A retrospective analysis of dental implantation under anticoagulant treatment.

OBJECTIVES: To present our experience treating patients who have undergone dental implantation under no change in their constant anticoagulant treatment. PATIENTS AND METHODS: A retrospective study on patients who have undergone dental implantation. The study group consisted of patients under oral anticoagulants for at least 6 months before dental implantation. The control group was consisted of healthy patients with no oral anticoagulant treatment. Bleeding events were recorded and treated during the first 2 weeks postoperatively. RESULTS: A total of 193 patients were included in the study. Seventy-two of them who were under anticoagulants served as a study group and the rest (121 patients) served as a control group. Mean age: 65 years old in the study group and 59 years old in the control group. Gender: male to female ratio was higher in the study group and lower in the control group. Four patients in the study group and 7 patients in the control group presented postoperative bleeding and were treated successfully by additional local hemostasis methods. CONCLUSION: With the limitation of this study, it can be concluded that patients under oral anticoagulant treatment can undergo dental implantation safely. Bleeding events are rare and can be controlled by local hemostasis. CLINICAL RELEVANCE: Prior to dental implant insertion, patients under oral anticoagulants can continue their constant medical treatment. The procedure can be performed on outpatient basis under local hemostasis.

Predictability of Mandibular Autorotation After Le Fort I Maxillary Impaction in Case of Vertical Maxillary Excess.

A retrospective study of 20 patients treated for vertical maxillary excess between 2009 and 2010, solely by superior surgical repositioning of the maxilla. Clinical and radiological cephalometric parameters were analyzed statistically and their impact on achieving the predicted postoperative mandibular autorotation and on relapse. According to our study, patients presenting with an anterior open bite and a low occlusal plane angle might fail to achieve the predicted mandibular autorotation and are prone to postoperative relapse. No correlation was found between the extent of maxillary impaction and the presence of autorotation.

Dental implants in medically complex patients-a retrospective study.

INTRODUCTION: Dental implant insertion for oral rehabilitation is a worldwide procedure for healthy and medically compromised patients. The impact of systemic disease risks on the outcome of implant therapy is unclear, since there are few if any published randomized controlled trials (RCTs). OBJECTIVE: The objective of this study is to investigate the rate of complications and failures following dental implantation in medically compromised patients in order to elucidate risk factors and prevent them. MATERIAL AND METHODS: A retrospective cohort study was conducted from patient files treated with dental implantation between the years 2008-2014. The study group consisted of medically complex patients while the control group consisted of healthy patients. Preoperative, intraoperative, and post operative clinical details were retrieved from patients' files. The survival rate and the success rate of the dental implants were evaluated clinically and radiographically. RESULTS: A total of 204 patients (1003 dental implants) were included in the research, in the study group, 93 patients with 528 dental implants and in the control group, 111 patients with 475 dental implants. No significant differences were found between the groups regarding implant failures or complications. The failure rate of dental implants among the patients was 11.8 % in the study group and 16.2 % in the control group (P = 0.04). It was found that patients with a higher number of implants (mean 6.8) had failures compared with patients with a lower number of implants (mean 4.2) regardless of their health status (P < 0.01). CONCLUSIONS: We found a similar rate of failure and complications of dental implantation in medically complex patients and in healthy patients. CLINICAL RELEVANCE: Medically complex patients can undergo dental implantation. There are similar rates of complications and failures of dental implants in medically complex patients and in healthy patients.

How Patients Percept Their Recovery Following Impacted Mandibular Third Molar Coronectomy.

