[Inferior alveolar nerve lateralisation in pre-implantation surgery]. / Latéralisation du nerf alvéolaire inférieur à visée préimplantaire.

The inferior alveolar nerve remains an anatomical obstacle for implant insertion in the posterior part of the mandible. Inferior alveolar nerve lateralisation allows new implant-borne prosthetic alternatives, after a careful radiological check-up and for an adapted prosthetic project, for removable and fixed prostheses. We present the infra-alveolar nerve lateralisation technique, its indications and contra-indications. This technique completes the armamentarium of surgical techniques for the correction of inferior molar edentulism.

Survival rate for implants placed in the posterior maxilla with and without sinus augmentation: a comparative cohort study.

BACKGROUND: The reduced bone height and proximity of the maxillary sinus are the most common limitations for placement of dental implants in the posterior maxilla. Reconstruction of the atrophic posterior maxilla can be performed with a sinus augmentation procedure. The aim of this cohort study is to compare the survival rate of implants placed in augmented sinus to implants placed in native bone in the posterior maxilla. METHODS: This study was designed as a prospective cohort study and included consecutively treated patients. Patients who required the sinus augmentation (test group) were treated according to the two-stage technique. Patients were scheduled for follow-up evaluation at 3, 6, and 12 months after implant placement and then every 6 months for ≤ 6 years. RESULTS: One hundred and five patients with 393 implants were enrolled in the study. Two hundred and one implants were placed after preliminary sinus floor grafting in 41 patients. The control group contained 64 patients with 192 implants that were placed in pristine bone of the posterior maxilla. The cumulative implant survival rates were 86.1% and 96.4%, respectively. The difference between the two groups was highly significant (P <0.005). CONCLUSIONS: These findings show that implants placed in augmented sinuses had a lower survival rate compared to implants placed in pristine bone. All the implant failures in the augmented sinuses occurred before the prosthetic rehabilitation. Moreover, it should be considered that most of the failures were observed in few patients, thus suggesting cluster behavior.

Incidence of venous thromboembolism in oral and maxillofacial surgery: a retrospective analysis.

This study retrospectively investigates the incidence and risk factors for venous thromboembolism (VTE) in patients undergoing maxillofacial surgery. Data were obtained from patients treated between January 2005 and June 2006. Patients' records were reviewed for complaints and information relating to deep venous thrombosis (DVT) and pulmonary embolism (PE). All patients completed a questionnaire on complaints relating to DVT and PE. The patients were classified according to risk and the incidence of reported DVT and PE was calculated. The study population comprised 411 patients with a mean age of 32 (+/- 17) years. The median postoperative follow-up period was 53 (23-639) days. None of the patients received thromboembolism prophylaxis. The incidence of VTE in the study group was 0.5%. Logistic regression analysis demonstrated a relationship between body mass index and hospital stay with thromboembolism (p<0.05). Patients undergoing pre-implant surgery with bone graft proved to be at risk (p=0.07). The incidence of VTE in oral and maxillofacial surgery seems to be low, but thromboembolism prophylaxis may be justified in patients with clear potential risk factors.

Cirugía preprotética de tejidos duros y blandos: estudio sobre pacientes ambulatorios de la Cátedra de Cirugía III, Facultad de Odontología de Córdoba / Preprosthetic surgery of soft and hard tissues: a study on ambulatory patients from the Department of Surgery III, Cordoba School of Dentistry

El propósito de este estudio fue realizar un seguimiento de los pacientes con problemas relacionados a factores preprotéticos y analizar la etiopatogenia, ubicación, técnicas quirúrgicas empleadas, control postoperatorio inmediato y frecuencia de las mismas. En los tratamientos para los tejidos blandos consideramos que las frenectomías y frenotomáis son procedimientos adecuados por su practicidad en la técnica quirúrgica y mejoramiento para el asentamiento de la prótesis. En las técnicas quirúrgicas empleadas asociadas con injertos óseos se observaron mejores resultados en cuanto a la modelación ósea para el asentamiento protético, comparado con las técnicas quirúrgicas sin injertos óseos. La técnica de cielo abierto es de nuestra elección para el levantamiento de reborde con injertos óseos. En general, el seguimiento de los pacientes a distancia (más de tres meses) resultó difícil debido a que son pacientes ambulatorios que buscan solamente la solución inmediata a sus problemas

