Efficacy of fentanyl transdermal patch in pain control after lower third molar surgery: A preliminary study.

BACKGROUND: Surgical removal of impacted lower third molars is a common oral surgical procedure, generally followed by moderate to severe postoperative pain. Transdermal drug delivery as a concept offers interesting possibilities for postoperative pain control. The aim of this study was to evaluate the efficacy of transdermal system with fentanyl in relieving pain following impacted lower third molar surgery. MATERIAL AND METHODS: Seventeen patients with bilateral impacted lower third molars were included in this preliminary study. For postoperative pain control, patients randomly received a fentanyl patch plus placebo tablet after the first operation and regular (placebo) patch and an analgesic, after the second operation. Analgesia was evaluated during first 24 hours postoperatively according to patients' reports about time of first pain appearance and additional analgesic consumption. Pain severity was rated using a 10 cm long visual analogue scale (VAS). RESULTS: Intensity of postoperative pain and postoperative analgesic consumption were significantly lower after the Fentanyl Transdermal System (FTS) was applied (p<0.05). Duration of postoperative analgesia was significantly higher with FTS when compared to control treatment (p<0.05). CONCLUSIONS: Based on the results of this preliminary study, transdermal system with fentanyl significantly reduced postoperative pain after third molar surgery.

Lidocaine+clonidine for maxillary infiltration anaesthesia: parameters of anaesthesia and vascular effects.

The local anaesthetic and haemodynamic parameters achieved by lidocaine with clonidine or epinephrine, administered for maxillary infiltration anaesthesia, were studied in 40 patients (American Society of Anesthesiologists, physical status 1) who underwent upper third molar surgery. All patients received 2 ml of 2% lidocaine with clonidine (15 microg/ml; n=20) or epinephrine (12.5 microg/ml; n=20) in a randomized, double-blind fashion. Vascular effects were evaluated on the isolated human infraorbital arteries. The parameters of maxillary infiltration anaesthsia produced by a combination of lidocaine+clonidine were similar to those obtained with lidocaine+epinephrine. In both groups, haemodynamic parameters exhibited similar variations, with the exception of a significant reduction in heart rate and systolic blood pressure in the lidocaine+clonidine group and significant increase in heart rate in the lidocaine+epinephrine group, 10 min after surgery. Clonidine (10(-7), 10(-6) and 10(-5)M) produced an endothelium-independent vasocontractile effect on the isolated human infraorbital arteries. The results of this study indicate for the first time in dental anaesthesia that the lidocaine+clonidine combination could be a useful and safe alternative to lidocaine+epinephrine for intraoral infiltration anaesthesia.

Human cytomegalovirus is present in odontogenic cysts.

INTRODUCTION: Recent studies suggest that some viruses, including human cytomegalovirus (CMV), may be involved in the pathogenesis of periapical lesions. Since periapical cysts (PCs) represent the next stage in the evolution of periapical granuloma, it seemed reasonable to investigate the presence of CMV in PCs and any possible relationship between its presence and the clinical features of those cysts, as well as to compare the results obtained with corresponding findings in non-inflammatory lesions, like odontogenic keratocysts (OKCs). METHODS: Samples of 33 PCs and 10 OKCs, obtained at the time of surgery, were used for the detection of CMV DNA by polymerase chain reaction. Presence of the virus was correlated with clinical and radiographic features of the cysts. RESULTS: CMV was detected in 18 PCs (54.5%) and six OKCs (60%). The presence of CMV was more frequent in cyst samples collected from patients who reported previous episodes of acute infection. The presence of sinus tract was more frequent in CMV-positive cysts and CMV presence was less frequent in a group of cysts showing signs of acute inflammation at the time of sample collection. The mean sizes of CMV-positive and CMV-negative PCs were almost the same; CMV-positive OKCs were slightly larger than CMV-negative OKCs. None of these results proved to be statistically significant. CONCLUSION: The presence of CMV in the cystic wall is a common feature of both inflammatory and non-inflammatory odontogenic cysts. Although this study has not proved that CMV affects pathogenesis of odontogenic cysts, such a possibility could not be ruled out.

Comparison of clonidine and epinephrine in lidocaine anaesthesia for lower third molar surgery.

The admixture of clonidine or epinephrine to lidocaine for inferior alveolar nerve block was studied with regard to onset, duration, intensity of anaesthesia, postoperative analgesia, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), ST segment depression > or =1 mm and cardiac arrhythmias. Forty healthy patients (ASA I) received 2 ml 2% lidocaine with clonidine (15 microg/ml; n = 20) or epinephrine (12.5 microg/ml; n = 20) in a double-blind fashion for lower third molar surgery. Duration and intensity were not different between groups, while onset was significantly different by subjective evaluation. The need for postoperative pain medication was significantly lower in the clonidine group. There was a significant decrease in SBP and MAP in both groups 35 min after administration of anaesthesia compared with basal values, while DBP was significantly lower only in the clonidine group. There was no significant difference in SBP, DBP and MAP between groups. HR was significantly increased in the epinephrine group 5 min after administration of anaesthesia and during surgery compared with the clonidine group and with basal values. The presented data suggest that clonidine could be a useful and safe alternative to epinephrine for intraoral block anaesthesia.

