- Email: [email protected]
Poster 38: Survey of General Dentist and Oral and Maxillofacial Surgeon Warfarin Protocol for Tooth Extractions
Scientific Poster Session with the ability to sleep through the night, lifestyle improvement, and daytime sleepiness. The patients rated the questions on a scale from 0-8. In addition, a retrospective chart review was performed which measured preoperative and postoperative respiratory disturbance indices (RDI) and Epworth Sleep Scales (ESS). Method of Data Analysis: A mean was taken to compress all data, a t-test and ANOVA were employed, with a p-value less than 0.05 to be statistically significant. Results: Pre- versus postoperative ESS for phase I patients was 12.96 and 7.56. Pre- versus postoperative ESS for phase II patients was 16.29 and 5.47. Pre- versus postoperative RDI for phase I was 38.83 and 18.7. Preversus postoperative RDI for phase II was 67.27 and 10.46. Also, improvement average for phase II versus phase I was 5.80 and 4.16. Satisfaction average for phase II versus phase I was 5.75 and 5.0, p-value .258, not statistically significant. Conclusion: Reduction in the RDI to a value of less than or equal to 10, or of 50% or greater of the original is considered a success. In addition, a ESS value of less than 11 was considered successful. According to this criteria, phase I was 61% (RDI) and 74% (ESS) successful. Also, phase II was 100% (RDI) and 94% (ESS) successful. Overall, both phase I and phase II surgeries have shown increased improvement and satisfaction average, with phase II surgery showing higher averages when compared to phase I. References Dattilo D, Drooger S. “Outcome assessment of patients undergoing maxillofacial procedures for the treatment of sleep apnea: comparison of subjective and objective results. J Oral Maxillofac Surg. 2004;62: 164-168 Prinsell JR. “Maxillomandibular advancement surgery in site-specific treatment approach for obstructive sleep apnea 50 consecutive patients. Chest. 1999;116:1519-1524
Materials and Methods: Nasopharyngoscopy is routinely used to examine the airway before and approximately 4-6 weeks after maxillomandibular advancement. Photographs are taken to document changes in the nasal airway. The photographs of 8 patients status post maxillary and mandibular advancement were used to evaluate the nasal airway for ozena, nasal crusting, perforation, and septal deviation. Method of Data Analysis: A nasopharyngoscopy form was created to evaluate the nasal airway and septum for ozena, nasal crusting, perforation, and septal deviation. Nasopharyngoscopy photographs for 8 cases were reviewed and preoperative and postoperative forms were completed. Results: The mean age of patients is 54 years with a range of 35-74 years. The mean time to post-operative nasopharyngoscopy was 40 days with a range of 27-50 days. At post-operative nasopharyngoscopy, 25% of patients had nasal crusting and 62.5% of patients had a septal perforation; 83.3% of patients with septal deviation prior to surgery were corrected during surgery. No patients demonstrated post-operative ozena. Conclusion: A greater incidence of change in the nasal airway was shown than previously anticipated. A substantial change in the nasal airway was not expected, yet this limited study shows otherwise. Further research is necessary to determine whether the demonstrated septal perforations will close and whether the nasal crusting will resolve. References Lehotay, Göde U, Wigand ME, Neukam FW. Nasal airway changes M. Erbe, M. after Le Fort I—impaction and advancement: anatomical and functional findings. Int J Oral Maxillofac Surg. 2001;30:123–129 Smith K, Heggie A. Vomero-sphenoidal disarticulation during the Le Fort I maxillary osteotomy. Journal of Oral and Maxillofacial Surgery. 1995;53:465-467
POSTER 37 Evaluation of the Nasal Airway and Septum Before and After Le Fort I Osteotomy Rakesh Shah, MD, DMD, Birmingham, AL (Waite P) Statement of the Problem: Little research has been done to examine the nasal septum after separation from the maxillary crest during Le Fort I procedures. Disruption of the interface between the nasal septum and the maxillary crest can permanently change the nasal anatomy. The changes in the nasal airway could potentially cause ozena, nasal crusting, perforation, or septal deviation. The project was designed to evaluate changes of the nasal airway before and after Le Fort I osteotomy for maxillomandibular advancement in patients with obstructive sleep apnea. 90
