Development of an oral health-related quality of life questionnaire on neurosensory disturbances after orthognathic surgery - a pilot study.

OBJECTIVE: Development of a new questionnaire, Oral Health-Related Quality of Life - Neurosensory Disturbances after Orthognathic Surgery (OHRQL-NDO), designed to measure the effects of neurosensory disturbance (NSD) on patients' oral health-related quality of life (OHRQL) and to evaluate reliability and validity of this questionnaire. MATERIALS AND METHODS: A questionnaire including 11 items was constructed. Thirty patients with NSD affecting the lower lip and/or chin following orthognathic surgery were included. Convergent validity was assessed by comparing OHRQL-NDO with OHIP-14 and two global questions. Test-retest reliability was assessed by asking the patients to complete OHRQL-NDO at two different occasions with an interval of two to three weeks. RESULTS: The internal consistency, measured with Cronbach's alpha, was 0.84. The test-retest reliability, measured with ICC, was 0.89 (95% CI 0.77-0.95). The correlation between the mean sum score for the OHRQL-NDO and the mean sum score for the OHIP-14 was r = 0.75, using Pearson correlation coefficient. The correlations between the mean total score for the OHRQL-NDO and the global questions 1 and 2 were r = 0.74 and r = 0.72, respectively. CONCLUSIONS: The current instrument OHRQL-NDO is a promising test, but needs further development to better capture the different aspects of OHRQL. Further tests of the questionnaire must follow in other samples to finalize the instrument.

Phenotype of Crohn's disease according to the Montreal classification in relation to dental health status.

OBJECTIVE: The relationship between oral health and Crohn's disease is uncertain. Previous studies have yielded contradictory results, reflecting perhaps the different phenotypes of the disease. The aim of the present study was to describe and analyse the dental status of a group of patients with Crohn's disease (CD), considering the positions of the inflammatory loci and disease phenotype. METHODS: In total, 47 patients with Crohn's disease (18 males and 30 females; mean age. 48.7 years; range, 23-61 years) were consecutively recruited to this study. Interviews and clinical examinations were performed to assess dental status, medication, smoking history, heredity of inflammatory bowel disease (IBD), duration of disease, oral mucosal manifestations of Crohn's disease. Furthermore, data on subjective health assessments and family status, along with medical histories from the patients were obtained through questionnaires. The disease phenotypes were assessed and classified according to the Montreal classification. The data on oral health status were first correlated with the Montreal classifications of IBD, and, thereafter, all the collected data were included in a multivariate generalised linear model. RESULTS: The dental status of the patients was comparable to that of the Swedish average. No statistically significant associations were found between oral status and the different CD phenotypes. However, within the Montreal classification, there were significantly fewer teeth in those patients with perianal lesions than in those without such lesions, and there was a significant correlation between deeper pocket depth and problems with strictures and penetrations. No significant differences (p = .074) between the patients with CD (N = 47) and controls (N = 38) were found regarding the presence of oral mucosal lesions. CONCLUSION: Dental health may be adversely affected in severe cases of CD whereas most of the remaining patients with CD appear to have a level of dental health that is comparable to that in the general population.

Influence of a single preoperative dose of antibiotics on the early implant failure rate. A randomized clinical trial.

