A Comparison of 2,845 Head and Neck Injuries in Various Martial Arts.

PURPOSE: The primary purpose of this study is to estimate and compare the frequencies, types, and hospital admission rates of head and neck injuries in subjects who practice different martial art fighting styles, including karate, kung fu, kickboxing, taekwondo, judo, and jiu jitsu. METHODS: The investigators designed and implemented a 20-year cross-sectional study using the National Electronic Injury Surveillance System database. Information related to head and neck martial art injuries from January 2000 through December 2019 was included in this study. Study variables were obtained from both patient demographics and injury characteristics (date of injury, diagnosis, body part, type of martial art, and disposition). Patient and injury characteristics were compared through χ2 and independent sample tests. RESULTS: Taekwondo was the most likely type of martial art to lead to a head injury (P < .01), whereas jiu jitsu (P < .01) and judo (P < .01) were most likely to cause neck injuries. The type of martial art was not significantly associated with admission rates (P = .190); however, patients with head injuries were more likely to be admitted relative to patients who did not suffer head injuries (P < .05). Moreover, injuries secondary to judo were more likely to result in admissions relative to that of all other martial arts (P < .05). CONCLUSIONS: Judo was the most severe martial art during this time period as it led to the highest rate of hospital admissions. Karate injuries are most likely to occur in younger populations of fighters under the age of 18 years.

For treatment of odontogenic keratocysts, is enucleation, when compared to decompression, a less complex management protocol?

PURPOSE: To determine whether the clinical management of odontogenic keratocysts (OKCs) is more complex in patients who undergo enucleation with or without adjuvant therapy than in patients who undergo decompression with or without residual cystectomy. MATERIALS AND METHODS: The authors implemented a retrospective cohort study and enrolled a sample composed of patients presenting for the evaluation and management of OKCs. The predictor variable was treatment group, classified as decompression with or without residual cystectomy versus enucleation with or without adjuvant therapy (Carnoy solution, cryotherapy, or peripheral ostectomy). The outcome variables were measurements of complexity of management, including total number of procedures, venue of procedure (operating room vs office), type of anesthesia, hospital admissions, and total number of follow-up visits. Data analyses were performed using univariate and bivariate statistics and a multiple linear regression model. RESULTS: The study sample was composed of 45 patients (66 OKC lesions) with a mean age of 43.3 years. Of the 66 OKCs treated, 34 (51.5%) were treated with decompression with or without residual cystectomy and 32 (48.5%) were treated with enucleation with or without adjunctive therapy. Larger lesions and lesions with radiographic evidence of cortical perforation were treated more often with decompression with or without residual cystectomy. Based on the multiple linear regression model, patients who underwent enucleation with or without adjuvant therapy compared with those who underwent decompression with or without residual cystectomy had on average 1) 1.1 fewer total procedures (P < .01), 2) 0.8 fewer total office procedures (P < .01), 3) 0.6 fewer local anesthesia procedures (P < .01), and 4) 4.8 fewer postoperative visits (P < .01). There was no difference in the number of general anesthesia procedures, office sedation procedures, or hospital admissions. CONCLUSION: Given comparable recurrence rates, the increased complexity of managing OKCs with decompression with or without residual cystectomy might not be warranted. Enucleation with or without adjunctive therapy could be the more efficient treatment option.

Limited evidence to demonstrate that the use of hyperbaric oxygen (HBO) therapy reduces the incidence of osteoradionecrosis in irradiated patients requiring tooth extraction.

SELECTION CRITERIA: The search covered Medline from January 1948 through March 2008. The subject search by the authors used the following key phrases: Prophylactic hyperbaric oxygen (HBO); preventing osteoradionecrosis (ORN); HBO; ORN; HBO and ORN; HBO, ORN, and dental extractions; HBO and dental extractions; ORN and dental extractions; prophylactic HBO and dental extractions. The authors used EndNote 8.01 (Thomson Reuters, Philadelphia, PA) to perform the search, to import reference data, and to manage the imported references. The electronic search yielded 696 articles. Following further review, which evaluated for compliance to inclusion criteria and data quality, 14 articles were selected for assessment. KEY STUDY FACTOR: The efficacy of HBO use in irradiated patients. MAIN OUTCOME MEASURE: The presence of osteoradionecrosis (ORN). MAIN RESULTS: The authors assessed the quality of the 14 studies in their review using separate criteria for observational studies (cohort and case-control) and for randomizedcontroltrials (RCT). Therewas only 1RCTamongthe 14studies selected. Among the observational studies, 5 articles specified the type of cancer. Among these 6 studies, only 2 studies evaluated patients with nasopharyngeal carcinoma. Another article assessed patients with cancer of the oral cavity, the oropharynx, and the face. Eight articles did not provide any information about the type of cancer. In 7 of the 14 studies, no HBO was used. Of the remaining 7 that had HBO, 4 used the protocol of Marx et al(1): 20 dives of 90 minutes each, breathing 100% humidified oxygen at 2.4 atm of absolute pressure before surgery, and 10 dives after surgery. Three studies did not mention the specific protocol. The use of antibiotics as adjunctive therapy was noted in 7 studies: 4 studies used antibiotics preoperatively and postoperatively, and only 3 studies used antibiotics postoperatively. Of the 14 articles, 10 articles reported a definition of ORN. Six articles described ORN as exposed bone that had been irradiated and had been present for 3 to 6 months. In another study, the bone necrosis was described as developing in 2 forms: minor, as a series of small sequestra that separated spontaneously after periods of weeks or months, and major, where necrosis involved the entire thickness of the jaw with pathologic fracture inevitable. Information provided on the method of extraction used was limited, with only 3 of the 14 reports stating the method (nonsurgical or atraumatic extraction). Primary closure was attempted or used in 3 studies, whereas 2 noted that primary closure was not used. Five studies did not indicate either the method of extraction or whether there was primary closure. The only one randomized, prospective, controlled trial in this systematic review-Marx et al(1)-compared the incidence of ORN in head-and neck-irradiated patients who required dental extractions. They had 2 groups: one group received prophylactic HBO, whereas the other group received antibiotics. The HBO group had a lower incidence of ORN compared with the antibiotic group (5.4% vs 29.9%). In the cohort and observational studies, the occurrence rate of ORN in the prophylactic HBO patients was in the range from 0% to 11% (median, 4.1%), whereas in the non-HBO patients the range was from 0% to 29.9% (median, 7.1%). CONCLUSIONS: The systematic review by the authors did not identify any reliable evidence to either support or refute the efficacy of HBO in the prevention of postextraction ORN to irradiated patients. As a result, additional controlled clinical trials will be needed to address this important question.

