Efficacy and safety of 1% ropivacaine for postoperative analgesia after lower third molar surgery: a prospective, randomized, double-blinded clinical study.

OBJECTIVES: The purpose of this study was to investigate postoperative analgesic effect of ropivacaine administered as main or supplemental injection for the inferior alveolar nerve block (IANB) in patients undergoing lower third molar surgery. MATERIALS AND METHODS: The double-blind randomized study comprised 72 healthy patients. All patients received two blocks, the IANB for surgical procedure + IANB after surgery for postoperative pain control, and were divided into three groups: (1) 2 % lidocaine/epinephrine + 1 % ropivacaine, (2) 2 % lidocaine/epinephrine + saline, and (3) 1 % ropivacaine + saline. The occurrence of postoperative pain, pain intensity and analgesic requirements were recorded. Data were statistically analyzed using chi-square, Fisher, and Kruskal-Wallis tests and analysis of variance (ANOVA) with Bonferroni and Tukey correction. RESULTS: Ropivacaine was more successful than lidocaine/epinephrine in obtaining duration of postoperative analgesia, reduction of pain, and analgesic requirements whether ropivacaine was used for surgical block or administered as a supplemental injection after surgery. CONCLUSIONS: Ropivacaine (1 %, 2 ml) resulted in effective postoperative analgesia after lower third molar surgery. CLINICAL RELEVANCE: Since pain control related to third molar surgery requires the effective surgical anesthesia and postoperative analgesia, the use of 1 % ropivacaine could be clinically relevant in a selection of appropriate pain control regimen for both surgical procedure and early postsurgical treatment.

Gene-expression analysis of matrix metalloproteinases 1 and 2 and their tissue inhibitors in chronic periapical inflammatory lesions.

BACKGROUND: Periapical inflammatory lesions have been investigated previously, but understanding of pathogenesis of these lesions (granulomas and radicular cysts) at the molecular level is still questionable. Matrix metalloproteinases (MMPs) are enzymes involved in the development of periapical pathology, specifically inflammation and tissue destruction. To elucidate pathogenesis of periapical granulomas and radicular cysts, we undertook a detailed analysis of gene expression of MMP-1, MMP-2 and their tissue inhibitors, TIMP-1 and TIMP-2. METHODS: A total of 149 samples were analyzed using real-time PCR (59 radicular cysts, 50 periapical granulomas and 40 healthy gingiva samples as controls) for expression of MMP-1, MMP-2, TIMP-1 and TIMP-2 genes. The determination of best reference gene for expression analysis of periapical lesions was done using a panel of 12 genes. RESULTS: We have shown that ß-actin and GAPDH are not the most stable reference controls for gene expression analysis of inflammatory periapical tissues and healthy gingiva. The most suitable reference gene was determined to be SDHA (a succinate dehydrogenase complex, subunit A, flavoprotein [Fp]). We found that granulomas (n = 50) and radicular cysts (n = 59) exhibited significantly higher expression of all four examined genes, MMP-1, MMP-2, TIMP-1, and TIMP-2, when compared to healthy gingiva (n = 40; P < 0.05). CONCLUSION: This study has confirmed that the expression of MMP-1, MMP-2, TIMP-1, and TIMP-2 genes is important for the pathogenesis of periapical inflammatory lesions. Since the abovementioned markers were not differentially expressed in periapical granulomas and radicular cysts, the challenge of finding the genetic differences between the two lesions still remains.

Anterior and middle superior alveolar block is efficient for maxillary premolar teeth extractions regardless of the injection system or anesthetic with adrenaline used.

Introduction: The anterior and middle superior alveolar nerve block was claimed to be unpredictably efficient for clinical application. Objective: The aim of this report was to establish the efficacy of the anterior and middle superior alveolar nerve block, applied with a computer-controlled injection system or a conventional syringe, for upper premolars extraction. Methods: Sixty healthy adults were divided into two groups regarding the device used as follows: the first group was injected by a computer-controlled injection system, and the second group by a conventional syringe. Pain ratings were obtained via a visual analog scale (VAS) and a verbal rating scale (VRS). Results: Anterior and middle superior alveolar injection enabled a painless extraction in all patients, regardless of the local anesthetic or injection system used. It was slightly less painful when administered by a computer-controlled injection system, but insignificantly when evaluated by VRS. Conclusion: The anterior and middle superior alveolar nerve block may be recommended if maxillary permanent premolars have to be extracted.

