A dose-ranging study of bromfenac sodium in oral surgery pain.

OBJECTIVE: The purpose of this study was to evaluate the analgesic efficacy and safety of five graded doses of bromfenac sodium in patients experiencing moderate to severe pain after the surgical removal of impacted third molar teeth. STUDY DESIGN: The study employed a randomized, double-blind, single-dose, 8-hour, inpatient evaluation period. The treatment groups included placebo (n = 21) and bromfenac (n = 102) at dosage strengths of 5 mg (n = 21), 25 mg (n = 20), 50 mg (n = 20), 100 mg (n = 20), and 200 mg (n = 21). Patients ingested a dose of study medication when their postsurgical pain reached a moderate or severe intensity. Pain intensity and pain relief were rated at 15, 30, 60, 90, and 120 minutes and then hourly for the remaining 6 hours. Efficacy and safety variables were analyzed by means of analysis of variance and chi-squared tests where appropriate. RESULTS: At all doses, bromfenac exhibited statistical superiority (p < 0.05) to placebo, with all but the 5-mg dose being significantly more efficacious for every summary analgesic measure (3- and 8-hour sum pain intensity difference and sum pain analog intensity difference, total pain relief, peak effects, sum of pain half gone, and global evaluation). Peak analgesic effects did not increase beyond those provided by the 25-mg dose of bromfenac, although both the 100- and 200-mg bromfenac doses provided a more rapid onset and a longer duration of analgesia than either the 25- or 50-mg dosage strengths. The most common side effects reported were headache, nausea, dizziness, and drowsiness; the incidence in the bromfenac group was no different from that in the placebo group. CONCLUSIONS: Bromfenac is a safe and efficacious analgesic, with a threshold dose of 5 mg and a positive dose-response up to 25 mg for peak effects and 100 mg for total analgesic activity.

Ketoprofen Dental Pain Study.

Ketoprofen is a nonsteroidal antiinflammatory drug, recently approved as an over-the-counter (OTC) analgesic at a 12.5 mg dosage strength. This is the first published study which explores the analgesic efficacy and safety of ketoprofen 12.5 mg in patients experiencing pain following the removal of impacted third molars. This study was single-dose, double-blind and randomized utilizing a 6-hour in-patient evaluation period. Patients ingested a single dose of ketoprofen 12.5 mg (n = 30), ketoprofen 37.5 mg (n = 32) or placebo (n = 15) when their post-surgical pain reached at least a moderate intensity on a 5-point categorical (CAT) scale and greater than 50 mm on a 100 mm visual analog scale (VAS). Measures of pain intensity and relief were gathered every 20 minutes for the first 2 hours, and then hourly from hours 3 through 6. Adverse drug reactions were also recorded as they occurred. Both dosages of ketoprofen were significantly more efficacious than placebo (two way ANOVAs, p < 0.05). For pain intensity difference (PID) and pain relief, the 12.5 mg dose exhibited statistical superiority from hours 1 through 3, while the 37.5 mg dose exhibited statistical superiority from 40 minutes through 4 hours. Ketoprofen 37.5 mg was significantly more efficacious than the 12.5 mg dose only at 40 minutes for PID(VAS) and relief, and at 60 minutes for PID(VAS). Both ketoprofen dosages displayed significantly greater 3-hr, 4-hr and 6-hr summary analgesic measures (SPID(VAS), SPID(CAT), TOTPAR) than placebo, with the exception of the 6-hr SPID(CAT) measure for ketoprofen 12.5 mg. No serious side effects were observed in this study. We conclude that ketoprofen in a dose range of 12.5 mg to 37.5 mg is a safe and effective analgesic for the relief of post-operative dental pain.

Using pulsatile pressure saline/antibiotic irrigation before reduction and fixation of infected mandibular fractures: literature review and report of two cases.

The efficacy of pulsatile pressure saline irrigation has been demonstrated in the orthopedic, surgical, and dental literature. However, its use for treating infected mandibular fractures has not been documented. This article reviews the literature concerning pressure irrigation. The pulsatile pressure saline/antibiotic irrigation technique and indications for its use during the treatment of infected mandibular fractures are demonstrated with two case reports. The pulsatile pressure saline/antibiotic irrigation system is a useful adjunct to the standard therapeutic modalities of infection management. It is also useful for managing infected mandibular fractures, especially when open reduction and internal fixation with bone plates have been planned.

Preprosthetic surgery for the edentulous patients.

