Study of serum CTX in 50 oral surgical patients treated with oral bisphosphonates.

OBJECTIVES: To determine whether there is a relationship between the total BP dose administered and the variations in serum CTX concentration. STUDY DESIGN: The study included 50 patients requiring dental implant surgery and treated with oral BPs, seen in an Oral Surgery and Implantology Unit between January 2007 and June 2009. The patients were divided into two groups: those in which the medication was not suspended before obtaining the laboratory test sample, and those patients referred from other dental clinics in which BPs was suspended before reporting to our Unit. The total drug dosage administered and the total dose per kilogram body weight were evaluated for comparison with serum CTX. The data obtained were correlated to the osteonecrosis risk table developed by Marx et al. in 2007. RESULTS: There were no significant differences between the two groups in relation to the total administered dose and the dose in mg/kg b.w. Likewise, in both groups no relationship was observed between the serum CTX value and the total administered dose or the dose in mg/kg b.w. No differences were found between the two patient groups regarding chemical osteonecrosis risk based on the criteria of Marx et al. CONCLUSIONS: No relationship was observed between the oral BP dose administered (total dose or expressed in mg/kg b.w.) and serum CTX concentration, and suspension of the medication did not influence the serum CTX levels.

Hemodynamic and ventilatory changes during implant surgery with intravenous conscious sedation.

PURPOSE: This study was conducted to determine the hemodynamic and ventilatory changes during implant surgery with intravenous conscious sedation, and whether preoperative anxiety, gender or age influence these parameters. PATIENTS AND METHODS: A prospective study carried out between May 2004 and February 2007, on 102 patients treated with dental implants under local anesthesia and conscious intravenous sedation. Patients completed a questionnaire prior to surgery to evaluate preoperative dental anxiety using Corah's scale. The hemodynamic and ventilatory changes were evaluated by monitoring systolic pressure (SP), diastolic pressure (DP), heart rate (HR) and oxygen saturation (SaO2). These values were collected at 5 points during surgery; before commencing the operation (baseline value), during local anesthetic injection, at the moment of incision and raising of a mucoperiosteal flap, during implant placement, and finally at suturing. Intravenous conscious sedation was administered between baseline value and injection of the local anesthetic. RESULTS: The highest SP and DP were recorded at baseline and at suturing. The highest HR was recorded at the moment of incision and raising of the mucoperiosteal flap; the lowest SaO2 was recorded at local anesthetic injection. There was no relationship between hemodynamic and ventilatory values and preoperative anxiety or gender. A greater age was associated with higher SP and lower SaO2, these differences being statistically significant. CONCLUSIONS: Most of the cardiovascular and ventilatory changes induced by the implant surgery with intravenous conscious sedation were within normal ranges. The results indicate that midazolam with fentanyl do not produce important hemodynamic and ventilatory changes, being a good association for intravenous conscious sedation in dental implant surgery.

Relationship between preoperative anxiety and postoperative satisfaction in dental implant surgery with intravenous conscious sedation.

PURPOSE: To study if patient preoperative anxiety is related to age and gender and to compare preoperative anxiety with postoperative patient and surgeon satisfaction in dental implant surgery under intravenous conscious sedation. MATERIALS AND METHODS: Dental implants were placed in 102 patients under local anesthesia and intravenous conscious sedation. The procedures were performed with or without dental extractions, and with or without bone regeneration. Anxiety was evaluated using Corah's Dental Anxiety Scale and levels of surgeon and patient satisfaction were evaluated on an adapted scale. RESULTS: Low preoperative anxiety was observed in 27.8% of patients, moderate in 50%, and high in 22.2%. Mean value of anxiety was 9.8+/-3.7. The level of surgeon satisfaction was adequate in 87.8% of the surgeries; patients were awake and nervous in 4.4% of surgeries, and excessively sleepy, with little cooperation in 7.8% of surgeries. Regarding patient satisfaction, the procedure was comfortable for 23.3% of patients, neither comfortable nor uncomfortable for 28.9%, a slightly uncomfortable experience for 36.7%, and very uncomfortable for 10% of patients. Younger patients and women were observed to have more anxiety, the difference being statistically significant. Patients with higher preoperative anxiety expressed a lower level of satisfaction, with statistically significant differences. There was no significant relationship between preoperative patient anxiety and postoperative surgeon satisfaction. CONCLUSION: Anxiety was higher in younger patients and women. In this study, a higher preoperative patient anxiety was associated with lower patient satisfaction, but had no influence on postoperative surgeon satisfaction.

Preoperative Anxiety and Its Influence on Patient and Surgeon Satisfaction in Patients Receiving Dental Implant Surgeries Performed Under Intravenous Conscious Sedation.