Coronectomy of two neighbouring ankylosed mandibular teeth--a case report.

INTRODUCTION: Intentional partial odontectomy or coronectomy is primarily advocated in situations with intimate relationships between the roots of the tooth indicated for extraction and the inferior alveolar nerve (IAN). The aim of this report was to present a patient with two neighbouring infraoccluded teeth in the right mandible indicated for extraction prior to prosthetic rehabilitation, which were coronectomied as to prevent injuring of the IAN and causing iatrogenic fracture of the mandibular body. CASE REPORT: Coronectomy of both teeth was performed as recommended in the literature. The patient had no special discomfort after the operation or deficit in sensitive nerve function, and the wound healed uneventfully. The patient was followed regularly during a 2-year period. CONCLUSION: The presented case suggests coronectomy as quite beneficial solution for avoiding serious problems (injuring of the IAN and possible fracture of the mandible) and making feasible forthcoming prosthetic rehabilitation.

The influence of different radiopacifying agents on the radiopacity, compressive strength, setting time, and porosity of Portland cement.

OBJECTIVES: The aims of this study were to evaluate the radiopacity, compressive strength, setting time, and porosity of white Portland cement (PC) with the addition of bismuth oxide (Bi2O3), zirconium dioxide (ZrO2), and ytterbium trifluoride (YbF3) after immersion at 37 °C for 7 days in distilled water or phosphate buffer saline. MATERIALS AND METHODS: Specimens measuring 8 mm in diameter and 1 mm in thickness were fabricated from PC with the addition of 10, 20, and 30 wt% Bi2O3, ZrO2 or YbF3. ProRoot MTA (Dentsply, Tulsa, OK, USA) and pure PC were used as controls. For radiopacity assessments, specimens were radiographed alongside a tooth slices and an aluminum stepwedge on Extraspeed occlusal dental films (Insight Kodak, Rochester, New York). Mean optical density of each specimen was calculated and used to express radiopacity of the material as an equivalent thickness of aluminum. Compressive strength was measured by using 4-mm diameter and 6-mm high specimens and Universal testing machine. High-pressure mercury intrusion porosimeter (Carlo Erba Porosimeter 2000) was employed to measure the porosity of the specimens. The setting time was measured by using a needle of 100 g in weight. The morphology of specimens was evaluated using a scanning electron microscope (TESCAN Mira3 XMU, USA Inc.). Data were analyzed by one-way ANOVA and post hoc Tukey test (P < 0.05). RESULTS: The PC with the addition of at least 10 wt% Bi2O3 and 20 wt% ZrO2 or YbF3 demonstrated greater radiopacity value than the recommended 3 mmAl cut-off. ZrO2 and YbF3 increased the compressive strength of PC, but it was not statistically significant (P > 0.05), while Bi2O3 decreased it (P < 0.05). All radiopacifiers significantly increased the porosity of the experimental cements (P < 0.05). Bi2O3 extended the setting time of PC (P < 0.05), whilst ZrO2 and YbF3 did not significantly affect it (P > 0.05). CONCLUSIONS: ZrO2 and YbF3 may be used as a suitable alternative to replace Bi2O3 in MTA without influencing its physical properties.

A preliminary study on local administration of dexamethasone after tooth extraction--Better preservation of residual alveolar ridge?

