- Email: [email protected]
Preinjection refrigerant
100
were 2.6 times more likely to fail in smokers than nonsmokers, with an 87.3% survival rate for smokers after 5 and 10 years, and a 94.6% and 93.1% survival rate for nonsmokers after 5 and 10 years, respectively. All osteoporotic status groups showed the increased risk of failure with smoking.
Survival (%)
90 80 70 Nonsmoker Smoker
60 50 0
1
2
3
4
5
6
7
8
9
10
Years following implant placement
Fig 4.—Effect of smoking status on implant survival. (Courtesy of Holahan CM, Koka S, Kennel KA, et al: Effect of osteoporotic status on the survival of titanium dental implants. Int J Oral Maxillofac Implants 23:905-910, 2008.)
Discussion.—The risk of implant failure was not increased in patients diagnosed with osteoporosis or osteopenia compared to those with a normal BMD T-score. However, implant failure was much more likely among smokers than nonsmokers regardless of osteoporotic status. Thus having a diagnosis of osteoporosis or osteopenia should not be a contraindication to dental implant therapy.
Clinical Significance.—With our aging population, we are seeing more patients with systemic disorders who have come for dental rehabilitation. The effect of these systemic problems on dental implant therapy and other procedures is often unknown. The good news is that patients with osteoporosis or osteopenia appear to have no greater risk of implant failure than patients with normal BMD T-scores. Dental implant survival rates were 92.5% over 10 years. Smoking status is the determining factor, with an implant failure rate 2.6 times greater for smokers than nonsmokers. This effect was most evident in the first year after the implant was placed.
Results.—Of the 646 implants placed, 37 failed, with 35 caused either by failure to achieve osseointegration or loss of osseointegration. Two suffered implant fractures. The survival rates for 5 and 10 years were 93.8% and 92.5%, respectively. Forty-nine percent of the women were diagnosed as non-osteoporosis (normal BMD T-score), 29.7% with osteopenia, and 21.4% with osteoporosis. The numbers of implant failures in each group were 17, 10, and 10, respectively. Women diagnosed with osteoporosis or osteopenia showed no significant increase in the risk of developing implant failure than those considered non-osteoporotic (Fig 2). Arch location was not associated with any increased risk for implant failure. Sixteen failures occurred in the posterior mandible, four in the anterior mandible, nine in the anterior maxilla, and eight in the posterior maxilla.
Holahan CM, Koka S, Kennel KA, et al: Effect of osteoporotic status on the survival of titanium dental implants. Int J Oral Maxillofac Implants 23:905-910, 2008
Implant failure was negatively affected by active smoking status during implant placement (Fig 4). The implants
Reprints available from S Koka, 200 First St SW, Rochester, MN 55905; fax: þ507 284 8082; e-mail: [email protected]
Local Anesthetic Preinjection refrigerant Background.—Injection pain is a barrier to seeking dental care cited by many prospective patients. Various methods are used to minimize the pain of injections, such as topical anesthetics, vibration, pressure, and mechanical delivery systems. The use of a refrigerant such as ice and a refrigerant spray has been utilized (Fig.) but is not routine practice. The effectiveness of a refrigerant
128
Dental Abstracts
in reducing injection pain before dental procedures was investigated. Methods.—The refrigerant or a topical anesthetic gel was used alternately during a posterior palatal anesthetic injection given before a full-mouth scaling and root planing or routine operative treatment. The 16 participants
Results.—Nine participants received the refrigerant first and seven the topical anesthetic gel first. The mean VAS distance was 17.7 mm for the refrigerant group and 26.2 mm for the topical anesthetic gel group. Thus use of the refrigerant reduced the pain of the local anesthetic injection significantly more than use of the gel. Discussion.—Compared to the topical anesthetic gel, use of the refrigerant was more effective against the pain of a posterior palatal injection.
Fig.—A cotton-tipped applicator soaked in refrigerant spray is placed on palatal tissue for 5 seconds as a maxillary palatal injection of local anesthetic solution is administered. (Courtesy of Kosaraju A, Vandewalle KS: A comparison of a refrigerant and a topical anesthetic gel as preinjection anesthetics: A clinical evaluation. J Am Dent Assoc 140:68-72, 2009.)
had a 5-second application of 1,1,1,3,3-pentafluoropropane/1,1,1,2-tetrafluoroethane refrigerant or a 2-minute application of 20% benzocaine gel. The local anesthetic solution was then administered using a 30-gauge needle. A 100-mm visual analog scale (VAS) was used by the patients to record the degree of pain experienced after each injection. The scale ranged from ‘‘no pain’’ to ‘‘worst possible pain.’’ VAS scores were assessed by measuring the distance in millimeters from the ‘‘no pain’’ end of the scale and performing statistical analysis.
