The effect of non-steroidal anti-inflammatory drugs on bleeding during periodontal surgery

BACKGROUND: With the increasing prevalence of individuals taking non-steroidal anti-inflammatory drugs (NSAIDs), there is concern as to whether low-dose NSAIDs cause bleeding problems during periodontal surgery. METHODS: A controlled, single-blind study was designed to measure the effect of ibuprofen at peak plasma levels on intraoperative bleeding. Fifteen medically healthy subjects (seven males and eight females), each having two sites requiring periodontal surgery of similar complexity, type, and duration, were selected for the study. The subjects were instructed to take ibuprofen prior to one of the surgeries. A standard bleeding time and papillary bleeding index score were recorded at initial consultation, and prior to the first and second surgeries. The volume of aspirated blood was measured during each surgery by subtracting the amount of water used for irrigation from the total volume of fluid (blood + irrigation water) collected at 15-minute intervals during the surgery. RESULTS: An analysis of the results showed an increase in intraoperative bleeding when ibuprofen was taken prior to surgery (31.93 +/- 15.72 versus 17.80 +/- 9.57 ml; P <0.01). Ibuprofen appeared to have its greatest effect on bleeding mid-surgery. The average bleeding time also increased significantly (P <0.01) when ibuprofen was preadministered (4.17 +/- 0.96 versus 3.8 +/- 0.92 minutes), although the bleeding remained within the normal range. Papillary bleeding did not show a significant difference between the two surgeries. Surgeries involving osseous resection showed a significant increase in bleeding when ibuprofen was preadministered. CONCLUSION: Taken prior to periodontal surgery, ibuprofen increases intraoperative blood loss in patients up to almost two times that of those who did not take ibuprofen.     

Comparison of presurgical and immediate postsurgical ibuprofen on postoperative periodontal pain.

Previous studies have indicated that non-steroidal anti-inflammatory drugs administered prior to oral surgery procedures are effective in reducing postoperative pain. The purpose of the present study was to compare the efficacy of medicating with ibuprofen immediately presurgically to medicating immediately postsurgically on postoperative pain associated with periodontal surgery. Sixty patients who were to undergo periodontal surgery were randomly divided into 3 groups: the I-pretreatment group received 600 mg ibuprofen immediately presurgically and placebo immediately after the surgery; the I-post-treatment group received placebo before surgery and 600 mg ibuprofen postsurgically; the placebo group received placebo at both time periods. Responses from an 8-hour pain diary completed by each subject were quantified and statistically evaluated non-parametrically. Results indicated that dosing with ibuprofen either immediately before or immediately after periodontal surgery significantly delays onset of pain as compared to placebo, with dosing after surgery demonstrating a significantly greater delay of onset of pain as compared to dosing presurgically. In addition, unlike the presurgical dosing, dosing postsurgically significantly decreases mean pain intensity for a combined 8-hour period following periodontal surgery as compared to placebo.     

Assessment of morbidity after periodontal resective surgery

Background: The goal of this study is to evaluate morbidity after periodontal surgery and to compare postoperative morbidity of male and female patients treated by experienced periodontists to patients treated by postgraduate (PG) periodontal students. Methods: A total of 271 patients underwent resective periodontal surgery. Of them, 122 patients were treated by PG periodontal students and 149 patients were treated by experienced periodontists. One week after surgery a questionnaire was given to the patients to rate postoperative pain, swelling, thermal sensitivity, and bleeding. Tactile sensitivity was evaluated in terms of presence or absence. Data were analyzed statistically by applying the analysis of variance test for comparison of the values of bleeding and the Student t test for comparing pain, swelling, tenderness to percussion, and thermal sensitivity. Results: Postoperative bleeding did not show statistically significant differences between surgeries performed by PG periodontal students and experienced periodontists. There were statistically significant differences in contact sensitivity, thermal sensitivity, edema, and pain between surgeries performed by PG periodontal students and experienced periodontists. There were no statistically significant differences in postoperative morbidity between male and female patients. Conclusions: Morbidity after resective periodontal surgery is low. Patients treated by experienced periodontists had lower postoperative morbidity than patients treated by PG periodontal students. There were no differences in morbidity between male and female patients.     

