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Nigerian Journal of Clinical Practice Jul 2022Bone reduction and shelf preparation is a common procedure to establish a new alveolar plane before implant surgery, which might effect the primary stability.
BACKGROUND
Bone reduction and shelf preparation is a common procedure to establish a new alveolar plane before implant surgery, which might effect the primary stability.
AIM
Primary stability was questioned in terms of bone reduction and shelf preparation. The suitability of immediate loading was compared between the implants placed on crests, which underwent alveoloplasty, and the implants placed on a naturally healed alveolar bone.
PATIENTS AND METHODS
We designed and implemented a retrospective cohort study. Twenty patients (mean age 49.2 years) were treated with 160 dental implants. The primary predictor variable was extraction and bone reduction. The secondary predictor variables were bone density and the implant surface. The outcome variables were resonance frequency analysis (RFA) and insertion torque (IT) values.
RESULTS
There was no statistically significant difference between groups regarding RFA and IT (P > 0,05). Interactions of surface area with the RFA and IT in both groups were not statistically significant; however, bone density presented a statistically significant effect on outcome variables for both groups.
CONCLUSION
IT and RFA are not influenced by bone reduction, shelf preparation, or the implant surface. Primary stability is mostly affected by bone density in the immediate load of 4 implants to support a full-arch prosthesis.
Topics: Bone Screws; Dental Prosthesis; Humans; Maxilla; Middle Aged; Retrospective Studies; Torque
PubMed: 35859469
DOI: 10.4103/njcp.njcp_1630_21 -
Journal of Prosthodontics : Official... Jul 2022Treatment planning for the transition of patients from terminal dentition to full-arch implant rehabilitation poses challenges. Such challenges pertain to achieving the...
Treatment planning for the transition of patients from terminal dentition to full-arch implant rehabilitation poses challenges. Such challenges pertain to achieving the new orientation of the occlusal and esthetic plane as well as the change of vertical dimension of occlusion (VDO), while the fixed provisionalization using a digital workflow still tends to be considered complex and hard to perform. This article illustrates step-by-step the utilization of a digital workflow protocol in the treatment planning for rehabilitation of terminal dentition patients, simplifying the smile design and ensuring that fixed provisionalization serves both functional and esthetic requirements. This protocol includes facially driven, three-dimensional (3D) digital smile design and chairside mock-up restoration workflows that enable prosthetically driven assessment prior to implant treatment planning and 3D printing of surgical templates and prefabricated interim prostheses, which can predictably reduce chairside time and adjustments at the surgical and fixed provisionalization appointment.
Topics: Computer-Aided Design; Dental Implants; Dental Prosthesis, Implant-Supported; Dentition; Esthetics, Dental; Humans; Workflow
PubMed: 35343618
DOI: 10.1111/jopr.13510 -
The Cleft Palate-craniofacial Journal :... Nov 2022Primary CL/P repair, revisions, and secondary procedures-cleft rhinoplasty, speech surgery, and alveolar bone grafting (ABG)-performed from 2014-2018 were identified...
UNLABELLED
Primary CL/P repair, revisions, and secondary procedures-cleft rhinoplasty, speech surgery, and alveolar bone grafting (ABG)-performed from 2014-2018 were identified from the Pediatric National Surgical Quality Improvement Program (NSQIP) database. Utilization estimates were derived via univariable and multivariable logistic regression. A Kruskal-Wallis rank-sum test and multivariable linear regression were used to assess differences in timing for each procedure cohort. The primary outcome measures were the odds of a patient being a certain race/ethnicity, and the age at which patients of different race/ethnicity receive surgery. There were 23 780 procedures analyzed. After controlling for sex, diagnosis, and functional status, there were significant differences in utilization estimates across procedure groups. Primarily, utilization was lowest in patient who were Black for cleft rhinoplasty (OR = 0.70, = .023), ABG (OR = 0.44, < .001) and speech surgery (OR = 0.57, = .012), and highest in patients who were Asian patients in all surgery cohorts (OR 2.05-4.43). Timing of surgery also varied by race, although differences were minimal.
