Simultaneous management of chronic maxillary sinusitis from dental origin and the relevance of nasal septal deviation: A retrospective evaluation of 65 cases.

PURPOSE: Dental origin constitutes most chronic unilateral maxillary sinusitis (CMS) and is referred to as dental chronic maxillary sinusitis (DCMS). Recently, dental implants and related surgical procedures have become more prevalent. We present an evaluation of the simultaneous treatment of DCMS. MATERIALS AND METHODS: A retrospective review of records from 395 patients with CMS treated at our medical center from 2015 to 2020 found 65 patients diagnosed with DCMS. Statistical analyses were performed using the records data. RESULTS: Four patients were excluded. The final study population included 35 males and 26 females with a mean age of 55. 29 % were post-dental implant placement or related pre-prosthetic procedures. Presenting symptoms included middle meatus edema (72 %), pus in the middle meatus (70 %), and nasal secretion (39 %). Clinical findings included septal deviation (39 %), among them 87 % deviated toward the diseased sinus, OAF (49 %), and nasal polyposis (16 %). In 32 patients, the OAF was closed in one layer using a local mucoperiosteal flap. In 29 patients, the closure was done in two layers, including a buccal fat pad (BFP) regional flap. One patient had a reopened OAF, and five patients required revision surgery. 92 % of patients in this study had complete clinical and radiological resolution of the DCMS. CONCLUSIONS: Relevance of nasal septal deviation in association with DCMS is present. There is no distinct difference in the manner of OAF closure if it is done in a simultaneous procedure. One stage combined multidisciplinary surgical procedure is sufficient to treat DCMS.

Surgical correction of neonatal obstructive sleep apnea due to a temporomandibular joint ankylosis.

In growing children, temporomandibular joint (TMJ) ankylosis and septic arthritis are uncommon. Retrognathia and micrognathia affect airway patency and can cause obstructive sleep apnea (OSA). No unified diagnostic criteria have been established for the management of this pathology. We describe the first case of treatment for pediatric TMJ ankylosis and severe OSA due to neonatal group B streptococcal septic TMJ arthritis. Untreated pathological changes in the TMJ will eventually lead to ankylosis. Among children, this will include facial growth disturbances leading to mandibular retrognathia, reduction in the oropharyngeal spaces, and OSA. Our patient had severe OSA with an apnea-hypopnea index of 24.9 events/h and oxygen saturation nadir of 73% as measured by polysomnography. She was treated successfully according to Andrade protocol. This is the first report of pediatric OSA due to TMJ ankylosis following neonatal group B streptococcal septic arthritis. CITATION: Pesis M, Goldbart A, Givol N. Surgical correction of neonatal obstructive sleep apnea due to a temporomandibular joint ankylosis. J Clin Sleep Med. 2024;20(1):173-179.

Perforating dental implants and maxillary sinus pathology.

OBJECTIVES: To study the association between perforation dental implants into the maxillary sinus cavity and the development of sinus pathology. METHODS: We retrospectively examined 3732 computerized tomography (CT) scans to detect maxillary implants. The detected scans were grouped based on apparent or lack of perforated dental implants in the maxillary sinus (study and control group, respectively). Clinical data was gathered including the CT indication, patients' demographics, comorbidities and medications, implant features, and the radiographic appearance of the maxillary sinuses. We conducted a logistic regression to identify risk factors to develop radiopaque thickening in the sinuses. RESULTS: Included in the study were 198 patients with 719 maxillary implants; of these, 236 and 483 implants were in the study and control groups, respectively. Sinus opacification was associated with implants' perforations (p < 0.001), diameter, and side and place (p < 0.05). Implants' perforation (OR = 3.679; 95% CI = 1.891-7.157) and diameter (OR = 1.608; 95% CI = 1.067-2.424), sinus floor augmentation (OR = 2.341; 95% CI = 1.087-5.042), male gender (OR = 2.703; 95% CI = 1.407-5.192), and smoking (OR = 6.073; 95% CI = 2.911-12.667) were associated with ipsilateral sinus fullness. CONCLUSIONS: A first large study on the association between maxillary dental implant and sinus pathology. Dental implant perforation is associated with sinus opacification. Considering dental implant diameter, rather than vertical depth of penetration into the sinus, as an important criterion when examining perforated dental implants necessitates a new approach to clinical decision-making.