OBJECTIVES: To compare the quality of life (QOL), side effects, risks, and complications following mandibular third molar coronectomy compared with conventional third molar extraction. METHODS: Sixty-nine patients referred for extraction of impacted mandibular third molars were prospectively studied. The decision to perform coronectomy was made according to radiological data indicative of a risk for inferior alveolar nerve injury. The patients were asked to fill out a questionnaire on their QOL during the first postoperative week, and the surgeon was asked to fill out a questionnaire on these patients' demographic, clinical, and radiological details as well as surgery-related data. The study participants were followed up for at least 1 year postoperatively. RESULTS: Thirty-four of the 69 patients underwent coronectomy (study group) and 35 underwent full extraction (control group(. There was no group difference in QOL scores during the first postoperative week. There was no patient of nerve injury in either group. No complications were found in the postoperative period. Two patients of coronectomy necessitate residual tooth removal prior to planned orthodontic treatment. CONCLUSIONS: These patients' QOL are similar to those for patients following total extraction. No difference in side effects following procedure was found between coronectomy and total extraction. CLINICAL RELEVANCE: Coronectomy of impacted mandibular third molars may be offered instead of total extraction in patients presenting radiological characteristics of root proximity to the inferior alveolar nerve.

Integrative approach for supernumerary teeth: a single-center retrospective analysis.

OBJECTIVE: The study aims to provide a comprehensive case analysis from a single center, with the objective of clarifying the optimal timing and recommending a preferred treatment strategy customized to the specific presentation of each type of supernumerary tooth (SNT) identified in our research. METHODS AND MATERIAL: A retrospective study was conducted on patients who presented with SNT and were treated through an interdisciplinary at the clinic. RESULTS: 55 patients with 81 SNT of the permanent dentition were analyzed. They included 30 males and 25 females. The dentition status of the patients was as follows: 31 patients with mixed dentition, 0 patients with deciduous dentition, and 24 patients with permanent dentition. The diagnosis of SNT diagnosis was primarily made by general or pediatric dentists and/or orthodontists. Patients were then referred to maxillofacial surgeons for treatment decision. The timing of treatment was mainly determined by the oral surgeon, based on the recommendations of the other specialists involved. Cases involving mal-eruption or malalignment of permanent teeth required both surgical and orthodontic treatment. Patients over 9 years old were treated either under local anesthesia or sedation, while those under 9 years old were treated under deep sedation or general anesthesia A comprehensive investigation of cases involved the utilization of cone beam computerized tomography (CBCT) at the SNT site to facilitate treatment planning. There was a significant correlation between younger age and the preference for treatment under sedation or general anesthesia (p=0.01, t-test). Similarly, a strong association was found between younger age and the need for additional orthodontic treatment (p=0.016, t-test). Cases of surgical removal of SNT at a young age typically did not require orthodontic traction of the permanent tooth, in contrast to cases of late surgical intervention (patients over 11 years old), which often did necessitate such traction. There was a strong tendency for treating supernumerary teeth (SNT) in the maxilla. The proximity of SNTs to vital anatomical landmarks significantly influenced treatment decisions. Patients with SNTs near the mental foramen or the inferior dental canal in the premolar area were exclusively placed under follow-up care (p=0.002, Pearson's chi-square test). However, in the maxilla, the proximity of SNTs to vital structures such as the floor of the nose and the incisive nerve did not affect the treatment approach, and those supernumerary teeth were mostly removed. CONCLUSIONS: A team approach for managing supernumerary teeth (SNT) is recommended. The timing of treatment should carefully consider the advantages and disadvantages of early versus late intervention. Early surgical treatment in cases where eruption is disturbed might result in spontaneous eruption, eliminating the need for orthodontic traction of the permanent teeth.

Presence of Periopathogens in Sinus Floor Augmentation Sites: A Cohort Study.

PURPOSE: To investigate the effects of periopathogens on bone grafts for maxillary sinus floor augmentation and implant survival. MATERIALS AND METHODS: A cohort study was designed. Samples from maxillary sinus floor augmentation sites and from periodontal pockets in adjacent teeth of the same patients were collected during the surgery and following periodontal maintenance and plaque removal. Polymerase chain reaction (PCR) was performed by an external lab service for analysis of the following periopathogens: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola. Correlations between the presence of periopathogens in sinus sites and periodontal pockets in adjacent teeth and the clinical findings (bone and implant survival) were studied. RESULTS: A total of 23 patients were suitable for study inclusion. Periopathogens were found in sinus sites in 6 patients (26%) and in tooth sites in 15 patients (65%). There was low correlation for the presence of periopathogens between tooth sites and sinus sites and for complications. CONCLUSION: The presence of periopathogens as revealed by PCR was lower in sinus sites compared with tooth sites. Their presence neither caused bone pathology nor affected dental implant survival. The presence of periopathogens in sinus sites is inevitable even under periodontal maintenance. Although its presence did not endanger implant survival, future studies are recommended for studying this issue. Further analyses of the presence of periopathogens in cases of bone resorption at the apex of dental implants inserted into sites of augmented sinuses are warranted.

