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Autotransplantation
Oral Medicine Cost-effective burning mouth syndrome treatment Background.—Burning mouth syndrome (BMS) is characterized by burning pain in the tongue or oral mucous membranes usually in the absence of any pertinent clinical or laboratory findings. Among the complaints of BMS patients are burning, dryness, and taste alterations. Patients are often referred from one healthcare professional to another without obtaining effective management. Among the treatments are antidepressants, analgesics, benzodiazepines, capsaicin, hormone replacement therapy, hypericum extract, vitamin complexes, cognitive behavioral therapy, and electroconvulsive therapy. These have demonstrated various degrees of effectiveness and are accompanied by various adverse events. BMS is associated with a significant social and financial burden, but the cost-effectiveness of the various therapies has been unclear.
terms of cost-effectiveness than their brand-name forms except for amisulpride in France, where the generic and brandname forms had the same average cost-effectiveness ratio (ACER). Drugs proved most cost-effective in the Netherlands (except for amisulpride, which is not marketed there) and least cost-effective in the United Kingdom. Sensitivity analysis also found topical clonazepam to be the most efficient therapy.
Methods.—A cost-effectiveness analysis was conducted from the perspective of a health care payer for amisulpride, paroxetine, sertraline, and topical clonazepam used to treat BMS. A decision tree model incorporating direct health care costs and probabilities associated with possible events and outcomes was used for the analysis. Average cost-effectiveness and incremental cost-effectiveness ratios were calculated. The costs of brand name and generic drugs in five European countries—France, Italy, the Netherlands, Spain, and the United Kingdom—were studied using a sensitivity analysis to determine the robustness of the cost-effectiveness results.
Clinical Significance.—Topical clonazepam is recommended as the drug of choice for managing patients with BMS clinically. This study found that this agent is also the best drug for BMS in terms of cost-effectiveness.
Results.—Topical clonazepam was the most effective agent and the most efficient BMS therapy in all five countries. Generic forms of the drugs were generally more efficient in
Discussion.—In patients with BMS, normal social relationships and quality of life are disrupted. Topical clonazepam proved to be more efficient therapy for BMS than both generic and brand-name versions of amisulpride, paroxetine, and sertraline.
Hens MJ, Alonso-Ferreira V, Villaverde-Hueso A, et al: Costeffectiveness analysis of burning mouth syndrome therapy. Community Dent Oral Epidemiol 40:185-192, 2012 Reprints available from M Posada de la Paz, Monforte de Lemos 5, Pabellon 11, Madrid 28029, Spain; fax: þ34 913877895; e-mail: [email protected]
Oral Surgery Autotransplantation Background.—The autotransplantation of immature teeth is often done in combination with orthodontic treatment to manage impaction, aplasia, and displacement, among other problems. Autotransplantation has been done with donor teeth that have complete root formation and with bridge abutments as well. However, most reports cover procedures done in the surgery departments of universities or hospitals. A field survey was undertaken to evaluate autotransplantation done in private dental clinics and determine its practicality. Methods.—Questionnaires were distributed to 42 dentists, asking for information on transplantations they had
performed between January 1990 and December 2010. Thirty-seven dentists responded, supplying data for 614 teeth from 552 patients. Patients’ mean ages were 44.1 years (range: 17 to 79 years). Cumulative survival rate and mean survival time were determined. Results.—A mean of 1.4 patients per clinic per year received transplants. The transplanted teeth were observed for a mean of 63.8 months (range: 0 to 237 months). Of the teeth transplanted, 36.8% were upper third molars, 37.1% were lower third molars, 6.7% were premolars, and 5.0% were incisors. The most common recipient site was
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2013
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Table 6.—Main Causes of Transplantation Failure (n = 102) Main causes
Attachment loss Root resorption Caries Root fracture Others Total
n
%
56 27 4 3 12 102
54.9 26.5 4.0 2.9 11.8 100
(Courtesy of Yoshino K, Kariya N, Namura D, et al: A retrospective survey of autotransplantation of teeth in dental clinics. J Oral Rehabil 39:37-43, 2012.)