Positive Outcomes of Denosumab Treatment in 2 Patients With Cherubism.

Cherubism is a rare autosomal dominant disease whose severity ranges widely, from asymptomatic to life-threatening. Bilateral symmetrical painless expansion of the mandible and maxilla resulting in a typical appearance of the face resembling a cherub, are the highlighted features of the condition. In most cases, cherubism-induced lesions in the jaws appear around the age of 3 years and tend to expand and increase in numbers until puberty. Treatment options for cherubism range from observation to surgical correction and various pharmacologic therapies. Given the excess sensitivity of cherubism osteoclasts to RANKL (receptor activator of nuclear factor κB ligand) and the positive effects of denosumab (XGEVA; Amgen, Thousand Oaks, CA) treatment in patients with giant cell granuloma, we have designed a treatment based on denosumab for 2 cherubism patients that achieves what we consider promising results.

Deep Neck Infections Are Life Threatening Infections of Dental Origin: a Presentation and Management of Selected Cases.

BACKGROUND: Untreated dental caries or even dental manipulations, such as a tooth extraction, might cause direct spread of an odontogenic infection and consequently the development of life-threatening conditions such as deep neck infections (DNI). The most common source of DNI is of odontogenic origin (38.8-49%). Abscess formation or cellulitis can lead to life-threatening complications, despite new diagnostic imaging technology and widespread availability of antibiotics. OBJECTIVES: To demonstrate the dangers of DNI, which can create life-threatening situations. METHODS: Five cases of DNI of odontogenic origin, which were referred to the oral and maxillofacial surgery unit, are presented. RESULTS: Clinical manifestations included trismus, dysphagia, dysphonia, dyspnea, and infection symptoms. In all cases, computed tomography confirmed diagnosis and extent of abscess. Complications included mediastinitis, respiratory distress, osteomyelitis of the jaws, and in rare cases the mandibular condyle. Treatment included securing the airway, immediate surgical drainage, removal of the infection source, and antibiotic therapy. All patients were discharged in stable and improved condition. CONCLUSIONS: DNI treatment on an emergency basis requires proper diagnosis and effective management. To confirm diagnosis and prevent serious complications, it is essential for physicians to recognize the spaces of the head and neck that are likely to be affected by DNI.

Treatment of Intermittent Locking of the Jaw in Wilkes Stage II Derangement by Arthroscopic Lysis and Lavage.

PURPOSE: This study evaluated the efficacy of a standardized arthroscopic lysis and lavage in decreasing the intermittent locking and transient pain episodes that characterize patients with early- to intermediate-stage internal derangement (Wilkes stage II). PATIENTS AND METHODS: This is a retrospective analysis of the medical records of 27 patients (39 joints) treated by arthroscopic lysis and lavage in the authors' department during a 2.5-year period. Patients were diagnosed preoperatively as having mild internal derangement (Wilkes stage II) that was unresponsive to previous conservative therapy. Three outcome variables were used to assess the efficacy of treatment: 1) frequency of intermittent locking or catching episodes, 2) severity of pain, and 3) maximal interincisal opening. RESULTS: Ninety-two percent of patients reported improvement regarding the locking and catching episodes. Most patients (77%) denied experiencing any locking episodes during the follow-up period, and 15% reported experiencing locking episodes but with less frequency or severity. The median duration of symptoms for patients who were freed from locking episodes was 16 months compared with 36 months for patients who still had locking episodes after treatment (P = .059). Mean pain values (visual analog scale, 0 to 10) decreased from 7.5 preoperatively to 3.2 postoperatively (P < .0001). For maximal interincisal opening, there was no significant difference after treatment (mean, 39.4 mm preoperatively vs 41.3 mm postoperatively; P = .06). Success was defined as a decrease in locking episodes, a decrease of pain, and maintenance of normal interincisal opening (>36 mm). The overall success rate was 81.4% (22 of 27 patients). CONCLUSION: Arthroscopic lysis and lavage is an efficient treatment modality for treating mild internal derangement of the temporomandibular joint. It decreases the frequency of locking episodes and decreases transient pain periods.

Coronectomy of the mandibular third molar: a retrospective study of 185 procedures and the decision to repeat the coronectomy in cases of failure.