Efficacy of ibuprofen-hydrocodone for the treatment of postoperative pain after periodontal surgery

BACKGROUND: Previous studies have shown that non-steroidal anti-inflammatory drugs (NSAIDs) have significant benefits in the control of postoperative pain after periodontal or oral surgical procedures. The combination of a peripherally acting NSAID with a centrally acting opioid drug is found to be more effective. The purpose of this study was to compare an alternative combination of ibuprofen 400 mg with 5 mg of hydroxycodone to ibuprofen 400 mg used alone in the management of pain following periodontal surgery. METHODS: This study used a double-masked cross-over design with the patients acting as their own controls. Twelve patients underwent two periodontal surgeries in different quadrants of the same dental arch at least 2 weeks apart. A standardized amount of local anesthetic and similar extent and duration of surgery for each side was required. The patients received four doses of medication at predetermined intervals and filled out a visual analog pain scale every 2 hours for the first 12 hours after surgery. RESULTS: The overall pain reported by the patients on visual analog scale was 1.55 (SE +/- 0.16), out of a possible 10. More pain was reported with ibuprofen alone, 1.81 (SE +/- 0.12), compared to the ibuprofen with hydrocodone combination, 1.30 (SE +/- 0.16). The difference was statistically significant (P<0.05). CONCLUSION: The findings suggest that a combination analgesic preparation of ibuprofen (400 mg) with hydrocodone (5 mg) results in better pain control compared to ibuprofen used alone.     

The effect of aspirin on the periodontal parameter bleeding on probing

BACKGROUND: The absence or presence of bleeding on probing (BOP) is a sign of periodontal health or disease, but the presence of BOP is not an accurate predictor of disease progression. Aspirin is increasingly used in the prevention of cerebrovascular and cardiovascular diseases and is a non-disease factor that may modify bleeding indices given its antithrombolytic activity. The purpose of this double-blind placebo-controlled randomized clinical trial was to study the effect of short-term daily aspirin ingestion on the clinical parameter BOP. METHODS: A total of 46 periodontally healthy subjects were included in this study: 16 received placebo, 15 low-dose aspirin (81 mg), and 15 regular dose (325 mg) aspirin. Clinical parameters assessed included plaque index, periodontal probing depth, and BOP using an automated pressure-sensitive probe. Measurements were recorded before and after 7-day exposure to placebo and aspirin regimens. RESULTS: A statistically significant difference in BOP was found in patients with > or = 20% of bleeding sites during the visit prior to placebo or aspirin exposure (n = 11). The group treated with 325 mg aspirin exhibited a moderate yet statistically significant increase in BOP (12.4%) compared to the placebo group (there was no significant difference between the 81 mg aspirin group and placebo). The tendency to bleed was not statistically significant in the group which exhibited <20% (n = 35) of bleeding sites during the visit prior to exposure. CONCLUSION: Aspirin intake of 325 mg daily for 7 days moderately increased the appearance of bleeding on probing in a population that had > or = 20% BOP sites.     

Intraoperative bleeding during open flap debridement and regenerative periodontal surgery

Background: The objective of this study was to measure the intraoperative bleeding during periodontal flap surgery. Methods: Patients scheduled for periodontal surgery were recruited for this study. Data regarding smoking habits, general health, and medications were collected. The amount of the local anesthetic that was injected was then recorded, as well as the number of teeth in the operative field and the duration of the procedure. During surgery, the liquids from the oral cavity were suctioned and collected into a sterile empty vial. To calculate the net amount of blood volume in the liquids, colorimetric assay using capillary blood fructosamine as a reference molecule was used. Results: Twenty‐six patients were included in this study. The amount of blood lost during the procedure ranged from 6.0 to 145.1 mL, with an overall mean of 59.47 ± 38.2 mL. Patients taking aspirin (acetylsalicylic acid) showed mean blood loss of 43.26 ± 31.5 mL, whereas the mean blood loss among patients that did not use this medication was higher (65.4 ± 39.4 mL) but not statistically significant. Local anesthetic amount, surgical field size, and the operation duration did not relate to blood‐loss volume. The mean blood loss among current smokers was significantly higher (96.47 ± 44.2 mL) compared to former (12 ± 8.4 mL) or never (54.74 ± 30.5 mL, P = 0.011) smokers. Conclusion: The results of the current study support previous papers and confirm that blood loss during periodontal surgery is minimal.     