POSTER 38 Survey of General Dentist and Oral and Maxillofacial Surgeon Warfarin Protocol for Tooth Extractions Ryan D. Morris, DDS, Iowa City, IA (Morris R; Synan W; Morgan T; Zeitler D; Qian F; Damiano P) Statement of the Problem: Perioperative bleeding risk must be weighed against the risks of thromboembolic events when warfarin anticoagulant therapy discontinuation is considered. Dentists and dental specialists may not be aware of the protocols recommended by current literature that discourage discontinuation of warfarin prior to dental treatment as patients may be placed at unnecessary medical risk. AAOMS • 2009
Scientific Poster Session Materials and Methods: Data was collected by mailed survey. The survey was sent to 1,320 general dentists and 662 oral surgeons across the United States. The number of surveys sent to each state was proportional to state population and a random mail list was prepared by the American Dental Association. Method of Data Analysis: Sample size was 522, a response rate of 26.3%. SAS software was used for data analysis. The chi-square tests, Cochrane-Mantel-Haenszel chi-square tests, and Fisher’s exact tests were conducted to determine whether significant differencs existed in responses for questions of managing patients taking warfarin between two areas of practice. Results: 84% of respondents were males; the average age was 47.8. 46.2% of respondents were general dentists (n⫽241). Age and gender were not significantly related to how general dentists and oral surgeons managed warfarin patients. Among those who routinely interrupted warfarin therapy, there was no statistically significant difference between general dentists and oral surgeons in regard to the number of days of warfarin interruption prior to tooth extraction procedures. Oral surgeons were more likely to perform tooth extractions for patients taking warfarin on a regular basis (within the last week) and were more likely to perform surgical tooth extractions requiring removal of bone. Oral surgeons were also more likely to check level of anticoagulation on the day of the procedure. Oral surgeons were significantly less likely to ask patients to stop taking warfarin prior to tooth extractions than general dentists. Conclusion: Oral surgeons were more likely to comply with current recommendations, however increased awareness is needed among all dental professionals about the risks of warfarin discontinuation prior to tooth extraction.
Lee H. Akin, DDS, Loma Linda, CA (Herford AS)
for surgery involving a secondary autogenous donor site. The purpose of this investigation was to study the clinical results and desirability of utilizing the Mucograft collagen membrane as a substitute for soft tissue autografts in patients restored by conventional prosthesis and/or implants. Materials and Methods: A single centered clinical study of patients presenting with areas of deficient attached mucosa and/or deficient vestibular depth. Mucograft is a bilayer porcine structure having a compact layer—facing the oral cavity— consisting of compact collagen to fulfill the cell occlusive properties and allow tissue adherence and marginal adaptation as a prerequisite for favorable wound healing. This layer has a smooth texture with appropriate elastic properties to accommodate suturing to the host mucosal margins. The second layer consists of a thick porous collagen spongy structure to allow tissue integration. This roughened surface is placed next to the host tissue to facilitate organization of the blood clot and promote neoangiogenesis. Method of Data Analysis: Twenty patients underwent soft-tissue grafting of various oral defects. The size of the regenerated area and the degree of scarring which might reduce the area was determined by leaving half of the monofilament sutures in place for a period of 4-6 weeks. The sutures served as a marker for measurement of the regenerated area. Results: The primary efficacy parameters evaluated were the degree of lateral and/or alveolar extension and the evaluation of re-epithelialization and shrinkage of the grafted area. Overall the percentage of shrinkage of the graft was 14% (range 5 to 20%). The amount of soft tissue extension averaged 3.4 mm (range 2 mm to 10 mm). The secondary efficacy parameters included hemostatic effect, pain evaluation, medication used to control pain and discomfort and clinical evaluation of the grafted site. All patients reported minimal pain and swelling associated with the grafted area. No infections were noted. Conclusion: The porcine collagen membrane Mucograft provides a biocompatible surgical material as an alternative to an autogenous transplant with respect to wound contraction, re-establishment of lateral mucosal width and height and increasing the surrounding zone of keratinized and non-keratinized gingiva, and other criteria, thus obviating the need to harvest soft tissue autogenous grafts from other areas of the oral cavity.