PURPOSE: The aims of this study were to evaluate the relationship of age, sex, and type and duration of the surgery with preoperative anxiety in patients undergoing dental implant surgeries under intravenous conscious sedation, and to assess preoperative anxiety association with the postoperative satisfaction of both the patient and surgeon. MATERIALS AND METHODS: This prospective study included 180 patients receiving dental implant surgeries under intravenous conscious sedation by means of midazolam, fentanyl, and propofol. Preoperative anxiety (Corah Dental Anxiety Scale), number of implants, duration of surgery, surgeon satisfaction (evaluated as three categories: patient too awake and nervous, adequate sedation, or patient too asleep), and patient satisfaction (classified as five levels: agreeable, neither agreeable nor disagreeable, slightly uncomfortable, unpleasant, traumatic) were recorded. RESULTS: All 180 patients completed the study, and 72.2% of them experienced moderate or high levels of anxiety. The mean Corah scale score was 9.2 ± 3.5. Anxiety was significantly higher among men but showed no relation to age. A significant relationship was found between patient anxiety and the number of implants: those patients who received eight or more implants, with a duration of surgery longer than 60 minutes, had lower anxiety. Surgeon satisfaction was adequate in 90% of the cases. Patients evaluated the procedure as agreeable in 34.4% of cases, neither agreeable nor disagreeable in 26.7%, slightly uncomfortable in 29.4%, unpleasant in 7.8%, and traumatic in 1.7%. High anxiety levels were related with poor patient satisfaction but not with surgeon satisfaction. CONCLUSION: Preoperative anxiety was moderate or high in two-thirds of patients undergoing dental implant surgeries, having a negative influence on patient satisfaction, but not affecting surgeon satisfaction. Additionally, the intravenous conscious sedation technique was considered a satisfactory technique by the surgeon to control anxiety.

Study of serum CTX in 50 oral surgical patients treated with oral bisphosphonates

Objectives: To determine whether there is a relationship between the total BP dose administered and the variations in serum CTX concentration. Study design: The study included 50 patients requiring dental implant surgery and treated with oral BPs, seen in an Oral Surgery and Implantology Unit between January 2007 and June 2009. The patients were divided into two groups: those in which the medication was not suspended before obtaining the laboratory test sample, and those patients referred from other dental clinics in which BPs was suspended before reporting to our Unit. The total drug dosage administered and the total dose per kilogram body weight were evaluated for comparison with serum CTX. The data obtained were correlated to the osteonecrosis risk table developed by Marx et al. in 2007.Results: There were no significant differences between the two groups in relation to the total administered dose and the dose in mg/kg b.w. Likewise, in both groups no relationship was observed between the serum CTX value and the total administered dose or the dose in mg/kg b.w. No differences were found between the two patient groups regarding chemical osteonecrosis risk based on the criteria of Marx et al Conclusions: No relationship was observed between the oral BP dose administered (total dose or expressed in mg/kg b.w.) and serum CTX concentration, and suspension of the medication did not influence the serum CTX levels (AU)

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Hemodynamic and ventilatory changes during implant surgerywith intravenous conscious sedation

Purpose: This study was conducted to determine the hemodynamic and ventilatory changes during implant surgerywith intravenous conscious sedation, and whether preoperative anxiety, gender or age influence these parameters.Patients and Methods: A prospective study carried out between May 2004 and February 2007, on 102 patientstreated with dental implants under local anesthesia and conscious intravenous sedation. Patients completed aquestionnaire prior to surgery to evaluate preoperative dental anxiety using Corah’s scale. The hemodynamic andventilatory changes were evaluated by monitoring systolic pressure (SP), diastolic pressure (DP), heart rate (HR)and oxygen saturation (SaO2). These values were collected at 5 points during surgery; before commencing theoperation (baseline value), during local anesthetic injection, at the moment of incision and raising of a mucoperiostealflap, during implant placement, and finally at suturing. Intravenous conscious sedation was administeredbetween baseline value and injection of the local anesthetic.Results: The highest SP and DP were recorded at baseline and at suturing. The highest HR was recorded at themoment of incision and raising of the mucoperiosteal flap; the lowest SaO2 was recorded at local anesthetic injection.There was no relationship between hemodynamic and ventilatory values and preoperative anxiety or gender.A greater age was associated with higher SP and lower SaO2, these differences being statistically significant.Conclusions: Most of the cardiovascular and ventilatory changes induced by the implant surgery with intravenousconscious sedation were within normal ranges. The results indicate that midazolam with fentanyl do not produceimportant hemodynamic and ventilatory changes, being a good association for intravenous conscious sedation indental implant surgery (AU)

Relationship between preoperative anxiety and postoperative satisfaction indental implant surgery with intravenous conscious sedation

Purpose: To study if patient preoperative anxiety is related to age and gender and to compare preoperative anxietywith postoperative patient and surgeon satisfaction in dental implant surgery under intravenous conscious sedation.Materials and Methods: Dental implants were placed in 102 patients under local anesthesia and intravenousconscious sedation. The procedures were performed with or without dental extractions, and with or without boneregeneration. Anxiety was evaluated using Corah’s Dental Anxiety Scale and levels of surgeon and patient satisfactionwere evaluated on an adapted scale. Results: Low preoperative anxiety was observed in 27.8% of patients,moderate in 50%, and high in 22.2%. Mean value of anxiety was 9.8+/-3.7. The level of surgeon satisfaction wasadequate in 87.8% of the surgeries; patients were awake and nervous in 4.4% of surgeries, and excessively sleepy,with little cooperation in 7.8% of surgeries. Regarding patient satisfaction, the procedure was comfortable for23.3% of patients, neither comfortable nor uncomfortable for 28.9%, a slightly uncomfortable experience for36.7%, and very uncomfortable for 10% of patients. Younger patients and women were observed to have moreanxiety, the difference being statistically significant. Patients with higher preoperative anxiety expressed a lowerlevel of satisfaction, with statistically significant differences. There was no significant relationship between preoperativepatient anxiety and postoperative surgeon satisfaction. Conclusion: Anxiety was higher in youngerpatients and women. In this study, a higher preoperative patient anxiety was associated with lower patient satisfaction,but had no influence on postoperative surgeon satisfaction (AU)