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Evaluation of piezoelectric osteotomy use in third molar surgery
Int. J. Oral Maxillofac. Surg. 2005; 34 (Supplement 1): $ 1 - $ 1 8 1
60 population being especially prone to develop secondary or tertiary squamous cell carcinomas at the site of dental implants. If these patients with a multicentric carcinogenesis disposition obtain dental implants, they require a long term observation at short intervals.
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RETROSPECTIVE STUDY FOLLOWING EXPLANTATION OF OSSEOINTEGRATED IMPLANTS
D. Grimm, R. Sch6n, A. Dini, B. Hohlweg-Majert, R. Schmelzeisen.
Clinic and Policlinic for Oral and Maxillofacial surgery, University-clinic, Freiburg, Dresden, Germany During January 2001 and December 2004 in 33 patients explantations were performed and evaluated based on X-rays and documentations retrospectively. 20 female and 13 male patients with a mean age of 50 years were evaluated. Indication of implantation, lifetime, duration of implants, type, length and width of the implants, location and lifetime of the implants, type of bone augmentation, dental and general medical condition prior to implantation were evaluated before explantation. After explantation panoramic X-rays were performed and length and width of the bony defects where measured and compared to the pre operative panoramic X-rays. Explantation was performed with trepanation drills, round drills and forceps. Prior to secondary implantation bone grafting was performed in 9 out of 33 patients. Donor sites for the bone grafts were iliac crest, maxillary tuberosity, zygomaticoalveolar crest and retro molar area. 16 blade types of implants and 49 endosseous implants were explanted. A correlation of previous dental status, age and impaired medical condition with explantation was not found. The major cause for explantation was periimplantitis (n = 53), nerve lesion (n = 2) or insufficient prosthetic work (n = 1), lack of primary stabilization (n =3), implant fracture (n = 2), mandible fracture (n = 1) and cancer (n = 1 ). The explantated plate type implants had an average lifetime of 8-10 years. The endosseus implants had duration between 1 day and 5 years. A relation between loss of implants caused by periimplantitis and periodontitis was noted. The bony defects after explantation where approximately 10 mm in length and 5 mm in width. Bone augmentation and sinus lifting procedures were performed after explanation in 7 patients using iliac crest bone, and in 1 patient using bone from maxillary tuberosity and zygomaticoalveolar crest. Bone augmentation procedures without sinus lifting were performed in one patient using retro molar bone. In 5 out of 9 patients bone augmentation was performed 3 months following explantation, in 4 out of 9 augmentation was performed at time of explantation. Complications such as bone loss, sinusitis and osteomyelitis occurred more often following primary augmentation compared to augmentations made 3 months after explantation. Complications were reduced when the augmentation procedure was performed 3 months after explantation.
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QUANTITATIVE STUDY OF BONE AUGMENTED WITH AUTOGENOUS BONE PARTICLES AND A TITANIUM MESH
Y. Matsui, M. Ohta, K. Ohno, M. Nagumo. Department of Oral and
Maxillofacial Surgery, School of Dentistry, Showa University, Kazakhstan Recent reports describe the use of titanium mesh and autogenous bone particles for alveolar ridge augmentation. However, it has been unclear how much bone volume, height, or width would be obtainable with this technique. This paper studied the usefulness of a titanium mesh for alveolar bone augmentation through a quantitative analyses of augmented bone. The subjects were 28 patients (11 males and 17 females, 13-62 averaged 28.3 years old) who had undergone autogeneous bone graft for alveolar ridge augmentation. The primary lesion was alveolar clefts in 18 patients, dental disease in seven, trauma in two and tumor in one. Donor sites were the iliac bone or the jaw. Donor sites were the iliac bone or the jaw.The augmented bone was quantitatively evaluated with the reconstructed CT images. Parameters were as follows: augmented bone ratio (ABR); the percentage of bone in the space created by titanium mesh, increased bone height (IBH); the difference of the bone height before and after the operation of the patients aiming at increasing bone height, the ratio of the increased bone height (%IBH); the percentage of increased bone height against the vertical gap between the mesh and the alveolar crest in the patisnts, increased bone width (IBW); the difference of the bone width before and after the operation of the patients aiming at increasing bone width, and the ratio of the increased bone width (%IBW); the percentage of increased bone width against the horizontal gap between the mesh and the cortical bone in the patients. The following results were obtained: 1. The ABR was 39.7-100%, averaged 90.4%.
