomplish gingival displacement have been described. The techniques have been noted and their relative advantages and disadvantages summarized. The practicing dentist can use this review to make better informed decisions regarding the method he or she chooses for the treatment of a particular patient.     

Degree of Patient Pain,Complications, and Satisfaction after Root Canal Treatment or a Single Implant: A Preliminary Prospective Investigation

Introduction

Dentists often face the choice between tooth retention with root canal treatment and tooth replacement with implant treatment. To date, there has not been a prospective clinical trial directly comparing nonsurgical root canal treatment and single delayed implant therapy with regard to the degree of preoperative and postoperative pain, complications, and patient satisfaction.

Methods

Twenty-four patients had initial nonsurgical root canal treatment, and another 24 had single implant treatment in healed sites. Questionnaires were given at pretreatment, 7 days, 3 months, 6 months, and 12 months.

Results

All patients completed the 12-month follow-up period. No significant difference in pain, complications, or overall satisfaction was noted between the 2 groups at any of the time points (P > .05). However, there were differences within each group between the time points. There was more pain at pretreatment for root canal treatment and 7-day post-treatment point for single implant treatment than any other time point. For complications, more were reported at the 7-day post-treatment point than any other time point for both groups. With overall satisfaction, there was no difference from any time point for either group.

Conclusions

The results of this study suggest that patients perceive both treatments with high degrees of satisfaction with minimal pain and discomfort. Differences were found at different time points of treatment and were related to the nature of the treatment itself. This information is useful to help patients with treatment decisions.     

Exploiting molecular methods to explore endodontic infections: Part 1--current molecular technologies for microbiological diagnosis

Endodontic infections have been traditionally studied by culture-dependent methods. However, as with other areas of clinical microbiology, culture-based investigations are plagued by significant problems, including the probable involvement of viable but uncultivable micro-organisms with disease causation and inaccurate microbial identification. Innumerous molecular technologies have been used for microbiological diagnosis in clinical microbiology, but only recently some of these techniques have been applied in endodontic microbiology research. This paper intended to review the main molecular methods that have been used or have the potential to be used in the study of endodontic infections. Moreover, advantages and limitations of current molecular techniques when compared to conventional methods for microbial identification are also discussed.     

Antiangiogenic therapy with interferon alpha for giant cell lesions of the jaws.

PURPOSE: Giant cell tumors are classified and treated based on their biologic behavior. We hypothesize that they are proliferative vascular lesions and would be expected to respond to antiangiogenic therapy. The purpose of this report is to present a treatment protocol consisting of enucleation, with preservation of vital structures, followed by subcutaneous interferon alpha. MATERIALS AND METHODS: Patients with a biopsy-confirmed giant cell lesion satisfying criteria for "aggressive giant cell tumor" were included. Instead of wide en bloc resection, lesions were enucleated and the patients started on interferon alpha-2 or beta (3,000,000 units/m(2)) 48 to 72 hours postoperatively. The subjects were followed by clinical examination and radiography, immediately after surgery and every 3 months until the bone cavity completely healed. Thereafter, follow-up was every 6 months. RESULTS: Eight patients (7 females), with a mean age of 18.7 +/- 11.1 years, have been enrolled. Six tumors were in the posterior mandible, and 2 were in the anterior maxilla. The mean size was 29.0 mm (range, 15 to 70 mm). All patients underwent enucleation. There were no postoperative complications, and all patients tolerated interferon. There was no evidence of tumor growth during treatment. Seven of 8 patients have completed interferon therapy, and there have been no recurrences during 1 to 6 years of follow-up. The other patient continues on treatment with no evidence of disease. CONCLUSION: Antiangiogenic therapy, in combination with curettage, is a promising strategy for treatment of aggressive giant cell tumors. Combined treatment results in a high rate of tumor control with decreased operative morbidity compared with conventional treatment.     

Intubation Techniques: Preferences of Maxillofacial Trauma Surgeons

Objective

To evaluate the clinical outcomes of alternative techniques of intubation in patients sustaining maxillofacial injuries, where nasotracheal intubation (NTI) is best avoided.

Material and Methods

Alternative techniques to standard naso-tracheal intubation like submental intubation, orotracheal intubation-retrotuberosity/retromolar and missing dentition were used and variables of clinical outcome recorded.

Results

Submental intubation provides an unobstructed intraoral surgical field, avoids intraoperative and postoperative complications of tracheostomy, and overcomes the disadvantages of NTI. In our experience with submental intubation (6 cases), we only had complication related to tube apparatus like damage to pilot balloon. With retrotuberosity intubation (5 cases) we did not encounter any complications and the only limitations were bulbous maxillary tuberosity. Retromolar intubation (4 cases) a safe noninvasive technique has disadvantages like tube interference within the surgical field and not feasible in case of limited retromolar space. Orotracheal-missing dentition intubation (4 cases) is of great advantage i.e. it can be used in cases where NTI is contraindicated, no specialized skill required, no added cost, avoids the need for tracheostomy, no extra-oral procedures required and does not interfere with occlusion/MMF; with disadvantage of occasional tube interference within the surgical field.