Surgical periodontal therapy at Tokyo Dental College Suidobashi Hospital: a statistical profile in 2010-2011

The aim of the present study was to investigate the profile of surgical periodontal therapy performed at the Suidobashi Hospital of Tokyo Dental College, during the period of April 2010 through March 2011. A total of 112 periodontal surgeries in 69 patients (mean age: 51.4 years; 28 men and 41 women) were registered for the data analysis. The surgical interventions performed by 17 dentists comprised 79 cases of open flap debridement, 27 cases of periodontal regenerative therapy with enamel matrix derivative and 6 cases of periodontal plastic surgery. Eighty percent of the surgical sites were in the molar region and 41 cases had furcation involvement. In these patients, an improvement in oral hygiene status was observed prior to surgery: the mean plaque score of 45% at initial visit was significantly reduced to 31% after initial periodontal therapy (p<0.01). At sites that subsequently received open flap debridement or periodontal regenerative therapy, the mean probing depth and clinical attachment level after initial therapy was 6.4 mm and 7.6 mm, respectively. These values were significantly lower than those at initial visit (p<0.01). Lower prevalence of sites with positive bleeding on probing was observed after initial therapy. The initial periodontal therapy performed was considered to be effective in improving the periodontal condition of the sites prior to surgery. More effort, however, is indicated in improvement of patient oral hygiene status.     

The analgesic efficacy of ibuprofen in periodontal surgery: A multicentre study

The efficacy of a non-steroidal anti-inflammatory agent, ibuprofen, was evaluated in pain control following periodotal surgery. This type of agent acts peripherally by inhibiting the release of prostaglandins and minimizing the local inflammatory response. Thus there may be an advantage in pre-treatment administration of the drug so as to delay or even prevent postoperative pain.
The study was multicentre, involving a Public Hospital Periodontal Unit, two specialist periodontal practices in Sydney, NSW, ad two in Canberra, ACT. One hundred and twenty-seven pateints who were to undergo periodontal surgery were randomly given either two 200 mg tablets of ibuprofen or two matching placebo tablets at least 30 minutes before administration of local anaesthesia. The procedure was double blind: neither the patient nor the colinical was aware of the tablet identity.
Postoperatively, all patients were given labelled ibuprofen for pain relief, but were randomly divided into two groups: As directed who were instructed to take the drug regularly for two days postoperatively, and As required , who were to take the drug only if needed for pain relief. All patients completed a diary recording quantity and time of medication, and regular assessment of pain experience utilizing a viaual analogue scale.
The As directed group showed no significant difference in pain experience between pre-operative and post-operative only medication, but the As required group experienced significantly less pain and requirement for medication if the ibuprofen was administered pre-operatively.     

Nd∶YAP激光用于牙周再生性手术的临床效果观察

目的：评价Nd:YAP激光用于牙周再生性手术的临床效果。方法：选择牙周基础治疗1个月后复查,PD≥6 mm,BOP(+),伴骨缺损的牙周炎患者48例,共60颗患牙,随机分为两组。实验组采用 Nd:YAP激光联合牙周再生性手术进行治疗,对照组单纯采用牙周再生性手术治疗。对患者术后24 h、术后3 d的疼痛程度予以视觉模拟量表（VAS）记分评价,术前和术后6个月分别进行探诊深度(PD)、临床附着丧失（CAL）检查,比较2组术前、术后X线影像。采用SPSS 26.0软件包对数据进行统计学分析。结果：实验组术后24 h、术后3 d疼痛显著轻于对照组（P<0.001）;术后6个月,2组患牙的PD、CAL水平均比术前显著减小（P<0.001）。2组术前PD、CAL组间比较无统计学差异,术后6个月实验组显著低于对照组(P<0.001)。X线片显示,术后6个月2组牙槽骨缺损区有不同程度的新骨形成影像。结论：Nd:YAP激光用于牙周再生性手术可减轻术后疼痛反应,提高手术疗效。     

The efficacy comparison of ibuprofen, acetaminophen-codeine, and placebo premedication therapy on the depth of anesthesia during treatment of inflamed teeth

