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The International Journal of... 2024Tooth autotransplantation is an effective treatment to replace missing teeth. Digital planning can facilitate successful autotransplantation. Guiding templates are...
Tooth autotransplantation is an effective treatment to replace missing teeth. Digital planning can facilitate successful autotransplantation. Guiding templates are highly recommended when performing cases in healed ridges in the posterior area to reduce excessive bone loss and increase the chances of fitting the donor tooth in the new socket. This case report highlights the use of 3D planning tools and fully guided drilling templates for successful tooth autotransplantation in the posterior area. Two tooth autotransplantations were performed in a 51-year-old patient using mandibular third molars to replace hopeless mandibular first and second molars. Root canal treatments were carried out before the surgeries, and different alveoloplasty techniques were used in each recipient area. The prosthetic phase was carried out after 9 months. Both teeth were asymptomatic, functional, and exhibited no signs of resorption or apical radiolucency and showed complete regeneration of the periodontal apparatus at the 2-year follow-up.
Topics: Humans; Middle Aged; Transplantation, Autologous; Molar, Third; Tooth; Molar; Tooth Socket; Treatment Outcome
PubMed: 37655975
DOI: 10.11607/prd.6801 -
Journal of the American Dental... Apr 2021It is unknown which procedures account for the most US dental opioid prescriptions. Moreover, few national studies have assessed opioid prescribing patterns for these...
BACKGROUND
It is unknown which procedures account for the most US dental opioid prescriptions. Moreover, few national studies have assessed opioid prescribing patterns for these procedures. These knowledge gaps impede the optimal targeting of dental opioid stewardship initiatives.
METHODS
The authors analyzed claims data from the 2013 through 2018 IBM MarketScan Dental, Commercial, and Medicaid Multi-State Databases. Patients aged 13 through 64 years undergoing 1 of 120 procedures were identified. "Initial prescriptions" were opioid prescriptions dispensed on the date of procedures to 3 days afterward. For the procedures accounting for the 5 highest proportions of initial prescriptions, the authors fitted linear regression models assessing trends in the probability of 1 or more initial prescriptions and mean total morphine milligram equivalents prescribed-a standardized measure of opioid amount. Regressions were adjusted for demographic characteristics and comorbidities.
RESULTS
The 9,482,976 procedures in the sample were associated with 2,721,688 initial prescriptions. Of these prescriptions, 5 procedures accounted for 95.2%: tooth extraction (65.2%), problem-focused limited oral evaluation (17.2%), endodontic therapy (8.4%), alveoloplasty (2.9%), and surgical implant services (1.5%). Among the 5 procedures, the median adjusted annual change in the probability of 1 or more initial prescriptions was -1.3 percentage points. The median adjusted annual change in mean total morphine milligram equivalents was -4.5 (roughly 1 pill containing 5 mg of hydrocodone). In 2018, 45.3% of tooth extractions resulted in 1 or more initial prescriptions.
CONCLUSIONS
Five procedures accounted for 95.2% of dental opioid prescriptions, and tooth extraction accounted for almost two-thirds of those. Opioid prescribing for tooth extractions is declining but remains common, despite the availability of equally effective nonopioid alternatives.
PRACTICAL IMPLICATIONS
Eliminating routine opioid prescribing for tooth extraction could reduce dental opioid exposure substantially.
Topics: Adolescent; Analgesics, Opioid; Humans; Hydrocodone; Insurance, Health; Medicaid; Practice Patterns, Dentists'; Practice Patterns, Physicians'; United States
PubMed: 33637299
DOI: 10.1016/j.adaj.2021.01.001 -
Cureus Apr 2023Background Dental implants are increasingly being used in the rehabilitation of the edentulous areas in the maxilla and mandible. The anterior mandible is considered a...