Orthognathic surgery complications: The 10-year experience of a single center.

The retrospective cohort study aimed to assess the incidence and characteristics of these complications in patients who underwent orthognathic procedures. Data on the intraoperative and the postoperative complications were extracted from the patients' medical files. Procedures were further subdivided into single-jaw procedures and bimaxillary procedures. A total of 209 orthognathic procedures were carried out in 190 patients. 184 (88%) were performed to treat angle class III malocclusion, while 25 (12%) aimed to treat class II malocclusion. A total of 94 complication events were observed (44.9% of 209 procedures). 22 of them occurred in single-jaw procedures (28.2% of 78 single jaw operations), and 72 occurred in bimaxillary procedures (55% of 131 bimaxillary operations). When compared regarding the type of complication, complication rates were comparable between the study groups with the exception of late-stage malocclusion. A significant difference (p-value = 0.028) in malocclusion incidences between the bimaxillary and single-jaw groups were observed (9 events, 4.3% and zero events, 0%, respectively). The majority of the complications during and following orthognathic surgical procedures are temporary or minor and require little or no treatment at all.

Headache Attributed to Temporomandibular Disorders: Axis I and II Findings According to the Diagnostic Criteria for Temporomandibular Disorders.

AIMS: To analyze Axis I and II findings of patients diagnosed as having painful temporomandibular disorder (TMD) with headache attributed to TMD (HAattrTMD) in order to assess whether HAattrTMD is associated with a specific Axis I and II profile suggestive of the central sensitization process. METHODS: This retrospective study included 220 patients with painful TMD divided into those with (n = 60) and those without (n = 160) HAattrTMD, and the patients were compared for Axis I and II results according to the Diagnostic Criteria for TMD (DC/TMD). A P value < .05 was considered statistically significant. RESULTS: A total of 27.3% of the patients received a diagnosis of HAattrTMD. Myofascial pain with referral was significantly more common in the HAattrTMD group (P < .001), while local myalgia was significantly more common in the non-HAattrTMD group (P < .001). Characteristic pain intensity was significantly higher in the HAattrTMD group (P = .003), which also showed significantly higher levels of depression (P = .002), nonspecific physical symptoms (P = .004), graded chronic pain (P = .008), and pain catastrophizing (P = .013). Nonspecific physical symptoms were positively associated with HAattrTMD (odds ratio [OR] = 1.098, 95% CI = 1.006 to 1.200, P = .037). Local myalgia was negatively associated with HAattrTMD (OR = .295, 95% CI = 0.098 to 0.887, P = .030). CONCLUSIONS: Painful TMD patients who report headache in the temple area and are diagnosed as having local myalgia rather than myofascial pain with referral probably do not have HAattrTMD. The diagnosis of HAattrTMD may point to a central sensitization process and possible current/future chronic TMD conditions.

Continuous tooth eruption adjacent to single-implant restorations in the anterior maxilla: aetiology, mechanism and outcomes - A review of the literature.

INTRODUCTION: Dental trauma and congenital anodontia are common causes of anodontia in the anterior maxilla. The proposed restorative treatment constitutes a challenge for many dentists, particularly if it is a question of a young patient who has not yet completed skeletal and dental development. Current treatments for anterior maxillary anodontia include: fixed or removable partial dentures; orthodontic closure of interdental spaces; and dental implants. Dental implants do not move with the dento-alveolar complex during the growth period of the maxilla. Therefore, many researchers maintain that implants should be postponed until after adolescence, in order to prevent complications, such as infra-occlusion, that would require the replacement of the abutment and crown-implant restoration, or even invasive treatments, such as the removal of the implant in the future. The objective of this literature review is to investigate the aetiology of the phenomenon, and outcome. RESULTS: Continuous tooth eruption is not affected by age, so considerable changes may occur due to eruption of adjacent teeth. In addition, both women and men are affected by this phenomenon and, usually, there is no significant difference in the amount of growth between the short face and the long face. CONCLUSION: It can be concluded that continuous facial skeletal growth and teeth eruption are evident in the second and third decades. Where possible, it is advisable to delay placement of an anterior maxillary implant in the adolescent patient.

