[Conduction anesthesia of the infraorbital nerve - A guide to intraoral nerve block anesthesia of the infraorbital nerv]. / Leitungsanästhesie des Nervus infraorbitalis.

In order to be able to perform major oral surgery in the upper jaw, sufficient local analgesia is indispensable. While the inferior alveolar nerve is often blocked for dental treatments in the lower jaw, block anesthesia in the upper jaw is less common. This article gives pragmatic advice on how to block the infraorbital nerve. By using this method patients comfort is significantly improved and the surgeon can focus on the treatment at hand.

Associated Ophthalmic Injuries in Patients With Fractures of the Midface.

PURPOSE: Concomitant ophthalmic injuries are common in patients with facial fractures, though frequency varies widely in the literature. Major ophthalmic injuries can have drastic consequences for patients, and permanent visual impairment cannot be prevented in all cases. This study analyzed the frequency and distribution pattern of associated ophthalmic injuries in patients who received operative treatment for fractures of the midface. MATERIAL AND METHODS: The clinical information system was searched for patients with midface fractures that were treated operatively between December 2014 and November 2017. Demographic, fracture-related, and ophthalmic data were assessed and statistically analyzed. RESULTS: This study included 282 patients. The most common fracture types were zygomaticomaxillary complex fractures and orbital floor fractures. Falls and violence were the most common causes of fractures (43.3% and 24.5%, respectively). Chemosis and subconjunctival bleeding were the most common associated eye injuries. The most prevalent long-term eye injury was diplopia, which was identified in 18.4% of cases preoperatively. Postoperative diplopia persisted in 36 cases (12.8%) at 3-month follow-up. Optic neuropathy, enophthalmos, exophthalmos, and retrobulbar hematomas were identified infrequently. CONCLUSION: Minor ophthalmic injuries, including chemosis and subconjunctival bleeding, are more frequently associated with midface trauma. These minor injuries tend to heal quickly and without sequela. Major ophthalmic injuries, including retinal detachment, optic neuropathy, and retrobulbar hematomas, are identified less frequently. Special attention should be paid to patients with diplopia, as this condition may persist and have long-term occupational consequences. Therefore, close interdisciplinary collaboration is essential when treating patients with fractures of the midface to prevent permanent visual impairment.

Accuracy of Computer-Guided Template-Based Implant Surgery: A Computed Tomography-Based Clinical Follow-Up Study.

OBJECTIVE: The aim of this clinical study was to analyze the accuracy of computer-guided implant surgery. MATERIALS AND METHODS: Assisted by computed tomography (CT)-based planning software and navigational templates, 16 patients successfully received 26 dental implants. Each implant parameter (a-d) was calculated based on superimposed preoperative and postoperative cone beam CT scans: (a) deviation at entry point; (b) deviation at apex; (c) angular deviation; and (d) depth deviation. RESULTS: Mean central deviation at implant entry point and apex was 0.91 mm (standard error [SE] = 0.11 mm; 95% confidence interval [CI]: 0.69-1.13) and 1.22 mm (SE = 0.11 mm; 95% CI: 0.99-1.45), respectively. Mean angulation deviation was 4.11 degrees (SE = 0.52 degrees; 95% CI: 3.04-5.17) and the average depth deviation was 0.65 mm (SE = 0.11 mm; 95% CI: 0.42-0.87). For the total number of implants placed, the maximum error was 2.34 mm at entry point, 2.71 mm at apex, 9.44 degrees in angular deviation, and 2.00 mm in depth deviation. CONCLUSION: Great accuracy was reached even in advanced cases with prior bone augmentation and complex traumas. This leads to the conclusion that particularly in advanced cases, computer-guided implantation can be beneficial.

Precision of Simultaneous Guided Dental Implantation in Microvascular Fibular Flap Reconstructions With and Without Additional Guiding Splints.