Background Dental implants are increasingly being used in the rehabilitation of the edentulous areas in the maxilla and mandible. The anterior mandible is considered a safe zone for implant placement, but clinicians often find it challenging to control bleeding in this area. This is due to the presence of the sublingual artery, which can be of varying dimensions and can cause severe bleeding. This can be of higher significance in patients with high or uncontrolled blood pressure and in patients on blood thinners like Aspirin or Coumadin where establishing a clot can be difficult. With newer guidelines recommending that medication be discontinued only a few hours before surgery and that bleeding be managed locally, this issue has become even more challenging. With three-dimensional (3D) imaging using cone beam computed tomography (CBCT) becoming more common for implant planning, the presence of the sublingual artery can be evaluated and incorporated into the treatment plan. The objective of this study is to evaluate the 3D location of the sublingual artery in the edentulous anterior mandible of CBCT scans of patients referred for dental implant therapy. Methodology A total of 50 de-identified CBCT scans with an edentulous anterior mandible referred for dental implant therapy were evaluated for this study. Cross-sectional images were generated using a CBCT reconstruction program INVIVO-5 (Anatomage, San Jose, CA, USA). After the sublingual artery was localized, measurement was conducted from a standardized point on the alveolar crest to the artery's entry point on the lingual aspect. Measurements were also obtained from the terminal point of the artery's course to the buccal cortical plate. Alveolar crest can either resorb or be subjected to alveoloplasty during implant placement, similar measurements were also done from a standardized point on the inferior cortical border of the mandible to the artery's entry points on the lingual aspect. Two oral and maxillofacial radiologists conducted all measurements. Results It was found that the median value of the sublingual artery from the alveolar crest to the level of entry (V1) was 6.78, the vertical measurement of the artery coursing into the alveolar bone was ~4.03 mm (V2), the vertical measurement of the artery's position within the alveolar bone at the terminal point form the crest was ~11.71 (V3), and the inferior vertical measurement from the course of the artery to the inferior border of the mandible was 9.60 mm. The artery extended about ~8.3 mm within the alveolar bone from the lingual cortex (H1), and the artery was located about 4.97 mm away from the buccal cortex (H2). Cronbach's Alpha test showed high interoperator reliability. Conclusions In this retrospective study, the sublingual artery was noted to be at a critical location in the potential implant site. A site-specific evaluation using CBCT can help in localizing and avoiding perforation of the sublingual artery.
PubMed: 37122981
DOI: 10.7759/cureus.38084 -
Journal of Prosthodontics : Official... Apr 2023The two-implant-supported mandibular overdenture is considered a reliable treatment option to restore masticatory function. Digital planning has been shown to improve...
The two-implant-supported mandibular overdenture is considered a reliable treatment option to restore masticatory function. Digital planning has been shown to improve the precision and accuracy of the surgical procedure. The outcomes are indeed pertinent to the ideal three-dimentional positioning of the implant placement. Recently, the uses of cone-beam computed tomography (CBCT) and intraoral scan have improved greatly the workflow of digital planning; however, the sophisticated technology caused confusion among clinicians. The purpose of this case series was to exhibit the efficacy of a bone-supported guide in applying simultaneous implant placement and bone reduction, solely based on CBCT data. The bone reduction can therefore be determined accordingly, by adding windows to the guide, allowing the clinician to decide the amount of bone reduction as well as the location for implant placement. This novel surgical guide would not only fit properly on the bone but also provide the benefits of less-invasive surgery and the opportunity to place implants parallel. The digital workflow described not only simplifies the fabrication process but also yields predictable surgical outcomes.
Topics: Dental Implants; Denture, Overlay; Surgery, Computer-Assisted; Dental Implantation, Endosseous; Cone-Beam Computed Tomography; Computer-Aided Design
PubMed: 36752037
DOI: 10.1111/jopr.13657 -
International Journal of Environmental... Aug 2021Hajdu-Cheney syndrome (HCS) is a very rare autosomal-dominant congenital disease associated with mutations in the gene. This disorder affects the connective tissue and...
BACKGROUND
Hajdu-Cheney syndrome (HCS) is a very rare autosomal-dominant congenital disease associated with mutations in the gene. This disorder affects the connective tissue and is characterized by severe bone resorption. Hajdu-Cheney syndrome most frequently affects the head and feet bones (acroosteolysis).