Characteristics of early versus late implant failure: a retrospective study.

PURPOSE: Implant failures can be divided into early and late according to the timing of failure. The purpose of this study was to characterize and compare both types. PATIENTS AND METHODS: A retrospective cohort study was conducted in 194 patients (98 men and 96 women) who presented after dental implant failures during a 6-year period (2000 to 2006). The patient served as the unit of analysis. A history of at least 1 failed and removed dental implant served as the inclusion criterion. Patients were excluded from this study whenever their files had missing data. The collected data included a patient's characteristics, failure characteristics, and the anatomic status of the alveolar ridge after failure. RESULTS: Late failures were associated with moderate to severe bone loss, a larger number of failed implants per patient, a higher incidence in men, and mostly in posterior areas. Early failures were associated with minimal bone loss, occurred more in women, at a younger age, and in most cases the implants were intended to support single crowns. CONCLUSIONS: Meticulous follow-up is needed to reveal and treat failing or ailing implants. Once established as hopeless, they should be removed as soon as possible to prevent further bone loss.

Factors affecting the decision to replace failed implants: a retrospective study.

BACKGROUND: The purpose of the present study was to explore the major factors that can affect the decision to replace failed implants. METHODS: A retrospective cohort study was conducted on 194 patients who presented following dental implant failure during a 6-year period (2000 to 2006). The collected data included patient characteristics, failed implant characteristics, the anatomic status of the alveolar ridge after failure, and factors affecting the decision to avoid reimplantation. The study group included patients in whom the failed dental implants were replaced, whereas there was no reimplantation in the control group. RESULTS: Seventy-four patients (135 implants) made up the control group, and 120 patients (157 implants) made up the study group. The mean patient age was higher and the medical status was worse in the control group. The number of failed implants per patient was higher in the control group. The time between the diagnosis of failure and removal and between implant placement and removal were greater in the control group. The chances of a patient with minor bone loss undergoing reimplantation was 20 times greater (odds ratio, 20.4) than a patient with severe bone loss. The main patient-related reasons for avoiding reimplantation were the additional costs (27%), fear of additional pain (17.7%), and fear of a second failure (16.2%). CONCLUSION: The removal of a failing implant as soon as it is diagnosed as hopeless will improve the chances for reimplantation.

Brain abscess following dental implant placement via crestal sinus lift - a case report.

PURPOSE: To describe a rare case of odontogenic brain abscess. MATERIALS AND METHODS: A healthy, 35-year-old male had two dental implants placed in a simultaneously augmented maxillary sinus. One implant failed and the patient developed a maxillary sinusitis that failed to improve following antibiotic treatment at home. The neglected sinus infection led to formation of a brain abscess. The patient was hospitalised only when he had pan sinusitis with neurological signs. Symptoms were headache attacks, a subfebrile fever and a purulent secretion from the left nostril. The osteomeatal complex was blocked, the maxillary sinus was filled with pus and the Schneiderian membrane thickened. The patient was treated with intravenous antibiotic treatment. Computerised tomography (CT) and magnetic resonance imaging (MRI) scans and functional endoscopic sinus surgery (FESS), were implemented. When his conditions worsened, the patient underwent a left frontal mini craniotomy. RESULTS: Following the craniotomy and antibiotic treatment, there was a gradual resolution and the patient was dismissed after 2 months in hospital with no neurological deficit or signs of sinusitis. CONCLUSIONS: Maxillary sinusitis following dental implant insertion and concomitant maxillary sinus elevation should be treated immediately and thoroughly since untreated sinusitis may cause life-threatening situations such as a brain abscess. In case of severe infection, clinicians should refer immediately the patient to hospital specialists.

Extended Maxillary Sinus Augmentation to the Apical Area of the Neighboring Teeth: Advantages and Limitations.