the lower first molar region used in 32.6% of cases. The lower second molar region, upper first molar region, and upper second molar region received implants in 28.9%, 13.2%, and 10.9% of cases, respectively. Prosthodontic treatment was performed for a single crown in 72.5% of cases, for the abutment of a bridge in 18.9%, and for the abutment of an overdenture in 7.7%. One percent of cases involved other treatment. One hundred two of the transplanted teeth were lost during the observation period (Table 6). Reasons for tooth loss were attachment loss (54.9%), root resorption (26.5%), caries (4.0%), root fracture (2.9%), and other causes (11.8%). Of the 512 surviving teeth, 79.1% were clinically successful, 10.9% had root resorption, 4.7% had ankylosis, and 5.3% had other complications. Cumulative survival rate of donor teeth with complete root formation was 90.1% after 5 years, 70.5% after 10 years, and 55.6% after 15 years (Fig 1). Mean survival time was 165.6 months. Younger patients (those aged <40 years) had significantly better survival rates than older patients (those aged R40 years). Discussion.—Tooth autotransplantation requires highly skilled techniques. The dentists performing these transplantation procedures did not use standardized surgical procedures. However, the results were quite favorable, making autotransplantation a valid treatment option that should be considered before choosing a bridge or implant approach.
Fig 1.—Survival analysis of autotransplanted teeth by Kaplan– Meier method (n = 599). (Courtesy of Yoshino K, Kariya N, Namura D, et al: A retrospective survey of autotransplantation of teeth in dental clinics. J Oral Rehabil 39:37-43, 2012.)
Clinical Significance.—The advantages of doing autotransplantation include retained periodontal ligaments, which allow for tooth movement and promote bone regeneration; avoiding the need to prepare teeth for bridges; and possibly lower cost, depending on insurance coverage. If suitable donor teeth are available, this approach may be a good treatment option to replace missing teeth. Performing the procedure in a dental clinic appears to have good prospects for success.
Yoshino K, Kariya N, Namura D, et al: A retrospective survey of autotransplantation of teeth in dental clinics. J Oral Rehabil 39:37-43, 2012 Reprints available from K Yoshino, Dept of Epidemiology and Public Health, Tokyo Dental College, 1-2-2 Masago, Mihama-ku, Chiba 261-8502, Japan; e-mail: [email protected]
Glove perforation Background.—Gloves protect both the patient and the surgeon from the risk of cross-infection during surgery. Viruses, bacteria, and other pathogens can be barred from access as long as the gloves are intact, but once perforated,
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Dental Abstracts
gloves lose their safeguarding ability. It is not clear how often glove perforations occur, especially during orthognathic surgery, when several sharp instruments, such as bone-cutting devices and fixation wires, are used. The
terms of cost-effectiveness than their brand-name forms except for amisulpride in France, where the generic and brandname forms had the same average cost-effectiveness ratio (ACER). Drugs proved most cost-effective in the Netherlands (except for amisulpride, which is not marketed there) and least cost-effective in the United Kingdom. Sensitivity analysis also found topical clonazepam to be the most efficient therapy.
Methods.—A cost-effectiveness analysis was conducted from the perspective of a health care payer for amisulpride, paroxetine, sertraline, and topical clonazepam used to treat BMS. A decision tree model incorporating direct health care costs and probabilities associated with possible events and outcomes was used for the analysis. Average cost-effectiveness and incremental cost-effectiveness ratios were calculated. The costs of brand name and generic drugs in five European countries—France, Italy, the Netherlands, Spain, and the United Kingdom—were studied using a sensitivity analysis to determine the robustness of the cost-effectiveness results.
Clinical Significance.—Topical clonazepam is recommended as the drug of choice for managing patients with BMS clinically. This study found that this agent is also the best drug for BMS in terms of cost-effectiveness.
Results.—Topical clonazepam was the most effective agent and the most efficient BMS therapy in all five countries. Generic forms of the drugs were generally more efficient in
Discussion.—In patients with BMS, normal social relationships and quality of life are disrupted. Topical clonazepam proved to be more efficient therapy for BMS than both generic and brand-name versions of amisulpride, paroxetine, and sertraline.
