Dental implant procedures in immunosuppressed organ transplant patients: a systematic review.

During the last decades, the number of immunosuppressed organ transplant patients has increased consistently. Nevertheless, immunosuppression has been discussed as a contraindication for dental implant procedures for many years. Hence, the purpose of this systematic review was to assess the survival rate and outcomes of dental implants after solid organ transplantation. An electronic and manual literature search was conducted up to March 2021. Publications describing dental implants placed in patients after organ transplantation were included without any limitations regarding study design or date of publication. Ten articles met the inclusion criteria, leading to a sample of 93 patients with 249 implants. Implant survival rates were 100% over a mean follow-up of 60 months. In every case, implant surgery was performed under antibiotic coverage. No major medication-related complications were reported. Despite the limited amount of evidence in the literature, implant procedures seem to be a safe treatment option in immunosuppressed organ transplant patients. The observance of appropriate treatment protocols including a strict maintenance programme seems to be crucial for the long-term success of such treatments. However, stringent data regarding various influencing factors such as the prevalence of peri-implantitis are still missing.

Intraligamentary anaesthesia as a possible anaesthetic option in oral implantology: a retrospective analysis.

This investigation was conducted to analyse the usefulness of intraligamentary anaesthesia (ILA) as an alternative anaesthetic procedure in oral implantology. Forty consecutive patients with single-tooth gaps in the posterior mandible were included in the analysis. Implant insertion was performed after ILA of the gap-delimiting teeth (two injections distal to the mesial tooth, two injections mesial to the distal tooth). Implant surgery was performed successfully under ILA of the gap-delimiting teeth in 39 cases. Injection pain correlated significantly with lower periodontal probing depths (<3mm) of the delimiting teeth (P=0.003). The total amount of anaesthetic solution and the pain during surgery were significantly higher if a root canal-treated tooth was present in the area of surgery (P=0.010 and P=0.020, respectively). Overall, the mean pain score during treatment was low at 0.76±0.51 on a numerical rating scale from 0 to 10. At the control visit, no major complication was encountered. All implants were successfully restored with single crowns after a healing period of 2 months. Taking into consideration the limitations of the study, ILA seems to fulfil all conditions to be defined as an alternative, minimally invasive anaesthetic technique for the insertion of single-gap implants.

Long-term influence of mandibular advancement on the volume of the posterior airway in skeletal Class II-patients: a retrospective analysis.

In the past, maxillomandibular advancement has resulted in considerable improvement in the volume of the posterior airway space. The objective of the present study was to find out how mandibular advancement without maxillary involvement would affect the posterior airway space in patients with mandibular retrognathism. Cone-beam computed tomographic (CT) scans were done for 20 patients before, and six months after, mandibular advancement. Cephalometric analysis at both time points included 2-dimensional and 3-dimensional assessment of the upper airway. Eight men and 12 women presented a preoperative mean (SD) Wits value of 7.4 (1.54) mm, with an airway area of 7.11 (1.88) cm2 and a volume of 14.92 (4.46) cm3. Six months postoperatively they showed a Wits value of 2.7 (0.41) mm, an airway area of 11.33 (3.49) cm2, and a volume of 25.7 (6.10) cm3. There was a mean (range) enlargement of 59 (22-82) % of the area and 73 (29-108) % of the volume. A preoperative Wits value of 8mm or more correlated significantly with a larger increase of the posterior airway space (p=0.002). At the same time, an improvement in the Wits value of 4.5mm or more correlated significantly with an increase in volume (p=0.016). The effect of mandibular advancement on the posterior airway space was significant, and the volumetric effect seems to be even more relevant than the two-dimensional changes.

The impact of sexual behavior on oral HPV infections in young unvaccinated adults.

OBJECTIVE: Different authors hypothesized an important impact of sexual behavior on the prevalence of oral human papillomavirus (HPV) infections. In order to investigate this relationship more in detail and in contrast to most other studies, the present work focused on the population group with the highest risk for sexually transmitted infections: young and sexual active adults. MATERIALS AND METHODS: Three hundred and ten men and women aged 18-30 years could be recruited. After the completion of a risk-factor survey, brush smear samples for oral HPV detection were taken in every participant. RESULTS: In 18.1 %, oral HPV could be detected. Overall, smoking (p = 0.0074) and a high number of different sexual partners (vaginal: p = 0.0001; oral: p < 0.0001) were significantly correlated with a positive HPV testing. In case of high risk HPV infections, besides tobacco and sexual behavior, alcohol consumption showed a significant association with a positive testing (p = 0.0212). CONCLUSIONS: Overall, the prevalence of oral HPV seems to be higher in young, sexual active adults compared to other population groups. Tobacco and alcohol may facilitate an oral HPV infection. Sexual behavior, especially oral sex practices, seems to play a crucial role in the transmission of oral HPV. CLINICAL RELEVANCE: The presented data, especially the association of oral high risk HPV positivity and promiscuity, may lead to improvements in the existing oral HPV prevention strategies like a HPV vaccination for both genders.