The extension of sinus floor augmentation beyond the edentulous area, apical to the adjacent teeth, has many therapeutic advantages, but the reliability and safety of the procedure has not been assessed in depth. The present study compares the gain of bone anterior and posterior to the edentulous area and evaluates potential advantages and limitations in the clinical setting. The maximum vertical bone height in the edentulous and extended maxillary sinus augmentation (EMSA) areas and the thickness of the sinus membrane of 65 patients were measured. Those measurements were analyzed using the t test and Pearson correlations. The average vertical bone gain was 11.98 ± 3.53 mm in the edentulous sinus area and 8.60 ± 3.89 mm in the EMSA area (P < .05). Minor perforations of the sinus membrane occurred in 4 patients. There were no postsurgical graft contaminations or periradicular changes during follow-up. EMSA is a reliable and safe procedure with a very low complication rate. This approach is effective and safe for patients who have lost part of their posterior dentition. It enables future implant placement while avoiding the need for sinus reentry and proximal teeth extraction.

Complications and Management of Implants Migrated into the Maxillary Sinus.

The article describes complications following dental implant dislocation into the maxillary sinus and their management and attempts to elucidate the reasons for these complications and their prevention. This retrospective study presents 55 cases of dental implant migration into the maxillary sinus. Patients were 30 men and 25 women with average age of 58 years. Oroantral communication was found in 46 cases, primarily in cases without prior bone augmentation, in patients aged older than 60 years (mean), and medically compromised patients (ASA > 1). The dislocated implant and the infected tissue were removed from the sinus in most cases by Caldwell-luc intervention. The oroantral communication was closed by local and regional flaps. In most of the cases, the oroantral communication was closed by a single intervention. The conclusion was that oroantral communication and maxillary sinusitis are common findings following dental implant migration and dislocation into the maxillary sinus. The risk factors for these complications were dental implantation in the posterior maxilla without sufficient alveolar bone, implantation without prior maxillary sinus augmentation, and older and medically compromised patients. Successful closure of the communication is usually performed with local or regional flaps.

Lingual perimandibular vessels associated with life-threatening bleeding: an anatomic study.

PURPOSE: To describe the anatomy of the lingual perimandibular vessels and emphasize the distance to the bone. MATERIALS AND METHODS: The hemifacial lower third was dissected in 12 human cadavers. The blood vessels in the floor of the mouth were exposed using sagittal incisions at the canine, mental foramen, and second molar areas. RESULTS: The diameter of the dissected vessels ranged from 0.5 to 3 mm (mean, 1.5 mm). Most vessels were found superior to the mylohyoid muscle in the canine area and beneath the muscle in the mental and second molar areas. The smallest median vertical distance from blood vessel to bone was in the canine area (14.5 mm), followed by the mental foramen area (15.5 mm) and the second premolar area (19 mm). The median horizontal distance of the vessels from the lingual plate was 2 mm at the canine and second molar areas and 4 mm at the mental area. DISCUSSION: Lingual plate perforation, especially anterior to the canine area, can easily injure blood vessels in the floor of the mouth and cause life-threatening hemorrhage following implant placement. Bleeding can occur when the mandibular lingual plate is perforated. Care should be taken to recognize situations where this complication may occur. CONCLUSIONS: Based on the study of human cadavers, it appears that vessels in the floor of the mouth are sometimes in close proximity to the site of implant placement. Caution should be exercised when placing implants in this area.

Are different imaging methods affecting the treatment decision of extractions of mandibular third molars?

OBJECTIVES: To find the differences between treatment decisions of lower impacted third molars among experts of oral and maxillofacial surgery according to panoramic radiographic and CBCT findings. METHODS: A retrospective analysis of 62 panoramic radiographs and CBCT of lower third molars evaluated for treatment decisions by 9 independent experts of oral and maxillofacial surgery. RESULTS: Differences in interpretation of the panoramic radiography were found between surgeons. The absence of radiological signs suspected for risk to the inferior alveolar nerve lead to the decision of extraction according to panoramic radiography without CBCT (p < 0.01). The presence of those signs lead to referral to CBCT by surgeons before treatment but did not change their decision. CONCLUSIONS: Treatment decision for surgical treatment of the lower third molar can be accepted without CBCT findings. The use of CBCT is popular before extraction of lower third molars. We found that it has a little effect on the treatment decision of the surgical intervention in comparison to panoramic radiography.

