Effective postoperative pain prevention through administration of bupivacaine and diclofenac.

The efficacies of bupivacaine and lidocaine together with a preoperatively administered single-dose oral combination of normal- and sustained-release preparations of diclofenac in preventing postoperative pain after third molar removal were compared in a double-blind crossover study. Bilaterally impacted lower third molars were removed in two sessions. Each patient was given one type of local anesthetic on one session and the other in the second. Pain was recorded using a visual analog scale. When the diclofenac combination (150 mg) was given before the operation, postoperative analgesia was better with bupivacaine plus diclofenac than with lidocaine plus diclofenac. Twenty-five out of 40 patients preferred bupivacaine to lidocaine for local anesthesia. It is possible to achieve effective postoperative pain prevention by combining bupivacaine and preoperative normal- and sustained-release preparations of diclofenac.

Preoperative intravenous diclofenac for postoperative pain prevention in outpatients.

Fifty patients undergoing a standard removal of an impacted lower third molar were given a single dose of 75 mg sodium diclofenac or saline (placebo) intravenously before operation, on a double-blind basis. Pain was measured postoperatively by means of a visual analogue scale hourly for the first 8 h and during the first and second days after operation. Administration of diclofenac resulted in greater pain relief than administration of placebo for the first 3 h after surgery, whereafter the treatments did not differ. The results suggest that intravenous preoperative diclofenac may be useful in some clinical situations but generally it probably offers little benefit over the corresponding oral treatment.

A comparison of diclofenac with and without single-dose intravenous steroid to prevent postoperative pain after third molar removal.

The efficacy of 40 mg of methylprednisolone given intravenously before operation in combination with orally administered rapid-release and sustained-release diclofenac preparations in preventing postoperative pain after third molar removal was studied. The administration of methylprednisolone and diclofenac resulted in greater pain relief than did administration of diclofenac alone.

Third molars confusing the diagnosis of carcinoma.

The purpose of this study was to describe cases of oral cancer in which the initial presenting symptoms were considered to be due to third molars and in which the underlying carcinoma therefore escaped early diagnosis. Between 1986 and 1990 a total of five cases with squamous cell carcinoma associated with a third molar (impacted, partially or totally erupted, or recently extracted) were treated at our unit. Because of acute or chronic symptoms related to disturbed eruption of third molars, the detection of a simultaneous malignant change and referral were delayed. In conclusion, all third molars, especially impacted, partially erupted, or overerupted ones, should be examined critically, especially if the patient has symptoms.

Postoperative pain prevention by a single-dose formulation of diclofenac producing a steady plasma concentration.

The preoperative single-dose oral administration of a combination of rapid- and slow-release diclofenac (Voltaren, Ciba-Geigy, Basel, Switzerland) preparation in a placebo-controlled trial proved to be more effective in postoperative pain prevention following third molar removal than the combination of intramuscular diclofenac and an oral depot formula.

Reparative bone growth in an extremely atrophied edentulous mandible stimulated by an osseointegrated implant-supported fixed prosthesis: a case report.

This case report demonstrates that severe disuse atrophy of an edentulous mandible can be changed to reparative bone growth through restoration of function and masticatory ability using an osseointegrated implant-supported fixed prosthesis. In 8 years, bone height in the retroforaminal area nearly doubled and a new bony layer remodeled the cranial roof of the mandibular canal.

Keratocyst recurrences at intervals of more than 10 years: case reports.

The two cases reported here are of keratocysts which recurred after exceptionally long intervals. In the first case, the keratocyst recurred twice during the 37-year follow-up: 16 years after the initial operation and 21 years after the second. In the second case the recurrence occurred 14 years after surgical treatment. Recommendations for the duration of follow-up are discussed.

A 30-year follow-up study of temporomandibular joint meniscectomies: a report on five patients.

Five patients who underwent temporomandibular joint (TMJ) meniscectomy 30 to 40 years ago were examined clinically and radiologically for functional limitations, pain or structural changes in the articular hard tissues. The results are presented and the role of meniscectomy in the treatment of persistent TMJ disorders is discussed.

Technique for converting an existing complete denture to a tissue-integrated prosthesis.

A technique for modification of an existing complete denture into a tissue-integrated prosthesis is described. An acceptable conventional denture is clinically attached to titanium abutments in the maxillomandibular position that has proved to function well during a trial period. The framework is fabricated to fit the reduced denture base (Fig. 16). The advantages of this technique include (1) the appearance of the tissue-integrated prosthesis is known in advance; (2) the technique is simple and requires only four visits to complete; (3) the framework fit is predictable; (4) there is minimum insertion and removal; (5) the base has a natural look and the lips have support; and (6) minimum phonetic problems are encountered.

Effective postoperative pain control by preoperative injection of diclofenac.

We have treated ninety-five patients undergoing surgical removal of third molar with diclofenac or placebo, administered double-blind either pre- or postoperatively. Postoperative pain was recorded hourly for the first 8 h using a 100 mm visual analogue scale. Preoperative administration of diclofenac produced more effective pain relief than either postoperative administration or placebo. Since diclofenac has an inhibitory action on prostaglandin synthesis prophylactic intramuscular administration may have reduced the inflammatory process before synthesis of prostaglandins was activated.

Late effects of radiation treatment of tongue and floor-of-mouth cancer on the dentition, saliva secretion, mucous membranes and the lower jaw.

The purpose of this study was to determine retrospectively any changes in the dentition, saliva secretion, mucous membranes and the lower jaw resulting from the radiation treatment given to patients with cancer of the tongue or floor of the mouth. The study covers 29 patients treated at the Department of Radiotherapy and Oncology of Helsinki University Central Hospital between 1972 and 1981. 23 of the patients were treated for cancer of the tongue and the remaining 6 for cancer of the floor of the mouth. The radiation doses ranged from 5300 to 6700 rad. Clinical examination revealed that the number of carious teeth doubled as a result of radiotherapy, while the incidence of cervical lesions increased by a factor of 10, both compared with the controls. About 70% of the patients studied were found to have either moderate or extensive fungal growth. Stimulated saliva secretion had fallen to about 20% and resting saliva secretion to about 30% of the values for the control group. Radiography revealed pathological changes in the mandible in 34% of the patients. Clinically, 2 patients were found to have extra-oral fistulae. In 1 of these, the spontaneously fractured end of the mandible was visible for several cms. 3 of the patients had undergone hemimandibulectomy because of osteoradionecrosis.

Primary intra-osseous carcinoma involving the maxilla.

Primary intra-osseous carcinoma, especially in the maxilla, is a rare sub-type of odontogenic carcinoma. The authors describe a recurrent case with maxillary involvement. In 1981, an intra-osseous maxillary tumour was excised from a 33 year-old male. There were two recurrences (in 1983 and 1984). Extra-osseous sites for the origin of the tumour were excluded. The histopathological appearance of the tumour was that of a primary intra-osseous carcinoma. At the age of 22 years, the patient had an osteosarcoma of the radius and at the age of 31 years, pulmonary tuberculosis. The differential diagnosis of primary intra-osseous carcinoma is discussed.