The purpose of this study was to elucidate whether premedication therapy with acetaminophen-codeine or ibuprofen is able to increase the depth of anesthesia in inflamed teeth. Sixty patients with the diagnosis of irreversible pulpitis in 1 mandibular tooth requiring root canal therapy (RCT) were selected. Two other teeth in the same quadrant were selected as controls. An electric pulp tester (EPT) was used to evaluate pulp sensitivity at the baseline and after drug administration and anesthesia injection. The subjects were divided into 3 groups randomly, and in each group 1 of the 3 drugs including acetaminophen-codeine, ibuprofen, and placebo were administered 1 hour before anesthesia delivery. After 1 hour, anesthesia was injected and after a waiting period, the EPT measurement was recorded. The reversed EPT scale was used to evaluate the depth of anesthesia achieved during RCT. Data were analyzed to statistically compare the results before and after intervention in cases and controls of each group and among different groups. Significanly lower tooth sensitivity levels (TSLs) were observed after intervention in acetaminophen-codeine and ibuprofen groups, which was more significant in the ibuprofen group. The comparison of inflamed teeth TSLs in the acetaminophen-codeine group and the placebo group after anesthesia and drug administration showed significant differences (P = .001). This comparison between ibuprofen and placebo groups also showed significant differences (P approximately 0). Also, significantly lower TSL of inflamed teeth was observed in the ibuprofen group in comparison with the acetaminophen-codeine group (P = .002). This study reflected preoperative administration of ibuprofen, if not contraindicated, as a drug of choice 1 hour before local anesthesia injection as an effective method for achieving a deep anesthesia during RCT of teeth with irreversible pulpitis.     

The use of celecoxib and dexamethasone for the prevention and control of postoperative pain after periodontal surgery

BACKGROUND: Conventional non-steroidal anti-inflammatory drugs have been widely used in the control of postoperative pain, but sparse information is available on the efficacy of celecoxib, a selective cyclooxygenase-2 inhibitor, or dexamethasone, a steroidal anti-inflammatory drug, after periodontal surgeries. The purpose of the present study was to compare the use of celecoxib and dexamethasone in the management of pain after mucoperiosteal flap surgery. METHODS: A randomized double-masked cross-over clinical trial was conducted on 20 patients from 27 to 52 years old with generalized moderate to advanced chronic periodontitis. Mucoperiosteal flap surgeries for scaling and root planing were performed under local anesthesia on at least three quadrants, with a 4-week interval between. Each quadrant was randomly assigned to one of the following medication protocols: placebo, 4 mg dexamethasone 1 hour before surgery and 8 hours after the first dose, and 200 mg celecoxib 1 hour before surgery and 12 hours after the first dose. Postoperative pain was accessed during the first 8 hours and on the following 3 days using the visual analog scale (VAS), the 101-point numerical rate scale (NRS-101), and the four-point verbal rating scale (VRS-4). RESULTS: Pain perception was statistically significantly lower in the celecoxib group than in the placebo group during the first 4 hours using VAS (P = 0.01) and at 1, 2, 3, 4, 6, and 7 hours using NRS-101 (P = 0.03). The level of pain was lower in the dexamethasone group than in the placebo only at the 3-hour period (P = 0.001). Statistically significant differences could be found among the groups at 1 hour (P = 0.015), 3 hours (P = 0.004), 4 hours (P = 0.02), and 7 hours (P = 0.05) using VRS-4. There was no statistically significant difference between the celecoxib and dexamethasone groups. CONCLUSION: The findings of this study suggest that the preemptive and postoperative use of celecoxib or dexamethasone were effective in the management of postoperative pain following open-flap debridement.     

A histopathological investigation on the effect of systemic administration of the bisphosphonate alendronate on resorptive phase following mucoperiosteal flap surgery in the rat mandible