PURPOSE: Dental rehabilitation in patients receiving free flap reconstructive surgery on the mandible or maxilla is an important part of bringing patients back to normality in both a physical and psychological way. It is therefore important to be able to do this in the fastest way possible. Virtual preplanned reconstructions of jaws with implants placed simultaneously are a good way to expedite this process and have the advantage of allowing true backward planning to achieve bone placement where it prosthetically needs to be. Thus, the precise transfer of the virtually preplanned implant position to the intraoperative situation is crucial for prosthetic rehabilitation. PATIENTS AND METHODS: We compared a control group of patients (4 patients with 15 implants) with preplanned fibular reconstructions of the mandible with implants incorporated in the planning and a trial group of patients (4 patients with 13 implants) with an additional intraoperative splint for the verification of the implants' angulation. The preoperative planning and postoperative computed tomography scans were compared. RESULTS: The average positioning error at bone level was 0.9 mm in the trial group and 1.3 mm in the control group. The average angulation error in the buccolingual plane was 2.9° in the trial group and 5.5° in the control group; axially, the difference was 6.3° in the trial group and 4.1° in the control group. CONCLUSIONS: The use of digitally backward-planned fibula cutting guides with direct dental implant positioning is feasible, and the precision found is comparable with that of standard splint-guided implant placement in the general population. Although the axial angulation error has more to do with anatomic variance and positioning of the bony cutting guide, the trial population clearly profited from the additional splint in the important buccolingual angulation. Overall, we showed a high level of precision over all implants in both groups.

Outcome of Surgically Treated Fractures of the Condylar Process by an Endoscopic Assisted Transoral Approach.

PURPOSE: Fractures of the condylar process are frequent. Ideal management of these fractures, as discussed in the literature, is controversial. Some recent meta-analyses have favored open reduction and internal fixation using various approaches. A strictly transoral approach has been described to minimize scarring and risk of facial nerve injury but has restricted visibility. This retrospective study analyzed outcomes of patients with unilateral mandibular condyle fractures who were treated by open reduction and internal fixation through an endoscopic-assisted transoral approach. MATERIALS AND METHODS: This study included 40 patients who were operated on from January 2015 through December 2016. All patients underwent surgery for a condylar process fracture using an endoscopic-assisted transoral approach. Fracture classification, demographic, and outcome data were collected. RESULTS: Most condylar process fractures were caused by falls from a height less than 3 m. Most were condylar base fractures and classified according to Spiessl and Schroll as Classes I and II. Sixteen patients showed a preoperative malocclusion, whereas 2 patients showed a slight postoperative malocclusion. In cases in which only 1 plate could be placed, the proximal fragment was shorter. A higher Spiessl and Schroll class showed a tendency toward longer operation times. For postoperative outcomes, 1 case of temporary facial palsy was the worst complication (2.5%), 2 cases exhibited minimal occlusal interference (5%), and 1 case exhibited a deviated mouth opening (2.5%). Ramus height was restored in all cases. No chronic pain was found in any cases. CONCLUSIONS: It is feasible to treat condylar process fractures in a safe manner using a transoral approach with endoscopic assistance and angled instruments without facial scarring and at a low complication rate. The endoscope improves the restricted visibility of the transoral approach, although a learning curve is necessary. This applies especially to dislocated fractures or to fractures with a short proximal fragment.

3D-evaluation of the maxillary sinus in cone-beam computed tomography.

