Intense, Instantaneous, and Shooting Pain During Local Anesthesia for Implant Surgery.

Administration of local anesthetics is daily routine for most dental practitioners. Normally, the effect is achieved, and no adverse effects are seen. In this article, the authors describe the complications of immediate, intense and shooting pain, numbness, and marked pallor of the cheek, which occurred during infiltration of a local anesthetic in buccal vestibule infiltration. The patients moved suddenly because of pain and marked pallor of the cheek near the root of the nose and lower eyelid pallor was observed. The pain was very short and the injection was performed again after a few minutes. Two patients also reported an alteration of vision or paralysis of the extra-ocular muscles and drooping eyelid due to paralysis of the levator palpebrae superioris muscle and signs of numbness in the infraorbital area on the same side as the anesthesia. While 3 patients were also apprehensive and started to scare with heart palpitations, as they did not understand what was happening. Probably the anesthetic solutions were injected into an intravascular artery and passed from the extraosseous branch of posterior superior alveolar artery through to the infraorbital artery, which could produce the clinical signs observed in the present study. At the same time, the inoculation of anesthetic in the artery could be grounds for legal disputes for the dentist. In fact, in the absence of vascular disease, anomalies documented by the dentist, they would, however, respond to professional liability and be liable for damages caused to the patient. In conclusion, despite the fact that this condition requires no treatment, it could lead to the recognition of clinical signs in patient with injection of local anesthesia into the artery. At the same time, the inoculation of anesthetic in the artery could be grounds for legal disputes for the dentist.

Non-randomized controlled prospective study on perioperative levels of stress and dysautonomia during dental implant surgery.

PURPOSE: The purpose of this study was to compare pre- and postoperative autonomic activities and changes in salivary stress biomarkers between patients who received only local anesthesia and those who received local anesthesia together with intravenous sedation in dental implant surgery. METHODS: A total of 21 patients were enrolled in this non-randomized controlled prospective study; 7 subjects underwent implant surgery under local anesthesia with intravenous sedation and 14 subjects underwent surgery under only local anesthesia. Stress was evaluated by measuring salivary levels of chromogranin A (CgA) and a spectral analysis of heart rate variability (HRV) at baseline (on a day other than the day of surgery), 1h preoperatively, and 1h postoperatively. HRV analysis yields low- (LF) and high-frequency (HF) components, the LF/HF ratio, and the component coefficient of variance (CCV[HF]), which provide indices of sympathetic and parasympathetic regulatory activity. RESULTS: CgA levels were significantly higher (p<0.05) at baseline in patients who received sedation than those who did not, but CgA levels did not differ prior to surgery. Also, the values of most parameters, including LF, HF, LF/HF (L/H), and CCV(HF), did not significantly differ between groups or among the three time points. Only ΔL/H and ΔCCV(HF) were significantly lower (p<0.05) at 1h preoperatively in patients who received sedation than those who received only local anesthesia. CONCLUSIONS: CgA levels were high in both groups immediately before surgery, and thus CgA values immediately before surgery may not be a reliable indicator of the need for intravenous sedation. Also, spectral analysis of HRV, especially ΔL/H and ΔCCV(HF), could be useful for assessing tension and anxiety.

Micro CT and human histological analysis of a peri-implant osseous defect grafted with porous titanium granules: a case report.

Treatment of peri-implant osseous defects represents a significant challenge for clinicians, and the need to evolve within predictable surgical procedures is important. This case report describes the surgical treatment and grafting with porous titanium granules (PTG) of one patient with a peri-implant osseous defect. The suggested thrombogenic properties of titanium are intriguing from the perspective of osseous reconstructive surgery. In an ongoing randomized clinical trial using PTG for treatment of peri-implant osseous defects, one patient with one test implant was excluded and scheduled for implant removal. The surgical therapy included open flap debridement with surface decontamination with 24% EDTA gel, grafting with PTG, and resubmersion of the implant. After 12 months of healing, the implant with surrounding tissues was excised en bloc and micro CT and histological analyses were performed. Analyses showed PTG in close contact with new bone and with bone growing both into the porosities of the graft material and onto the adjacent implant surface. Element analysis demonstrated calcium and phosphorus in the new tissue embedding the PTG and the implant. Int J Oral Maxillofac Implants 2011;26:e9-e14.