BACKGROUND: The present study was designed to assess histopathologically whether the systemic administration of aminobisphosphonate (alendronate), 0.5 mg/kg body weight, is effective in preventing alveolar bone resorption following mucoperiosteal flap surgery, and whether alendronate modulates tissue factors. METHODS: The effect of alendronate on bone resorption was evaluated in mucoperiosteal flaps used as a resorptive model. The animals were given subcutaneous injections of either saline (control group) or 0.5 mg/kg of alendronate (experimental group). The alendronate or saline was administered subcutaneously 1 week prior to surgery, immediately prior to surgery, and 1 week after surgery. The parameters determined with a semiquantitative subjective method for histopathological evaluation were as follows: inflammatory cell infiltration (ICI) of adjacent periodontal tissue, degree of fibrosis and collagen bundle formation, number and morphology of osteoclasts of the alveolar bone and interdental septum, resorption lacunae (osteoclast surfaces), and osteoblastic activity (forming surfaces). RESULTS: There were no statistically significant differences between the saline and alendronate groups with regard to inflammatory cell infiltration, number of osteoclasts, and osteoblastic activity. Fibrosis and collagen bundle formation, osteoclast morphologies, and resorption lacunae formation were significantly different between the two groups, in favor of the alendronate group. CONCLUSIONS: The systemic administration of 0.5 mg/kg alendronate was effective in preventing alveolar bone loss and in modulating tissue factors. These findings indicate that alendronate would be a valuable addition to the therapeutic armamentarium available for the treatment of periodontal diseases, either alone or in combination with regenerative components such as anti-inflammatory drugs, bone graft materials, and guided tissue regeneration techniques, and even with dental implants.     

Does low-dose aspirin therapy complicate oral surgical procedures?

BACKGROUND: The fear of uncontrolled bleeding often prompts medical practitioners to stop aspirin intake for seven to 10 days before any surgical procedure. The authors initiated this study to evaluate the effect of aspirin on bleeding in patients undergoing oral surgery. METHODS: The study group consisted of 39 patients who were scheduled to undergo dental extractions. All patients were receiving 100 milligrams of aspirin daily on a regular basis. The authors randomly divided the patients into two groups: those who stopped the aspirin therapy before the procedure and those who continued the aspirin therapy. One hour before the procedures, all patients underwent a bleeding time test. In addition, the amount of bleeding during the procedure was measured. RESULTS: The mean (+/- standard deviation) bleeding time was 1.8 +/- 0.47 minutes for patients who stopped aspirin therapy one week before the procedure. For patients who continued aspirin therapy, the bleeding time was 3.1 +/- 0.65 minutes. The difference was statistically significant (P = .004). However, both groups were within the normal bleeding time range, and in both groups, a local hemostatic method was sufficient to control bleeding. No episodes of uncontrolled intraoperative or postoperative bleeding were noted. CONCLUSION: Low-dose aspirin therapy should not be stopped before oral surgery. Local hemostasis is sufficient to control bleeding. CLINICAL IMPLICATIONS: Patients receiving aspirin therapy to prevent blood clot formation may be subject to emboli formation if the treatment is stopped. The results of this study show that aspirin therapy should be continued throughout oral surgical procedures. Local measures are sufficient to control any bleeding during surgery.     

牙周炎症对牙龈组织巨噬细胞胞外诱捕网形成的影响

目的:探讨牙周炎症对牙龈组织中巨噬细胞胞外诱捕网(METs)形成的影响。方法:纳入基础治疗后,需进行牙周翻瓣手术的牙周炎患者29例,以牙周健康的牙冠延长术患者20例作为对照。术前记录菌斑指数(PLI)、牙龈指数(GI)、探诊深度(PD)、临床附着丧失(CAL)等牙周临床指标,收集龈沟液(GCF)样本,术中收集牙周炎患者牙周破坏最严重部位的牙龈组织及牙冠延长术患者的健康牙龈组织。采用激光共聚焦显微镜观察牙龈组织中METs的形成情况,采用ELISA技术检测GCF中TNF-α和IL-9表达水平,分析两组样本METs形成水平与各牙周临床指标、GCF中TNF-α、IL-9水平的相关性。结果:牙周炎组METs形成分数,PLI、GI、PD、CAL等牙周临床指标,以及TNF-α、IL-9水平均显著高于正常对照组(P<0.05)。METs形成分数与PD、CAL正相关(P<0.05)。结论:牙周炎症破坏可以促进牙龈组织中METs的形成。     

超声刀在前臂皮瓣制备术中的应用研究

目的探讨超声刀在前臂皮瓣制备术中的应用及疗效评价。方法 2014年8月至2015年12月在南京医科大学附属口腔医院行前臂皮瓣修复口腔组织缺损的患者26例,随机分为两组,每组13例,试验组运用超声刀制备,对照组运用普通手术刀制备,分析两组患者手术时间、术中出血量及术中术后并发症发生情况。结果术后前臂皮瓣全部存活,试验组手术时间少于对照组(P<0.05),试验组术中出血少于对照组(P<0.05)。两组均未出现并发症。结论运用超声刀行前臂皮瓣制备术可以缩短手术时间、减少手术中出血量,可在临床推广应用。     

