Removal of dental implants: review of five different techniques.

The aims of this study were to review five different explantation techniques for the removal of failing implants and to propose a practical clinical protocol. During a 10-year period, 95 implants were explanted from 81 patients. Explantation techniques used were the bur-forceps (BF), neo bur-elevator-forceps (ηBEF), trephine drill (TD), high torque wrench (HTW), and scalpel-forceps (SF) techniques. The following parameters were analyzed: indications for explanation, site of implantation, and the type, diameter, and length of the implant removed. The most frequent indications for implant removal were peri-implantitis (n=37) and crestal bone loss (n=48). The posterior maxilla was the most frequent site of implant removal (n=48). The longer implants were more frequently removed (n=78). The majority of implants were removed after 1 year in function (n=69). The BF/ηBEF and SF techniques were found to be the most efficient. Explantation techniques appeared to be successful for the removal of failing implants. The BF/ηBEF and SF techniques demonstrated 100% success. The ηBEF technique enabled safe insertion of a new implant in the same explantation site. The HTW technique appeared to be the most elegant technique with the highest predictability for insertion of another implant. An explantation protocol is proposed.

Anatomical study of the pterygopalatine fossa pertinent to the maxillary nerve block at the foramen rotundum.

The anatomy of the pterygopalatine fossa pertinent to the technique of maxillary nerve block at the foramen rotundum was investigated and the ability of inexperienced surgeons to apply the required angles of the injection needle to the sagittal plane in a clinical environment. In 85 dried human skulls the volume, length, width and depth of 159 intact pterygopalatine fossae were measured. The frequency of reaching the sphenopalatine foramen using a 20 G spinal needle advanced from the frontozygomatic angle through the pterygomaxillary fissure was determined. 49 oral surgery postgraduates aligned the injection needle with angles of 60 degrees and 80 degrees to the sagittal plane of a volunteer's head. The dimensions of the pterygopalatine fossa were inconsistent; volume (0.1-1 cm(3)), width (1-9 mm) and depth (6-22 mm) showed the greatest variations. An enlarged sphenoidal process and a narrow pterygomaxillary fissure (<2 mm) were found in 15% and 8%, respectively. The sphenopalatine foramen was reached successfully in 75%. Postgraduates in oral surgery were highly accurate in the assessment of the 60 degrees and 80 degrees angles to the sagittal plane. A previously described technique of blocking the maxillary nerve at the foramen rotundum was adjusted and recommendations given to overcome anatomical obstacles.

Effects of Carnoy's solution on blood vessels of the axillary fossa of rats.

Carnoy's solution is applied to reduce the recurrence of odontogenic keratocysts and unicystic ameloblastomas. The deleterious action of this fixative on nerves has been studied but no attention has been paid to its effects on nearby vessels. The aim of this study was to investigate the effects of Carnoy's solution on blood vessels. The rat axillary artery and vein were surgically exposed, soaked with Carnoy's solution and kept in place for 2, 5 or 10 min, depending on the treatment group. The 5-min group was followed for 1, 2 and 3 weeks postoperatively. The vessels in the 2-min and 5-min exposure groups showed histological changes to the vessels, represented by focal loss of the endothelium and hyalinization of the wall. These alterations increased in the 10-min group. The vessels in the 3-week observation period revealed signs of recovery. It is concluded that Carnoy's solution can damage blood vessels but the process is reversible for exposure times less than 5 min.

Mandibular nerve block at the oval foramen using reliable landmarks: refinement of a previously described procedure.

The aim of this study was to improve the injection technique when blocking the mandibular nerve at the oval foramen by using consistent landmarks. The lower lateral orbital angle (LLOA) and the junction of the external acoustic canal and the mastoid process (AM) proved to be reliable landmarks. Distances between landmarks for the localization of the puncture point (PP), cranial indices as well as the angle of the injection needle to the sagittal plane were calculated on 22 human dried skulls. The PP was found to lie exactly in the middle between the LLOA and AM. The angle of the injection needle to the sagittal plane was 71.86 degrees. No correlation was found between the cranial index and the angulation of the needle or the distances for the localization of the PP. From this study a modified puncture technique was developed.

Galeal skin island flap in the reconstruction of scalp defects caused by missile injuries.

The use of the galeal skin island flap pedicled either on the superficial temporal or occipital vessels for coverage of scalp defects following neurosurgical treatment of cranial missile injuries, is presented. This technique was applied in seven consecutive patients. The defect was closed in all patients, however, only in three without complications. Indications, advantages and disadvantages of the treatment described are discussed.