CONCLUSIONS
Estimates of utilization and timing of secondary cleft procedures varied by race, particularly among patients who were Black (poor utilization) or Asian (high utilization). Further studies should identify the causes and implications of underutilized and/or delayed cleft care.
Topics: Alveolar Bone Grafting; Alveoloplasty; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Cohort Studies; Delivery of Health Care; Healthcare Disparities; Humans; Racial Groups; Retrospective Studies; Rhinoplasty; Surgical Flaps; United States
PubMed: 34662225
DOI: 10.1177/10556656211047134 -
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 -
Journal of the Korean Association of... Aug 2021Wound healing is an integral part of any surgical procedure. Appropriate wound closure is critical to any successful surgical procedure, especially intraoral procedures....
OBJECTIVES
Wound healing is an integral part of any surgical procedure. Appropriate wound closure is critical to any successful surgical procedure, especially intraoral procedures. Various factors aid in wound healing, both pharmacological and non-pharmacological. Dehydrated human amniotic/chorionic membrane (dHACM) is an emerging bioinert material that contains anti-inflammatory properties, angiogenetic properties, osteogenic potential, and various growth factors. The purpose of this study was to evaluate the efficacy of wound healing properties of dHACM in bilateral alveoloplasty patients.
MATERIALS AND METHODS
A prospective split-mouth study was conducted on 10 patients. Site A received sutures with dHACM and site B was sutured without dHACM. Wound healing was assessed with the Landry, Turnbull, and Howley Index.
RESULTS
Sites A and site B were compared. A <0.05 and a test value of 22 was obtained, indicating a statistical difference between the two sites.
CONCLUSION
Our study showed better healing with dHACM than without.
PubMed: 34462385
DOI: 10.5125/jkaoms.2021.47.4.279 -
Journal of Pharmacy & Bioallied Sciences Jun 2021Dental treatment in patients on antiplatelet drug therapy is a long standing debate. Discontinuation of medication increases the risk of thrombotic complications,...
BACKGROUND
Dental treatment in patients on antiplatelet drug therapy is a long standing debate. Discontinuation of medication increases the risk of thrombotic complications, whereas continuation leads to increased postoperative bleeding.
AIM
We conducted this prospective cross-sectional study to assess risk of bleeding in patients continuing antiplatelet medication while performing minor oral surgical procedures such as single or multiple teeth extraction, transalveolar extraction of third molar, biopsy, and alveoloplasty.
MATERIALS AND METHODS
We calibrated the steps taken to achieve hemostasis, time taken to arrest bleeding, and correlated time taken to achieve hemostasis in patients under antiplatelet drug therapy (Group A [n = 64] - aspirin, Group B [n = 36] - aspirin and clopidogrel) and in patients without any drug therapy (Group C [n = 100] healthy patients).
RESULTS
Out of 200 patients, Level 1 hemostatic measures were required for 129 (64.5%) patients, Level 2 hemostatic measures were taken for 68 (34.0%) patients, and Level 3 hemostatic measures were taken for 3 (1.5%) patients. Chi-square test conducted to compare the local hemostatic measures taken for minor oral surgical procedure for all groups was statistically significant ( ≤ 0.001).
CONCLUSION
Overall, there was no postoperative bleeding within 24 h of extraction in any patient group. In conclusion, surgical procedures can be safely accomplished in patients receiving single or dual antiplatelet therapy when appropriate local hemostatic measures are taken.