Preprosthetic surgery is a rapidly changing area of dentistry. A knowledge of the range, capabilities, and limitations of the commonly used surgical procedures is a must for anyone treating a patient who will receive a complete denture prosthesis. It cannot be overemphasized that the establishment of a clear treatment plan and close coordination of all parties involved in the reconstructive effort are essential to achieve the best overall result.

Evaluation of topical viscous 2% lidocaine jelly as an adjunct during the management of alveolar osteitis.

PURPOSE: This study evaluated the efficacy of topical viscous 2% lidocaine jelly for the alleviation of pain experienced during the instrumentation of mandibular third molar extraction sites diagnosed with alveolar osteitis and for pain relief during the postinstrumentation period. PATIENTS AND METHODS: Thirty adult patients with a diagnosis of alveolar osteitis in a mandibular third molar extraction site were included in this prospective, double-blind study. Each patient had their sutures removed, the socket irrigated, and 2% lidocaine jelly placed on the tip and side of the tongue to blind the patient against the test substances. The subjects were then randomly distributed into two groups. Group 1 had a nonactive jelly base placed into the socket 2 minutes prior to the placement of a standard obtundant dressing. Group 2 had viscous 2% lidocaine jelly placed into the socket in the same manner. Patients subjectively quantified their pain intensity pretreatment, during instrumentation, immediately postmanipulation, at 5-minute intervals to 30 minutes, and at 45 and 60 minutes. They also subjectively quantified their pain relief at each of the time intervals following instrumentation. RESULTS: There was no statistical difference between the pretreatment pain experienced by both groups. The use of 2% lidocaine jelly had a measurable (P = .056), but not statistically significant, effect on pain due to instrumentation. At every time interval thereafter, the use of 2% lidocaine jelly elicited a statistically significant (P < .05) decrease in pain perception, and a statistically significant increase in pain relief when compared with the inactive jelly. CONCLUSION: Topical viscous 2% lidocaine jelly is a useful adjunct during the treatment of alveolar osteitis, especially in the early (< or = 60 minutes) postinstrumentation period.

Immediate loading of bilaterally splinted titanium root-form implants in fixed prosthodontics--a technique reexamined: two case reports.

A load-free healing period has been advocated as a prerequisite to achieving osseointegration. This article reports two cases in which immediate loading of a specially designated additional, or "expendable," set of titanium root-form implants was successfully utilized to support provisional fixed restorations in the maxilla and the mandible. This immediate-loading protocol is suggested as a reliable adjunctive therapeutic modality for offering implant patients access to fixed interim restorations during the healing phase of the primary fixtures. Another advantage of this approach is that it provides protection from potential transmucosal overload of the primary implants as well as any sites undergoing osseous regenerative procedures.

Diagnosis and treatment of transverse maxillary deficiency.

Treatment of skeletally mature patients is often complicated by inadequately treated or undiagnosed transverse skeletal discrepancy. This report emphasizes diagnosis of transverse maxillo-mandibular discrepancy and describes recommendations for treatment. Proper treatment strategy must consider the type and magnitude of transverse deficiency, patient's growth status, dentofacial esthetics, stability factors, and periodontal tissue health. Indications for surgically assisted maxillary expansion are listed, and the recommended surgical technique to improve frontal dentofacial esthetics, provide better stability, and enhance long-term periodontal health is described. Specific modifications in surgical technique to help prevent postoperative complications are included. New recommendations for sequencing, timing, and correction of transverse deficiency are presented.

The status of implant training in oral and maxillofacial surgery residency programs.

PURPOSE: The results of a survey concerning the status of oral and maxillofacial surgery resident training in oral implantology are discussed. RESULTS: The results demonstrate that oral and maxillofacial surgery residents are exposed to a variety of implant types and systems, with most implant surgery being performed in association with intravenous sedation. The number of implants placed by each resident during training varied greatly. CONCLUSION: Most program directors believe that the implantology training of oral and maxillofacial surgery residents is superior or comparable to that of periodontal graduate students. However, this survey suggests that certain aspects of residency training in implantology, such as the performance of sinus lift procedures and participation in implant research, may require more emphasis.

Short-term healing of autogenous and allogeneic bone grafts after sinus augmentation: a report of 2 cases.