The use of etoricoxib and celecoxib for pain prevention after periodontal surgery: a double-masked, parallel-group, placebo-controlled, randomized clinical trial

Background: Postoperative pain is an adverse effect of periodontal surgeries and may therefore be prevented or minimized. This study was conducted to evaluate the clinical efficacy of two selective cyclooxygenase‐2 inhibitors, celecoxib and etoricoxib, on pain prevention after periodontal surgery. Methods: For this double‐masked, parallel‐group, placebo‐controlled, and randomized clinical trial, 56 open‐flap debridement surgeries were performed. The groups received three different protocols 1 hour before surgery: 1) 200 mg celecoxib (and another 200 mg 12 hours after the first dose); 2) 120 mg etoricoxib; or 3) placebo. Pain intensity and discomfort were assessed up to 2 days after surgery using the visual analog scale and the four‐point verbal rating scale, respectively. Patients were instructed to take 750 mg acetaminophen as a rescue medication if necessary. Results: Pain intensity levels in the etoricoxib group were lower than in the placebo group at the 2‐, 3‐, 4‐, 5‐, 6‐, and 7‐hour periods after surgery (Kruskal‐Wallis test; P <0.05). There was no statistically significant difference between celecoxib and etoricoxib. Discomfort in the celecoxib group was significantly lower than in the placebo group only at the 3‐hour period (P = 0.03). Rescue medication intake was significantly less frequent in the etoricoxib group than in the placebo and celecoxib groups (analysis of variance; P = 0.009). Conclusion: It was concluded that a single etoricoxib dose is not superior to two split doses of celecoxib when used for pain prevention after open‐flap debridement surgery.     

Clinical and microbiological changes associated with the use of 4 adjunctive systemically administered agents in the treatment of periodontal infections

Abstract. The purpose of the present investigation was to assess the effects of periodontal surgery and 4 systemically administered agents, Augmentin, tetracycline, ibuprofen or a placebo on clinical and microbiological parameters of periodontal disease, 98 subjects were monitored at 2-month intervals at 6 sites per tooth for clinical parameters. Subgingival plaque samples were taken from the mesial surface of each tooth at each visit and evaluated for their content of 14 subgingival species using DNA probes and a colony lift method. 40 subjects who exhibited loss of attachment >2.5 mm at 1 or more sites during longitudinal monitoring were treated using modified Widman flap surgery at sites with probing pocket depth >4 mm, subgingival scaling at all other sites and were randomly assigned 1 of the 4 agents. Treatment was completed within 30 days during which time the subject took the assigned agent. Overall, subjects exhibited a mean attachment level “gain” of 0.34±0.10 mm (SEM) and a mean pocket depth reduction of 0.62±0.09 mm 10±4 months post-therapy. However, certain subjects in each treatment group showed a poor response. Subjects receiving antibiotics exhibited significantly more attachment level “gain” (0.57±0.15 mm, SEM) than subjects receiving either ibuprofen or a placebo (0.02±0.10). The differences between Augmentin and tetracycline groups were not significant, nor were the differences between ibuprofen and placebo, 10 months post-therapy, there was a reduction in the number of sites colonized in any subject group by detectable levels (10³) of P. gingivalis. Species showing similar reductions were B. foraythus, P. intermedia and P. micros. Subjects receiving systemically administered antibiotics had a significant increase in the proportion of sites colonized by C. ochracea coupled with a greater decrease in the number of sites colonized by P. gingivalis. B. forsythus, P. intermedia and P. micros post-therapy than subjects not receiving antibiotics. The results of this investigation indicate that adjunctive systemic antibiotics increase periodontal attachment “gain” and decrease the levels of some suspected periodontal pathogens in subjects with evidence of current disease progression.     