PURPOSE: A prevalent complication associated with mandibular third molar extraction is inferior alveolar nerve (IAN) injury. This study evaluated the success rate of coronectomy and, in the event of failure of the procedure, retreatment. PATIENTS AND METHODS: One hundred seventy-three patients underwent 185 coronectomy procedures of the mandibular third molar to prevent IAN injury. The coronectomy was performed along the cementoenamel junction. Residual roots were trimmed 3 to 4 mm below the crest margin. No pulp treatment was performed and the roots were left vital. A postoperative orthopantogram was recorded immediately after the procedure or at follow-up 1 month later. Two additional orthopantographic views were taken at 6- and 12-month follow-up appointments. Statistical analyses were performed to assess differences in root migration, pain, wound healing and failure by age, gender, and time elapsed from coronectomy. Statistical data were considered significant at a P value less than .05. RESULTS: Statistical differences in the migration of residual roots from 6 to 12 months were found. Migration of the roots was found in younger patients. In a total of 10 cases of failure, 4 were treated with repeat coronectomy. The other 6 cases were treated with reoperation (ie, removal of residual roots). CONCLUSION: Immediate postoperative radiographic imaging is recommended, as well as, follow-up evaluation 12 months after surgery. In addition, repeat coronectomy is recommended for cases in which enamel retention is diagnosed to prevent residual roots from becoming infected.

Arthroscopic lysis and lavage for internal derangement of the temporomandibular joint.

INTRODUCTION: Arthroscopy of the temporomandibular joint (TMJ) is a valuable diagnostic and therapeutic tool for various intra-articular disorders, especially internal derangement (ID) of the TMJ. OBJECTIVES: To evaluate the efficacy and safety of a standardized arthroscopic procedure for the treatment of two stages of ID; early/intermediate stage and intermediate/late stage. MATERIALS AND METHODS: Retrospective analysis of medical records of 78 patients (99 joints) treated by arthroscopic lysis and lavage in the authors' department during a 5-year period. Patients were diagnosed preoperatively as suffering from ID of the TMJ. The results were stratified according to the stage of ID. Three outcome variables were used to assess efficacy of treatment: Maximal interincisal opening (MIO), level of pain on a visual analog scale (VAS), and frequency of intermittent locking episodes. In addition, complications were reported. RESULTS: Mean MIO of the group of patients with intermediate/late stage ID increased from 27 ± 4.7 mm preoperatively to 38 ± 5.4 mm postoperatively (P < 0.0001). For the group of patients with early/intermediate stage ID, mean MIO did not change significantly after arthroscopy (39.1 ± 6.2 mm compared to 41.4 ± 5 mm, P = 0.06), however, subjective evaluation of pain on a VAS decreased from 7.2 ± 1.2 preoperatively to 3.4 ± 2.2 postoperatively (P < 0.0001), and 80% of the patients (25 of 31) denied experiencing intermittent locking episodes after treatment (P < 0.0001). CONCLUSION: Arthroscopic lysis and lavage is a safe and effective therapeutic modality for the treatment of both mild and advanced stages of ID.

Inferior alveolar neurosensory deficiency associated with placement of dental implants.

BACKGROUND: This study reports and analyzes a large series of patients with neurosensory deficiency related to the placement of dental implants (DIs) and resulting in liability claims (LCs). METHODS: From 1998 to 2009, there were 92 LCs related to persistent altered sensation post DI placements in Israel. Patients' demographics, year and source of LCs, interval between the procedure that resulted in a neurosensory deficiency and the LC, qualifications of the surgeon, preoperative imaging modality, DI length, available alveolar bone for DI placement, placement site, timing of DI placement (immediately after tooth extraction or after socket healing), and treatment after the diagnosis of neurosensory deficiency were recorded and analyzed. RESULTS: There were 21 cases during the first 5 years of the study (mean 4.2/year) and 63 cases (mean 12.6/year) over the following 5 years. Thirty LCs were issued during the second postoperative year and 15 LCs after >5 years. Most LCs (76%) involved procedures that were planned and performed according to radiographs and 24% after computed tomography. Sixty-five percent of the LCs were performed by general dental practitioners and 35% by specialists. More than one DI was performed during the surgical procedure that resulted in a neurosensory deficiency in 73 LCs (79.3%), and the DI was >10 mm in 55 (59.8%) cases. CONCLUSIONS: LCs for DIs that result in a neurosensory deficiency pose a legal risk to the practitioner long after the injury has occurred.