BACKGROUND: There are few studies measuring the dimensions of the maxillary sinus, being mostly based on computed tomography imaging and rarely being based on cone-beam computed tomography (CBCT). The aim of this study was to measure the 3D osseous and soft tissue defined volume and surface area of the maxillary sinus. Further, possible associations with patient-specific and sinus-related variables were evaluated. METHODS: A total of 128 maxillary sinuses in 64 patients were analyzed using cone-beam computed tomography data. Surface area and volume of the osseus maxillary sinuses as well as of the remaining pneumatized cavities in cases of obliterated sinuses were calculated by the implant planning software SMOP (Swissmeda AG, Baar, Switzerland). Further, patient-specific general variables such as age, gender, and dentition state as well as sinus-related factors including apical lesions, sinus pathologies, and number of teeth and roots communicating with the maxillary sinus were recorded. RESULTS: For osseus bordered sinuses, mean surface area was 39.7 cm2 and mean volume 17.1 cm3. For the remaining pneumatized cavities, mean surface area was 36.4 cm2 and mean volume 15 cm3. The calculated mean volume of obliterated sinuses (42.2% of all sinuses were obliterated) was 5.1 cm3. Further, an association between the obliterated volume and the presence of pathologies was detected. Male patients showed a significantly higher mean osseus volume compared to female patients. No association was apparent between a patient's age or dentition state and sinus volume, nor for communicating tooth roots and sinus pathologies or unilateral opacity and apical radiolucency. There was also no significant association between bilateral obliterated sinuses and the scan date being in autumn/winter. CONCLUSIONS: The present study showed that the CBCT is suitable for the evaluation of the maxillary sinus. The implant planning software SMOP and its included volume measuring tool are valuable for the analysis of the maxillary sinus, and possible relations with the dentition can be analyzed.

Therapeutic options to manage bleeding in a dentist's office / Therapieoptionen bei Blutungen in der zahnärztlichen Praxis

This manuscript provides an overview of therapeutic options for the problem of bleeding in a dentist's office. Bleeding after tooth extraction is a very common finding in dental medicine and persistent blood in the mouth is obviously uncomfortable and sometimes terrifying for the patient. Most bleedings can be stopped simply with compression, in some cases a homeostatic therapy is necessary. For local compression, a swab with tranexamic acid is useful. If local compression is not sufficient, sutures are often an option. A very effective therapy would also be Tabotamp®, a local hemostypticum which is placed onto the bleeding and should increase the thrombocytic aggregation. In the worst case Floseal®, a human Thrombin, can be placed locally. It stops the bleeding very fast and sufficiently.

Cone Beam Computed Tomography Evaluation of the Artery in the Lateral Wall of the Maxillary Sinus: Retrospective Analysis of 602 Sinuses.

PURPOSE: This retrospective study evaluates the location of the arteries in the maxillary sinus, particularly in the middle portion, using cone beam computed tomography (CBCT) scans that can detect the lateral arteries with high reliability. METHODS: In this retrospective study, 2 experienced independent examiners evaluated 602 sinuses on CBCT scans. DISCUSSION: No significant correlation was found between the location of arteries and the patient's age, sex, or dentition. In 92.0% (P ≤ 0.001) of the sinuses, at least 1 arterial branch was detectable. CONCLUSION: Based on the CBCT scans, we found that a very high proportion of patients have the maxillary artery in their lateral sinus wall, which is important information for sinus augmentation or sinus surgery.

Intraoperative 3-dimensional cone beam computed tomographic imaging during reconstruction of the zygoma and orbit.

OBJECTIVE: Fractures of the zygoma and orbit are common facial skeleton injuries. Inadequate reduction and internal fixation may result in functional and aesthetic impairment. The aim of this study was to assess the use of intraoperative 3-dimensional (3-D) cone beam computed tomography (CBCT) for determining the intraoperative revision rate and the need for additional reconstruction of the orbit. STUDY DESIGN: We conducted a retrospective analysis of 48 consecutive patients (15 females, 33 males) suffering from simple or complex zygomatic fractures, seen between June 2015 and October 2016. Intraoperative 3-D CBCT (Xoran Technologies, Ann Arbor, MI) was performed, and the intraoperative image was overlaid on the preoperative image by using iPlan software (Brainlab, Feldkirchen, Germany) for quality control. Categorical variables were cross-tabulated and compared using Fisher's exact test. P values and 95% confidence intervals were assessed. RESULTS: In 6 of 48 patients, intraoperative revision was deemed necessary on the basis of the superimposition on the preoperative images. Five of these 6 patients had comminuted fractures (P = .001). In 7 patients, the indication for orbital reconstruction was revised after intraoperative 3-D CBCT. CONCLUSIONS: Intraoperative 3-D CBCT allows for immediate revision and prevents unnecessary orbital reconstruction.