2. The IBH was 2.5-11.8mm, averaged 6.4mm and the %IBH was 70-100%, averaged 90.4%. 3. The IBW was 1.0-11.2mm, averaged 4.9 mm and the %IBW was 22-100%, averaged 83.2%. These results indicated the availability of titanium mesh in alveolar ridge augmentation.
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EVALUATION OF PIEZOELECTRIC OSTEOTOMY USE IN THIRD MOLAR SURGERY
M. Hern~ndez, S. Baeza, J. Jaramillo, E. Valencia. University of
Valparaiso, Chile Compare the traditional osteotomy, with burs versus the piezo electric technique, in third molars surgery. Bilateral third molar surgery was performed in 20 patients with bone impaction. In one side the traditional technique was performed. In the contralateral side the osteotomy was performed with a piezo electric device. Post operative swelling and pain was evaluated and compared, in a double blinded design. Preliminary results are showing better results for the piezo electric side. Final results will be presented at the meeting. After performing orthognatic surgery, grafts and now third molar surgery, the device seems to be less aggressive to the patient than burs and saws. References [1] Valencia E, Hernandez M, Baeza S, Jaramillo J: Piezoelectric Osteotomies in Orthognatic Surgery. Revista de la Facultad de Odontologia. Vol 3 N 2. Oct 2004. [2] Rabiony M, Pollini F, Costa F, Vercellotti T, Pollini (2004): Piezoelectric bone cutting in multipiece maxillary osteotomies. J. Oral Maxillofac. Surg. 62: 759-761. [
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EFFICACY OF LIDOCAINE WITH CLONIDINE IN MAXILLARY INFILTRATION ANAESTHESIA
B. Brkovic 1, D. Stojic2, L. Todorovic1. 1Clinic of Oral Surgery and
2Department of Pharmacology, Faculty of Stomatology, University of Belgrade, Serbia & Montenegro Purpose: Previous studies have confirmed that clonidine, an ~2-adrenoceptor agonist with direct vasoconstricting effect on blood vessels, is very useful in prolonging and increasing lidocaine produced regional and block anaesthesia - epidural or brachial plexus block. Recently, it has been presented that similar effects of lidocaine with clonidine were observed during intraoral block anaesthesia. Since there is no data concerning clonidine effect in maxillary infiltration anaesthesia, the aim of the present study was to compare the effects of clonidine and adrenaline, as vasoconstrictors, in lidocaine maxillary infiltration anaesthesia with regard to onset, duration, intensity of anaesthesia and the requirement for postoperative pain medication. Materials and Method: Forty healthy patients undergoing upper third molar surgery were equally divided in two groups receiving 2 ml of 2% lidocaine and clonidine (15 #g/ml), or 2 ml of 2% lidocaine and adrenaline (12.5#g/ml) for maxillary infiltration anaesthesia. The response to pinprick testing and subjective soft tissue signs of numbness determined the onset and duration of anaesthesia. Intensity of anaesthesia was evaluated by a 100-mm visual analog scale (VAS) and eight-point verbal rating scale (VRS). The total number of pain medication doses taken, and the number of patients reporting no pain medication requirements were also recorded. Results: The obtained results showed that there were no significant differences with regard to onset (70±9 s, 63±11 s), duration (98±8 min, 102±12 min) and intensity (5.6±2.7 mmVAS, 1.8±0.5 mmVAS) of infiltration anaesthesia produced by lidocaine with clonidine and lidocaine with adrenaline, respectively. Our results also showed that maxillary infiltration anaesthesia was followed by similar need of analgesics for reduction of postoperative pain regardless of the used anaesthetic solutions. Conclusion: Although clonidine does not offer advantages concerning local anaesthetic parameters of maxillary infiltration anaesthesia in comparison with adrenaline, it may be a useful adjunct to local anaesthetics in those patients in whom the administration of adrenaline is undesirable. ~
DENTAL PREPARATION FOR OOKP STAGE 1 SURGERY: A RETROSPECTIVE REVIEW OF CASES IN SINGAPORE
A.B.G. Tay. Department of Oral & Maxi//ofacia/ Surgery, National Dental
Centre, 5 Second Hospital Avenue, Singapore 168938, Singapore To determine the proportion of patients who have suitable teeth and cheek mucosa for OOKP (osteo-odonto-keratoprosthesis) surgery, referred to the National Dental Centre. Consecutive patients referred from
60 population being especially prone to develop secondary or tertiary squamous cell carcinomas at the site of dental implants. If these patients with a multicentric carcinogenesis disposition obtain dental implants, they require a long term observation at short intervals.
