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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 -
Annals of Maxillofacial Surgery 2023Traditionally, sutures have been widely used to close intraoral wounds. Various alternatives have been developed amongst which newer tissue adhesives such as...
INTRODUCTION
Traditionally, sutures have been widely used to close intraoral wounds. Various alternatives have been developed amongst which newer tissue adhesives such as N-butyl-2-cyanoacrylate having accepted clinical properties are gaining popularity. The primary purpose of the present study is to evaluate the efficacy of N-butyl-2-cyanoacrylate for intraoral attached mucosal wound closure following alveoloplasty.
MATERIALS AND METHODS
In this prospective split-mouth study, 25 patients requiring alveoloplasty in either maxillary or mandibular arch bilaterally with a total of 50 sites were divided into two equal groups, namely silk suture (Group 1) and cyanoacrylate (Group 2). Each patient was evaluated on the first, third, seventh, 14 and 21 post-operative days. Parameters evaluated were time taken to close incision and to achieve haemostasis, pain, oedema, post-operative wound healing, patient discomfort and possible complications.
RESULTS
Time taken to close incision, time taken to achieve haemostasis, post-operative pain and oedema were found to be less in Group 2. Wound healing too was found to be better in Group 2. There was one case of adhesive peel off on the first post-operative day which was managed by reapplying the tissue adhesive. The incidence of wound dehiscence and wound infection was observed more in Group 1 on the third post-operative day. Suture breakage (16%) and adhesive dislodgement (8%) were reported on the seventh post-operative day.
DISCUSSION
The use of cyanoacrylates' inherent benefits, such as improved wound seal off in attached mucosa, quick polymerisation and bacteriostatic characteristics can be beneficial when performing minor oral surgical procedures on elderly, young and mentally challenged patients.
PubMed: 37711540
DOI: 10.4103/ams.ams_2_23 -
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 Maxillofacial and Oral... Sep 2022The conventional alveoloplasty approach which uses manual equipment results in more resorption of the underlying alveolar ridge that makes denture prosthesis unstable....
PURPOSE
The conventional alveoloplasty approach which uses manual equipment results in more resorption of the underlying alveolar ridge that makes denture prosthesis unstable. The goal of this study was to compare results of piezosurgery alveoloplasty to those of conventional alveoloplasty.
MATERIALS AND METHODS
This was an in-vivo comparative study consisting of ten edentulous individuals who needed alveoloplasty due to bilateral bony projection. On one side, a conventional alveoloplasty was performed with a bone rongeur and bone file, whereas the contralateral side was treated with a piezosurgery unit. The clinical parameters were analyzed using SPSS version 21 software including operating time, postoperative pain evaluation on day 3 and a healing on day 7.
RESULTS
There was a statistically significant difference between the two groups in terms of outcome variables such as operating time, pain and healing. The Conventional group has a lower mean of operating time, a higher mean rank of VAS and a lower mean rank of healing index compared to the piezosurgery group.
CONCLUSION
Piezosurgery alveoloplasty not only lowers postoperative patient discomfort but also preserves alveolar bone integrity by not disrupting soft and hard tissue architecture thus allowing faster tissue healing and easier prosthesis replacement in the future.
PubMed: 36274873
DOI: 10.1007/s12663-022-01716-3 -
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 -
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 -
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