A retrospective study on the approach to the tooth in the fracture line of the mandible

The presence of a tooth in the fracture line constitutes a specific problem in mandibular fractures. Therefore, our objective was to characterize the approach to teeth in the fracture line used in the Department of Maxillofacial Surgery, Plovdiv, by retrospectively investigating the association between various preoperative factors and the decision to extract or preserve the tooth. MATERIAL AND METHODS: The following variables were studied based on data from available hospital records: 1) gender and age of patients; 2) local preoperative infections; 3) time from trauma to treatment; 4) degree of fracture displacement; 5) relationship between tooth and fracture line; 6) periapical pathology; 7) periodontal diseases; 8) type of tooth in the fracture line; 9) degree of eruption; 10) method of treatment. RESULTS: 593 fractures with a tooth in the fracture line were included in the study. The tooth was preserved in 69.90 +/- 0.14% of the cases, it was extracted in 29.30 +/- 1.91% and exarticulated in 0.80 +/- 0.38% of all fracture lines. The results demonstrated the existing association between the studied variables and the decision to extract or preserve the tooth. Extraction was generally preferred in the following cases: if a local preoperative infection was present; the time from trauma to treatment was more than 72 hours; there was a significant displacement of the fracture; the dental root was fractured; periapical pathology or periodontal disease was present; the tooth was multi-rooted; or treatment consisted of open reduction and internal fixation. CONCLUSIONS: Making a decision to extract or preserve the tooth in the fracture line is a complex process. Each case, therefore, should be approached individually.     

下颌第三阻生牙拔除术并发症回顾性分析

目的探讨下颌第三阻生智齿拔除术术中和术后并发症的原因和防治方法。方法对2008年1月到2012年3月拔除的482例下颌第三阻生齿临床资料进行回顾性分析,对术中并发症和术中并发症进行分析,寻找阻生齿拔除术并发症的有效防治手段。结果术中发生断根25例,舌侧牙槽骨板折裂30例,牙龈撕裂16例,邻牙损伤5例。术后早期并发症425例,其中同时具备疼痛、肿胀和张口受限症状的患者253例,单纯疼痛者22例,疼痛伴张口受限者80例,疼痛伴肿胀者70例,后期并发症中出血20例,干槽症30例。局部感觉异常12例,间隙感染10例。结论阻生牙术前应拍曲面断层片,正确评估拔牙难度和阻力分析,选用涡轮钻法,动作轻柔,缩短拔牙时间,减少创伤,能预防并发症的发生。     

Evaluation of the costs and relative effectiveness of alternative strategies for the removal of mandibular third molars

Decision analysis is used to compare the cost and disability of alternative treatment strategies for asymptomatic mandibular third molars. The analysis shows that extracting only those third molars that remain impacted and become pathologically involved is always associated with less expected cost and disability than prophylactic removal of asymptomatic wisdom teeth.     

云南白药胶囊对智齿拔除术后反应的影响

目的：探讨云南白药胶囊对智齿拔除术后临床反应的影响。方法：选择双侧下颌水平阻生智齿患者48例,一侧智齿拔除后常规给予甲硝唑和阿莫西林,另一侧智齿拔除后除甲硝唑和阿莫西林外加用云南白药胶囊,对比两侧术后反应。结果：术后24h,云南白药组局部肿胀消退者18例,对照组3例,两组比较差异有统计学意义（P〈0.01）;术后72h,云南白药组局部肿胀消退者41例,对照组33例,两组比较差异有统计学意义（P〈0.05）;术后7d,云南白药组局部肿胀消退者48例,对照组42例,两组疗效无明显差异。结论：阻生智齿拔除术后给患者服用云南白药胶囊可明显减轻术后反应。     

300例下颌阻生智齿拔除的临床疗效分析

目的：探讨拔除下颌阻生智齿的手术方法、注意事项及临床效果。方法随机选择300例需行下颌阻生智齿拔除术患者,根据患者的临床情况,下颌阻滞加局部麻醉下采用挺出法、近中磨除法、劈开挺出法、倒冲法、去骨法综合拔除各类下颌阻生智齿。结果所有患者阻生智齿都完全拔除,均痊愈。术中断根20例,术中翻瓣时出血12例,术中邻牙松动2例,牙齿坠入下颌骨舌侧骨膜下2例,牙根坠入下颌管内1例,拔牙后拔牙创感染8例,干槽症2例,无严重并发症发生。结论下颌阻生智齿拔除术是较为复杂的牙槽外科手术,选择合适的拔除方法、拔除时间,掌握好防治对策可有效减少下颌阻生智齿拔除术中术后并发症的发生,是成功实施拔除术的关键。     