Medico-legal aspects of altered sensation following endodontic treatment: a retrospective case series.

OBJECTIVE: The objective of this study was to analyze cases of liability claims related to persistent altered sensation following endodontic treatments so as to characterize the medico-legal aspects of this complication. STUDY DESIGN: A comprehensive search of an Israeli professional liability insurance database was conducted to retrospectively identify and analyze cases of persistent altered sensation following endodontic treatment. RESULTS: Sixteen claims of persistent altered sensation following endodontic treatments were identified and analyzed. The typical profile of a claim was a female patient who underwent an endodontic treatment at a second mandibular molar, which was associated with overfilling. A significant correlation between the tooth location and the suggested cause of nerve injury was found. None of the claims were reported by the practitioners, and all cases were identified as a result of the patient's demand for financial compensation, either directly or by legal actions. CONCLUSIONS: When a nerve injury is diagnosed, the treating practitioner should be encouraged to seek medical and legal assistance so as to prevent permanent damage and to enable a better medico-legal response.

Serologic bone markers for predicting development of osteonecrosis of the jaw in patients receiving bisphosphonates.

PURPOSE: Osteonecrosis of the jaw is a well-documented side effect of bisphosphonate (BP) use. Attempts have recently been made to predict the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). We prospectively investigated the predictive value of serum levels of C-terminal telopeptide of collagen I (CTX), bone-specific alkaline phosphatase, and parathyroid hormone for the development of BRONJ. PATIENTS AND METHODS: Data on the demographics, comorbidities, and BP treatment were collected from 78 patients scheduled for dentoalveolar surgery. Of the 78 patients, 51 had been treated with oral BPs and 27 had been treated with frequent intravenous infusions of BPs. Blood samples for CTX, bone-specific alkaline phosphatase, and parathyroid hormone measurements were taken preoperatively. Surgery was performed conservatively, and antibiotic medications were prescribed for 7 days. RESULTS: Of the 78 patients, 4 patients taking oral BPs (7.8%) and 14 receiving intravenous BPs (51.8%) developed BRONJ. A CTX level less than 150 pg/mL was significantly associated with BRONJ development, with an increased odds ratio of 5.268 (P = .004). The bone-specific alkaline phosphatase levels were significantly lower in patients taking oral BPs who developed BRONJ. The parathyroid hormone levels were similar in patients who did and did not develop BRONJ. CONCLUSION: The incidence of BRONJ after oral surgery involving bone is greater among patients receiving frequent, intravenous infusions of BPs than among patients taking oral BPs. Although the measurement of serum levels of CTX is not a definitive predictor of the development of BRONJ, it might have an important role in the risk assessment before oral surgery.

Risk management in endodontics.

INTRODUCTION: Endodontic claims are the most frequently filed malpractice claims in dentistry. The aim of this study was to categorize and review errors and complications related to endodontic procedures that resulted in legal actions against the treating practitioner. METHODS: All dental malpractice complaints reported to the Medical Consultants International Company (MCI) in Israel between the years 1992-2008 were retrospectively analyzed according to a structured form. All complaints were categorized as either financial risk bearing (eg, justified) or financial non-risk bearing (eg, nonjustified). The treatment errors that were found in the files were categorized according to phases of treatment: preoperative, intraoperative, and postoperative errors. RESULTS: A total of 720 complaints were analyzed including 520 complaints (72.2%) that were found to be justified and 200 complaints (27.8%) that were judged as not justified. Most of the treatment errors occurred during the intraoperative phase. In lower anterior teeth and in cases involving more than 1 tooth, significantly more errors were found during instrumentation and root canal filling (P < .05). There was a similar distribution of operator errors and of negative outcomes for teeth with elective endodontic treatment and teeth with endodontic treatment as a result of a pathologic process. CONCLUSIONS: The technical skills of the dental practitioners performing root canal treatments require improvement. All possible risks and complications should be considered and explained to the patient before treatment.

