Restoration of irradiated patients using osseointegrated implants: Current perspectives

Statement of problem. The success rates of osseointegrated implants used to restore patients who were irradiated for head and neck tumors are influenced by radiation-induced changes in the hard and soft tissues.Purpose. This article examined, by review of the literature, current perspectives on the restoration of irradiated patients using osseointegrated implants.Results. In published reports that investigated both intraoral and extraoral applications, irradiation decreased implant success rates and the amount of reduction was dependent on the location within the craniofacial skeleton. The limited number of implants and patients in these studies precludes definitive conclusions regarding the efficacy of placing implants into irradiated tissues. The implants placed into the irradiated anterior mandible have demonstrated an acceptable implant success rate of 94% to 100% with a minimal risk of osteoradionecrosis. The efficacy of implants in the posterior mandible has not been examined. Implant success rates ranged from 69% to 95% in the irradiated maxilla for intraoral applications. Extraoral applications demonstrated excellent implant success rates in the temporal bone (91% to 100%). The rates in the anterior nasal floor have varied from 50% to 100%. The implant success rates in the frontal bone decreased as the length of the studies increased (96% to 33%). The long-term efficacy of implants in the irradiated frontal bone is poor. (J Prosthet Dent 1998;79:641-7.)     

False aneurysm of the facial artery

A case of an unusual traumatic aneurysm of the facial artery secondary to blunt trauma is reported. The lesion was typical in that it was pulsatile, had a systolic bruit, and had a filling defect that was evident on carotid angiography. Although a traumatic aneurysm is a rare occurrence in the facial region, the inclusion of this lesion in the differential diagnosis of soft tissue lesions is important if the serious consequences of hemorrhage are to be avoided.     

Surgical correction of mandibulofacial deformities secondary to large cervical cystic hygromas

The clinical features of cystic hygroma are presented. The effect on mandibular morphology is described, and surgical correction of the deformities is discussed.     

The Relationship Between Dental Utilization and Preventive Participation Among a Well-elderly Sample

Previous studies have shown that dental utilization by older people is lower than for the general population. This study hypothesizes that an elder's tendency toward participating in preventive health activities may be an important factor in explaining the likelihood of accessing the dentist. Subjects included 1,911 older individuals who enrolled in the UCLA Medicare Screening and Health Promotion Trial. All were interviewed about their utilization of preventive health services and participation in preventive behaviors. A recent dental visit was positively associated with all sociodemographic variables examined except age and sex. It was also related to health status questions and utilization of the preventive health services and health behaviors studied. Logistic regression analysis showed that both summary preventive health behavior and preventive service utilization variables were important factors in explaining a recent dental visit (model chi-square/221.4, P=.001) along with income, not having a removable prosthesis, and perceiving the need for dental care. This study showed that dental utilization is related to older people's participation in other preventive activities. When in contact with older people, health care professionals should consider current oral and general preventive health status and encourage appropriate referral for preventive activities.     

An investigation of the composite resin/porcelain interface.

Failures at composite resin/porcelain interfaces under shear-like loading were examined. Porcelain surfaces were treated with hydrofluoric acid and/or one of two silane coupling agents, using two different composite resin cements. The results showed that after seven days storage, bond strengths of specimens which had undergone porcelain surface treatment were greater than the cohesive strength of the porcelain itself, resulting in brittle fracture of the porcelain. The diluted restorative composite resin performed as well as the commercial composite resin cement. Silane pretreatment of porcelain was important as the bond strength of etched/silane primed specimens was significantly higher than the etched only specimens. However, one primer appeared to be more efficient than the other in bond promotion. Some explanations for the differences in bond strengths are offered.     

Adenomatoid odontogenic tumour of the jaws

The adenomatoid odontogenic tumour of the jaws is rare. It is important to differentiate it from other odontogenic tumours because of its benign behaviour and this can be reliably done by the histological features.     

Improving the oral health status of all Americans: roles and responsibilities of academic dental institutions: the report of the ADEA President's Commission

Academic dental institutions are the fundamental underpinning of the nation's oral health. Education, research, and patient care are the cornerstones of academic dentistry that form the foundation upon which the dental profession rises to provide care to the public. The oral health status of Americans has improved dramatically over the past twenty-five to thirty years. In his 2000 report on oral health, the Surgeon General acknowledges the success of the dental profession in improving the oral health status of Americans over the past twenty-five years, but he also juxtaposes this success to profound and consequential disparities in the oral health of Americans. In 2002, the American Dental Education Association brought together an ADEA President's Commission of national experts to explore the roles and responsibilities of academic dental institutions in improving the oral health status of all Americans. They have issued this report and made a variety of policy recommendations, including a Statement of Position, to the 2003 ADEA House of Delegates. The commission's work will help guide ADEA in such areas as: identifying barriers to oral health care, providing guiding principles for academic dental institutions, anticipating workforce needs, and improving access through a diverse workforce and the types of oral health providers, including full utilization of allied dental professionals and collaborations with colleagues from medicine.     

Comparison of early telescope loading of non-submerged ITI implants in irradiated and non-irradiated oral cancer patients

OBJECTIVE: To compare early dental implant loading in irradiated and non-irradiated oral cancer patients in order to accelerate masticatory function improvement and quality of life. PATIENTS AND METHODS: One hundred and fourteen non-submerged interforaminal ITI implants were early loaded in 30 patients after 3 weeks in situ (telescoped overdenture). Nineteen patients received 72 implants (63%) after local irradiation; 11 non-irradiated patients received 42 implants (37%) with a 24-month follow-up. RESULTS: At 24 month follow-up, one early failure had occurred in an irradiated patient (=99% functioning implants in situ). Peri-implant bleeding and plaque index were similarly high in both groups (40 to 68% average).The Results of other measured parameters were as follows (values for mean; irradiated; non-irradiated patients with respective standard deviations; significance of comparison): bone loss (0.9+/-0.9; 1.4+/-0.9; 0.4+/-0.5 mM; P<0.01); Periotest score (-2.7+/-2.7; -2.4+/-2.2; -3.1+/-3.3; P<0.2); gingival recession (0.6+/-0.7 mM; 0.8+/-0.9 mM; 0.4+/-0.5 mM, P<0.02); and peri-implant probing depths (3+/-1.2; 2.6+/-0.6; 3.4+/-1.7 mM; P<0.002). CONCLUSION: The results suggest reliable non-submerged implantation and early loading. However, bone loss in irradiated mandibles, combined with higher average Periotest values and gingival recession in an oral environment of altered saliva quantity, quality, microflora and local scarring, requires extended follow-up.