Statement of the Problem: Insufficient attached, keratinized gingiva is a frequently occurring clinical soft tissue grafting indication. Treatment options involve autografts, xenogenic, or allogenic materials with each having advantages and disadvantages. Principally the graft should prevent contracture, and eliminate the need
Fröschl T, Kerscher A. The optimal vestibuloplasty in preprosthetic surgery of the mandible. J Craniomaxillofac Surg. 1997;25:85-90 Gregory EW, Triplett RG, Connole PW. Comparisons of fresh autogenous and freeze-dried skin for mandibular vestibuloplasty. J Oral Maxillo Surg. 1983;41:75-79
References Wahl MJ. Myths of dental surgery in patients receiving anticoagulant therapy. JADA. 2000;131:77-81 Jeske AH, Suchko GD. Lack of a scientific basis for routine discontinuation of oral anticoagulation therapy before dental treatment. JADA. 2003;134:1492-7
POSTER 39 Use of a New Porcine Surgical Membrane as a Substitute for Free Mucosal Grafts in Preprosthetic Surgery
AAOMS • 2009
References
91
Materials and Methods: Nasopharyngoscopy is routinely used to examine the airway before and approximately 4-6 weeks after maxillomandibular advancement. Photographs are taken to document changes in the nasal airway. The photographs of 8 patients status post maxillary and mandibular advancement were used to evaluate the nasal airway for ozena, nasal crusting, perforation, and septal deviation. Method of Data Analysis: A nasopharyngoscopy form was created to evaluate the nasal airway and septum for ozena, nasal crusting, perforation, and septal deviation. Nasopharyngoscopy photographs for 8 cases were reviewed and preoperative and postoperative forms were completed. Results: The mean age of patients is 54 years with a range of 35-74 years. The mean time to post-operative nasopharyngoscopy was 40 days with a range of 27-50 days. At post-operative nasopharyngoscopy, 25% of patients had nasal crusting and 62.5% of patients had a septal perforation; 83.3% of patients with septal deviation prior to surgery were corrected during surgery. No patients demonstrated post-operative ozena. Conclusion: A greater incidence of change in the nasal airway was shown than previously anticipated. A substantial change in the nasal airway was not expected, yet this limited study shows otherwise. Further research is necessary to determine whether the demonstrated septal perforations will close and whether the nasal crusting will resolve. References Lehotay, Göde U, Wigand ME, Neukam FW. Nasal airway changes M. Erbe, M. after Le Fort I—impaction and advancement: anatomical and functional findings. Int J Oral Maxillofac Surg. 2001;30:123–129 Smith K, Heggie A. Vomero-sphenoidal disarticulation during the Le Fort I maxillary osteotomy. Journal of Oral and Maxillofacial Surgery. 1995;53:465-467
POSTER 37 Evaluation of the Nasal Airway and Septum Before and After Le Fort I Osteotomy Rakesh Shah, MD, DMD, Birmingham, AL (Waite P) Statement of the Problem: Little research has been done to examine the nasal septum after separation from the maxillary crest during Le Fort I procedures. Disruption of the interface between the nasal septum and the maxillary crest can permanently change the nasal anatomy. The changes in the nasal airway could potentially cause ozena, nasal crusting, perforation, or septal deviation. The project was designed to evaluate changes of the nasal airway before and after Le Fort I osteotomy for maxillomandibular advancement in patients with obstructive sleep apnea. 90
POSTER 38 Survey of General Dentist and Oral and Maxillofacial Surgeon Warfarin Protocol for Tooth Extractions Ryan D. Morris, DDS, Iowa City, IA (Morris R; Synan W; Morgan T; Zeitler D; Qian F; Damiano P) Statement of the Problem: Perioperative bleeding risk must be weighed against the risks of thromboembolic events when warfarin anticoagulant therapy discontinuation is considered. Dentists and dental specialists may not be aware of the protocols recommended by current literature that discourage discontinuation of warfarin prior to dental treatment as patients may be placed at unnecessary medical risk. AAOMS • 2009
Scientific Poster Session Materials and Methods: Data was collected by mailed survey. The survey was sent to 1,320 general dentists and 662 oral surgeons across the United States. The number of surveys sent to each state was proportional to state population and a random mail list was prepared by the American Dental Association. Method of Data Analysis: Sample size was 522, a response rate of 26.3%. SAS software was used for data analysis. The chi-square tests, Cochrane-Mantel-Haenszel chi-square tests, and Fisher’s exact tests were conducted to determine whether significant differencs existed in responses for questions of managing patients taking warfarin between two areas of practice. Results: 84% of respondents were males; the average age was 47.8. 46.2% of respondents were general dentists (n⫽241). Age and gender were not significantly related to how general dentists and oral surgeons managed warfarin patients. Among those who routinely interrupted warfarin therapy, there was no statistically significant difference between general dentists and oral surgeons in regard to the number of days of warfarin interruption prior to tooth extraction procedures. Oral surgeons were more likely to perform tooth extractions for patients taking warfarin on a regular basis (within the last week) and were more likely to perform surgical tooth extractions requiring removal of bone. Oral surgeons were also more likely to check level of anticoagulation on the day of the procedure. Oral surgeons were significantly less likely to ask patients to stop taking warfarin prior to tooth extractions than general dentists. Conclusion: Oral surgeons were more likely to comply with current recommendations, however increased awareness is needed among all dental professionals about the risks of warfarin discontinuation prior to tooth extraction.