PubMed: 34447048
DOI: 10.4103/jpbs.JPBS_554_20 -
Clinics in Plastic Surgery Jul 2021Alveolar distraction osteogenesis (ADO) has been used for the reconstruction of atrophic alveolus for decades. The advantage of this technique is that it augments the... (Review)
Review
Alveolar distraction osteogenesis (ADO) has been used for the reconstruction of atrophic alveolus for decades. The advantage of this technique is that it augments the bone and soft tissues together, creating a better alveolar platform for subsequent surgeries and dental rehabilitation. It is especially useful in patients with large and/or complex alveolar clefts for which approximating the alveolar segments reduces the size of the bony cleft and associated fistula. Displacement of the transported segment is the most frequently encountered complication of ADO but can be managed by constructing case-specific distractors.
Topics: Adolescent; Alveolar Bone Grafting; Alveolar Process; Alveoloplasty; Cleft Palate; Humans; Male; Orthodontics, Corrective; Osteogenesis, Distraction; Young Adult
PubMed: 34051895
DOI: 10.1016/j.cps.2021.02.004 -
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 -
Journal of Prosthodontics : Official... Mar 2021Fabricating an immediate complete denture can be very challenging in some clinical situations. This clinical report describes a digital workflow to fabricate a printed...
Fabricating an immediate complete denture can be very challenging in some clinical situations. This clinical report describes a digital workflow to fabricate a printed maxillary immediate complete denture for a patient with a severely compromised maxilla. Digital data obtained by using an intraoral scanner was utilized to reconstruct the three-dimensional (3D) image of the jaws at the desirable vertical dimension of occlusion. After performing the virtual teeth extraction and alveoloplasty, the denture base and teeth were designed. The resulting data were exported to a 3D printer for denture fabrication and the 3D printed (additively manufactured) denture was successfully inserted immediately after the surgery. After initial healing and confirmation of good retention and function, a new printed denture was fabricated by digitally duplicating the relined denture maintaining the same teeth positions but adjusting the base to a new intraoral scan of the healed ridge.
Topics: Computer-Aided Design; Dental Occlusion; Denture, Complete; Denture, Complete, Immediate; Humans; Maxilla; Printing, Three-Dimensional; Rhabdomyosarcoma
PubMed: 33325048
DOI: 10.1111/jopr.13305 -
Special Care in Dentistry : Official... Jan 2021The edentulous mandibular ridge and associated shallow vestibule are often seen as a challenge in the oral rehabilitation of patients. Dental implants can provide an... (Review)
Review
The versatile "lip switch" or transitional flap vestibuloplasty combined with alveoloplasty and implant placement to treat atrophic mandibles with inadequate vestibules and attached tissue: A case series and review of the literature.
INTRODUCTION/AIMS
The edentulous mandibular ridge and associated shallow vestibule are often seen as a challenge in the oral rehabilitation of patients. Dental implants can provide an improvement in mastication and patient satisfaction. The aim of this study is to utilize a preprosthetic mucosal flap combined with a repositional periosteal flap concomitant with an alveoloplasty and placement of endosteal implants as a single-stage procedure in the anterior mandible. This approach provides a valued alternative for dental rehabilitation in patients with poor masticatory efficiency using a conventional denture.
METHODS
Eight patients underwent the preprosthetic surgical plan in the oral surgery clinic of the dental school during a 1-year period. Age, sex, preoperative, and postoperative vestibular depth, as well as hard and soft tissue elements were measured (P < .05) at 4-6 months.
RESULTS
Mean age was 53 years ± 14.62 (N = 8). Anterior mandible height was 19 ± 4.8 mm. A significant difference was measured using a two-tailed Student's t-test between pre- and postoperative vestibular depths, respectively (3.9 mm vs 10.5 ± 0.96 mm; P < .01).
CONCLUSIONS
A lip switch vestibuloplasty combined with placement of two implants provide a one-stage procedure that is convenient, provides a shorter postoperative period, and can be financially affordable. Future research requires larger sampling to support this treatment as a standard of care.
Topics: Alveoloplasty; Dental Implantation, Endosseous; Dental Prosthesis, Implant-Supported; Humans; Infant; Jaw, Edentulous; Lip; Mandible; Middle Aged; Vestibuloplasty
PubMed: 33270928
DOI: 10.1111/scd.12546