A life care community from three perspectives.

Changing societal supports, family structures, and an increasing number of affluent elders have altered the caring giving and receiving patterns for many middle-aged and older adults in the United States. Life care communities have been available for several decades, but only in the last two decades have they begun to flourish. The following report exemplifies some of the benefits and the concerns encountered in a life care community.

Is carbamazepine less effective in the treatment of trigeminal neuralgia when prescribed by oral and maxillofacial surgeons?

Carbamazepine therapy is generally suggested as a first line of treatment for patients with idiopathic trigeminal neuralgia (ITN). This study was intended to investigate patient compliance and effects of carbamazepine in a group of ITN patients referred to oral and maxillofacial surgeons. A total of 19 patients with ITN who were taking carbamazepine as recommended and were unlikely to go into spontaneous remission were analyzed in a retrospective study. The following criteria were used for the assessment: pain-free periods, success, recurrence and failure rate, side effects, and discontinuation of the treatment. Pain relief was recorded in 16 patients with pain-free periods of 1 to 48 mo. Pain recurred in 11 patients within 1 to 30 mo. Side effects were recorded in six patients. The treatment was discontinued in 13 patients for various reasons. At the last visit, the treatment was successful in six patients with pain-free periods of 6 to 48 mo. It is concluded that the carbamazepine treatment of patients with ITN referred to oral and maxillofacial surgeons should not be expected to be successful as generally accepted. Since a relatively high percentage of patients were reluctant to take drugs, a new treatment scheme for patients with ITN referred to an oral and maxillofacial surgeon was suggested.

Blocks of the foramen rotundum and the oval foramen: a reappraisal of extraoral maxillary and mandibular nerve injections.

OBJECTIVE: To present our experience of regional anaesthesia with blocks of the foramen rotundum and the oval foramen. DESIGN: Open study. SETTING: University Hospital, Beograd, Yugoslavia. SUBJECTS: 107 patients who underwent 58 maxillary and 49 mandibular nerve blocks. INTERVENTIONS: Injection of 2% lignocaine with adrenaline 1/80,000 with an 18 G venflon or 20 G spinal needle. MAIN OUTCOME MEASURES: Quality of anaesthesia and morbidity. RESULTS: 49 of the 58 maxillary (84%) and 45 of the 49 mandibular (92%) nerve blocks were successful (no sensitivity to pinprick in the distribution of the injected nerve and a painless operation). There were 17 complications (26%), 8 in the maxillary and 9 in the mandibular group. All complications were minor and transient, and 6 could be attributed to anhydrous glycerol rather than the injection technique itself. CONCLUSION: Blocks of the foramen rotundum and the oval foramen achieve good regional anaesthesia in the maxillofacial region.

Anatomical considerations relevant to implant procedures in the mandible.

The authors review anatomical facts significant for preoperative planning of implant procedures in the mandible. This planning includes the precise evaluation of distinct anatomical factors, such as the position of the mandibular canal, the width of the mandibular cortical plates and the degree of involutive changes of the inferior dental artery. The mandibular canal is usually situated centrally in the mandibular corpus, slightly closer to the lingual cortex in its distal parts; towards the front, it approaches the vestibular cortical layer. Mesially from the mental foramen, a clearly defined incisive canal is present in only one third of the edentate mandibles. Mandibular corpus of the edentate mandibles consists of cancellous bone enclosed by a shell of compact cortical bone. Cortical layers demonstrate significant variations in width; nevertheless, the widths of lateral cortical layers, generally, enable safe placement of endosseous implants. Finally, in patient's preoperative assessment, involutive changes of the inferior dental artery should also be considered. During the involution of the mandibular alveolar process, it shows changes of direction and calibre, changes in arborization and, sometimes, complete occlusion of the main trunk. The degree of these involutive changes points out the mandibular vascular supply and the regenerative capacity of the tissues needed for the success of the implant procedure.

Morphometric analysis of mandibular canal: clinical aspects.