Cirugía preprotética de tejidos duros y blandos / Hard and soft tissues preprosthetic surgery

El propósito de este estudio fue realizar un seguimiento de los pacientes con problemas relacionados a factores preprotéticos y analizar la etiopatogenia, ubicación, técnicas quirúrgicas empleadas, control post operatorio inmediato y frecuencia de las mismas. En los tratamientos para los tejidos blandos consideramos que las frenectomías y frenotomías son procedimientos adecuados por su practicidad en la técnica quirúrgica y mejoramiento para el asentamiento de la prótesis. En las técnicas quirúrgicas empleadas asociadas con injertos óseos se observan mejores resultados en cuanto a la modelación ósea para el asentamiento protético, comparado con las técnicas quirúrgicas sin injertos óseos. La técnica de cielo abierto es de nuestra elección para el levantamiento de reborde con injertos óseos. En general, el seguimiento de los pacientes a distancia (más de tres meses) resultó difícil debido a que son pacientes ambulatorios que buscan solamente la solución inmediata a sus problemas

The reasons for the extraction of various tooth types in Scotland: a 15-year follow up.

OBJECTIVES: The aim of this survey was to investigate the reasons for extraction of the various tooth types in Scotland. This study replicated one which was undertaken 15 years earlier. A further aim, therefore, was to identify any changes in the frequency of extraction of each tooth type in the 15 years between the two studies. METHODS: The names of every fourth dentist on the list of the Scottish Dental Practice Board were obtained. Four hundred and twenty-five general dental practitioners were asked to record permanent tooth extractions for 1 week. Data requested for each extraction were: the patient's age, gender and dental attendance pattern, the type of tooth removed and the reason for the extraction. RESULTS: Three hundred and fifty-two dentists participated (a response rate of 82.8%). There were 25% fewer teeth extracted per patient and 30% fewer per dentist than in the 1984 study. In 1999, more teeth of most types were extracted from regular attenders whereas, in 1984, more teeth of all types were extracted from irregular attenders. Premolars and first and second molars were the tooth types most frequently extracted in both surveys. In 1999 premolars were the teeth most commonly removed below 21 years of age, accounting for 57.5% of extractions in this age range. Molars accounted for 33.8% of extractions in this age range compared with 52% in 1984. Overall, caries was found to be the principal reason for loss of all tooth types apart from lower incisors which were extracted mainly for periodontal reasons. However, below 21 years, 84.5% of premolar extractions were performed for orthodontic purposes. CONCLUSIONS: Over the last 15 years, the overall number of extractions has reduced and the proportion of extractions from regular attenders has increased. Proportionately more premolars and fewer molars were extracted from under-21-year-olds. This observation can be explained by an increase in orthodontic extractions or a decline in extractions for caries in this age group. However, when extractions from the population as a whole are considered, caries and its sequelae remains the principal reason for loss of all tooth types other than lower incisors which are extracted mainly for periodontal reasons.

Reasons for tooth extraction in a Brazilian population.

AIM: To identify the reasons for tooth extraction in Recife, Brazil and to test whether they differ by socio-economic groups and levels of caries experience. DESIGN: Cross-sectional survey. SETTING: Ten health centres of the public health system and ten health centres of insurance companies. PARTICIPANTS: Patients attending health centres. METHODS: Ten dentists from each selected centre and two patients from each selected dentist were randomly selected from; the list of all health centres in Recife, all dentists carrying out dental extractions at each selected centre and all patients who had an appointment with the selected dentists respectively. Participants were examined by both the researcher (AC) and dentists. OUTCOME MEASURE: Reasons for tooth extraction. RESULTS: Of the 404 teeth extracted, 70.3 per cent were because of caries and its sequelae; 15.1 per cent because of periodontal disease; 6.4 per cent for pre-prosthetic reasons; 3.7 per cent wisdom teeth, 2.5 per cent for orthodontic reasons and 1 per cent for trauma and patient's request. A trend was observed for patients with less than secondary school education and lower salaries to have more tooth extraction due to caries, but the differences were not of statistical significance.

Maxillary sinus floor elevation for implant placement with demineralized freeze-dried bone and bovine bone (Bio-Oss): a clinical study of 20 patients.