Sequence of treatment in mandibular prognathism patients.

Intraoral vertical ramus osteotomy (IVRO) and advancement genioplasty are effective and predictable methods of treating selective individuals with mandibular prognathism. The sequence of performing these procedures does have a clinical effect, but this is not found in the literature. The purpose of this article is to introduce the clinical implication of the sequence of procedures and to recommend the preferred sequence based on experience. A retrospective study was conducted on 75 patients treated by IVRO with or without genioplasty. In 31 patients, IVRO was performed without genioplasty; only one patient suffered from transient hypoesthesia. When IVRO was performed before genioplasty (sequence I) in 20 patients, nine suffered from mental nerve hypoesthesia. However, when IVRO was performed after genioplasty (sequence II) in 24 patients, permanent mental nerve anesthesia occurred in five patients and mental nerve hypoesthesia in 15 patients. Based on these results, it is recommended that IVRO be performed before genioplasty.

A Retrospective Analysis of Dental Implants Replacing Failed Implants in Grafted Maxillary Sinus: A Case Series.

PURPOSE: To evaluate the survival rate of dental implants replacing failed implants in grafted maxillary sinuses using the lateral approach vs nongrafted posterior maxillae. MATERIALS AND METHODS: A retrospective analysis was conducted to study the survival of secondary dental implants inserted in the posterior maxilla in previously failed implant sites between the years 2000 and 2010. The study group consisted of patients who had also undergone maxillary sinus augmentation, and the control group consisted of patients in whom implants in the posterior maxilla had failed. Clinical and demographic data were analyzed using a structured form. RESULTS: Seventy-five patients with a total of 75 replaced implants were included in the study. The study group comprised 40 patients and the control group, 35 patients. None of the replaced implants in the study group failed, resulting in an overall survival of 100%; three replaced implants in the control group failed (92% survival). The main reason for the primary implant removal was lack of osseointegration (35 [87.5%] of 40 study group implants and 23 [65.7%] of 35 control group implants [P = .027]). The difference between the groups with regard to the timing of primary implant failure was statistically significant. The study group had more early failures of the primary implant than did the control group (77% vs 62%; P = .038). CONCLUSION: Dental implants replaced in the posterior maxilla had a high survival rate. A higher rate of survival was found in augmented maxillary sinus sites. Within the limits of the present study, it can be concluded that previous implant failures in the grafted maxillary sinus should not discourage practitioners from a second attempt.

Levels of bacterial contamination in fresh extraction sites after a saline rinse.

PURPOSE: To determine the level of bacterial contamination in immediate implantation or augmentation sites vs pristine bone, before and after saline rinses. MATERIALS AND METHODS: Bacterial samples were taken from fresh extraction sites (17 patients) and pristine bone (15 patients) before performing implant dentistry surgical procedures. Levels of bacterial contamination were estimated before and after saline rinses. Samples from the socket were placed on an agar plate for total bacterial account and on selective plates for Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis counts. RESULTS: The level of bacterial contamination before saline rinse was 1.2 × 10(4) units of bacterial colony (CFU)/mL in fresh extraction sites (study group) and 5 × 10(2) CFU/mL in pristine bone sites (control group). After a saline rinse, the bacterial level was lowered significantly to 5.2 × 10(3) CFU/mL in the study group and to zero in the control group (P < .05). Levels of bacterial contamination were higher in the mandibular sockets (7.5 × 10(3) CFU/ml) than in the maxillary sockets (5.6 × 10(3) CFU/mL), and the difference was statistically significant (P = .034). All implanted/augmented fresh or pristine sites survived in the follow-up period. CONCLUSION: Fresh extraction sockets with clinical signs of infection show bacterial presence. Pristine bone shows a lower bacterial level. Saline rinse in addition to a decontamination protocol may reduce the level of bacterial contamination significantly both in fresh extraction sites and pristine bone.