Safety of dental implant surgery in patients undergoing anticoagulation therapy: a prospective case-control study

Objectives: Several studies have described oral surgical procedures in patients receiving anticoagulant therapy, but no prospective studies on dental implant surgery during anticoagulant treatment are currently available, and only a limited number of case reports refer to endosseous dental implant treatment in these patients. In the setting of oral surgery, it has been suggested that anticoagulant treatment is not required when the International Normalized Ratio (INR) is <4 and local haemostatic measures are applied. The purpose of this preliminary study was to evaluate the incidence of bleeding complications following surgical implant therapy in a group of 50 consecutive patients receiving oral anticoagulant therapy (warfarin) without interruption or modifications to their therapy (group A). Materials and methods: One hundred and nine otherwise healthy patients comparable for age, sex, extent and site of the implant surgical procedure formed the control group (group B). In both groups, a standard protocol of local haemostasis, including non‐reabsorbable sutures and compressive gauzes soaked with tranexamic acid, was applied. Surgeons, blind to the group allocation, performed all the procedures in an outpatient setting. Results: Two and three late‐bleeding complications were reported in group A and group B, respectively, without significant difference in the bleeding risk (relative risk = 1.45; P= 0.65; 95% confidence interval 0.2506–8.4271). These complications were managed using a compressive gauze soaked with tranexamic acid at the site of the surgical wound. Conclusion: According to our preliminary results, local haemostasis in dental implant surgery is able to prevent bleeding complications in patients on oral anticoagulants, allowing these surgical procedures to be performed on an outpatient basis. To cite this article:
Bacci C, Berengo M, Favero L, Zanon E. Safety of dental implant surgery in patients undergoing anticoagulation therapy: a prospective case–control study.
Clin. Oral Impl. Res. 22 , 2011; 151–156.
doi: 10.1111/j.1600‐0501.2010.01963.x     

Interrelationship between implant and orthognathic surgery for the rehabilitation of edentulous cleft palate patients: a case report

A 43-year-old woman with a unilateral cleft lip and palate, presenting a totally edentulous maxilla and mandible with marked maxillomandibular discrepancy, attended the Prosthodontics section of the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo for treatment. She could not close her mouth and was dissatisfied with her complete dentures. Treatment planning comprised placement of six implants in the maxilla, four in the mandible followed by prostheses installation and orthognathic surgery. The mandibular full arch prosthesis guided the occlusion for orthognathic positioning of the maxilla. The maxillary complete prosthesis was designed to assist the orthognathic surgery with a provisional prosthesis (no metal framework), allowing reverse treatment planning. Maxillary and mandibular realignment was performed. Three months later, a relapse in the position of the maxilla was observed, which was offset with a new maxillary prosthesis. This isa complex interdisciplinary treatment and two-year follow-up is presented and discussed. It should be considered that this type of treatment could also be applied in non-cleft patients.     

Long-term success of dental implants in patients with head and neck cancer after radiation therapy

The purpose of this study was to analyze the long-term success and factors potentially influencing the success of dental implants placed in patients with head and neck cancer who underwent radiation therapy with a minimum total dose of 50 Gy during the years 1995–2010. Thirty-five patients (169 dental implants) were included in this study. Data on demographic characteristics, tumour type, radiation therapy, implant sites, implant dimensions, and hyperbaric oxygen therapy (HBOT) were obtained from the medical records and analyzed. Implant survival was estimated using Kaplan–Meier survival curves. Seventy-nine dental implants were placed in the maxilla and 90 in the mandible. The mean follow-up after implant installation was 7.4 years (range 0.3–14.7 years). The overall 5-year survival rate for all implants was 92.9%. Sex (P < 0.001) and the mode of radiation therapy delivery (P = 0.005) had a statistically significant influence on implant survival. Age, time of implantation after irradiation, implant brand and dimensions, and HBOT had no statistically significant influence on implant survival. Osseointegrated dental implants can be used successfully in the oral rehabilitation of patients with head and neck cancer with a history of radiation therapy. Risk factors such as sex and the mode of radiation therapy delivery can affect implant survival.     