Sinus augmentation to facilitate the placement of cylindrical endosseous implants in the posterior maxilla has become more commonplace, and many different materials have been used for the sinus graft. The results of two sinus augmentation procedures, one grafted with demineralized freeze-dried bone (DFDB) and the other with autogenous iliac bone, are presented. Bone cores were obtained with a trephine drill from the grafted regions at the time of implant placement. Eight implants were placed into the grafted areas in each subject. The sample from the sinus grafted with autogenous bone was obtained 8 months postoperatively and the bone core from the sinus grafted with DFDB was taken 16 months postoperatively. The bone specimens were subsequently examined under light microscopy. The autogenous specimens demonstrated new bone formation with increased quantity and improved quality when compared to the specimens obtained from the sites grafted with allogeneic bone. All 8 implants placed into the autogenous grafts were clinically osseointegrated at stage 2. At 16-months postsurgery, the bone core taken from the site grafted with DFDB demonstrated poor bone quality and still contained remnants of the graft material in the region approximating the sinus membrane. Two of the 8 implants placed into the allogeneic grafts failed at stage 2. These findings suggest that autogenous sinus grafts produce bone of adequate quantity and quality for implant placement, whereas DFDB sinus grafts are not completely remodeled by the host and may produce bone of insufficient quality and quantity for predictable implant placement.

Pulsatile pressure irrigation treatment of mandibular osteomyelitis.

The usefulness of the pulsatile pressure saline irrigation system has been demonstrated in the orthopedic, surgical, and dental literature. Its use during the treatment of mandibular osteomyelitis has not been documented. The literature concerning pressure irrigation is reviewed, and the indications and technique of pulsatile pressure saline/antibiotic irrigation for the treatment of mandibular osteomyelitis are enumerated and demonstrated with two case reports. The pulsatile pressure saline/antibiotic irrigation system may be a useful adjunct to the standard therapeutic modalities of infection management and can be used during the management of mandibular osteomyelitis.

Multiple central giant cell lesions with a Noonan-like phenotype.

A small number of patients with the phenotypic features of Noonan syndrome have also developed giant cell lesions of the jaws similar to those seen in cherubism. This case report describes an individual with the features of the recently described Noonan-like/multiple giant cell lesion syndrome. Previously reported cases and issues relative to diagnosis and management are considered.

Osseous changes following placement of the transmandibular implant system in edentulous mandibles.

The transmandibular implant system is designed for the reconstruction and rehabilitation of the endentulous mandible utilizing an extraoral approach. Transmandibular implants were placed in 19 patients and mandibular bony changes were followed using standardized panoramic radiography. Eleven sites were identified on each postoperative radiograph and the percentage of radiographic enlargement was calculated for each site. The true bony changes were then computed for both short-term (9.4 months) and long-term (53.4 months) follow-up. Patients with an average mandibular height in the saddle areas of 3.5 to 8.9 mm showed bilateral bony regeneration in the saddle areas and over the most distal cortical screws of the implants. Most of these bony changes were seen in the first year, but continued beyond that time. Patients with residual bone height of 9.0 to 12.9 mm had little bone change, while patients with bone height of 13.0 to 20.5 mm demonstrated slight resorption. Theories for the observed changes are presented. The transmandibular implant is especially indicated for the severely atrophic mandible because its position within the mandible and the rigid box frame design of the implant promote bilateral bone regeneration distal to the framework of the implant.

Changes in the nasal and labial soft tissues after surgical repositioning of the maxilla.

Accurate prediction of postsurgical function and esthetics of the nose and upper lip requires an understanding of the relationship between maxillary surgical movement and soft tissue change. Thirty-two patients underwent Le Fort I osteotomies, some with concomitant mandibular procedures. Preoperative, postoperative, and 1-year postsurgical data derived from cephalometric and nasolabial cast analysis were compared to assess skeletodental changes, soft tissue changes, and stability. A multiple stepwise regression (including age, gender, alar cinch suture, V-Y closure, and contouring of the anterior nasal spine as variables) indicated that accurate prediction equations could be formulated, particularly if the patients were grouped by vector-specific maxillary movements. In general, the base of the nose widened in all patients regardless of the vector of surgical maxillary movement. An associated shortening of the nose was found. The nasolabial angle decreased or remained constant in most patients. The upper lip widened and lengthened at the philtral columns. Narrow noses widened more than did broad noses and alar cinch suturing widened the alar base even more. Results indicated that soft tissue changes associated with maxillary surgery may be more affected by the position of the soft tissue incision and methods used in closure than by the surgically induced hard tissue change.