Conclusion

Preferred techniques of securing an airway like orotracheal, nasotracheal may not always be applicable, thus a trauma surgeon-anesthesist team should always have alternative techniques in their armamentarium to reduce the morbidity associated with these patients without interference with occlusion, which is prime goal in jaw fracture reduction. We have used these techniques in a country with limited resources and found them equally effective and convenient to use.     

Surgical pocket reduction

It is not possible within the scope of this paper to describe in any detail each of the aforementioned procedures. These can be found in the various textbooks and journals on clinical periodontology. Instead, the objectives of treatment, the spectrum of techniques available, and the rationale for their use have been described. Periodontal surgery should be performed only under certain conditions: the patient must be physically and mentally competent to undergo any type of surgery, and should understand and agree to the procedure and to postoperative management. Finally, periodontal surgery should only be considered when nonsurgical therapy will not accomplish the desired result. When periodontal surgery for pocket elimination is performed for selected defects that have been properly evaluated after a debridement and healing period, and is executed with technical competence and proper postoperative care, it can preserve the dentition affected by periodontal disease.     

Lateralization of the inferior alveolar nerve with simultaneous implant placement: a modified technique

PURPOSE: Several nerve repositioning techniques have ben presented in the literature, each with limitations. This article presents a new technique involving the use of 2 osteotomies, with minimizes particularly the potential duration of sensory disruption and the risk of nerve paresthesia and inadvertent nerve transection or compression. MATERIALS AND METHODS: Ten patients ranging in age from 47 to 67 years were selected for nerve lateralization utilizing the modified technique. A total of 23 cylindrical implants were placed. An average follow-up period was 29.8 months. RESULTS: Of the 10 patients, 4 experienced total return of sensation within 3 to 4 weeks. One patient experienced complete recovery at 6 weeks. DISCUSSION: Creating 2 osteotomies as described minimizes the chances for postoperative neuropraxia and nerve paresthesia or anesthesia. CONCLUSION: When there is moderate-to-severe bone resorption of the mandible posterior to the mental foramen, repositioning the inferior alveolar nerve using both an anterior and posterior osteotomy allows for more bone to accommodate ideal placement and greater length of implant.     

Adipose-derived stem cells in dentistry

In the last decade, applications of tissue engineering technology in dental regenerative medicine have expanded enormously. In particular, the use of mesenchymal stem cells, which are highly proliferative and have the capacity to differentiate into osteogenic, chondrogenic, and adipogenic cells, promises to have a positive impact on the future of dentistry. The therapeutic potential of human multipotent mesenchymal stem cells, which are harvested from bone marrow and adipose tissue, has generated a markedly increased interest within a wide range of biomedical disciplines. Adipose-derived stem cells are especially interesting because of their strong potential for cell differentiation and growth factor secretion. Furthermore, these cells have some advantages over stem cells from other sources, including the fact that a large number of stem cells can be easily and quickly isolated from subcutaneous adipose tissue.In clinical dental therapy, several non-stem-cell-based methods have been developed for periodontal and bone tissue engineering. These methods include the stimulation of regeneration using enamel matrix proteins, guided tissue regeneration, various bone grafting techniques, and the application of growth factors and have been applied either alone or in combination. However, there are various limitations and shortcomings in the currently available methods. Therefore, it will be a significant step forward to establish dental tissue engineering techniques using mesenchymal stem cells. In this review, the fundamentals of periodontal tissue regeneration and bone tissue engineering are discussed. In particular, the use of adipose-derived stem cells in periodontal tissue regeneration, bone tissue engineering, and the engineering of other complex tissues are discussed.     

Endoscopic mechanical retrieval of sialoliths

OBJECTIVE: We sought to assess the efficacy of sialoendoscopic mechanical retrieval techniques for the treatment of obstructive salivary gland disease. This study documents the authors' long-term experience with mechanical retrieval techniques, the long-term results of the procedures, the technical issues, the techniques that have been used, and the advantages and limitations of these modalities. STUDY DESIGN: Mechanical endoscopic techniques were used in a large referral center from 1993 to 2001 to treat 217 salivary glands for salivary gland sialolithiasis. RESULTS: We found that 189 of the 217 glands with salivary gland sialolithiasis became completely symptom- and stone-free, both endoscopically and by radiographs (overall success rate, 87%). In the submandibular gland group specifically, the success rate was higher, 89%. In the parotid group, it was 83%. Follow-up was continued for 40 months after treatment. No severe complications were noted. The endoscope used was the third-generation Sialoendoscope. CONCLUSION: The endoscopic mechanical retrieval of sialoliths is both safe and efficacious. This is an excellent method for the complete and certain removal of sialoliths, with minimal damage to the surrounding tissue.     

Minor tooth movements using microimplant anchorage: case reports

For the treatment of extruded or tipped molars, various conventional techniques have been used. But those methods may lead to undesirable movement of the anchorage units and lengthen treatment time because of limited tooth-borne anchorage potential. Introduction of microimplants as orthodontic anchorage has expanded treatment possibilities because of their advantages. Some advantages are a less complex surgical procedure, decrease in cost, immediate loading, and their ability to be placed in any area of the alveolar bone. This article will illustrate clinical experiences in patients who were treated with the intrusion of overerupted molars, the up-righting of tilted molars, and other clinical applications for minor tooth movements. Anchorage control was achieved with the surgical insertion of titanium microimplants for immediate loading in the alveolar bone. When needed, minimal fixed appliances were used and orthodontic treatment was completed without any other complications.     