Comparison of quality of life after surgical endodontic treatment using two techniques: a prospective study.

OBJECTIVE: The purpose of this prospective study was to compare patient experience of quality of life following surgical endodontic treatment using 2 different techniques: a technique that included the use of a dental operating microscope, root resection with minimal bevel and retrograde preparation with ultrasonic tips, and a traditional technique that included root resection with a 45 degrees bevel and retrograde preparation by bur performed without magnification. STUDY DESIGN: The study consisted of 66 patients referred for surgical endodontic treatment. One operator (I.T.) carried out all treatment. An equal number of patients were assigned to each group. Group 1 was treated by the traditional technique without an operating microscope and Group 2 by a technique using an operating microscope and minimal osteotomy. All patients were given a questionnaire with 15 questions to evaluate their quality of life for 7 days postsurgery. RESULTS: On day 5, patients in Group 1 reported significantly more pain and took significantly more analgesics (P < .05). On days 1 and 2, patients in Group 2 reported significantly more difficulty in mouth opening, mastication, and the ability to speak (P < .05). CONCLUSION: Patients in both groups reported a high incidence of symptoms. The technique using the operating microscope provided significantly less postoperative pain, but more difficulties in mouth opening, mastication, and the ability to speak immediately postoperatively.

Biomaterial resorption rate and healing site morphology of inorganic bovine bone and beta-tricalcium phosphate in the canine: a 24-month longitudinal histologic study and morphometric analysis.

PURPOSE: An inorganic xenograft (inorganic bovine bone [IBB]) and a porous alloplast (beta-tricalcium phosphate [beta-TCP]) material were compared at different healing periods in experimental bone defects in dogs. MATERIALS AND METHODS: Six round defects, 5 x 4 mm, were made on the lateral bony mandibular angle in 8 dogs at different times. Two defects were randomly filled with IBB, 2 with beta-TCP, and 2 were left to blood clot. A bi-layer collagen membrane covered 1 defect of each type. Four specimens per treatment group were obtained for each treatment group at 3, 6, 12, and 24 months postoperatively. Morphometric analysis of decalcified (Donath technique) histologic slides was conducted using the measured areas of regenerated bone, grafted particles, and remaining concavity. RESULTS: In IBB sites, complete bone healing was evident at 12 and 24 months, but grafted particles dominated the sites. In beta-TCP sites, only particle remnants remained at 12 months. At 24 months, particles had completely resorbed in both membrane-protected (MP) and uncovered (UC) defects. Data were combined for final analysis since there were no statistically significant differences within each graft material group (MP or UC). Mean bone area fraction increased from 3 to 24 months at all sites. In bone area fraction a statistically significant difference was found between 3 and 6 months in the IBB and beta-TCP groups. IBB sites also showed such significance between 6 and 12 months. A statistically significant difference was found between MP ungrafted sites (42.9%) vs IBB (24.7%) and vs the control (24.8%) at 3 months. At 6 months, beta-TCP bone area fraction (68.8%) was significantly greater than IBB (47.9%) and control (37.5%) sites. At 12 months, beta-TCP bone area fraction (79.0%) was significantly greater than the control (42.5%). At 24 months, beta-TCP bone area fraction (86.5%) was significantly greater than IBB (55.6%) sites. Mean particle area fraction of beta-TCP sites decreased gradually until complete resorption at 24 months. IBB sites showed a significant decrease only between 3 (38.7%) and 6 (29.4%) months. DISCUSSION AND CONCLUSION: Complete bone healing was established in all grafted defects. IBB and beta-TCP are both excellent biocompatible materials. However, at 24 months beta-TCP particles were completely resorbed, whereas IBB particles still occupied a remarkable area fraction without significant resorption beyond 6 months. (More than 50 references.)

Perianesthetic dental injuries: analysis of incident reports.

