[Oral dexketoprofen tromethamine for preemptive analgesia in extraction of impacted teeth: a randomized controlled double-blind trial].

PURPOSE: To study the preemptive analgesic effect of dexketoprofen tromethamine in extraction of impacted teeth. METHODS: Twenty patients with bilateral mandibular impacted teeth were selected, and were randomly divided into dexketoprofen tromethamine group(experimental group) and placebo group(control group). The pain scores of patients at 0.5, 2, 4, 8, 12, and 24 hours after tooth extraction were counted by numeric rating scale(NRS), and the total dosage of emergent analgesic drugs used in 24 hours was recorded. COX analysis method was used to compare the interval time and the number of cases of first application of emergent analgesic drugs after two operations, and the survival curve was drawn. SPSS 20.0 software package was used for data analysis. RESULTS: The NRS scores of postoperative pain in the experimental group were significantly lower than those in the control group at 2, 4, 8 and 12 hours after operation (P＜0.05). The dose of emergent analgesics used in the experimental group for 24 h was significantly lower than that in the control group (P＜0.05). Survival curve showed that the interval time between the first application of analgesics in the experimental group was significantly longer than that in the control group(P＜0.05). CONCLUSIONS: Dexketoprofen tromethamine can achieve obvious analgesic effect within 12 hours, but the analgesic effect is not obvious after 12 hours.

[Study on the thickness and morphology of lingual bone of impacted mandibular third molar based on CBCT and Simplant 3D reconstruction].

PURPOSE: The potential relationship between impacted mandibular third molar and lingual bone thickness was investigated by quantitative measurement of lingual bone thickness, and a three-dimensional visualization model of lingual bone was established. METHODS: Image data of 200 cases of mandibular impacted third molar were collected from the database of Hefei Stomatological Hospital. Thickness measurement and three-dimensional reconstruction of lingual bone at different measurement sites were performed by Simplant Pro software. Statistical analysis was performed using SPSS 22.0 software package, and the comparison of lingual thickness at different measurement sites was performed using rank sum test. Whether the thickness of bone plate was "high-risk type" was taken as the result variable, different related factors were analyzed by logistic regression. RESULTS: The lingual bone at the middle point of the root of the third molar was the thinnest. Multiple teeth, mesio-inclined and dial-inclined teeth, and Class Ⅱ and Ⅲ impacted teeth had thin lingual bone(P＜0.05). The mesial and distal inclines were observed, and the lingual bone was thin in the root apical region of the teeth in Class Ⅱ and Class Ⅲ(P＜0.05). In the lower impacted teeth, the thin lingual bone at the central crown site was more likely to be found in Class Ⅲ teeth(P＜0.05). CONCLUSIONS: The thickness of lingual bone was related to the number of impacted tooth roots, tilt direction and impacted type. In the extraction of impacted teeth, the above factors should be considered, and the injury of lingual nerve, lingual bone and surrounding soft tissue should be vigilant.

[Evaluation of the effect of digital crown extension guide in aesthetic restoration of anterior teeth].