Clinical Significance.—Topical anesthetics are widely used to prepare injection sites and minimize the patient’s pain. However, it requires at least 2 minutes to administer the anesthetic, the taste is unpleasant, and the anesthesia spreads well beyond the injection site. A refrigerant offers the advantages of minimal time for application, ease of use, no associated bad taste, and effective reduction of pain. It seems like a good alternative.
Kosaraju A, Vandewalle KS: A comparison of a refrigerant and a topical anesthetic gel as preinjection anesthetics: A clinical evaluation. J Am Dent Assoc 140:68-72, 2009 Reprints available from A Kosaraju, Advanced Education in General Dentistry Residency, 579 DS/SGD, 238 Brookley Ave, Bolling Air Force Base, Washington, DC 20332; e-mail: [email protected]
Inferior dental nerve block complication Background.—Complications rarely accompany local anesthetic use for dental procedures. Local complications may involve direct nerve damage, with paresthesia, trismus, hematoma formation, or needle breakage. Systemic complications usually result from toxicity after excessive administration or from allergy. A complication related to the infra-orbital nerve was reported while an inferior dental block (IDB) was being administered. Case Report.—Man, 44, came for removal of a mandibular right third molar. No abnormal anatomy was depicted on the dental panoramic tomogram in the lingual area. The IDB was to be administered using an aspirating syringe with a 27-gauge long needle. The needle was advanced to the injection site and aspiration was performed. The patient
experienced an immediate sharp shooting pain over the area of the right infra-orbital nerve and the side of the tongue. Within 3 to 4 seconds, the patient’s skin over the distribution of the right infra-orbital nerve became quite pale and the patient reported profound anesthesia (Fig 1) there and along the right side of his tongue. Some pallor was also noted over the mucosa of the hard and soft palate. The needle had been withdrawn, but the injection was carried out a few minutes later. The local anesthetic took effect and the designated tooth was removed without further complication. The patient’s symptoms resolved within about 30 minutes. Discussion.—The patient’s reaction is difficult to explain, especially in the absence of any local anesthetic
Volume 54
Issue 3
2009
129
were 2.6 times more likely to fail in smokers than nonsmokers, with an 87.3% survival rate for smokers after 5 and 10 years, and a 94.6% and 93.1% survival rate for nonsmokers after 5 and 10 years, respectively. All osteoporotic status groups showed the increased risk of failure with smoking.
Survival (%)
90 80 70 Nonsmoker Smoker
60 50 0
1
2
3
4
5
6
7
8
9
10
Years following implant placement
Fig 4.—Effect of smoking status on implant survival. (Courtesy of Holahan CM, Koka S, Kennel KA, et al: Effect of osteoporotic status on the survival of titanium dental implants. Int J Oral Maxillofac Implants 23:905-910, 2008.)
Discussion.—The risk of implant failure was not increased in patients diagnosed with osteoporosis or osteopenia compared to those with a normal BMD T-score. However, implant failure was much more likely among smokers than nonsmokers regardless of osteoporotic status. Thus having a diagnosis of osteoporosis or osteopenia should not be a contraindication to dental implant therapy.
Clinical Significance.—With our aging population, we are seeing more patients with systemic disorders who have come for dental rehabilitation. The effect of these systemic problems on dental implant therapy and other procedures is often unknown. The good news is that patients with osteoporosis or osteopenia appear to have no greater risk of implant failure than patients with normal BMD T-scores. Dental implant survival rates were 92.5% over 10 years. Smoking status is the determining factor, with an implant failure rate 2.6 times greater for smokers than nonsmokers. This effect was most evident in the first year after the implant was placed.
Results.—Of the 646 implants placed, 37 failed, with 35 caused either by failure to achieve osseointegration or loss of osseointegration. Two suffered implant fractures. The survival rates for 5 and 10 years were 93.8% and 92.5%, respectively. Forty-nine percent of the women were diagnosed as non-osteoporosis (normal BMD T-score), 29.7% with osteopenia, and 21.4% with osteoporosis. The numbers of implant failures in each group were 17, 10, and 10, respectively. Women diagnosed with osteoporosis or osteopenia showed no significant increase in the risk of developing implant failure than those considered non-osteoporotic (Fig 2). Arch location was not associated with any increased risk for implant failure. Sixteen failures occurred in the posterior mandible, four in the anterior mandible, nine in the anterior maxilla, and eight in the posterior maxilla.