STUDY OBJECTIVE: To conduct a retrospective analysis of incident reports concerning dental injury, the most common cause for litigation against anesthesiologists, to determine specific risk factors that will help in formulating a risk reduction strategy for this clinical problem. DESIGN: Retrospective chart review of a large professional liability insurer. INTERVENTIONS: Of 40 hospitals that report to the MRM Co. as part of the professional liability insurance, during the years 1992-1999, 18 hospitals reported dental injury. A Maxillofacial surgeon (GN) and an anesthesiologist (ES), using a structured form, reviewed the reports. Evaluation of the cost of injury was determined from the patient's claims or from an evaluation of rehabilitation plan constructed by the maxillofacial surgery consultants to the company. MEASUREMENTS AND MAIN RESULTS: There were 203 incidents due to dental injury. The patients were most commonly in their 5(th) to 7(th) decade. Eighty six percent of the injured teeth were the upper incisors. Lower incisors were more likely to be injured during an urgent intubation, or due to airway manipulation other than intubation. (i.e., oral airway insertion) In only 38 (18.6%) cases was there a previous assessment of an expected difficult intubation. Dentition was judged to be pathological in 32% of the patients. CONCLUSIONS: In elective intubation, the teeth most likely to be injured are the upper incisors, in patients aged 50-70 years. In most cases dental injury is not associated with a pre-event prediction of difficult intubation.

Qualitative and quantitative expression of bovine bone mineral in experimental bone defects. Part 1: Description of a dog model and histological observations.

BACKGROUND: The purpose of this study was to evaluate histologically the contribution of inorganic bovine bone biomaterial in a new experimental bone defect in dogs at different healing periods and to examine newly formed bone around the grafted mineral particles and their relationship in membrane-protected (test) and non-protected intrabony (control) defects. METHODS: Four round intrabony defects, 5 x 4 mm were made bilaterally (at different times) on the lateral bony mandibular angle in eight dogs. Two defects were filled with bovine bone mineral (BBM) particles and two remained non-grafted but were blood clotted. A collagen membrane covered each defect type (n = 4). This procedure was repeated on the contralateral side at a different given time to obtain two different healing periods in each dog. Thus, four specimens were obtained at 3, 6, 12, and 24 months postoperatively for each healing period. The non-decalcification method (Donath technique) with Stevenel's blue and van Gieson's picro fuchsin staining was used for histological examination. RESULTS: Newly formed bone was observed at all examined defect types. The BBM particles were clearly evident regardless of the healing period. At 3 and 6 months, newly formed bone, woven in nature, was incorporated with the grafted particles. High cellular bone with occasional osteoclasts was noted towards the surface of the mineral particles. No substantial difference was observed between the protected and the non-protected defects except for higher ossified centers around the membrane-protected defects. At the non-grafted sites, the membrane-protected defect showed newly formed bone near the bony walls, and particularly under the membrane, establishing a bony bridge over the defect at the healing periods. The non-grafted unprotected defect (control) showed bone formation only at the base and close to the bony walls leaving a healed concave configuration. At 1 and 2 years, the grafted sites showed full bone healing configuration. However, the grafted particles still dominated the previous defect area and were completely surrounded by the newly formed bone. Osteons and lamellar bone arrangement were established but the bone was still highly cellular and osteoclasts could still be identified. The non-grafted membrane-protected sites showed excellent bone healing although areas of non-mineralized soft tissue were often seen. The control sites healed but still presented with a concave surface configuration. CONCLUSIONS: BBM biomaterial is a highly osteoconductive material. In a 4-wall bony defect, newly formed bone was well evident in establishing excellent bone healing configuration with or without a regenerative biological barrier. The grafted material dominated the experimental sites with no substantial resorption at any healing period up to 2 years observation.

Qualitative and quantitative expression of bovine bone mineral in experimental bone defects. Part 2: Morphometric analysis.