[•]
RETROSPECTIVE STUDY FOLLOWING EXPLANTATION OF OSSEOINTEGRATED IMPLANTS
D. Grimm, R. Sch6n, A. Dini, B. Hohlweg-Majert, R. Schmelzeisen.
Clinic and Policlinic for Oral and Maxillofacial surgery, University-clinic, Freiburg, Dresden, Germany During January 2001 and December 2004 in 33 patients explantations were performed and evaluated based on X-rays and documentations retrospectively. 20 female and 13 male patients with a mean age of 50 years were evaluated. Indication of implantation, lifetime, duration of implants, type, length and width of the implants, location and lifetime of the implants, type of bone augmentation, dental and general medical condition prior to implantation were evaluated before explantation. After explantation panoramic X-rays were performed and length and width of the bony defects where measured and compared to the pre operative panoramic X-rays. Explantation was performed with trepanation drills, round drills and forceps. Prior to secondary implantation bone grafting was performed in 9 out of 33 patients. Donor sites for the bone grafts were iliac crest, maxillary tuberosity, zygomaticoalveolar crest and retro molar area. 16 blade types of implants and 49 endosseous implants were explanted. A correlation of previous dental status, age and impaired medical condition with explantation was not found. The major cause for explantation was periimplantitis (n = 53), nerve lesion (n = 2) or insufficient prosthetic work (n = 1), lack of primary stabilization (n =3), implant fracture (n = 2), mandible fracture (n = 1) and cancer (n = 1 ). The explantated plate type implants had an average lifetime of 8-10 years. The endosseus implants had duration between 1 day and 5 years. A relation between loss of implants caused by periimplantitis and periodontitis was noted. The bony defects after explantation where approximately 10 mm in length and 5 mm in width. Bone augmentation and sinus lifting procedures were performed after explanation in 7 patients using iliac crest bone, and in 1 patient using bone from maxillary tuberosity and zygomaticoalveolar crest. Bone augmentation procedures without sinus lifting were performed in one patient using retro molar bone. In 5 out of 9 patients bone augmentation was performed 3 months following explantation, in 4 out of 9 augmentation was performed at time of explantation. Complications such as bone loss, sinusitis and osteomyelitis occurred more often following primary augmentation compared to augmentations made 3 months after explantation. Complications were reduced when the augmentation procedure was performed 3 months after explantation.
[
•
]
A
QUANTITATIVE STUDY OF BONE AUGMENTED WITH AUTOGENOUS BONE PARTICLES AND A TITANIUM MESH
Y. Matsui, M. Ohta, K. Ohno, M. Nagumo. Department of Oral and
Maxillofacial Surgery, School of Dentistry, Showa University, Kazakhstan Recent reports describe the use of titanium mesh and autogenous bone particles for alveolar ridge augmentation. However, it has been unclear how much bone volume, height, or width would be obtainable with this technique. This paper studied the usefulness of a titanium mesh for alveolar bone augmentation through a quantitative analyses of augmented bone. The subjects were 28 patients (11 males and 17 females, 13-62 averaged 28.3 years old) who had undergone autogeneous bone graft for alveolar ridge augmentation. The primary lesion was alveolar clefts in 18 patients, dental disease in seven, trauma in two and tumor in one. Donor sites were the iliac bone or the jaw. Donor sites were the iliac bone or the jaw.The augmented bone was quantitatively evaluated with the reconstructed CT images. Parameters were as follows: augmented bone ratio (ABR); the percentage of bone in the space created by titanium mesh, increased bone height (IBH); the difference of the bone height before and after the operation of the patients aiming at increasing bone height, the ratio of the increased bone height (%IBH); the percentage of increased bone height against the vertical gap between the mesh and the alveolar crest in the patisnts, increased bone width (IBW); the difference of the bone width before and after the operation of the patients aiming at increasing bone width, and the ratio of the increased bone width (%IBW); the percentage of increased bone width against the horizontal gap between the mesh and the cortical bone in the patients. The following results were obtained: 1. The ABR was 39.7-100%, averaged 90.4%.
