Surgically assisted rapid palatal expansion. An acoustic rhinometric, morphometric and sonographic investigation.

This study aimed to evaluate the effect of surgically assisted rapid palatal expansion on the skeletal structures of the midface. Ten patients (mean age 28.5 years) were investigated by means of acoustic rhinometry, study model analysis and sonography before and after the procedure of surgically assisted rapid palatal expansion. The measurements revealed that surgically assisted rapid palatal expansion not only resulted in transverse expansion of the maxilla, providing dental arch space for lining up the teeth; the procedure also caused a substantial enlargement of the maxillary apical base and of the palatal vault, providing space for the tongue for correct swallowing and thus preventing relapse. There was a distinct subjective improvement in nasal breathing associated with enlargement of the nasal valve towards normal values and with an increase of nasal volume in all compartments. The measurements showed a marked influence of surgically assisted rapid palatal expansion on the skeletal structures of the midface. The significant widening can be demonstrated by non-invasive examination. Success of the osteotomy procedure can be readily monitored by sonographic examination of the expansion and the subsequent ossification, which allows individually adjusted retention periods and avoids frequent radiation exposure.

[Prognosis and prognostic factors of endosseous implants in the irradiated jaw]. / Prognose und Prognosefaktoren enossaler Implantate im bestrahlten Kiefer.

In comparison to tumor patients not receiving radiotherapy, the rehabilitation of masticatory function after head and neck irradiation is limited due to radiation-induced caries, radioxerostomia, and the risk of osteoradionecrosis. This study focused on implants in the irradiated jaw and on the evaluation of the prognosis and the effect of potential factors on the prognosis. The retrospective study covered 197 implants (47 patients) from 1988 to 1997. The implant prognosis was determined by implant survival statistics (Kaplan-Meier). Losses not related to the implants were censored. In addition, groups were formed according to factors potentially affecting the prognosis. The significance of differences in the groups relative to survival were tested using the log-rank test. Twelve (6.1%) implants from a total of 197 were lost due to peri-implantitis, and eight (4.1%) due to possible biomechanical stress. A total of 52 losses (26.4%) due to death of patients and two (1.0%) due to resection of the jaw were censored; 111 (56.3%) implants remained at recall and the average interval was 33 months. The rates of implant survival (Kaplan-Meier) after 1 and 2 years were 95%, after 3 and 4 years 92%, and after 5 and 6 years 72%. The univariate analysis of group comparisons showed a significantly lower rate of loss after perimplant flap reconstruction (p = 0.036). There was no effect due to the doses of irradiation (p = 0.16), chemotherapy (p = 0.90), or peri-implant osteoplasty (p = 0.84). Although none of the implants inserted before radiotherapy had to be explanted, the implant survival difference in the very heterogeneous groups was not significant (preirradiation, n = 29; postirradiation: n = 156; p = 0.13). According to the literature, the rate of survival of teeth which were sound before radiotherapy (1 year, 75%; 5 years, 45%) was distinctly lower than the survival of enossal implants (1 year, 95%; 5 years, 72%). The high-quality rehabilitation of masticatory function with implant-based protheses is the preferred method of treatment for irradiated tumor patients. In addition, contraindications for enossal implants were ruled out for all studied factors affecting prognosis.

[The question of oral sedation using midazolam in outpatient dental surgery]. / Zur Frage der oralen Sedierung mit Midazolam bei ambulanten zahnärztlich-chirurgischen Eingriffen.

The aim of the present study was to evaluate the effect of one tablet of midazolam (Dormicum 7.5 mg) used as a premedicant for minor oral surgery and to assess the potential risk of hypoventilation. In all of the patients no significant drop in arterial oxygen saturation could be observed, but on the other hand, no real anxiolytic or amnestic effects either. With the little therapeutic use observed with the given premedication, a more widespread application of the substance in this dosage cannot be recommended, particularly when taking into account the possibility of complications and the loss of the patients's fitness to drive for the next twelve hours.

[Initial experience with digital luminescence radiography in the radiological diagnosis of the visceral cranium]. / Erste Erfahrungen mit der digitalen Lumineszenzradiographie bei der radiologischen Diagnostik des Gesichtsschädels.

The purpose of this study was the evaluation of digital luminescence radiography (PCR; Philips Computed Radiography) used in routine radiological analysis of the facial skull. Besides the standard radiographs additional PCR shots were taken in 16 cases. The subjective evaluation was carried out by three different people using clinical criteria. PCR films showed a significant advantage compared to standard radiographs for the above mentioned applications.

[Optimized analgesic sedation. Improved possibilities in high-risk patients through the use of pulse oximetry]. / Optimierte Analgosedierung. Verbesserte Möglichkeiten bei Risikopatienten durch Anwendung der Pulsoximetrie.

The pulse oximeter allows quick assessment of a patient's respiratory function and the early detection of imminent hypoxia (Singer and Thomas, 1988). It is a useful means in non-continuous circulatory monitoring and is not stressful to the patient. In analgosedation it enables the operator to monitor the respiratory effect of the drugs used with almost no delay, to take the counter-measures required and to adapt the dosage to the individual requirements of each patient.