Is carbamazepine less effective in the treatment of trigeminal neuralgia when prescribed by oral and maxillofacial surgeons?

Carbamazepine therapy is generally suggested as a first line of treatment for patients with idiopathic trigeminal neuralgia (ITN). This study was intended to investigate patient compliance and effects of carbamazepine in a group of ITN patients referred to oral and maxillofacial surgeons. A total of 19 patients with ITN who were taking carbamazepine as recommended and were unlikely to go into spontaneous remission were analyzed in a retrospective study. The following criteria were used for the assessment: pain-free periods, success, recurrence and failure rate, side effects, and discontinuation of the treatment. Pain relief was recorded in 16 patients with pain-free periods of 1 to 48 mo. Pain recurred in 11 patients within 1 to 30 mo. Side effects were recorded in six patients. The treatment was discontinued in 13 patients for various reasons. At the last visit, the treatment was successful in six patients with pain-free periods of 6 to 48 mo. It is concluded that the carbamazepine treatment of patients with ITN referred to oral and maxillofacial surgeons should not be expected to be successful as generally accepted. Since a relatively high percentage of patients were reluctant to take drugs, a new treatment scheme for patients with ITN referred to an oral and maxillofacial surgeon was suggested.

Blocks of the foramen rotundum and the oval foramen: a reappraisal of extraoral maxillary and mandibular nerve injections.

OBJECTIVE: To present our experience of regional anaesthesia with blocks of the foramen rotundum and the oval foramen. DESIGN: Open study. SETTING: University Hospital, Beograd, Yugoslavia. SUBJECTS: 107 patients who underwent 58 maxillary and 49 mandibular nerve blocks. INTERVENTIONS: Injection of 2% lignocaine with adrenaline 1/80,000 with an 18 G venflon or 20 G spinal needle. MAIN OUTCOME MEASURES: Quality of anaesthesia and morbidity. RESULTS: 49 of the 58 maxillary (84%) and 45 of the 49 mandibular (92%) nerve blocks were successful (no sensitivity to pinprick in the distribution of the injected nerve and a painless operation). There were 17 complications (26%), 8 in the maxillary and 9 in the mandibular group. All complications were minor and transient, and 6 could be attributed to anhydrous glycerol rather than the injection technique itself. CONCLUSION: Blocks of the foramen rotundum and the oval foramen achieve good regional anaesthesia in the maxillofacial region.

Prognostic significance of cortical perforation in the recurrence of central giant cell granulomas of the jaws.

This paper was intended to present clinicopathological findings of 31 cases with central giant cell granuloma of the jaws (CGCG) as well as the prognostic significance of the histologically confirmed cortical perforation. The subjects of the study were 22 females and 7 males with age range from 7 to 69 years. CGCG occurred predominantly in the premolar and intercanine region of both jaws. In one case multifocal lesions were found. Microscopically all lesions showed a fibrovascular stroma and multinucleated giant cells of the osteoclastic type. Cortical perforation and soft tissue extension were observed in seven cases. Treatment consisted of curettage in 29 cases and en bloc resection in one case. Lesions recurred in five cases. All lesions that recurred showed microscopically confirmed cortical perforation at the time of the first occurrence. It is concluded that cortical perforation has a prognostic significance in the recurrence of CGCG and when it is observed at operation curettage should be vigorous.

Hanhart's syndrome with facial asymmetry: case report.

An unusual variant of Hanhart's syndrome associated with facial asymmetry in a female patient is presented together with surgical treatment of her facial anomalies. Following reconstruction which included bimaxillary osteotomies and osteopericranial and pericranial flaps, a good aesthetic result was achieved which enabled the psychological and social rehabilitation of the patient.

Correction of facial deformities with pericranial and osteopericranial flaps.

Pericranial or osteopericranial flaps pedicled on the superficial temporal vessels were used in the correction of various facial deformities in 16 patients. In 5 patients orthognathic surgery was also performed. In all patients a significant aesthetic improvement was achieved. In order to achieve a satisfactory tissue volume and thickness it was necessary to create a folded pericranial flap. It is possible, as a one stage procedure, to combine osteopericranial with pericranial flaps to correct severe facial deformities. It is concluded that by using this method alone or in combination with orthognathic surgery, when indicated, it is possible to achieve good long term aesthetic and functional results.

Surgical treatment of posttraumatic enophthalmos: a study of 72 patients.