BACKGROUND/AIM: It is important that the height of the edentulous alveolar ridge after tooth extraction remains at a reasonable acceptable level for as long as possible. The aim of this study was to report preliminary results of the clinical effect of local oral submucous administration of dexamethasone after tooth extractions in order to prepare alveolar supporting tissues for acceptance of removable dentures. METHODS: In a total of 15 patients (11 partially and 4 completely edentulous) the quantity of 0.25 mL to 0.5 mL of dexamethasone was injected bucally and orally in the region of the tooth socket after complicated extractions. RESULTS: Healing of extraction wounds was uneventful in all the patients, without pain or local inflammation. CONCLUSION: Dexamethasone can be locally applied to oral tissues to prevent post-extraction inflammation and extensive resorption of the residual alveolar ridge. The obtained results are promising for patients undergoing classic prosthodontic rehabilitation soon after tooth extraction, demonstrating that there are no adverse effects after local oral corticosteroids administration.

Safety of local anaesthesia in dental patients taking oral anticoagulants: is it still controversial?

The aim of this study was to investigate the safety of local infiltration techniques and the inferior alveolar nerve block (IANB) in dental patients taking oral anticoagulants. A total of 352 patients were given a total of 560 injections of local anaesthetic (119 IANB and 441 others). The study group comprised 279 patients with therapeutic international normalised ratios (INRs), and the control group 73 patients who were taking oral anticoagulants but had subtherapeutic INR on the day of operation. Blood was aspirated 7 times (7.3%) during the IANB in the study group. However, there were no clinical signs of prolonged haemorrhage into the medial pterygoid muscle or pterygomandibular space after 96 IANB, including those from whom blood had been aspirated. Only two minor haematomas developed after multiple infiltrations in the lingual sulci. The results suggest that bleeding as a result of the use of local anaesthesia in patients with therapeutic INR is unlikely, provided that the IANB is done correctly.

Preimplantation filling of tooth socket with beta-tricalcium phosphate/polylactic-polyglycolic acid (beta-TCP/PLGA) root analogue: clinical and histological analysis in a patient.

INTRODUCTION: Bone resorption is a physiological process after tooth extraction. The use of bone substitutes to fill the tooth socket is suggested to prevent bone resorption and establish good bone architecture for implant placement. A pure beta-tricalcium phosphate coated with copolymer (polylactic-polyglycolic acid) as a root analogue, is suitable for filling tooth sockets. CASE REPORT: We presented a patient successfully treated with root analogue after extraction of the right second lower premolar. Three months later, the patient was planned for the placement of six TE ITI dental implants into the mandible. During the sugery, the biopsy of bone-like tissue from the previously treated socket was taken. All the implants were immediately loaded due to good primary stability. Histological analysis of the specimen revealed fibrous healing in the area treated with root analogue. CONCLUSION: The use of beta-tricalcium phosphate coated with copolymers after tooth extraction enables satisfactory bone architecture for consequent implant treatment.

Functional endoscopic sinus surgery as an adjunctive treatment for closure of oroantral fistulae: a retrospective analysis.

OBJECTIVE: The objective of this study was to report results of functional endoscopic sinus surgery (FESS) for treatment of chronic maxillary sinusitis of dental origin in a series of patients with oroantral fistulae (OAF). STUDY DESIGN: Fourteen patients were treated by FESS and OAF closure by local flap. Data on severity of symptoms, diagnostic endoscopy, and coronal CT scan findings, as well as intraoperative course and complications, were recorded. The follow-up period lasted up to 2 years, comprising clinical examinations and control CT scans. RESULTS: All OAF healed uneventfully. All patients reported improvement in severity of sinusitis symptoms, which was confirmed through results of clinical examinations and control CT scans. No significant complications were recorded. No revision surgery was needed in any case. CONCLUSION: These results indicate that FESS, combined with OAF closure by buccal flap, might be an effective and safe option for treatment of selected cases of chronic odontogenic sinusitis with OAF.

Intraseptal vs. periodontal ligament anaesthesia for maxillary tooth extraction: quality of local anaesthesia and haemodynamic response.