磨牙折裂铸造全冠修复保存功能的体会

目的:对折裂裂隙较大的磨牙做铸造全冠保留患牙并行使功能。方法:选择患者35例,共38颗患牙进行处理治疗后铸造全冠修复。结果:采取上述方法治疗的38颗折裂的磨牙,经2年以上的观察,除1例诉咀嚼乏力外,其余均诉患牙能正常行使咀嚼功能。结论:全冠修复可以使绝大多数的折裂牙保存并行使正常功能与美观的要求。     

超声骨刀与凿骨劈冠法拔除下颌低位阻生智齿的临床效果比较

目的:观察超声骨刀与凿骨劈冠法拔除下颌低位阻生智齿的临床效果.方法:本院2019年1月～2020年1月收治的74例下颌低位阻生智齿患者为本次研究对象,在患者自愿参与本次研究的前提下按照拔牙方法不同将患者分为对照组(37例,凿骨劈冠法)与观察组(37例,超声骨刀法),比较两组患者治疗效果.结果:观察组手术时间明显短于对照...     

Containing the cost of third-molar extractions: a dilemma for health insurance.

No known scientific studies support the extraction of third molars (wisdom teeth) to prevent future disease. Yet, third-molar surgery for this purpose has become so common that in at least one major U.S. health insurance plan, the cumulative cost exceeds that for every other kind of major surgery. Many third molars that are developing normally in adolescents are classified as impacted and removed before they erupt, a practice that results in large expenditures for unnecessary surgery. In addition, the difficulty of the extractions is frequently exaggerated, so that patients and insurance plans are overcharged. Third molar surgery is not without risk of iatrogenic injury. Fracture of the jaw, permanent numbness of the lip (paresthesia), and injury to other teeth may occur. This paper presents a mechanism for containing the cost of third-molar surgery by elimination of payment for nonessential extractions and of the related overcharges. Adoption of this policy by administrators of dental insurance plans would save millions of dollars each year, money that could be better used in providing care for more people with real dental disease.     

Investigation of some parameters influencing the sensitivity of human tooth enamel to gamma radiation using electron paramagnetic resonance

Electron paramagnetic resonance (EPR) has been successfully used as a physical technique for gamma radiation dose reconstruction using calcified tissues. To minimize potential discrepancies between EPR readings in future studies, the effects of cavity response factor, tooth position and donor gender on the estimated gamma radiation dose were studied. It was found that the EPR response per sample mass used for assessment of doses in teeth outside of the 70-100 mg range should be corrected by a factor which is a function of the sample mass. In the EPR measurements, the difference in sensitivity of different tooth positions to gamma-radiation was taken into consideration. It was determined that among all the pre-molars and molars tooth positions, the relative standard deviation of sensitivity was 6.5%, with the wisdom teeth and the first molars having the highest and lowest sensitivity to gamma-radiation, respectively. The current results reveal no effect of the donor gender on the sensitivity to gamma-radiation.     

铸造插销式分体桩核与银汞-银粉玻璃离子桩核修复磨牙残冠的临床研究

目的：比较两种桩核材料用于磨牙冠缺损的修复效果。方法：临床选择45例患者共61颗患牙的磨牙缺损,按照随机数字表法分为两组,分别进行铸造插销式分体桩核和银汞-银粉玻璃离子桩核金瓷冠修复,3年后对修复效果进行评价。结果：铸造插销式分体桩核组共20例患者25颗患牙,未出现桩冠脱落、根折和桩折等,成功率100%;银汞-银粉玻璃离子桩核组共25例患者36颗患牙,出现桩折1颗患牙,未出现桩冠脱落、根折等,成功率97.2%。两组成功率比较差异无统计学意义（P〉0.05）。结论：对于重度磨牙缺损病例,选用铸造插销式分体桩核和银汞-银粉玻璃离子桩核金瓷冠修复均可,但对于患者希望减少就诊次数、经济费用以及临床操作简便的,选用银汞-银粉玻璃离子桩核更合适。     

空心钉辅助PFNA内固定治疗特殊类型股骨粗隆间骨折的疗效研究

目的:探讨应用空心钉辅助抗旋股骨近端髓内钉系统(proximal femoral nail antirotation,PFNA)内固定治疗骨折线波及股骨颈的股骨粗隆间骨折患者的疗效.方法:选取2015年1月至2018年5月在某院治疗的90例骨折线波及股骨颈的股骨粗隆间骨折患者作为研究对象,采用随机数表法分为平行组和干预...     