The present article deals with the surgical experience of treating 72 patients for posttraumatic enophthalmos. Patients were divided into the following 4 groups with respect to the type of injury and the time of surgery: Group 1, recent midfacial injuries with orbital floor fractures; Group 2, recent blow-out fractures; Group 3, neglected blow-out fractures; and Group 4, neglected fractures of the zygoma or the zygomatic-maxillary complex. Osteoplasty of the floor of the orbit was performed in all groups with bone or cartilage grafts such as lamina from the anterior maxillary wall, iliac and calvarial graft as well as rib cartilage. In addition to osteoplasty, reposition and fixation of fractured bones as well as refracture of malunited zygomatic-maxillary complex were performed in patients in Groups 1 and 4, respectively. Enophthalmos was recorded in 5 and 2 of 20 patients from Groups 1 and 2, respectively. In Group 3, enophthalmos was corrected in 3 of 7 patients, whereas 16 patients were corrected of 25 from Group 4. Advantages and disadvantages of applied surgical techniques are discussed and personal observations emphasized.

Reconstruction of full-thickness cheek defect affecting the oral commissure by galeal skin island flap: a case report.

This article describes the use of the galeal skin island flap in the reconstruction of a full-thickness cheek defect affecting the oral commissure, created after radical surgery in a 60-year-old patient suffering from carcinoma of the cheek. Advantages and drawbacks of the described technique are discussed.

The buccal fat pad in the closure of oro-antral communications: a study of 56 cases.

This article describes the surgical technique, indications and possible complications of the use of the buccal fat pad in the closure of oro-antral communications (OAC), following tooth extraction, in 56 cases. The technique was successful in all patients and did not interfere with the buccal sulcus depth. It is concluded that it can be safely applied in the closure of OAC.

Altering the angulation of a curved osteotome--does it have effects on the type of pterygomaxillary disjunction in Le Fort I osteotomy? An experimental study.

A standard Le Fort I osteotomy was performed on 12 cadavers to determine whether the incidence of pterygoid plate fractures could be reduced by increasing the angle of the curved osteotome relative to the sagittal plane. In the group where an osteotome with the usual angulation was employed, fractures occurred on 9 of 12 sides. In the increased angulation group, 5 of 12 pterygoid plates were fractured. All fractures were restricted to the level of the horizontal osteotomy cut. It is concluded that increased angulation of a curved osteotome can decrease the incidence of fractures of the pterygoid plates. This procedure, however, is not recommended because it can cause fracture of the palatine bone or displacement of the fractured pterygoid plate fragment posteriorly.

Pterygoid plate separation using an oscillating saw in Le Fort I osteotomy. Technical note.

An oscillating saw is used to achieve pterygomaxillary separation. The procedure is quick and simple to perform and avoids the potentially hazardous use of osteotomes for this purpose. Down fracture of the maxilla allows visual confirmation of the integrity of the pterygoid plates.

Effects of glycerol on the rat infraorbital nerve: an experimental study.

Glycerol was injected into the infraorbital canal of 12 rats to determine neurolytic effects on the peripheral trigeminal nerve. Saline and 90% ethanol were injected in control animals. One week after the injection, histopathological changes were noted in both glycerol and alcohol groups. In the former group, axonolysis and demyelination were restricted to the outer zone of the nerve bundles. Centrally located axons remained undamaged. A total destruction of all axons was found in the alcohol group. Four weeks after the injection in the glycerol group, small sized axons with thin myelin replaced damaged axons at the periphery of the bundle. No signs of regeneration were noted in the alcohol group. A possible mode of action of glycerol injected at the peripheral trigeminal nerve in relieving trigeminal neuralgia is described.

Peripheral streptomycin/lidocaine injections versus lidocaine alone in the treatment of idiopathic trigeminal neuralgia. A double blind controlled trial.

Seventeen patients with long-lasting idiopathic trigeminal neuralgia (ITN) were treated with either five, weekly peripheral streptomycin/lidocaine (S/L) or lidocaine alone injections, in a double blind controlled study. Eight patients responded initially to the treatment in the S/L group and three patients in the lidocaine group. Pain recurred in four patients from the S/L group within two weeks and six months following the last injection. One patient from the lidocaine group remained pain-free for eight months. At the final assessment, three patients from the S/L group and two patients from the lidocaine group remained pain-free up to 30 months. Neither treatment affected sensory functions of the injected nerves. It is concluded that S/L injections are initially effective in the treatment of ITN. In the long term, however, their effects are similar to the effects of lidocaine alone.