Lee H. Akin, DDS, Loma Linda, CA (Herford AS)
for surgery involving a secondary autogenous donor site. The purpose of this investigation was to study the clinical results and desirability of utilizing the Mucograft collagen membrane as a substitute for soft tissue autografts in patients restored by conventional prosthesis and/or implants. Materials and Methods: A single centered clinical study of patients presenting with areas of deficient attached mucosa and/or deficient vestibular depth. Mucograft is a bilayer porcine structure having a compact layer—facing the oral cavity— consisting of compact collagen to fulfill the cell occlusive properties and allow tissue adherence and marginal adaptation as a prerequisite for favorable wound healing. This layer has a smooth texture with appropriate elastic properties to accommodate suturing to the host mucosal margins. The second layer consists of a thick porous collagen spongy structure to allow tissue integration. This roughened surface is placed next to the host tissue to facilitate organization of the blood clot and promote neoangiogenesis. Method of Data Analysis: Twenty patients underwent soft-tissue grafting of various oral defects. The size of the regenerated area and the degree of scarring which might reduce the area was determined by leaving half of the monofilament sutures in place for a period of 4-6 weeks. The sutures served as a marker for measurement of the regenerated area. Results: The primary efficacy parameters evaluated were the degree of lateral and/or alveolar extension and the evaluation of re-epithelialization and shrinkage of the grafted area. Overall the percentage of shrinkage of the graft was 14% (range 5 to 20%). The amount of soft tissue extension averaged 3.4 mm (range 2 mm to 10 mm). The secondary efficacy parameters included hemostatic effect, pain evaluation, medication used to control pain and discomfort and clinical evaluation of the grafted site. All patients reported minimal pain and swelling associated with the grafted area. No infections were noted. Conclusion: The porcine collagen membrane Mucograft provides a biocompatible surgical material as an alternative to an autogenous transplant with respect to wound contraction, re-establishment of lateral mucosal width and height and increasing the surrounding zone of keratinized and non-keratinized gingiva, and other criteria, thus obviating the need to harvest soft tissue autogenous grafts from other areas of the oral cavity.
Statement of the Problem: Insufficient attached, keratinized gingiva is a frequently occurring clinical soft tissue grafting indication. Treatment options involve autografts, xenogenic, or allogenic materials with each having advantages and disadvantages. Principally the graft should prevent contracture, and eliminate the need
Fröschl T, Kerscher A. The optimal vestibuloplasty in preprosthetic surgery of the mandible. J Craniomaxillofac Surg. 1997;25:85-90 Gregory EW, Triplett RG, Connole PW. Comparisons of fresh autogenous and freeze-dried skin for mandibular vestibuloplasty. J Oral Maxillo Surg. 1983;41:75-79
References Wahl MJ. Myths of dental surgery in patients receiving anticoagulant therapy. JADA. 2000;131:77-81 Jeske AH, Suchko GD. Lack of a scientific basis for routine discontinuation of oral anticoagulation therapy before dental treatment. JADA. 2003;134:1492-7
POSTER 39 Use of a New Porcine Surgical Membrane as a Substitute for Free Mucosal Grafts in Preprosthetic Surgery
AAOMS • 2009
References
91