Retrospective analysis of 471 surgically treated zygomaticomaxillary complex fractures.

PURPOSE: Zygomaticomaxillary complex (ZMC) fractures are frequent in facial trauma; only fractures of the mandible are more common. Although the frequency of these fractures is geographically consistent, the aetiology differs widely among countries and even regions. Differences in socio-economic status and the ageing population seem to be two causes. This retrospective epidemiological study evaluates patients who were surgically treated for ZMC fractures at a Swiss university clinic. MATERIALS AND METHODS: This study included 471 patients who were surgically treated for ZMC fractures in an oral and maxillofacial surgery clinic at a Swiss university hospital between January 2004 and December 2012. Complicated fractures such as LeFort II/III and bilateral ZMC fractures were excluded. Data on gender, age, and type of trauma were recorded. Fractures were classified by aetiology: motorised road traffic (car or motorcycle), bicycle, interpersonal violence, sports, falls (both less than and greater than 3 m in height) and other causes. RESULTS: A total of 350 patients were male (74%), and 121 were female (26%). The ZMC fractures were most likely to occur in the third decade (117 cases, 25%). A predominance of male patients was found in the young age groups, but an equal ratio was found in the elderly groups. Etiologically, falls of less than 3 m were the most common cause of ZMC fractures (125 cases, 27%). Interpersonal violence was second (88 patients, 19%); male patients dominated this group, which had a male-to-female ratio of 21:1. A predominance of male patients was found in every subdivision when analysing by aetiology and gender. The lowest proportion of males (57%) was found for falls of less than 3 m. CONCLUSION: In our study, interpersonal violence and falls outnumbered road traffic accidents among causes of maxillofacial fractures. This is probably a consequence of strict road and work laws. Additionally, the older and more active populations accounted for the highest proportion of falls, and young male patients were the predominant victims of ZMC fractures.

Denosumab as a Treatment Alternative for Central Giant Cell Granuloma: A Long-Term Retrospective Cohort Study.

PURPOSE: Giant cell granuloma (GCG) of the jaw is a rare disease with high morbidity. Various treatment options have been discussed in the past. Since 2010, a pharmaceutical therapy with denosumab seems to have been successful for giant cell tumors of the femur. The authors hypothesized the equally successful use of denosumab for GCGs of the jaws. MATERIALS AND METHODS: In the present retrospective cohort study, 5 patients with large GCGs of the jaws were treated with denosumab with a follow-up of 25 to 49 months. Frequent clinical follow-ups and a radiologic follow-up were performed and systematically analyzed. RESULTS: All patients showed a curative treatment response and complete metabolic resolution of the GCGs under treatment with denosumab. CONCLUSION: A brief review of the relevant literature and a detailed evaluation of current cases led to the conclusion that denosumab therapy should be considered a therapeutic option for large central GCGs of the jaws. The results of this study suggest denosumab is a successful treatment option. A treatment length no shorter than 12 months is recommended and monitoring of treatment response can be well managed by positron-emission tomographic computed tomography or magnetic resonance imaging.

Use of a monopolar microneedle device in a transconjunctival, retroseptal approach.