现役军人第三磨牙阻生状况抽样调查分析

为了了解第三磨牙阻生在我军人员中的分布情况，根据我军实际情况的需要，研究设定了第三磨牙阻生调查项目，在全军４２个调查点中，共调查人数为２５６１９人。调查结果表明，男性第三磨牙阻生率为２４．０％，女性第三磨牙阻生率为１０．８％。分析结果提示，第三磨牙阻生是军队口腔疾病的一个突出问题，是直接引起部队减员的重要疾病，对部队战斗力有直接影响     

HIV阳性合并陈旧闭合四肢骨折患者的手术治疗

目的 观察HIV阳性合并陈旧闭合四肢骨折患者的手术治疗效果,为治疗HIV阳性合并陈旧闭合四肢骨折患者提供参考.方法 回顾性分析2010年11月—2015年6月HIV阳性合并陈旧闭合四肢骨折进行手术治疗并获得随访患者资料.受伤至手术时间均大于3周,术后定期复查,观察骨折愈合情况、疗效及并发症发生情况.结果 入组患者共13例,均给予围手术期处理,手术方式均采用切开复位内固定植骨术,所有患者顺利完成手术.术后随访平均15个月,术后骨折愈合时间平均为(5.75±1.67)个月,疗效优良率92.3%.无骨不连及钢板断裂出现,无关节僵硬及静脉血栓发生,无切口感染及HIV感染相关并发症发生,所有患者骨折均正常愈合.结论 HIV阳性合并陈旧闭合四肢骨折患者在4周内手术治疗仍能取得很好的治疗效果.另外,HIV阳性骨折患者应注意加强围手术期处理.     

年轻恒前牙根中1/3折断的临床观察

目的观察通过简单的复位固定治疗年轻恒前牙根中1/3折断的临床疗效。方法局麻下复位,扁钢丝加光固化复合树脂固定,调牙合,避免咬合创伤,定期复查,摄X线片观察结果。结果所有患牙经过2~3年的追踪观察,21颗患牙牙根继续发育,根尖孔完全形成;牙根周围硬骨板完整,无根内外吸收。愈合率达91.3%。结论根中1/3折断的年轻恒牙经过保守治疗,可以保存活髓,使牙根继续发育,患牙成功保留。     

记忆合金聚髌器治疗髌骨骨折的临床研究

目的研究镍钛记忆合金聚髌器治疗髌骨骨折的机制、临床操作方法及注意事项,以提高临床技能,减少髌骨骨折的并发症。方法39例髌骨骨折中横断形骨折19例,粉碎性骨折15例,纵形骨折5例。均采用镍钛记忆合金聚髌器内固定,全面恢复髌骨功能。结果随访1～3年,平均2．0年,患者膝关节无粘连,功能恢复良好,无其他并发症。患者伤口均一期愈合,复查X片提示固定牢靠。结论利用镍钛记忆合金聚髌器治疗髌骨骨折,符合张力带内固定原则,设计合理,可多方位固定骨折块并持续加压,可早期进行功能锻炼,适应证广,疗效确切,值得推广。     

Complications of fracture treatment by traditional bonesetters in southwest Nigeria.