Holahan CM, Koka S, Kennel KA, et al: Effect of osteoporotic status on the survival of titanium dental implants. Int J Oral Maxillofac Implants 23:905-910, 2008
Implant failure was negatively affected by active smoking status during implant placement (Fig 4). The implants
Reprints available from S Koka, 200 First St SW, Rochester, MN 55905; fax: þ507 284 8082; e-mail: [email protected]
Local Anesthetic Preinjection refrigerant Background.—Injection pain is a barrier to seeking dental care cited by many prospective patients. Various methods are used to minimize the pain of injections, such as topical anesthetics, vibration, pressure, and mechanical delivery systems. The use of a refrigerant such as ice and a refrigerant spray has been utilized (Fig.) but is not routine practice. The effectiveness of a refrigerant
128
Dental Abstracts
in reducing injection pain before dental procedures was investigated. Methods.—The refrigerant or a topical anesthetic gel was used alternately during a posterior palatal anesthetic injection given before a full-mouth scaling and root planing or routine operative treatment. The 16 participants
Results.—Nine participants received the refrigerant first and seven the topical anesthetic gel first. The mean VAS distance was 17.7 mm for the refrigerant group and 26.2 mm for the topical anesthetic gel group. Thus use of the refrigerant reduced the pain of the local anesthetic injection significantly more than use of the gel. Discussion.—Compared to the topical anesthetic gel, use of the refrigerant was more effective against the pain of a posterior palatal injection.
Fig.—A cotton-tipped applicator soaked in refrigerant spray is placed on palatal tissue for 5 seconds as a maxillary palatal injection of local anesthetic solution is administered. (Courtesy of Kosaraju A, Vandewalle KS: A comparison of a refrigerant and a topical anesthetic gel as preinjection anesthetics: A clinical evaluation. J Am Dent Assoc 140:68-72, 2009.)
had a 5-second application of 1,1,1,3,3-pentafluoropropane/1,1,1,2-tetrafluoroethane refrigerant or a 2-minute application of 20% benzocaine gel. The local anesthetic solution was then administered using a 30-gauge needle. A 100-mm visual analog scale (VAS) was used by the patients to record the degree of pain experienced after each injection. The scale ranged from ‘‘no pain’’ to ‘‘worst possible pain.’’ VAS scores were assessed by measuring the distance in millimeters from the ‘‘no pain’’ end of the scale and performing statistical analysis.
Clinical Significance.—Topical anesthetics are widely used to prepare injection sites and minimize the patient’s pain. However, it requires at least 2 minutes to administer the anesthetic, the taste is unpleasant, and the anesthesia spreads well beyond the injection site. A refrigerant offers the advantages of minimal time for application, ease of use, no associated bad taste, and effective reduction of pain. It seems like a good alternative.
Kosaraju A, Vandewalle KS: A comparison of a refrigerant and a topical anesthetic gel as preinjection anesthetics: A clinical evaluation. J Am Dent Assoc 140:68-72, 2009 Reprints available from A Kosaraju, Advanced Education in General Dentistry Residency, 579 DS/SGD, 238 Brookley Ave, Bolling Air Force Base, Washington, DC 20332; e-mail: [email protected]
Inferior dental nerve block complication Background.—Complications rarely accompany local anesthetic use for dental procedures. Local complications may involve direct nerve damage, with paresthesia, trismus, hematoma formation, or needle breakage. Systemic complications usually result from toxicity after excessive administration or from allergy. A complication related to the infra-orbital nerve was reported while an inferior dental block (IDB) was being administered. Case Report.—Man, 44, came for removal of a mandibular right third molar. No abnormal anatomy was depicted on the dental panoramic tomogram in the lingual area. The IDB was to be administered using an aspirating syringe with a 27-gauge long needle. The needle was advanced to the injection site and aspiration was performed. The patient
experienced an immediate sharp shooting pain over the area of the right infra-orbital nerve and the side of the tongue. Within 3 to 4 seconds, the patient’s skin over the distribution of the right infra-orbital nerve became quite pale and the patient reported profound anesthesia (Fig 1) there and along the right side of his tongue. Some pallor was also noted over the mucosa of the hard and soft palate. The needle had been withdrawn, but the injection was carried out a few minutes later. The local anesthetic took effect and the designated tooth was removed without further complication. The patient’s symptoms resolved within about 30 minutes. Discussion.—The patient’s reaction is difficult to explain, especially in the absence of any local anesthetic
Volume 54
Issue 3
2009
129