PURPOSE: To evaluate the clinical effect of three-dimensional digital smile design (3D-DSD) combined with double positioning crown extension guide in aesthetic restoration of anterior teeth. METHODS: Twenty patients who needed aesthetic crown lengthening and full crown restoration of upper anterior teeth were selected and randomly divided into the experimental group and control group, with 10 cases in each group. The experimental group carried out 3D-DSD, after confirming the plan, 3D printed double positioning crown extension guides were used to guide aesthetic crown lengthening, and full crown was completed 3 months after operation. The control group used traditional aesthetic crown lengthening and full crown restoration. PES/WES evaluation was performed before operation, three months and six months after operation. Visual analogue scales(VAS) were used to evaluate patient satisfaction 6 and 7 months after surgery, and the repeatability evaluation of VAS was conducted. The correlation between PES/WES score and overall satisfaction was analyzed 6 months after operation. SPSS 23.0 software package was used for statistical analysis. RESULTS: The PES/WES scores of the two groups of patients at 3 months and 6 months after operation were higher than those before operation(P＜0.05). The two groups showed that the scores of the experimental group were significantly higher than those of the control group for PES 3 months after operation, PES and WES 6 months after operation(P＜0.05).Satisfaction survey results showed that the intra-group correlation coefficient of the two VAS results was 0.956(P＜0.05),and crown length-to-width ratio, smile curve, personality characteristics, patient participation and overall satisfaction in the experimental group were better than those of the control group(P＜0.05).The results of Speraman correlation analysis showed that PES and WES scores at 6 months after operation were positively correlated with overall satisfaction (rs1=0.905, P＜0.001; rs2=0.460, P=0.041). CONCLUSIONS: 3D digital smile design combined with double positioning crown extension guide guides the anterior aesthetic crown lengthening and restoration treatment, which can improve the effect of pink and white aesthetics after treatment and patient satisfaction.

[The relationships between different surgical approaches for maxillary sinus augmentation and implant failure and complications: a retrospective cohort study].

PURPOSE: To investigate the 5-year survival and complication rates of implants placed in grafted sinuses with different surgical approaches and analyze the causes for failure. METHODS: This study retrospectively observed the prognosis of patients who underwent maxillary sinus augmentation by means of lateral window technique(LWT) or transalveolar osteotomy technique (TOT) and simultaneously installed implants performed, in Hefei Stomatological Hospital. The primary predictor variables were surgical approaches, including LWT and TOT. The primary outcome measurement was the 5-year implant survival rate, complication rates and failure causes. Potential confounders included diabetes, age at surgery, gender, smoking habit, oral hygiene, tooth position, length and diameter of implants and type of prosthesis. Chi-square test and logistic regression analysis were performed with SPSS 21.0 software package. RESULTS: Fifty-nine patients (31 males and 28 females), installed with 93 implants, with a mean age of (61.3±10.1) years old, were enrolled. Over (5±1.2) years of follow-up, five implants failed, with a total survival rate of 94.6%. In detail, there were 3 failed implants in the LWT group and 2 failed implants in the TOT group, for a survival rate of 85.7% and 97.2%, respectively. Chi-square test showed that smoking habit (P=0.010), oral hygiene(P=0.037) as well as operative approach(P=0.040) were significantly associated with the final survival rates, multivariate logistic regression analysis displayed that smoking habit (OR=0.030, 95%CI: 0.002-0.493, P=0.014) was still associated with the finial survival rates. Surgical approach(P=0.025) was markedly related to causes for the failed implants. Of which, three (100%) failed implants in the LWT group was due to poor osseointegration and implant mobility 3 months after sinus augmentation, and 2(100%) in the TOT group was because of persistent peri-implantitis and loss of the graft or alveolar bone 4 years after sinus augmentation. Smoking habit was also significantly relevant to complication rates(P=0.014), and the occurrence incidence of controllable peri-implantitis in patient having a smoking habit was relatively higher, accounting for 6.8%(6/88), compared with patients without smoking habit. Significant relationship between surgical approaches and implant complications was not observed(P=0.051). CONCLUSIONS: Different surgical approaches for maxillary sinus augmentation do not significantly correlate with implant survival rates and implant complications. However, surgical approach is markedly related to the causes of failed implants. Smoking will lead to a decreased implant survival rate and controllable peri-implantitis.

[Different concentration of lidocaine used for an exodontia of the impacted mandibular third molar].