BACKGROUND: The use of a preoperative single dose of antibiotics as routine in conjunction with implant surgery is controversial, in light of the unclear effect on early implant failure rate and risk for development of resistant bacterial strains. PURPOSE: This randomized clinical trial compared the early implant failure rates in two different patient cohorts: One group receiving a single dose of preoperative antibiotics (AB group) and one group receiving no antibiotics, prior to implant surgery (noAB group). MATERIALS AND METHODS: Patients were referred for treatment at four specialist clinics in the county council of West Sweden, Vastra Gotaland and randomly assigned into one of the two groups. A total of 447 patients received 963 implants were included in the study. Of these, 223 patients (535 implants) belonged to the AB-group and 224 patients (428 implants) to the noAB-group. Four commercial implant brands were utilized, albeit one system was only represented with four implants. The outcome was evaluated after 4 months using either a one-stage or two-stage procedure. The surgical procedures were performed by experienced implant surgeons and the surgical protocol for implant placement follows standard. Failure was defined as removal of an implant for any reason. The study outcomes were statistically analyzed to evaluate the differences between the two groups. RESULTS: Twelve implants failed in 11 patients for the AB group, and 32 implants failed in 29 patients for the noAB group. Preoperative antibiotics, AB group, had significantly (P < 0.0011) lower implant failure 2.2% compared to 7.5% in the noAB group analyzed on implant level adjusted for dependence within patients, OR = 0.30, 95% confidence interval (0.14-0.62). CONCLUSION: Administration of a single dose of antibiotics in conjunction with implant placement surgery resulted in a statistically significant lower early implant failure rate compared to when no antibiotics were used.

Incidence and risk factors predisposing plate removal following orthognathic surgery.

OBJECTIVE: The aim of this study was to investigate the incidence and reasons for titanium fixation plate removal following orthognathic surgery, identify risk factors predisposing removal, and explore if discomfort was reduced postoperatively. STUDY DESIGN: Medical records of 404 consecutive cases were retrospectively reviewed. All patients received a questionnaire for follow-up, and 323 patients answered the questionnaire, thus forming the sample group. RESULTS: Of all the responding patients, 15% had plates removed, and 92% of these patients experienced relief from discomfort after removal of the plates. Infection was the most common reason for plate removal (10%). Smoking (hazard ratio 2.74) and surgery performed in the mandible (hazard ratio 2.40) increased the need for plate removal. For each plate added in the mandible, the risk for removal increased by 34%. CONCLUSIONS: Smoking, osteotomies, and additional numbers of plates in the mandible resulted in a higher incidence of plate removal. Most of the patients experienced relief from discomfort after plate removal.

Mandibular trabecular bone structure in adults with Crohn's disease.

OBJECTIVES: Crohn's disease (CD) is associated with reduced bone mineral density. The main objective of the present study was to assess the mandibular trabecular bone quality and to compare our findings with those among sex- and age-matched controls. Furthermore, background variables known to be significant for bone density were compared. MATERIALS AND METHODS: Intraoral radiographs of 49 Crohn's patients (23-61 years old) and 49 age- and sex-matched controls were evaluated. Mandibular trabecular pattern was classified as either sparse, mixed dense plus sparse, or dense. Furthermore, two computer-based methods analyzed the transitions from trabecula to intertrabecular spaces and the size and number of these spaces. Differences in continuous background variables were tested with Student's two-sample t test and ordinal variables with Mann-Whitney U test or Kruskal-Wallis nonparametric tests. RESULTS: All three methods to evaluate bone structure seen on dental radiographs showed significantly sparser trabeculation in Crohn's patients than in the control group. The Crohn's patients were heavier, more often smokers, and more frequently had mothers who developed fragility fractures. Furthermore, the Crohn's patients, especially smokers, had a significantly higher fracture rate than the matched control group but no significant relationship was found between trabeculation pattern and fracture. CONCLUSIONS: The results of this investigations indicated that trabecular bone is significantly sparser in subjects with Crohn's disease compared to a matched control group. CLINICAL RELEVANCE: An early identification of CD patients with sparse trabeculation and appropriate advice concerning nutrition and exercise may lead to less fractures and medication in the future.

Integration of fluoridated implants in onlay autogenous bone grafts - an experimental study in the rabbit tibia.