Results of morphometric analysis of the mandibular canal (MC), carried out on 105 conserved mandibles, 70 being dentate and 35 edentate, was performed. The analysis was carried out on consecutive sections, at mutual intervals of 0.5 cm. In the mandibular ramus sections were carried out obliquely, approximately in the frontal plane, and horizontally, from mandibular foramen to the lowest region of the vertical part of the MC (all together two sections). In the mandibular corpus, consecutive transversal sections were carried out between existing teeth, or at mutual intervals of 0.5 cm in edentate regions. The obtained results pointed out the very close relationship between the MC and lingual cortical plate of the mandibular ramus. In its horizontal part, the average diameter of the MC was 2.6 mm. It was situated more lingually in the molar region; towards the front, it approached the vestibular cortical plate, being closest to it in the region of the second premolar. Similar relationships of the MC and both cortical plates existed in edentate jaws. Relationships of the MC and tooth root apices varied; however, the MC was closest to the apices of the third molar. Mesially from the mental foramen, a clearly defined incisive canal was present in 92% of the dentale mandibles, but only in 31% of the edentate ones. The nearest to the incisive canal was the apex of the first premolar. The authors point out the importance of presented results in everyday practice, especially in oral and maxillofacial surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Peripheral streptomycin/lidocaine injections versus lidocaine alone in the treatment of idiopathic trigeminal neuralgia. A double blind controlled trial.

Seventeen patients with long-lasting idiopathic trigeminal neuralgia (ITN) were treated with either five, weekly peripheral streptomycin/lidocaine (S/L) or lidocaine alone injections, in a double blind controlled study. Eight patients responded initially to the treatment in the S/L group and three patients in the lidocaine group. Pain recurred in four patients from the S/L group within two weeks and six months following the last injection. One patient from the lidocaine group remained pain-free for eight months. At the final assessment, three patients from the S/L group and two patients from the lidocaine group remained pain-free up to 30 months. Neither treatment affected sensory functions of the injected nerves. It is concluded that S/L injections are initially effective in the treatment of ITN. In the long term, however, their effects are similar to the effects of lidocaine alone.

[Apicoectomy performed after supervoltage radiotherapy in the region of oral cavity and neck: case report]. / Resekcija vrha korena zuba posle supervoltazne radioterapije u predelu usne supljine i vrata: prikaz slucaja.

The author describes a case of apicoectomy of the lower canine in a patient who was previously exposed to supervoltage radiotherapy in the oral cavity and neck regions. After the comment on the uneventful postoperative course and the absence of complications one year and a half later, the author points out that apicoectomy should be taken into account when dental care of irradiated patients was planned.

[Possible usage of parallax phenomenon in dental radiography]. / Mogucnosti primene fenomena paralakse u stomatologskoj rendgenoloskoj dijagnostici.

The authors describe a method of X-ray recording which uses the phenomenon of parallax in determination of exact localisation and inter-relationship of some elements within the upper and lower jaws. By describing the method in detail, the authors also point out its advantages in everyday estimation of the position of impacted teeth and their relationship to the surrounding anatomical points.

Mandibular versus inferior dental anaesthesia: clinical assessment of 3 different techniques.

Inferior dental anaesthesia via the direct intraoral approach, mandibular conduction anaesthesia via extraoral landmarks (Gow-Gates) and mandibular conduction anaesthesia via the tuberosity approach (Akinosi) were evaluated using onset and duration of anaesthesia, pain during injection, aspiration test, pinprick, depth and frequency of anaesthesia. 90 patients undergoing simple tooth extraction were randomly selected into 3 groups. They were given injections of 2 ml of 2% lidocaine with adrenaline (1:80,000). All techniques were mostly painless, none of them showing any special advantage in that sense. The differences in duration of anaesthesia among the applied techniques were insignificant. Positive aspirations were most frequently observed with the direct method of inferior dental anaesthesia, but this method gave the best result for the frequency of anaesthesia. After using the Gow-Gates method, the external branches of the buccal nerve were usually anaesthetized but the onset of anaesthesia was relatively slow. Mandibular conduction anaesthesia via the tuberosity approach did not show any particular advantage over the other 2 techniques in this investigation. A progress study is needed to determine more precisely the aspiration rate and frequency of anaesthesia for all the techniques.

Peripheral streptomycin/lidocaine injections in the treatment of idiopathic trigeminal neuralgia. A preliminary report.

Streptomycin sulphate dissolved in 2% lidocaine solution was deposited adjacent to peripheral branches of maxillary or mandibular nerves in 20 patients with idiopathic trigeminal neuralgia. The patients were given five injections at approximately one week intervals. In the postinjection period, once the local anaesthetic had worn off, apparently normal sensation returned. All patients obtained pain relief, only four having a recurrence of symptoms. The remaining 16 patients remained free of pain after periods of up to 30 months.

Tissucol in closure of oroantral communication. A pilot study.

Complete closure of oroantral communication was achieved in 16 out of 17 patients using a single application of Tissucol. The wound healing was uneventful. The need of inserting the sealant mixture above the floor of the antrum in order to protect the clot from air flow was pointed out. Tissucol was safely applied even in cases with severely damaged buccal or palatal mucosa or after a failure of the buccal sliding flap technique.