The objective of this study was to determine the predictability of endosseous implants placed in a maxillary sinus grafted with a mixture of bovine porous bone mineral and demineralized freeze-dried bone. Sixty implants were placed in 20 patients representing 28 sinuses using either a one- or two-stage technique. After an implant loading period of more than 2 years, the survival rate (eg, a clinically functioning implant without signs of mobility or infection) varied from 90% to 96%. No infections or other complications were encountered. The data suggest that this treatment regimen can result in a high rate of survival.

Construction of a clinical implant performance scale for implant systems with overdentures with the Delphi method.

STATEMENT OF PROBLEM: The success of an implant system is often judged on the survival rate of the separate implants. This does not give a complete view of the "real" success of a system. To make that possible the total clinical performance, surgical and prosthetic, has to be considered. PURPOSE: This study aimed to set up a clinical performance scale for different implant systems retaining mandibular overdentures. MATERIAL AND METHODS: All data regarding surgical and prosthetic complications incurred and treatment procedures needed after implant placement were collected from a group of 90 patients who were treated either with two root form implants connected with a bar and supporting a mandibular overdenture or with a transmandibular implant system that supported an overdenture. All items were scored into five categories on the scale, defined as the "clinical implant performance" scale. The Delphi method was applied to categorize each item. A panel of experts assessed the items. RESULTS: After three rounds there was complete consensus between the experts for 65% of the items for the root form implant systems, and for 87% of the items at least five out of six experts gave the same score. For 55% of the items for the transmandibular implants systems there was complete consensus, and for 85% of the items at least five out of six experts scored in the same way. CONCLUSIONS: The Delphi method provides a useful scale for evaluating the clinical performance of implant systems retaining mandibular overdentures. The presented scale makes it possible to compare the overall performance of different implant systems for overdentures.

Sinus grafting related to implantology. Statistical analysis of 15 years of surgical experience (1979-1994).

Sinus cavities are often a major obstacle to the placement of dental implants in the posterior maxilla, especially when early tooth loss has occurred. Several grafting procedures aimed at reducing the expanded volume of these pneumatic cavities have been routinely utilized since 1979. Essentially, these techniques have consisted of recreating the necessary viable bone volume at the floor of sinus cavities by placing different bone substitute materials to allow for the insertion of endosseous implant devices. The progress achieved in the refinement of the surgical procedures and the knowledge acquired in the field of patient screening and selection, choice of biomaterials, management of complications, etc., have made sinus graft surgery highly codified and predictable. A comprehensive statistical study by multifactorial procedures was carried out to establish a Burt Contingency Chart. This chart visualizes the frequencies of all the "modality combinations" among the selected "qualitative parameters" and, by a " factorial analysis", the "multiple correlations", so that the "statistical affinities" that may exist among the same variables can be determined. This critical study endeavors to search for and reveal the favorable clinical, biologic and scientific parameters necessary for the success of sinus graft surgery on short-, medium-, and long-term bases (more than nine years). It is a particularly homogenous study, since all the operative procedures have been carried out exclusively by the author under standardized conditions. The wide variety of biomaterials utilized by the author since 1979 shows the development of bone substitute biomaterials as they have been introduced into the market during the past 15 years. The large number of patients treated, the variety of grafting materials, the important success rate obtained, and the long duration of patient follow-up have been instrumental in enabling us to establish scientifically significant results. Autogenous bone and its combinations with calcium- and phosphorus-containing biomaterials remain undoubtedly the best all-purpose biomaterials. The synthetic biomaterials have their own specific indications according to their stable (non-resorbable) or unstable (resorbable) nature and their rates of metabolic "turnover". Differently treated bones from the tissue bank (if not contaminated or immunologically questionable) behave in a fashion not unlike autogenous bone. Root-form implants are by far the best implants in the reconstructed sinus sites, while other implant types (subperiosteal implants, etc.) inserted beneath the reinforced osseous sinus floor, buccal wall, and pyramidal process, also have their indications.

Day case oral surgery: a review of 25 years experience at the Dublin Dental Hospital.

A retrospective analysis of the changing work-load at the Dublin Dental Hospital oral surgery day case unit was undertaken. This involved 26,697 operations performed during the 25-year period 1968-1992. The results show how the practice of oral surgery has changed over this time. Annual totals ranged from 766 to 1549 operations. While most categories of operations remained largely unchanged, the removal of impacted third molars increased from 10.5% of the annual total to 57.0%. Routine extractions of permanent teeth decreased from 53.9% of the annual total to 18.0%.