Bone mineral apposition rates at early implantation times around differently prepared titanium surfaces: a study in beagle dogs.

PURPOSE: This study evaluated the bone mineral apposition rate (MAR) at the bone-implant interface region of alumina-blasted/acid-etched (AB/AE), plasma-sprayed hydroxyapatite (PSHA), and nanometric-scale bioceramic-coated surfaces at early implantation times in a dog tibia model. MATERIALS AND METHODS: Implants (n = 12 per group) with three different surfaces-AB/AE, PSHA, and a bioceramic coating in the 300- to 500-nm thickness range-were placed bilaterally along the proximal tibiae of six male beagles. Implants remained for 3 and 5 weeks in vivo. Ten and 2 days prior to euthanization, calcein green and oxytetracycline were administered for bone labeling. Following euthanization, the limbs were retrieved by sharp dissection and the implants and bone were processed nondecalcified into ~30-Μm-thick sections along the implant long axis. MAR was measured by the distance between bone labels over time at the interface region (to 0.5 mm from the implant surface) and at regions > 3 mm from the implant surface (remote site). A generalized linear mixed-effects analysis of variance model was conducted with significance levels set at .05. RESULTS: Irrespective of implant surface, the MAR at the interface region was significantly higher than the MAR at the remote site. Significant MAR differences in the interface region were observed between the different surfaces (PSHA > AB/AE > nano). CONCLUSIONS: Bone kinetics during early healing stages were influenced by implant surface modifications.

Dimensional changes of peri-implant soft tissue over 2 years with single-implant crowns in the anterior maxilla.

OBJECTIVE: To compare the peri-implant soft tissue dimensions after insertion of single-implant crowns in the anterior maxilla. MATERIALS AND METHODS: Twenty patients were accepted according to well-defined inclusion criteria and randomized to porcelain-fused-to-metal (PFM) or all-ceramic groups. Follow-up was at: Baseline (B), Crown Insertion (CI), 1-year (1Y), and 2-year (2Y). The following parameters were statistically analysed: distance implant shoulder to marginal peri-implant mucosa (DIM), papilla height (PH), width of keratinized mucosa (KM), crestal bone level (CBL), full mouth plaque score (FMPS), full mouth bleeding score (FMBS), and probing pocket depth. RESULTS: Between groups measurements for DIM, PH, KM, CBL, FMPS, and FMBS showed no statistically significant differences except the distal CBLs to adjacent tooth. DIM (mid-facial) decreased from B to CI remaining stable at 1Y and 2Y (p-value 0.0014). DIM mesial and distal aspects significantly increased from B to CI showing signs of stability at the 2Y. PH between B and CI increased at the mesial site and at the distal site, thereafter, peri-implant soft tissues were stable at the 2Y. CONCLUSION: The insertion of an implant crown affects the peri-implant mucosa morphology by an apical displacement at the mid-facial aspect and coronal at mesial and distal sites.

Thin bioactive ceramic-coated alumina-blasted/acid-etched implant surface enhances biomechanical fixation of implants: an experimental study in dogs.

BACKGROUND: Thin bioceramic coatings have been regarded as potential substitutes for plasma-sprayed hydroxyapatite coatings. PURPOSE: This study tested the hypothesis that a thin bioactive ceramic coating deposition on an alumina-blasted/acid-etched (AB/AE) surface would positively affect the biomechanical fixation and bone-to-implant contact (BIC) of plateau root form implants. MATERIALS AND METHODS: Implants of two different lengths (i.e., 4.5 × 11 mm long, n = 36) and 4.5 × 6 mm (short, n = 36) and two different surfaces, that is, control (AB/AE) and test (AB/AE + 300 - 500 nm bioactive ceramic coating), were placed in the proximal tibiae of six beagle dogs. The implants were retrieved for analyses 2 and 4 weeks after placement. The implants in bone specimens were subjected to torque loads until a 10% drop of the maximum torque was recorded. The specimens were evaluated under optical microscopy for bone morphology and percent BIC. Statistical analysis was performed by a generalized linear mixed effects analysis of variance model and statistical significance set at p < 0.05. RESULTS: Significantly higher torque-to-interface fracture levels for test surface groups of both lengths when compared to control surfaces were observed. No significant difference in BIC was observed between test and control implants of equal length. Histomorphological analysis showed higher degrees of bone organization between the plateaus of test implant surfaces at both implantation times. CONCLUSION: Because the presence of a thin bioactive ceramic coating on the surface did not affect BIC, but positively affected implant biomechanical fixation, the hypothesis was partially validated.