INTRODUCTION: Bone augmentation before treatment with endosseous implants is a common procedure for rehabilitation of the edentulous jaw. Both machined and surface modified implants have been used in one-stage and two-stage surgery protocols with varying results and survival rates. The influence of surface modification on the integration of implants has been documented in both non-grafted and grafted bone. The aim of this study was to compare the integration and stability of surface modified fluoridated vs. machined implants when placed simultaneously with an onlay bone graft. MATERIAL AND METHODS: Eight rabbits were used in this study. A disc shaped bone graft was harvested from each side of the sagittal suture of the calvarial bone and fixed bi-cortically to the proximal tibial metaphysis by means of a dental implant, 9 mm long and 3.5 mm in diameter with a smooth machined surface as control and a blasted, fluoridated surface as test. Test and control sides were randomised. After a healing time of 8 weeks, the rabbits were sacrificed and the implants were removed en block for light microscopic analysis. Bone to implant contact (BIC) was registered as well as the amount of bone filling a rectangle indicating a region of interest (ROI) in the grafted area. Resonance frequency analysis (RFA) was conducted both at the time of surgery and at the end of the study. RESULTS: Our results showed statistically significant differences in BIC within the grafted area and the total bone to implant contact between the test and control sides in favour of the surface modified implants. The bone area filling the threads within a region of interest showed no statistically significant difference between the test and control sides. RFA showed higher implant stability with significant differences at the time of sacrifice in favour of the fluoridated implants. CONCLUSION: Surface modified fluoridated implants showed a higher degree of osseointegration and stability in onlay bone grafts compared with control implants with machined surface texture.

One-year results of a clinical and radiological prospective multicenter study on NEOSS® dental implants.

BACKGROUND: NEOSS® (Neoss Ltd., Harrogate, UK) dental implant system was introduced on the clinical arena in 2003. It is important that novel implant systems are systematically evaluated in a multicenter setting. PURPOSE: The aim of this study was to follow a large number of consecutively treated patients, with NEOSS dental implant system, both clinically and radiographically. The current report constitutes the 1-year data of a planned 5-year study. MATERIALS AND METHODS: The study included a total of 177 patients treated with 590 NEOSS implants at 13 clinics in Sweden. The material was composed of 72 males and 105 females treated for single, partial, and total edentulism. Clinical, radiographic, and subjective evaluations were performed. RESULTS: Out of 590 implants, 13 early failures have been reported, corresponding to a 1-year cumulative survival rate (CSR) of 97.8%. Evaluation of function and esthetics at the 1-year visit resulted in 100% success for function and 98% success for the esthetic outcome. The mean marginal bone loss was 0.6 mm (SD 1.1) after 1 year in clinical function. No adverse effects of the NEOSS dental implants were reported, and complications were few and similar to those reported for implant treatment in general. CONCLUSION: The CSR in the present study was 97.8%. No adverse effects of the NEOSS implants were reported, and complications during the study period were few and similar to those reported to for other well-documented implants system. Based on the present data, we conclude that NEOSS dental implant is a safe and predictable implant system. However, the high number of dropouts in the radiological evaluation must be considered when interpreting the data.

A retrospective evaluation of iatrogenic dental root damage with predrilled vs drill-free bone anchor screws for intermaxillary fixation.

AIMS: The aim of this study was to retrospectively evaluate iatrogenic dental root damage, caused by two different techniques that utilized bone anchor screws, for intermaxillary fixation (IMF) in orofacial trauma. MATERIALS AND METHODS: The techniques used included either predrilled or drill-free bone anchor screws. A total of 123 patients who required IMF were evaluated (97 men and 26 women). Sixty-four patients were treated in the predrilled group, and 59 patients were treated in the drill-free group. The data were collected over an 8-year period and were analyzed using crosstabs and Fisher's exact test. RESULTS: Injuries to dental roots were found only in the predrilled group. Twenty-nine patients (45.3%) were injured at the time of surgery. One year after surgery, 10 patients (15.6%) had permanently injured dental roots. There was a significant difference in injury rates between the predrilled and drill-free groups 1 year after surgery (P < 0.001). CONCLUSION: There is an increased potential risk of iatrogenic injury and permanent damage to the dental roots when a technique that involves predrilled holes for bone anchor screws is used.

Apical peri-implantitis: possible predisposing factors, case reports, and surgical treatment suggestions.

