The reliability of surgeons to avoid traumatic insertion of dental implants into high-risk regions: a panoramic radiograph study.

BACKGROUND: The posterior regions of the jaws usually represent a significant risk for implant surgery. A non-valid assessment of the available bone height may lead to either perforation of the maxillary sinus floor or encroachment of the inferior alveolar nerve and consequently to implant failure. This study aimed to evaluate the reliability of surgeon's decision in appraising the appropriate implant length, in respect to vital anatomical structures, using panoramic radiographs. METHODS: Only implants that are inserted in relation to the maxillary sinus (MS) or the mandibular canal (MC) were enrolled (first premolars [1P], second premolars [2P], first molars [1M], and second molars [2M]). All preoperative panoramic radiographs were evaluated under standard conditions. The postoperative estimation (under/over) was determined depending on the available bone height (ABH) measured from the apical end of the implant to the floor of the MS and the roof of the MC using cone beam computed tomography (CBCT). Any complication or side effect that associated with overestimated implants insertion was recorded. RESULTS: The study sample included 73 patients (predominantly females) who had consecutively received 148 implants, of which 68 were inserted in the posterior maxilla and 80 in the posterior mandible. Underestimation was recorded in 93.2% of the measurements. The remaining bone height after implants insertion was < 2 mm in the majority of underestimated cases (73.9%); they were significantly (P < 0.01) more than sites with remaining bone ≥ 2 mm (26.1%). In the posterior mandible, overestimation was significantly higher than posterior maxilla. Five cases with transient paresthesia were reported in the mandibular overestimated implants. CONCLUSIONS: This study specified that surgeon's choice of implants length, based on panoramic radiographs, was reliable regarding the incapability to insert implants with further length in the majority of underestimated cases, the low percent of overestimated measurements, and the minor associated complications.

Pain Reduction in Extensive Apical Surgery of the Anterior Maxilla: A Comparative Clinical Study.

PURPOSE: The purpose of this study was to compare the outcomes of 2 different anesthetic techniques (local infiltration vs infraorbital nerve block) for eliminating pain during apical surgeries that are associated with extensive periapical pathology in the anterior maxilla. MATERIALS AND METHODS: Patients were randomly divided into 2 groups: patients in group I were anesthetized labially by local infiltration injections, whereas those in group II received a single infraorbital nerve block. Palatal injections were given for the 2 groups. Once the pain was initiated during surgery, the procedure was discontinued until profound anesthesia was secured. The studied variables were age, gender, onset of anesthesia, operative time, and intraoperative pain. Any complication associated with the injection techniques, intraoperatively and postoperatively, also was assessed and recorded. Then, the collected data were analyzed using proper statistical methods. The significance level was set at a P value less than or equal to .05. RESULTS: One hundred patients (50 per group; age range, 16 to 43 yr), predominantly men, were enrolled in this study. The results showed rapid onset of anesthesia in group II with a highly significant difference from group I (P ≤ .05). Duration of the operation ranged from 44 to 57 minutes. Pain during the surgical procedure was reported by most patients in group I (92%). Collateral anesthesia (82%) and increased numbness of the upper lip (72%) were reported in group I. Ecchymosis at the infraorbital foramen or rim (8%) and paresthesia in the skin over the infraorbital region (6%) and cheek (4%) were observed in group II. CONCLUSIONS: In apical surgeries, the anesthetic efficiency of the infraorbital nerve block was superior to that of local infiltration. It had rapid onset, longer duration, and greater potency and avoided multiple transmucosal injections. Furthermore, it was associated with minor and transient side effects.