PURPOSE: To investigate the anesthesia outcomes of 1% lidocaine with 1∶100 000 epinephrine (EPI) for inferior alveolar nerve, lingual nerve and buccal nerve block, compared with 2% lidocaine with 1∶100 000 EPI. METHODS: A study with a cross-over design, with each patient also serving as their own control, was implemented to estimate the clinical outcomes. Predictor variable was 1% lidocaine with 1∶100 000 EPI versus 2% lidocaine with 1∶100 000 EPI. Outcome variables were patients' responses to pain on injection, onset time of anesthetizing, efficacy of anesthesia, and the time to sensation return for the lower lip and tongue. Patients reported pain level at every experimental stage with a 10-point Numerical Rating Scale(NRS). Three weeks later, the patients were tested with the alternate drug combinations. The same outcomes were assessed. A verification of treatment difference was performed using SPSS 17.0 software package. RESULTS: Twenty-one patients were recruited and completed the study protocol. Sixty-two percent of the patients were women and 38% were men with a median age of 24 years [interquartile range (IQR), 20-30 yr]. Patients reported significantly lower pain scores with 1% lidocaine (1.09,95%CI，0.77-1.41) on injection, compared with 2% lidocaine (1.66, 95%CI, 1.33-1.99) (P=0.010). Patients undergoing 1% lidocaine with 1∶100 000 EPI (52-63 s) had a markedly quicker onset time of anesthetizing than those using 2% lidocaine with 1∶100 000 EPI (259-335 s, P=0.000). The efficacy of anesthesia between 2 groups was not significantly different (P=0.751). Among the patients with the pain values of 1~3, there were 9 patients(100%) perceiving slight pain when splitting teeth was performed in 1% lidocaine group, while 4 patients(57%) felt slight pain when elevating soft flaps was performed and 3 patients(43%) perceived mild pain when splitting teeth was performed in 2% lidocaine group (P=0.019). The time to sensation return for the lower lip and tongue was significantly different between the 2 drug formulations (P=0.000), with an extended period of average 61 min (52-69 min) in 2% lidocaine group. CONCLUSIONS: 1% lidocaine with EPI plays a similar role in clinical outcomes for inferior alveolar nerve, lingual nerve and buccal nerve block as 2% lidocaine with EPI, which produces lower pain on injection as well as a relatively short time to sensation return. The reasons for slight pain during surgical operation are a relative lower efficacy of anesthesia on the inferior alveolar nerve in 1% lidocaine group, and on the buccal nerve anesthesia in 2% lidocaine group.

[Clinical analysis of impacted supernumerary teeth in 115 patients].

PURPOSE: To retrospectively analyze the clinical characteristics of impacted supernumerary teeth in 115 patients. METHODS: One hundred and fifteen patients with im-pacted supernumerary teeth who were admitted to the Department of Oral and Max-illofacial Surgery of Hefei Stomatological Hospital were selected randomly. The age, sex, number of teeth, location, direction, clinical manifestation, anaes-thesia method and operation time were analyzed retrospectively, T test and Chi-square test were used to determine the statistical differences with SPSS 19.0 software package. RESULTS: Among 115 patients, there were 176 impacted supernu-merary, most of them were in mixed dentition period (66.96%), the sex ratio was 2.29:1, and Most patients (59.1%) had one supernumerary tooth, followed by two supernumerary teeth(33.9%). Most supernumerary teeth were located in the middle of the maxilla (68.2%). Inverted ones were the most common (52.8%). The most common symptoms were delayed eruption, displacement, crowding, torsion and space of the adjacent teeth. 92.2% of patients underwent general anesthesia. The dee-per the locations of impacted supernumerary were, the longer the operation time was. CONCLUSIONS: There are regional characteristics of supernumerary teeth in Hefei City, which can provide a reference for clinical diagnosis and treatment.

[Supernumerary teeth: report of a rare case and review of the literature].

Supernumerary teeth is a well-recognized clinical phenomenon. Multiple supernumerary teeth are commonly associated with variable syndromes. However the multiple supernumerary teeth reported in mandibular and maxilla premolar region of an 14-year-old female patient without any associated systemic condition/syndrome is a rare case. A review of the literature relating to supernumerary teeth is presented including possible presentations, diagnostic features and treatment options.