Resultados de la Clínica de cirugía ortognática pediátrica: una revisión de 10 años de experiencia en la corrección de deformidades dentofaciales en niños y adolescentes / Results of the paediatric orthognathic surgery clinic: a ten years review of the experience on correction of dentofacial deformities in children and adolescents

Se presentan los resultados obtenidos de un estudio de 10 años de experiencia de la Clínica de Cirugía Ortognática Pediátrica para la corrección de las deformidades dentofaciales en pacientes menores de 15 años, atendidos en el Hospital de Pediatría del Centro Médico La Raza del Instituto Mexicano del Seguro Social, duante el periodo correspondiente de 1983 a 1993. Se analizaron los fundamentos y la justificación inicial de la clínica, así como de los procedimientos quirúrgicos, ortopédico maxilar y ortodóncicos empleados, confirmándose el beneficio que representa al paciente sometido a la cirugía ortognática. El estudio de 164 pacientes y 213 osteotomías maxilares incluyeron siete técnicas ortognáticas tanto en la mandíbula (159) y en maxilar superior (54 procedimientos), resultando un total de 5 recidivas postquirúrgicas

Root-form implants placed in subantral grafted sites.

Life-table analysis of survival data of implants placed in subantral grafts reveals a high rate of survival, particularly in comparison with implants placed in non-grafted subantral sites. However, sample size (158 grafted, 140 non-grafted, in a total of 120 patients) and follow-up time remain insufficient to reach a definite conclusion. Results also appear improved over other reports in which the sinus was penetrated by the implants, possibly because the procedure has become more standard over the years.

Nuevas consideraciones en cirugía preprotética / New considerations in preprosthetic surgery

Se presenta un nuevo proceder quirúrgico en coordinación con el médico de la familia para viabilizar en un solo tiempo quirúrgico la corrección de las estructuras bucales de soporte a las prótesis estomatológicas. Se analizan los resultados en 181 pacientes operados por este novedoso procedimiento

Oral surgery in Norwegian general dental practice--a survey. Extent, scope, referrals, emergencies, and medically compromised patients.

A questionnaire containing 37 questions concerning oral surgery and oral medicine was mailed to a systematic random sample of 500 Norwegian general dental practitioners in October 1989. A 60% return rate was obtained. From the 20 questions included in this paper the following conclusions were drawn: Norwegian general practitioners perform a substantial number and diversity of procedures in the field of oral surgery and oral medicine. The predictor variables sex, age, geographic location, and type of practice (private/public) showed by multiple classification analysis only limited correlation with the amount and diversity of procedures. On average, 12.3 patients were referred per practitioner per year to specialists in oral surgery. The indicated need for orthognathic consultations was 0.75 patient per year per practitioner. Serious emergencies demanding referral seldom occurred. Each month 6.6 medically compromised patients were seen in general practice, among which cardiovascular disorders dominated.

Primary reasons for extraction of permanent teeth in Norway: changes from 1968 to 1988.

The purpose of the present study was to investigate time trends in primary reasons for extraction of permanent teeth in Norway from 1968 to 1988. Johansen studied reasons for extraction of 8757 teeth in 4216 patients during a 3-week period in 1968. Twenty years later a random sample of 500 Norwegian dentists provided particulars about all extractions carried out during a 2-week period. 350 dentists (70%) replied in 1988 but 96 of them had not extracted any teeth during the observation period. Reasons for extraction of 985 teeth from 692 patients were available for analysis. Caries and its sequelae accounted for 35%, periodontitis for 19%, and orthodontic reasons for 20% of extractions in 1988. A comparison of the distribution of extraction according to reasons for patients over 20 yr of age revealed a highly significant difference between 1968 and 1988 (P less than 0.001) mainly due to a decrease in the role of caries and an increase in extractions for other reasons. Caries and its sequelae accounted for a higher proportion of extractions than periodontitis at all ages over 20 yr in 1968, only up to 45 yr of age in 1988. Thus it is concluded that the observed time trend in primary reasons for extraction corroborates expectations based on declining caries prevalence, increasing retention of teeth and a rise in dental attendance in Norway during the last 20 yr.