Transconjunctival approach is a standard procedure to address fractures of orbit and the infraorbital rim. Modifications such as transcaruncular or lateral canthal widening allow for extended orbital wall exposure. Especially concerning aesthetics, the transconjunctival approach shows benefits compared to the transcutaneous incisions, such as the transciliary and infraorbital access. Moreover, transconjunctival approach is favored in the literature concerning lid retraction. Monopolar devices have become popular in surgery in the past decades because of good depth control and simultaneous hemostasis with consequently improved overview. Also numerous surgeons use monopolar device in orbital surgery, their safety have never been proved. In this study monopolar microneedle device is compared with conventional access by scalpel concerning lid retraction, foreign body sensation and formation of symblepharon. In our collective complication rates were comparable between the scalpel and the microneedle group. The monopolar microneedle device shows favorable results compared with the scalpel and is easy to handle. Weather the conventional access by scalpel or the access by monopolar device is selected, is rather driven by the surgeon's preferences than by statistical relevance. Nevertheless, monopolar microneedle device shows better depth control and simplifies readaptation of the conjunctival wound's margin.

Amoxicillin mit Clavulansäure. Standardantibiotikum im allgemeinzahnärztlichen Alltag.

This script gives a pragmatic advice for general dentists on accurate use of amoxicillin with clavulanic acid considering current literature at acute inflammatory disease. In absence of contraindications a twice daily formulation of 1g amoxicillin with clavulanic acid is the first choice for concomitant therapy after treating the cause of inflammation or prophylaxis. Compared to clindamycin the concentration of amoxicillin in teeth and bone (Hallig 2014) is higher and has less gastrointestinal side-effects (Bax 2007). Furthermore it is prescribable during pregnancy and lactation. With these advantages amoxicillin with clavulanic acid is the first choice of antibiotics in general dental medicine.

Traitement médicamenteux du lichen plan buccal.

Oral lichen planus is a relatively common T-cell mediated inflammatory disease with potential malignant transformation. It may present itself with pain and oral lesions such as ulcers and Wickham’s striae. Treatment includes topical corticosteroids, preferably Clobetasol, immunosuppressive drugs and retinoids. Hyaluronic acid and aloe vera have been proven to be successful. If topical treatment fails, systemic therapy with corticosteroids may be needed. Because of the potential malignant transformation periodic follow-up is mandatory.

[Amoxicillin with clavulanic acid - standard antibiotic in general dentistry]. / L'association amoxicilline/acide clavulanique est l'antibiothérapie standard en médecine dentaire générale.

This script gives a pragmatic advice for gen-eral dentists on accurate use of amoxicillin with clavulanic acid considering current liter-ature at acute inflammatory disease. In ab-sence of contraindications a twice daily for- mulation of 1g amoxicillin with clavulanic acid is the first choice for concomitant therapy after treating the cause of inflammation or prophy-laxis. Compared to clindamycin the concen-tration of amoxicillin in teeth and bone (Hallig 2014) is higher and has less gastrointestinal side-effects (Bax 2007). Furthermore it is pre- scribable during pregnancy and lactation. With these advantages amoxicillin with clavulanic acid is the first choice of antibiotics in general dental medicine.

Traitement analgésique après des interventions en médecine dentaire.

This script gives a pragmatic advice for dentists on pain control and anti-inflammation treatment considering current literature and state of the art of analgesic treatment. Naproxen seems to be the feasible anti-inflammatory painkiller as it has a lower cardio-vascular risk profile compared to other NSAID. The higher gastrointestinal bleeding risk can be mitigated using proton-pump inhibitors. Additionally, the duration of the drug effect of about 12–15 hours allows excellent patient compliance and comfort in comparison to other NSAID.

Management von Schmerzen nach zahnärztlichen Eingriffen.

This script gives a pragmatic advice for dentists on pain control and anti-inflammation treatment considering current literature and state of the art of analgesic treatment. Naproxen seems to be the feasible anti-inflammatory painkiller as it has a lower cardio-vascular risk profile compared to other NSAID. The higher gastrointestinal bleeding risk can be mitigated using proton-pump inhibitors. Additionally, the duration of the drug effect of about 12–15 hours allows excellent patient compliance and comfort in comparison to other NSAID.