Hens MJ, Alonso-Ferreira V, Villaverde-Hueso A, et al: Costeffectiveness analysis of burning mouth syndrome therapy. Community Dent Oral Epidemiol 40:185-192, 2012 Reprints available from M Posada de la Paz, Monforte de Lemos 5, Pabellon 11, Madrid 28029, Spain; fax: þ34 913877895; e-mail: [email protected]
Oral Surgery Autotransplantation Background.—The autotransplantation of immature teeth is often done in combination with orthodontic treatment to manage impaction, aplasia, and displacement, among other problems. Autotransplantation has been done with donor teeth that have complete root formation and with bridge abutments as well. However, most reports cover procedures done in the surgery departments of universities or hospitals. A field survey was undertaken to evaluate autotransplantation done in private dental clinics and determine its practicality. Methods.—Questionnaires were distributed to 42 dentists, asking for information on transplantations they had
performed between January 1990 and December 2010. Thirty-seven dentists responded, supplying data for 614 teeth from 552 patients. Patients’ mean ages were 44.1 years (range: 17 to 79 years). Cumulative survival rate and mean survival time were determined. Results.—A mean of 1.4 patients per clinic per year received transplants. The transplanted teeth were observed for a mean of 63.8 months (range: 0 to 237 months). Of the teeth transplanted, 36.8% were upper third molars, 37.1% were lower third molars, 6.7% were premolars, and 5.0% were incisors. The most common recipient site was
Volume 58
Issue 3
2013
153
Table 6.—Main Causes of Transplantation Failure (n = 102) Main causes
Attachment loss Root resorption Caries Root fracture Others Total
n
%
56 27 4 3 12 102
54.9 26.5 4.0 2.9 11.8 100
(Courtesy of Yoshino K, Kariya N, Namura D, et al: A retrospective survey of autotransplantation of teeth in dental clinics. J Oral Rehabil 39:37-43, 2012.)
the lower first molar region used in 32.6% of cases. The lower second molar region, upper first molar region, and upper second molar region received implants in 28.9%, 13.2%, and 10.9% of cases, respectively. Prosthodontic treatment was performed for a single crown in 72.5% of cases, for the abutment of a bridge in 18.9%, and for the abutment of an overdenture in 7.7%. One percent of cases involved other treatment. One hundred two of the transplanted teeth were lost during the observation period (Table 6). Reasons for tooth loss were attachment loss (54.9%), root resorption (26.5%), caries (4.0%), root fracture (2.9%), and other causes (11.8%). Of the 512 surviving teeth, 79.1% were clinically successful, 10.9% had root resorption, 4.7% had ankylosis, and 5.3% had other complications. Cumulative survival rate of donor teeth with complete root formation was 90.1% after 5 years, 70.5% after 10 years, and 55.6% after 15 years (Fig 1). Mean survival time was 165.6 months. Younger patients (those aged <40 years) had significantly better survival rates than older patients (those aged R40 years). Discussion.—Tooth autotransplantation requires highly skilled techniques. The dentists performing these transplantation procedures did not use standardized surgical procedures. However, the results were quite favorable, making autotransplantation a valid treatment option that should be considered before choosing a bridge or implant approach.
Fig 1.—Survival analysis of autotransplanted teeth by Kaplan– Meier method (n = 599). (Courtesy of Yoshino K, Kariya N, Namura D, et al: A retrospective survey of autotransplantation of teeth in dental clinics. J Oral Rehabil 39:37-43, 2012.)
Clinical Significance.—The advantages of doing autotransplantation include retained periodontal ligaments, which allow for tooth movement and promote bone regeneration; avoiding the need to prepare teeth for bridges; and possibly lower cost, depending on insurance coverage. If suitable donor teeth are available, this approach may be a good treatment option to replace missing teeth. Performing the procedure in a dental clinic appears to have good prospects for success.
Yoshino K, Kariya N, Namura D, et al: A retrospective survey of autotransplantation of teeth in dental clinics. J Oral Rehabil 39:37-43, 2012 Reprints available from K Yoshino, Dept of Epidemiology and Public Health, Tokyo Dental College, 1-2-2 Masago, Mihama-ku, Chiba 261-8502, Japan; e-mail: [email protected]
Glove perforation Background.—Gloves protect both the patient and the surgeon from the risk of cross-infection during surgery. Viruses, bacteria, and other pathogens can be barred from access as long as the gloves are intact, but once perforated,
154
Dental Abstracts
gloves lose their safeguarding ability. It is not clear how often glove perforations occur, especially during orthognathic surgery, when several sharp instruments, such as bone-cutting devices and fixation wires, are used. The