BACKGROUND: Traditional bonesetters (TBS) practice widely in Nigeria. OBJECTIVE: Our aim was to evaluate the types of complications seen in patients previously treated by TBS and to assess factors that may predispose to the complications. METHODS: We carried out a prospective non-randomized controlled study in a general hospital in southwest Nigeria. All patients brought into the hospital over the 10-month study period with fractures who had been treated previously by a TBS and, as a control, all patients brought directly to and treated by us were studied. Each patient was assessed and prescribed the most appropriate treatment for their fracture: reduction, immobilization (operatively and otherwise) and physiotherapy. Malunion, non-union, delayed union, gangrene, stiffness of joints and loss of joint motion, Volkman's ischaemic contracture and tetanus were all investigated. RESULTS: Over half of the patients in the TBS subgroup had malunion, and a quarter had non-union. Only one out of the 36 (2.8%) had no complaints and was satisfied with the outcome of treatment of his fractures by the TBS. In the orthodox subgroup, there were seven complications as a result of treatment of a total of 49 bones (14%). Most of the complications involved the loss of joint motion. CONCLUSIONS: There were no statistically significant associations between the complications recorded and the ages of the patients, types of bone fractured or the duration of treatment in patients who were in the TBS subgroup. The introduction of a health insurance scheme in Nigeria may make it easier for individuals and families to be able to afford proper fracture treatment in hospitals.     

股骨近端髓内钉治疗老年不稳定股骨粗隆间骨折

目的探讨老年不稳定股骨粗隆间骨折治疗方法,以减少并发症,提高生活质量。方法选取2010年1月—2011年10月于本院进行治疗的40例股骨近端髓内钉PFN治疗患者为研究对象,观察股骨近端髓内钉PFN-A治疗的手术效果。结果 40例患者术后8个月左右骨折均愈合未出现严重内科并发症或股骨头切割。结论将股骨粗隆间骨折治疗方法应用于老年股骨粗隆间骨折手术中,可明显提高患者的满意度,降低术后病发症的发生几率,具有重要的临床意义。     

局部注射地塞米松减轻下颌智齿拔除后肿胀的疗效观察

目的观察局部注射地塞米松减轻下颌智齿拔除后肿胀的临床效果,为减轻下颌智齿拔除后肿胀提供可靠的治疗方法。方法对147例需拔除智慧齿的患者进行诊治,随机分为对照组77例和实验组70例,实验组予以术后拔牙创口周围局部注射地塞米松,对照组局部不注射地塞米松。拔牙后72 h门诊复诊,评估术后肿胀、张口受限及疼痛程度。结果实验组患者术后肿胀程度、张口受限以及疼痛情况均小于对照组,差别有统计学意义(p<0.05)。结论局部注射地塞米松是减轻阻生智齿拔除术后肿胀的有效办法,且药价低廉,操作方法相对简单,值得临床推广应用。     

四肢骨关节骨折经可吸收螺钉治疗后的临床疗效观察

目的 探讨四肢骨关节骨折经可吸收螺钉治疗后的临床疗效。方法 选择2017年5月—2018年11月就诊于本院的88例四肢骨关节骨折患者,按随机数字表法分为2组,各44例。研究组行可吸收螺钉治疗,对照组行传统金属螺钉固定。比较2组临床疗效、骨折愈合时间、2次手术率、术后并发症发生情况。结果 研究组治疗优良率为95.45%(42/44),高于对照组的70.45%(31/44),差异有统计学意义(χ2=9.724,P=0.002);研究组术后骨折愈合时间为(4.48±1.35)月,短于对照组的(8.32±2.09)月,差异有统计学意义(t=10.237,P=0.000);研究组2次手术率和并发症总发生率较对照组低,差异均有统计学意义(P<0.05)。结论 经可吸收螺钉治疗四肢骨关节骨折可有效改善关节活动度,减轻疼痛,缩短骨折愈合时间,减少2次手术率,降低并发症发生率。     

Hip fracture incidence in an urban area in Northeast Brazil

Hip fractures involve high morbidity and mortality and extensive treatment costs and are thus considered an important public health issue. Hip fracture incidence varies greatly between countries and even between cities in the same region. This study aimed to determine hip fracture incidence in Fortaleza, Ceará State, Brazil. Hip fracture cases were identified prospectively in patients aged 45 and over attending private and public hospitals in Fortaleza from July 2001 to June 2002. The study identified 673 patients with hip fractures, 382 of whom from Fortaleza. Annual hip fracture incidence in Fortaleza for patients over 60 years was 21.7/10,000 inhabitants (13.0/10,000 for men and 27.7/10,000 for women). Hip fractures were more frequent among women and with advancing age. Hip fracture incidence in Fortaleza was very low compared to rates reported from other parts of the world.