BACKGROUND: The purpose of this study was to evaluate morphometrically the rate of resorbability of an inorganic bovine bone material in a standardized intrabony defect in dogs whether protected or unprotected by a bioabsorbable membrane at different healing periods, and to assess histomorphometrically the amount of osteoconductivity of this material and final healing site configuration. METHODS: In eight mongrel dogs, four round intrabony defects (5 x 4 mm) were made on the lateral mandibular angle, bilaterally at a different given time. Bovine bone mineral randomly filled two sites, while the other two were left with blood clot. A bioabsorbable collagen membrane covered each type of defect. The blood clotted uncovered sites served as controls. Section blocks for histology were made at 3, 6, 12, and 24 months. Following the non-decalcification method and staining with Stevenel's blue and van Gieson's picro fuchsin, morphometric analysis was performed on each specimen lesion type. RESULTS: Average bone area fraction at the bovine bone mineral uncovered sites (BBM) was 23.1%, 44%, 63.4%, and 58.8% at 3, 6, 12, and 24 months, respectively. Differences were statistically significant between 3 to 6 and 6 to 12 months (P<0.001). Average particle area fraction was 35.6%, 29%, 27.6%, and 26.8% at the respective periods. Differences were statistically significant between 3 to 6 months (P<0.05). In the bovine bone mineral membrane-protected (BBMM) sites, average bone area fraction was 26.4%, 51.7%, 61.2%, and 52.4% at 3, 6, 12, and 24 months, respectively. Differences were statistically significant between 3 to 6 months (P<0.05). Average particle area fraction was 37.9%, 29.8%, 26.8%, and 33.7%, respectively. Differences between the two sites with regard to the newly formed bone and particle presence were insignificant. In both, the increasing pattern of osteoconduction as expressed by the osteoconductivity test along the different healing periods was similar, as well as the decreasing pattern of the remaining concavity of the healing site configuration. Multiple comparison analysis of bone area fraction disclosed statistically significant superiority (P<0.05) of the membrane-ungrafted sites over BBM sites at 3 and 6 months and over BBMM sites at 6 months. Bone area fraction of the BBMM sites (51.7%) was statistically higher than the control sites (37.5%) (P<0.05). At 12 months, all test sites were statistically superior over the controls with regard to the regenerated bone and its healing configuration; i.e., remaining concavity of the defect. The healing site configuration of the test sites was persistently different from the control sites at 24 months. CONCLUSIONS: Newly formed bone and complete healing were evident in the BBM and BBMM sites. The membrane contributed no substantial benefits. Bovine bone particle resorptive phase was observed up to 6 months. Thereafter, there was no continued resorption up to 24 months observation.

Medicolegal aspects of altered sensation following implant placement in the mandible.

PURPOSE: Altered mandibular sensation following implant surgery may result in liability claims. Therefore the authors conducted a retrospective analysis of all liability claims related to persistent altered sensation following placement of mandibular implants reported to the Medical Consultants International (MCI) Company from 1992 to 1999. MATERIALS AND METHODS: Reports related to persistent altered mandibular sensation in 16 patients (12 women and 4 men) who underwent implant surgery in Israel were examined. The MCI files were retrospectively evaluated according to a structured form. The parameters studied included patient age and gender, implant location and length, imaging modality, and the time between actual damage and filing of a claim (ie, letter of demand or lawsuit). RESULTS: The time in months between actual damage and filing of claim ranged from 0 to 60 months (mean 21.5 months). No cases were found involving transient changes in sensation. The female/male ratio was 3:1. Implant length was equal to or longer than 13 mm in 6 of 7 implants placed in the molar region. In the premolar area, nerve injury was evident in 6 of 7 cases where implants shorter than 12 mm were used. CONCLUSIONS: Transient nerve injury rarely results in legal action. Maximum effort should be devoted to accurately determining the appropriate implant length in the mandible.

Risk management aspects of implant dentistry.

PURPOSE: To categorize and review complications related to implant dentistry that have resulted in legal actions. MATERIALS AND METHODS: The records of 61 patients (39 women and 22 men) were retrospectively evaluated according to a structured form. Ages ranged from 28 years to 78 years (mean 49 +/- 12 years). The time lag in months between actual damage and legal action ranged from 0 months to 60 months (mean 12.7 months). RESULTS: Implant type, length, width, and locations varied widely and had no impact on the liability report. Half of the lawsuits were filed as a result of actual body damage (loss of sensation, oroantral fistula, life-threatening bleeding); 35% of the lawsuits were filed because of late complications; and 15% were related to immediate complications not leading to actual body damage. The dental consultants acknowledged liability in 41 of 61 cases. The clinician's errors that led to the reported complication were classified as preoperative in 39 of 41 cases. The doctor's attitude was considered positive in 40 cases and negative in 17 cases. DISCUSSION AND CONCLUSIONS: Clinicians should report as soon as possible to their insurance companies to get professional help. The main causes for lawsuits are actual body injury and major disappointment. Practitioners should dedicate a significant part of the entire treatment time to preoperative diagnosis and planning.