There is no data concerning the use of the intraseptal anaesthesia (ISA) for single tooth extraction. The aims of this study were to compare the clinical efficacy and haemodynamic responses of the ISA with the periodontal ligament anaesthesia (PLA) for single tooth extraction. Thirty-five randomly selected healthy patients (ASA I) undergoing maxillary lateral incisors extraction entered the study. Onset of anaesthesia, the width of the anaesthetic field and duration of anaesthesia were recorded by pinprick testing. Intensity of anaesthesia was evaluated on a visual analogue scale. Haemodynamic parameters were recorded simultaneously at different time points after anaesthesia injection. The two techniques of local anaesthesia did not show statistically significant differences regarding the success rate and onset of anaesthesia, while the duration of the ISA on the buccal site was significantly longer in comparison with the PLA. The intensity of the achieved anaesthesia, estimated by the experienced pain during procedure, pointed out that pain was recorded in 24% of cases in the ISA group, and in 19% in the PLA group without significant differences. Postoperative pain was found to be smaller in the ISA group (70.9% of treated sites) than in the PLA group (81.3% of treated sites); however, this difference was not significant. Although the heart rate increased in both groups, there were no significant differences in the patients' haemodynamic response between the ISA and the PLA. The results of the present study indicate that both techniques are useful and suitable for the routine tooth extraction.

The closure of oroantral communications with resorbable PLGA-coated beta-TCP root analogs, hemostatic gauze, or buccal flaps: a prospective study.

OBJECTIVE: The aim of this study was to compare the treatment of oroantral communications (OACs) with bioresorbable root analogs made of poly(lactide-co-glycolide) (PLGA)-coated beta-tricalcium phosphate (beta-TCP), hemostatic gauze or a buccal flap technique. STUDY DESIGN: In this prospective clinical study, 30 patients with oroantral communications were randomly assigned to a treatment. Clinical success, vestibular depth at the defect site, pain, and swelling were monitored. RESULTS: The OAC closure was successful in all cases. The vestibular depth stayed constant in the groups treated with the PLGA-beta-TCP composite or hemostatic gauze. In contrast, a vestibular depth reduction of 1.2 +/- 0.2 mm was observed in the buccal flap group, indicating atrophy of the alveolar ridge in these patients. Furthermore, pain and swelling were more pronounced in this group. CONCLUSION: Closures of OACs with PLGA-beta-TCP composite or hemostatic gauze are reliable minimally invasive methods that minimize atrophy of the alveolar ridge, swelling, and pain compared with a buccal flap technique.

Postoperative analgesia after lower third molar surgery: contribution of the use of long-acting local anesthetics, low-power laser, and diclofenac.

OBJECTIVES: Postoperative pain is a common phenomenon after surgical extraction of lower third molars (LTM), and its successful control is an essential part of routine oral surgery. The aims of the study were twofold: (1) to evaluate the postoperative analgesic efficacy, comparing long-acting and intermediate-acting local anesthetics; and (2) to compare the use of low-power laser irradiation and the nonsteroid anti-inflammatory drug diclofenac, which are claimed to be among the most successful aids in postoperative pain control. STUDY DESIGN: A twofold study of 102 patients of both sexes undergoing surgical extraction of LTM was conducted. In the first part of the study, 12 patients with bilaterally impacted LTMs were treated in a double-blind crossover fashion; local anesthesia was achieved with 0.5% bupivacaine plain or 2% lidocaine with 1:80.000 epinephrine. In the second part of the study, 90 patients undergoing LTM surgical extraction with local anesthesia received postoperative low-power laser irradiation (30 patients) and a preoperative single dose of 100 mg diclofenac (30 patients), or only regular postoperative recommendations (30 patients). RESULTS: The results of the first part of the study showed a strikingly better postoperative analgesic effect of bupivacaine than lidocaine/epinephrine (11 out of 12; 4 out of 12, respectively, patients without postoperative pain). In the second part of the study, low-power laser irradiation significantly reduced postoperative pain intensity in patients premedicated with diclofenac, compared with the controls. CONCLUSION: Provided that basic principles of surgical practice have been achieved, the use of long-acting local anesthetics and low-power laser irradiation enables the best postoperative analgesic effect and the most comfortable postoperative course after surgical extraction of LTMs.