Use of ultrafast computed tomography in dental surgery: a case report

Abstract - A case of a transdental fixation planned on the basis of ultrafast computed tomography is reported. This method allows to gain an insight in the osseous structures required for the operative procedure. Ultrafast computed tomography is superior to the convential radiographs in obtaining accurate information about the vertical bone supply and the extension of the facial osseous sinus wall. A set of axial CT-images with an extension of 3 mm was acquired in the region of the alveolar bone. By means of frontal reconstructions and data processing methods the thickness of the bone layer in transverse direction was accurately determined. The calculated bone thickness allowed to anchor a transdental self-tapping titanium screw.     

肾移植患者接受种植治疗的临床效果观察1例

报道1例曾接受双肾移植,因右下颌磨牙缺失导致咀嚼功能受限,通过种植治疗恢复缺失牙的患者。经过完善的术前检查制定治疗计划,术中严格执行无菌操作,术前、术后预防感染。治疗结束后患者缺失牙的功能和美观均得以恢复,随访2年,修复体行使功能良好,种植体周围骨吸收稳定,但远期效果有待进一步观察。     

Implants in children: a case report

Abstract A post-crowned, root-filled tooth in a 13-year-old child which is retraumatised resulting in palatal fracture of the root often necessitates removal of the root. The future treatment plan involves appropriate space management and restorative treatment. In this instance the root was retained in order to preserve alveolar bone until the patient was old enough for an implant     

Dental findings and special care in patients with Angelman syndrome: a report of three cases

Angelman syndrome (AS) is a neurogenetic disorder, characterized by intellectual disability, movement or balance disorders, specific abnormal behaviors, and severe speech and language limitations. Due to its low incidence and the nonspecifity of developmental problems in newborns and young children, AS is not easily identified by clinical pediatricians. The aim of this paper is to present three cases of AS, reporting the orofacial characteristics and requisite dental care in these patients. Interestingly, this investigation found that certain typical features of mouth breathing syndrome, such as long and narrow faces, open mouth, shortened upper lip, lowered mandible position, shadows under the eyes (infraorbital cyanosis), muscular hypotonia, and enlarged and anteriorized tongue, were present in the three studied AS patients.     

Mental nerve paresthesia associated with an amalgam filling: a case report

Hilú RE, Zmener O. Mental nerve paresthesia associated with an amalgam filling: a case report. Endod Dent Traumatol 1999; 15: 291–293.© Munksgaard, 1999.
Abstract — We present a case report in which a mental nerve paresthesia occurred in connection with an amalgam filling placed in direct contact with the pulp of a mandibular first molar. The main evidence for amalgam being the dominant etiological factor was the positive epicutaneous patch testing response to the components of the amalgam alloy, and the total remission of symptoms without further clinical complications after removal of the amalgam filling and subsequent endodontic therapy.     

Dental findings in Kabuki make-up syndrome: a case report

This article documents the case history of a 9‐year‐old Brazilian child diagnosed with Kabuki make‐up syndrome (KMS). The clinical features are described, with emphasis on the craniofacial and orodental manifestations. The patient had the distinctive KMS craniofacial features consisting of long palpebral fissure, hypertelorism, high‐arched eyebrows with sparse hair in the lateral one‐third, eyes with eversion of the lateral one‐third of the lower eyelids, long and curved eyelashes, palpebral ptosis, large anteverted prominent ears in a lower position, broad, depressed nasal root with a flat nasal tip, and mild neuropsychomotor developmental deficits. The intraoral examination revealed an anterior open bite, overretention of primary teeth, and a high‐arched palate. Two findings in this child have not been previously reported in patients with KMS: the presence of supernumerary teeth and taurodontic teeth in the maxillary arch. The clinical and radiographic detection of these unique dental features may be helpful in identifying children who may have milder forms of KMS.     

氟化钠甘油过敏1例

近年来药物过敏引起的口腔黏膜溃疡越来越多,但氟化钠甘油过敏引起的溃疡却极少见。山东大学千佛山校区医院遇到氟化钠甘油过敏1例,氟化钠甘油治疗后患者口腔黏膜充血水肿明显,颊、腭黏膜有大量红色粟粒状颗粒,3 h后出现吞咽困难,但无呼吸困难,次日出现口腔黏膜大面积溃疡。治疗7 d后患者痊愈,氟化钠敏感试验结果为阳性。     