Prospective study of postoperative sensory disturbances after surgical treatment of mandibular fractures

Introduction

This present study’s purpose is to evaluate the degree of paresthesia and recovery of inferior alveolar nerve in patients with mandible fractures who underwent surgical treatment.

Material and methods

Nineteen patients were evaluated (27 hemimandibles) at six different times: preoperative (T1), postoperative 1 week (T2), postoperative 1 month (T3), postoperative 3 months (T4), postoperative 6 months (T5), and postoperative 1 year (T6). Subjective and objective methods were used for this evaluation.

Results

The results were analyzed using likelihood ratio chi-square test for the hypothesis of no association between indicators of sensitivity and responses to the questionnaire, and the Cochran–Mantel–Haenszel test for equality hypothesis. All objective tests showed a statistically significant worsening in sensitivity at T2 (p?<?0.0001) and a significant improvement after T4 (α?<?0.05). The subjective tests showed an association with the objectives tests, and improvement in sensitivity after T4 (p?<?0.0001) was noted.

Discussion

The first postoperative week is the period in which there are major changes with respect to sensitivity, and after 3 months postoperatively, the recovery reaches its apex with little difference observed after this period. In this research 100 % of the patients analyzed recovered all sensibility until T6.     

Comparison of Nd:YAG laser versus scaling and root planing in periodontal therapy

BACKGROUND: The Nd:YAG laser has recently been used in the treatment of periodontal disease. However, although a clinical reduction of probing depth and gingival inflammation to this new approach has been reported, it has not been fully evaluated. Interleukin-1 beta (IL- 1beta), a potent stimulator of bone resorption, has been identified in gingival crevicular fluid (GCF), which is closely associated with periodontal destruction. The aim of this study was to compare the effects of Nd:YAG laser treatment versus scaling/root planing (SRP) treatment on crevicular IL-1beta levels in 52 sampled sites obtained from 8 periodontitis patients. METHODS: One or 2 periodontitis-affected sites with a 4 to 6 mm probing depth and horizontal bone loss from 3 adjacent single-root teeth in each of 4 separate quadrants were selected from patients for clinical documentation and IL-1beta assay. Sampling site(s) from each diseased quadrant was randomly assigned to one of the following groups: 1) subgingival laser treatment (20 pps, 150 mJ) only; 2) SRP only; 3) laser treatment first, followed by SRP 6 weeks later; or 4) SRP first, followed by laser therapy 6 weeks later. The GCF was collected and the amount of IL-1beta was assayed by enzyme-linked immunosorbent assay (ELISA). Clinical parameters and GCF were measured at baseline and biweekly after therapy for 12 weeks. RESULTS: An obvious clinical improvement (marked decrease in the number of diseased sites with gingival index > or =2) and reduction of crevicular IL- 1beta were found in all groups. The level of IL- 1beta was significantly lower in the SRP group (P = 0.035) than in the laser therapy group for the duration of the 12 weeks. The laser combined SRP therapy group showed a further reduction of IL- 1beta (6 to 12 weeks after treatment) than either laser therapy alone or SRP combined laser therapy. CONCLUSIONS: Our data suggest that laser therapy appeared to be less effective than traditional SRP treatment. Of the 4 treatment modalities, inclusion of SRP was found to have a superior IL- 1beta response, when compared to other therapies without it. In addition, no additional benefit was found when laser treatment was used secondary to traditional SRP therapy.     

STA无痛麻醉仪在口腔治疗中的应用特点

口腔局部麻醉可以减轻患者口腔治疗带来的疼痛,降低不适感,缓解其对口腔治疗的恐惧感,已经在口腔临床中被广泛应用。随着牙科器械的不断革新,STA无痛麻醉仪得到了广泛应用。本文就STA无痛麻醉仪的构造、基本使用方法、注射技术以及口腔治疗中的优点和局限性进行综述,从而为临床工作者在口腔操作中如何使患者得到无痛、舒适、安全的治疗而提供帮助。     

A randomized double-blind comparative study of Biolight light therapy following surgical extraction of impacted lower third molars

Monochromatic light has been used in many studies and indicated that phototherapy might be effective in the treatment of pain relief. The aim of this investigation was to evaluate the efficacy of monochromatic light phototherapy on patients who had undergone impacted third molar surgery. Sixty adult patients were included in the study. The patients were divided into 2 groups; the Biolight therapy group and the placebo therapy group. All the subjects received phototherapy 6 minutes preoperative and 10 minutes postoperative.They were examined 3 and 7 days after surgery to evaluate postoperative pain and wound healing. One patient was excluded from the study due to extraction of the third molar in maxilla. All the patients received a questionnaire to answer regarding pain and the number of pain killers consumed.The results from this study showed that Phototherapy using monochromatic light Biolight therapy had no significant differences compared to the placebo group.