2. The IBH was 2.5-11.8mm, averaged 6.4mm and the %IBH was 70-100%, averaged 90.4%. 3. The IBW was 1.0-11.2mm, averaged 4.9 mm and the %IBW was 22-100%, averaged 83.2%. These results indicated the availability of titanium mesh in alveolar ridge augmentation.
[•
EVALUATION OF PIEZOELECTRIC OSTEOTOMY USE IN THIRD MOLAR SURGERY
M. Hern~ndez, S. Baeza, J. Jaramillo, E. Valencia. University of
Valparaiso, Chile Compare the traditional osteotomy, with burs versus the piezo electric technique, in third molars surgery. Bilateral third molar surgery was performed in 20 patients with bone impaction. In one side the traditional technique was performed. In the contralateral side the osteotomy was performed with a piezo electric device. Post operative swelling and pain was evaluated and compared, in a double blinded design. Preliminary results are showing better results for the piezo electric side. Final results will be presented at the meeting. After performing orthognatic surgery, grafts and now third molar surgery, the device seems to be less aggressive to the patient than burs and saws. References [1] Valencia E, Hernandez M, Baeza S, Jaramillo J: Piezoelectric Osteotomies in Orthognatic Surgery. Revista de la Facultad de Odontologia. Vol 3 N 2. Oct 2004. [2] Rabiony M, Pollini F, Costa F, Vercellotti T, Pollini (2004): Piezoelectric bone cutting in multipiece maxillary osteotomies. J. Oral Maxillofac. Surg. 62: 759-761. [
~
EFFICACY OF LIDOCAINE WITH CLONIDINE IN MAXILLARY INFILTRATION ANAESTHESIA
B. Brkovic 1, D. Stojic2, L. Todorovic1. 1Clinic of Oral Surgery and
2Department of Pharmacology, Faculty of Stomatology, University of Belgrade, Serbia & Montenegro Purpose: Previous studies have confirmed that clonidine, an ~2-adrenoceptor agonist with direct vasoconstricting effect on blood vessels, is very useful in prolonging and increasing lidocaine produced regional and block anaesthesia - epidural or brachial plexus block. Recently, it has been presented that similar effects of lidocaine with clonidine were observed during intraoral block anaesthesia. Since there is no data concerning clonidine effect in maxillary infiltration anaesthesia, the aim of the present study was to compare the effects of clonidine and adrenaline, as vasoconstrictors, in lidocaine maxillary infiltration anaesthesia with regard to onset, duration, intensity of anaesthesia and the requirement for postoperative pain medication. Materials and Method: Forty healthy patients undergoing upper third molar surgery were equally divided in two groups receiving 2 ml of 2% lidocaine and clonidine (15 #g/ml), or 2 ml of 2% lidocaine and adrenaline (12.5#g/ml) for maxillary infiltration anaesthesia. The response to pinprick testing and subjective soft tissue signs of numbness determined the onset and duration of anaesthesia. Intensity of anaesthesia was evaluated by a 100-mm visual analog scale (VAS) and eight-point verbal rating scale (VRS). The total number of pain medication doses taken, and the number of patients reporting no pain medication requirements were also recorded. Results: The obtained results showed that there were no significant differences with regard to onset (70±9 s, 63±11 s), duration (98±8 min, 102±12 min) and intensity (5.6±2.7 mmVAS, 1.8±0.5 mmVAS) of infiltration anaesthesia produced by lidocaine with clonidine and lidocaine with adrenaline, respectively. Our results also showed that maxillary infiltration anaesthesia was followed by similar need of analgesics for reduction of postoperative pain regardless of the used anaesthetic solutions. Conclusion: Although clonidine does not offer advantages concerning local anaesthetic parameters of maxillary infiltration anaesthesia in comparison with adrenaline, it may be a useful adjunct to local anaesthetics in those patients in whom the administration of adrenaline is undesirable. ~
DENTAL PREPARATION FOR OOKP STAGE 1 SURGERY: A RETROSPECTIVE REVIEW OF CASES IN SINGAPORE
A.B.G. Tay. Department of Oral & Maxi//ofacia/ Surgery, National Dental
Centre, 5 Second Hospital Avenue, Singapore 168938, Singapore To determine the proportion of patients who have suitable teeth and cheek mucosa for OOKP (osteo-odonto-keratoprosthesis) surgery, referred to the National Dental Centre. Consecutive patients referred from