Infantile osteopetrosis: a case report on dental findings

In this paper we have described the case of a 7-yr-old Moroccan osteopetrotic boy, who had received a bone marrow transplant (BMT). He was transplanted from his older brother and, despite immunosuppressive therapy, developed chronic graft-versus-host disease and was placed on corticotherapy. Seven months after the bone marrow transplant, graft versus host disease (GVHD) was stabilized, but corticotherapy had inhibited growth. There was evidence of normalizing bone, his hearing was better but he had not recovered vision. Dental findings before the bone marrow transplant revealed some missing teeth, failure of teeth to erupt and decayed teeth but no enamel hypoplasia. The patient had developed one carious lesion on one unerupted tooth: bacteria seem to have found a way through the gubernaculum dentale. The scanning electronmicrographs showed decayed tooth and tissues fitted into each other. Since the bone marrow transplant, no tooth has erupted. We think that, in this case, failure of tooth eruption would be the sign of osteopetrosis.     

Eating disorder-induced dental complications: a case report

Eating disorders are potentially life threatening and have not lost their relatively poor prognosis in the last decades. Whereas the increase in incidence and prevalence rates of anorexia nervosa over time are questionable, an increasing trend in incidence and prevalence of bulimia nervosa has been reported. Dentists are often involved in treating teeth of patients with both anorexia nervosa and bulimia nervosa because the teeth of these patients are regularly affected by erosion and caries. Without identification of the underlying evidence of psychological problems and consequent treatment, a patient's medical and dental health will deteriorate as the eating disorder progresses. The dentition of the patient with an eating disorder may offer specific signs and characteristics to alert the dentist.     

Micro-scooter induced dental trauma: a case report

Abstract –  There has been a remarkable increase in the popularity of micro-scooters over the past few years. This has brought with it an astonishing rise in the number of associated injuries. Highlighted here is a case report which outlines the dental injuries associated with the use of a micro-scooter.     

The dental patient on oral anticoagulant medication: a literature review

Specific diseases and medications may considerably influence the delivery of oral care and the course of dental therapy. The purpose of this literature review is to examine the relationship between oral anticoagulant medication and dental treatment. Electronic and manual searches were conducted for clinical studies in the English literature for the years 1988-2010. The review process provided a total of 110 pertinent literature references, out of which 38 studies dealt with oral anticoagulants and dental treatment. Different treatment strategies relative to dental periprocedural anticoagulation regimens have been identified, and their accompanying thromboembolic and bleeding risks are being presented and discussed. Regarding to what extent a safe and successful dental treatment in patients on anticoagulant medication is feasible, the level of evidence is lacking. Until high-level data are provided, an individualised treatment approach after consultation with the physician of the patient is highly recommended.     

Osteonecrosis and spontaneous exfoliation of dental implants associated with oral bisphosphonate therapy: a case report

Bisphosphonates (BPs) have long been used for the treatment of osteoporosis and diseases like bone malignancies, active Paget's disease of bone, severe osteogenesis imperfecta and fibrous dysplasia among others. They bond highly to the bone surface and inhibit bone resorption. As BPs have a long half-life in bone because of their irreversible binding to bone, patients retain their risk profile even after drug cessation. This property also explains the complications wherein the cessation of bone resorption leads to halt in bone turnover. Usually with alendronate the risk of bisphosphonate-related osteonecrosis of jaw (BRONJ) wears off after 12 months. Reporting of the development of BRONJ is commonly associated with the intravenous BPs. Invasive surgical procedure associated with the placement of implants has been shown to be a major reason for the occurrence or initiation of BRONJ in susceptible patients. The prognosis of implants placed in the jaws of patients under or past BP medication is still uncertain. The present case report describes a patient on long-term oral BP therapy with spontaneous exfoliation of implant supported bone due to osteonecrosis.     

Use of dental implants in patients with Down syndrome: a case report

Down syndrome is caused by trisomy of the 21st chromosome and is associated with well-described physical and systemic problems. Most people with Down syndrome have some degree of mental retardation as well as malformation of head and neck. Oral structures that are commonly affected include the tongue (microglossia), abnormalities in the number and shape of teeth, and poor quality (osteoporotic-like) of alveolar bone and jaw. These oral malformations as well as a tendency toward poor cooperation in the dental office contribute to the belief among dentists that people with Down syndrome are not good candidates for oral rehabilitation with dental implants. This article describes the use of dental implants in the oral rehabilitation of a 16-year-old boy with Down syndrome. Although more experience is needed before dental implants can be considered a suitable option during oral rehabilitation in people with Down syndrome, this case report shows a promising beginning.