Ridge augmentation in an organ transplant patient.

With the continuing progress in medicine, the number of successful organ transplantations has continued to increase, a fact that also concerns dentists and implantologists. Implantology after organ transplantation remains controversial due to the patient's immunocompromised situation and the corresponding risk of infection. Only a few studies on this topic have been reported, with all of them showing the dental implant success rates in transplant patients to be similar to those in healthy subjects. However, immunosuppression has been identified as a contraindication to bone augmentation. Consequently, there is still a lack of knowledge regarding pre-implantology bone grafting procedures. The following case report describes the use of ridge augmentation and extended bilateral sinus lift procedures in a liver transplant patient. The patient was treated with an implant-supported fixed prosthesis in the upper jaw and was followed up for a total of 28 months after implant insertion. According to the findings presented, pre-implantology augmentation procedures may be performed successfully in immunosuppressed organ transplant patients. Stable peri-implant conditions were shown over a period of more than 2 years. Nevertheless, further investigations are needed to define a safe treatment protocol for these high-risk patients.

Ultralow-dose computed tomography imaging for surgery of midfacial and orbital fractures using ASIR and MBIR.

The influence of dose reductions on diagnostic quality using a series of high-resolution ultralow-dose computed tomography (CT) scans for computer-assisted planning and surgery including the most recent iterative reconstruction algorithms was evaluated and compared with the fracture detectability of a standard cranial emergency protocol. A human cadaver head including the mandible was artificially prepared with midfacial and orbital fractures and scanned using a 64-multislice CT scanner. The CT dose index volume (CTDIvol) and effective doses were calculated using application software. Noise was evaluated as the standard deviation in Hounsfield units within an identical region of interest in the posterior fossa. Diagnostic quality was assessed by consensus reading of a craniomaxillofacial surgeon and radiologist. Compared with the emergency protocol at CTDIvol 35.3 mGy and effective dose 3.6 mSv, low-dose protocols down to CTDIvol 1.0 mGy and 0.1 mSv (97% dose reduction) may be sufficient for the diagnosis of dislocated craniofacial fractures. Non-dislocated fractures may be detected at CTDIvol 2.6 mGy and 0.3 mSv (93% dose reduction). Adaptive statistical iterative reconstruction (ASIR) 50 and 100 reduced average noise by 30% and 56%, and model-based iterative reconstruction (MBIR) by 93%. However, the detection rate of fractures could not be improved due to smoothing effects.

Odontogenic deep neck space infection as life-threatening condition in pregnancy.

Odontogenic deep neck space infections represent a severe disease with possible life-threatening complications. Despite knowledge of these infectious diseases, treatment remains a challenge for every maxillofacial surgeon. Therapy of severe neck infections is even more crucial during pregnancy because of the possible life-threatening situation for both the mother and the foetus. The possible compromise of oral health during pregnancy is well known, however severe odontogenic infections are rarely considered in the literature. The following case report describes the dramatic course of a deep neck space infection in a pregnant patient, commencing with typical symptoms of localized odontogenic infection and ending in a critical, life-threatening condition for the patient and a lethal condition for the foetus. The case represents the first description of intrauterine, foetal death caused by a deep neck space infection. Implications for dental and medical treatment during pregnancy, especially regarding odontogenic infections, are presented and discussed with findings in the international literature.

Necrotizing periodontitis as a possible manifestation of common variable immunodeficiency.

Common variable immunodeficiency (CVID) is an inherited disease characterized by hypogammaglobulinaemia and impaired humoural immunoresponse and is mainly associated with recurrent infections of the airway and the digestive tract. An 18-year old female with a diagnosis of CVID associated with a devastating necrotizing periodontitis, ultimately resulting in complete destruction of the periodontium and loss of all teeth, is reported. Clinical, biochemical, microbiological and radiographic examinations are presented. The report highlights the likely importance of immunoglobulin replacement and intensive dental hygiene in CVID patients, and the devastating effect of non-compliance in such patients.