Characteristics and management of dental implants displaced into the maxillary sinus: a systematic review.

The displacement of dental implants into the maxillary sinus is increasingly reported and may lead to serious complications. Better knowledge of this condition could help clinicians improve their practice, but it is difficult to draw conclusions from the current literature. Therefore, a systematic review was performed to describe the main characteristics of dental implant displacement, as well as its management and temporal evolution over a 31-year period. This review was conducted according to the PRISMA methodology. The PubMed/Scopus electronic databases were searched to December 2021. Risk of bias was assessed using the Joanna Briggs Institute tools. A total of 73 articles reporting 321 patients with displaced dental implants were included. Implants located in the upper first molar site were the most frequently involved (23.7%). Displacement occurred mainly during the first 6 months after implant placement (62.6%). The majority became symptomatic (56.2%), most often due to maxillary sinusitis and/or oroantral communication (44.2%). The surgical approaches to remove displaced implants were the lateral approach (38.1%), the Caldwell-Luc approach (27.2%), and endoscopic nasal surgery (23.1%). This review highlights the importance of preventive measures: avoiding implant displacement by careful pre-implantation radiographic analysis, but also preventing infectious complications through early removal of the displaced implant (PROSPERO CRD42021279473).

Impact of cone-beam computed tomography for the identification and management of an oral portal of entry in patients with infective endocarditis. A Delphi study.

BACKGROUND: Infective endocarditis (IE) is a rare and life-threatening disease. Cutaneous portal of entry (POE) is predominant for IE, but an oral POE is the second most frequent source. Thus looking for and treating an oral POE in IE patients is of critical importance in order to reduce the risk of IE relapse or recurrence. The objectives of this study were: 1) To reach a consensus on decision-making following the detection of an oral POE on cone-beam computed tomography (CBCT) while they were not identified using the current recommended approach in IE patients (oral examination and orthopantomogram: OPT). 2) To determine whether this consensus differs when regarding the microbiology of IE. MATERIAL AND METHODS: Twenty oral or maxillofacial surgeons participated to this Delphi study. The questionnaire was based on five radiological cases (OPT and matching CBCT) with two scenarios according to the objectives of detecting oral POE in an IE patient (curative in case of oral causative microorganism, and preventive if not) and different therapeutic approaches (surgical or conservative treatment, no treatment) for each of them. Consensus was defined as an agreement rate of ≥75%. RESULTS: The response rate was≥85%. After four rounds, consensus was achieved for all proposals. CBCT changed the decision-making of experts in four cases. In one case, the decision was influenced by the IE microbiology toward a more radical approach in case of oral causative microorganism. CONCLUSIONS: In IE patients, CBCT changed markedly the decision-making of experts by eradicating more oral POE than when using OPT. This could reduce the risk of IE relapse and recurrence.

Anaphylactic reactions to local anesthetics in dental practice: a nationwide French retrospective study.

OBJECTIVES: The primary aims of the present study were (1) to quantify and characterize anaphylactic type I reactions related to local anesthetics (LAs) drawing on the French Pharmacovigilance Database System over a 35-year period and (2) to focuse on reactions associated with dental procedures. The secondary aim was to infer an incidence rate in dental practice. MATERIALS AND METHODS: All cases of anaphylactic reactions were selected using the algorithmic Standardized MeDRA Query "anaphylactic reaction." For each reaction, comprehensive data were collected, in particular the severity of symptoms, risk factors for anaphylaxis, and allergy testing. Imputability was assessed and a crude incidence rate in dental practice was estimated. RESULTS: The first-line search identified 416 anaphylactic reactions, mostly of grade II (138) or III (240) severity. When restricted to dental practice, this number fell to 26 (grade I: 4; grade II: 10; grade III: 11; and grade IV: 1). Lidocaine was most often involved (81.49%) and mostly associated with anaphylactic reactions of grade II and III. Overall, 11 cases of fatal anaphylaxis were recorded, but no in dental practice. In dental practice, lidocaine was also the most frequently involved LA (57.69%). CONCLUSIONS: All these findings highlight the very low incidence of type I-IgE-mediated reactions to LA, particularly in dental practice. The incidence rate of LA anaphylctic episodes in dental practice was estimated as 0.0261 anaphylactic episodes per million LA cartridges. CLINICAL RELEVANCE: True anaphylactic reactions to LAs do occur and may justify a thorough investigation in dental practice.

Evolution of the acceleration field and a reformulation of the sweeping decorrelation hypothesis in two-dimensional turbulence.

From simulations of two-dimensional inverse energy cascading turbulence, we show that points with low acceleration values are predominantly advected by the local fluid velocity. The fluid velocity u in the global frame and the fluid velocity u in the frame moving with a low-acceleration point are approximately statistically independent. This property remains valid in high-acceleration regions but only in the direction of the local acceleration vector. In the perpendicular direction, the acceleration velocity V_a=u-xi is approximately independent of xi everywhere. These statistical independences constitute our formulation of the sweeping decorrelation hypothesis for two-dimensional inverse energy cascading turbulence.

Linearized impulse wave propagating down a vertical column of heavy particles.

A granular column is subjected to a small amplitude impact on its top. For a generalized power-law contact force between neighboring grains, numerical simulations show that the propagation of the impulse wave is controlled by dispersion. This leads quantitatively to a power-law decrease of the amplitude of the wave with depth. We find numerically the dependence of this power-law exponent on the force-law exponent. An analytic expression for the decrease is then derived from a long-wave approximation.