CASE REPORT
We present an extremely rare case of a 34-year-old male with Hajdu-Cheney syndrome. The patient was admitted to the Department of Oral Surgery, Medical University of Gdańsk, in order to perform the extraction of three teeth. These teeth were not eligible for conservative treatment and prosthetic reconstruction. The patient was treated with denosumab (angiogenesis and receptor activator of nuclear factor-κB RANK ligand inhibitor, RANKL).
DISCUSSION
Denosumab is a monoclonal antibody against RANKL. This drug works through a suppression of osteoclast activity. In cases of patients in which the pathway of the RANK/RANKL/osteoprotegerin is dysregulated, denosumab has been approved for the treatment off-label. In patients receiving denosumab, a delayed wound healing in the oral cavity and osteonecrosis may occur. Dental procedures involving the alveolar bone process (tooth extractions and bone alveoloplasty) may be a risk factor for medication-related osteonecrosis of the jaw (MRONJ). Spontaneous osteonecrosis is rarely observed. MRONJ consists of the destruction of exposed bone, with the exposure persisting for a minimum of 6-8 weeks. This is the first article about an HCS patient treated with denosumab who underwent invasive oral surgery procedures. This case report highlights the difficulties for professionals occurring during the oral surgery procedures in such patients.
Topics: Acro-Osteolysis; Adult; Bone Density Conservation Agents; Denosumab; Hajdu-Cheney Syndrome; Humans; Male; Tooth Extraction
PubMed: 34501688
DOI: 10.3390/ijerph18179099 -
The Journal of Craniofacial Surgery 2020The aim of this study was to analyze the newly formed bone volume (FV), 6 months after secondary alveoloplasty using iliac cancellous bone graft, with and without... (Randomized Controlled Trial)
Randomized Controlled Trial
The aim of this study was to analyze the newly formed bone volume (FV), 6 months after secondary alveoloplasty using iliac cancellous bone graft, with and without platelet-rich plasma (PRP). Forty patients with unilateral alveolar cleft were involved in this randomized, prospective, comparative study, with 20 patients each forming the control (group A) and PRP (group B) groups, respectively. The preoperative alveolar defect volume (DV) and the postoperative FV were automatically calculated by the computer-aided engineering software using the patients' pre and postsurgical computed tomography data. The volume of the actual bone graft (AV) was identical to the DV calculated before surgery. The bone formation ratio (BF%) was calculated as follows: BF% = (FV/AV) × 100%. The mean BF% was 42.54 ± 9.32% in group A and 46.97 ± 18.49% in group B. There was no statistically significant difference between the 2 groups for BF% (P > 0.05). The study presents a fast and accurate method for assessing the effect of PRP in alveolar grafting. However, the study found no conclusive evidence on the effect of PRP on bone growth.
Topics: Adolescent; Alveolar Bone Grafting; Alveoloplasty; Bone Transplantation; Child; Cleft Palate; Female; Humans; Imaging, Three-Dimensional; Male; Osteogenesis; Platelet-Rich Plasma; Prospective Studies; Tomography, X-Ray Computed
PubMed: 31934980
DOI: 10.1097/SCS.0000000000006256 -
Journal of Plastic, Reconstructive &... Dec 2019
Topics: Alveolar Bone Grafting; Alveoloplasty; Bone Regeneration; Bone Transplantation; Child; Cleft Lip; Humans; Surgical Flaps
PubMed: 31582317
DOI: 10.1016/j.bjps.2019.09.001 -
Case Reports in Dentistry 2024Drug-influenced gingival enlargement is a common side effect associated with certain medications, particularly calcium channel blockers like nifedipine, which has been...
Drug-influenced gingival enlargement is a common side effect associated with certain medications, particularly calcium channel blockers like nifedipine, which has been extensively documented. However, the occurrence of nifedipine-influenced masticatory mucosa overgrowth in edentulous patients is rare. Here, we present a case of nifedipine-influenced mucosal enlargement persisting in a 67-year-old edentulous patient 3 months after the extraction of all his teeth. The patient underwent flap surgery and alveoloplasty to excise the overgrown tissue, followed by complete denture restoration. The antihypertensive medication was replaced with valsartan. A 2-year follow-up revealed no recurrence of overgrowth, indicating the effectiveness of this management strategy for such clinical situation.
PubMed: 38576511
DOI: 10.1155/2024/6889574