Hemostatic and anesthetic efficacy of 4% articaine HCl with 1:200,000 epinephrine and 4% articaine HCl with 1:100,000 epinephrine when administered intraorally for periodontal surgery

BACKGROUND: The objective of this double-masked, randomized, multicenter crossover study was to compare the efficacy of 4% articaine HCl with 1:100,000 epinephrine (A100) to 4% articaine HCl with 1:200,000 epinephrine (A200) for providing effective local anesthesia and hemostasis for periodontal surgery. METHODS: Anesthetic efficacy was based on patient self-report and lack of need for reinjection during the surgical procedures. Hemostatic properties of the formulations were compared using ratings of the surgeons' ability to visualize the surgical field and expectation for bleeding. The volume of blood collected during each surgical session also was measured and compared. RESULTS: Forty-two adult subjects (26 males and 16 females, mean age 46.3 +/- 9.7 years) diagnosed with moderate to severe periodontal disease requiring local anesthesia for matched bilateral periodontal surgery were enrolled and completed the study. Subjects reported satisfactory surgical anesthesia following the A100 and A200 formulations; no supplemental local anesthesia was administered. Significant differences between the A100 and A200 treatments were found for the surgeons' ability to visualize the surgical field (rated as clear 83.3% of the time with A100 and 59.5% of the time with A200; P = 0.008), bleeding expectation (rated as equal to or better than expected 85.7% of the time with A100 and 71.4% of the time with A200; P = 0.034), and volume of blood loss (54.9 +/- 36.0 ml for A100 and 70.2 +/- 53.0 ml for A200; P = 0.018). Sixteen patients experienced 27 mild or moderate adverse events; the most common were postoperative pain (nine patients) and swelling (eight patients). Six adverse events may have been related to treatment. The frequency of adverse events did not vary between formulations. CONCLUSIONS: For patients undergoing periodontal surgery, 4% articaine anesthetic formulations containing epinephrine (1:100,000 or 1:200,000) provided excellent surgical pain control. For patients who can tolerate higher amounts of epinephrine, the 4% articaine 1:100,000 epinephrine formulation had the additional therapeutic advantage of providing better visualization of the surgical field and less bleeding.     

头高脚低位对正颌外科术中出血量影响的研究

目的:比较头高脚低10°体位和平卧位对正颌外科手术术中出血量的影响。方法::将需行Le Fort I型截骨术、双侧下颌矢状劈开截骨术(bilateral sagittal ramus osteotomy,BSSRO)及水平截骨颏成形术(horizontal genioplasty)的牙颌面畸形患者63例根据投币随机分为A组(32例)和B组(31例),分别在头高脚低10°体位和平卧位下接受双颌正颌外科手术,比较两组术中出血量差异。结果:63例患者中,出血总量平均值:A组(147.1±62.6) mL,B组(243.9±86.8) mL,两组出血总量比较,差异具有统计学意义(P<0.001)。每分钟出血量平均值:A组(0.78±0.25) ml/min ,B组(1.20±0.39) ml/min,两组每分钟出血量比较,差异具有统计学意义(P<0.001)。不同术者对出血总量影响也具有显著性差异(P<0.001),不同术者对每分出血量影响无显著性差异(P=0.78)。结论:头高脚低10°体位相比平卧位显著减少正颌外科术中出血;若术者经验无明显差异,手术时间越短,术中出血量越少。     

The relationship between radiographic and clinical parameters in periodontal maintenance in class II furcation defects

The goal of the present study was to investigate the relationship between probing and radiographic parameters, and the reliability of repeated longitudinal periodontal probing measurements for early diagnosis of periodontal breakdown in class II furcation defects. Eighteen class II furcation defects in lower molars were included in this study. Standardized radiographs and clinical measurements, relative vertical clinical attachment level (CAL-v) and probing depth (PD) were obtained immediately before periodontal surgeries and at 6, 12, 18, and 24 months after surgery. A total of 72 pairs of radiographs were subtracted following correction for contrast and planar geometric discrepancies, and the bone loss/gain (in mm) was measured. There was no statistically significant correlation between CAL-v and bone height (BH) measurements. A statistically significant correlation for PD reduction at 24 months and BH increase at 18 months was found (r = 0.5, p < 0.05). These results suggest that clinical measurements and radiographic bone height reflect different features of periodontal destruction and periodontal healing, and repeated longitudinal measurements of vertical clinical attachment level are not reliable for early diagnosis of periodontal breakdown in class II furcation defects.