BACKGROUND: Apical peri-implantitis is often diagnosed by clinical findings such as pain, redness, tenderness, swelling, and sometimes the presence of a fistulous tract. There are few theories about how such a lesion occurs. Hence, the current clinical treatment protocols are scanty. PURPOSE: The aim of this report was to evaluate and confer a more extended surgical protocol and to discuss possible predisposing factors for the development of retrograde peri-implantitis. MATERIALS AND METHODS: Two patients were extensively evaluated with regard to clinical signs, implant treatment, postoperative complications, and surgical treatment. The surgical protocol comprised debridement, with the additional removal of the apical portion of the affected implant. Postoperative checkup included clinical examination and radiographs. The follow-up period ranged from 1 to 3 years following surgical debridement. The possible predisposing factors are also discussed in the article. RESULTS: Both cases healed uneventfully with no further symptoms. Radiographs revealed complete bone fill into the resected area and continuous stable bone levels around the previously affected implants. CONCLUSIONS: It is concluded that recommendations for treatment of apical peri-implantitis are still minimal. In the present study, a surgical approach with resection of the apical portion of the affected implants in combination with debridement is suggested. Our experience was that partially resected oral implants remain osseointegrated and also function well clinically with a follow-up period up to 3 years.

Sagittal split advancement osteotomy: comparison of the tendency to relapse after two different methods of rigid fixation.

Mandibular advancement was studied in 32 patients with mandibular retrognathia in whom the only intervention was in the mandible. Fifteen patients were treated with fixation by lag screws and 17 with monocortical miniplates. Lateral radiographs were taken preoperatively, postoperatively, 2 months postoperatively, and 1.5 years postoperatively, and mandibular movement analysed. All patients healed uneventfully. Cephalometric analysis of lateral radiographs showed no significant differences between the two groups in skeletal relapse during any of the control periods up to 18 months. Mandibular advancement for treatment of mandibular retrognathia using rigid fixation with either lag screws or miniplates was reproducable with only minor skeletal relapse.

A randomized double-blind comparative study of Biolight light therapy following surgical extraction of impacted lower third molars.

Monochromatic light has been used in many studies and indicated that phototherapy might be effective in the treatment of pain relief. The aim of this investigation was to evaluate the efficacy of monochromatic light phototherapy on patients who had undergone impacted third molar surgery. Sixty adult patients were included in the study. The patients were divided into 2 groups; the Biolight therapy group and the placebo therapy group. All the subjects received phototherapy 6 minutes preoperative and 10 minutes postoperative. They were examined 3 and 7 days after surgery to evaluate postoperative pain and wound healing. One patient was excluded from the study due to extraction of the third molar in maxilla. All the patients received a questionnaire to answer regarding pain and the number of pain killers consumed. The results from this study showed that Phototherapy using monochromatic light Biolight therapy had no significant differences compared to the placebo group.

Influence of different prophylactic antibiotic regimens on implant survival rate: a retrospective clinical study.

BACKGROUND: The routine use of antibiotics in oral implant treatment seems to be widespread. The pre- or postoperative use of antibiotics in conjunction with implant surgery and its correlation with failure and success rates are poorly documented in the literature. The debate regarding overprescription of antibiotics raises the need for a critical evaluation of proper antibiotic coverage in association with implant treatment. PURPOSE: The purpose of this study was to compare the implant survival rate following a 1-day single-dose preoperative antibiotic regimen with that following a 1-week postoperative antibiotic protocol. MATERIALS AND METHODS: The study included 868 consecutively treated patients. A total of 3,021 implants were placed. The population was split into two categories, either receiving a 1-day single-dose administration only, or a 1-week postoperative administration of antibiotics. Healing was evaluated at second-stage surgery (6 months for the upper jaw, 3 months for the lower jaw). Failure was defined as removal of implants because of non-osseointegration. Statistical analyses were performed with analysis of variance and the Scheffé test, with a significance level of 5% for comparison of data. RESULTS: No significant differences with regard to complications and implant survival were found in the study. CONCLUSION: Based on the present data, a more restrictive regimen consisting of a 1-day dose of prophylactic antibiotic in conjunction with routine implant procedures is recommended.