Incidence of alveoloplasty and its indications - protocol to reduce the incidence

Alveoloplasty is one of the common pre prosthetic surgical procedure carried out in dental surgical practice setups. The aim of pre-prosthetic surgery is to improve the quality of oral supporting structures, which can provide better retention and stability to dental prosthesis. It also prevents any further hard or soft tissue loss. Alveoloplasty procedure is used for recontouring of bony irregularities at time of extractions or after initial healing. Simplest form includes squeezing of socket walls at time of extraction, which reduces the incidence of secondary alveoloplasty at later stages when patient requires denture rehabilitation. It may involve more complex procedures such as maxillary tuberosity reduction, removal of excessive undercuts, and bony exostosis like mandibular and palatal tori. It also reduces the chances of post-operative discomfort and complications. Mucosa covering the alveolar arches after alveoloplasty should be of uniform thickness and density so that occlusal load is distributed equally throughout the dental arches, making it more comfortable for patients to wear prosthesis. This study includes data consisting of number of patients requiring secondary alveoloplasty at Oral and Maxillofacial Surgery department of Islamic International Dental Hospital in last 3 years [2009, 2010 and 2011]. It also includes the symptoms with which patients present and suggestions / protocols to reduce the incidence of this second surgical procedure. We have implemented these protocols in this department, to reduce the need of secondary alveoloplasty because this procedure causes extra financial and surgical burden on patients. It also delays the rehabilitation of oral health. Second arm of this study is being planned after implementation of these protocols to evaluate their outcome

Success and evaluation of dental implant patients at Islamic international dental college and hospital

Dental implant is a permanent metal fixture anchored into the jaw bone topped with individual replacement of a tooth, teeth or a bridge that screws or cements into the implant fixture. The successful outcome of implant procedure depends on a series of patient-related and procedure-dependent parameters. Predictors of success or failure are related to quality and quantity of the bone at the intended site, length of implant, axial loading, operator skills, patient's overall general health, age, habits and oral hygiene. Although long-term studies continue to show improving success rates for implants, failures occur unavoidably. Successful provision of dental implants to patients who have lost tooth/teeth and the surrounding bone, relies on careful gathering of clinical and radiological information, interdisciplinary communication and input, a detailed treatment planning and regular evaluation of the patients. Under proper conditions and diligent patient maintenance, implants can last for lifetime. The objective of this study is to assess and evaluate patients reporting to Islamic International Dental College and Hospital receiving implant therapy. We, very carefully conducted an evaluation of patients in order to find out our success rate. From August 2010 to December 2011, 31 patients received 68 implants. Vast majority of implants [63] were of Bio-Horizon of USA and rest [5] were Straumann implants of Switzerland. Out of these 68 implants, we had 3 failed cases. Further-more, we looked in detail the likely reasons of these failures

Evaluation of secondary alveolar bone grafting procedures

The most common procedure followed globally for the bony repair of a cleft palate is by grafting the iliac crest in the defect. The objective of this study was to evaluate the success of the alveolar bone grafting procedures carried out at our institute by using the Berglands Index. A total of 12 patients were evaluated by taking periapical radiographs of the grafted site 6 months post surgery. It was found that 77% of the patients had a bone level of more than 3/4. It was also deduced that the success rate of the grafted bone was 100% when the bone was grafted before the eruption of the canine while success rate dropped to 40% in patients in which the procedure was performed after the eruption of the canine

Removal of third molars-should we have guidelines for surgery?

Third molar surgery is the most frequent procedure carried out by the departments of oral and maxillofacial surgery all over the world. The procedure is accompanied by significant risks, with possible damage to the inferior alveolar and/or lingual nerve being of special concern. Considering these risks of morbidity, it is essential to establish the need of removal. National Institute of Clinical Excellence [NICE] in the United Kingdom introduced guidelines for removal of third molars in 2000, advocating that only pathological third molars should be removed. The following article makes reference to a study carried out in England where third molars are extracted in accordance with NICE guidelines. This study was carried out to assess the compliance of general dental practitioners to the NICE guidelines. It was noted that 95% of the patients referred for third molars extraction fulfilled the criteria set forth by NICE. 11% [15] patients who fulfilled the NICE guidelines criteria refused to undergo removal of third molars. Only 5% [7] patients did not meet referral criteria set by NICE guidelines. These guidelines cut down lot of unnecessary referrals and allowed for organization of the patient load by the secondary referral center, as well as limiting unnecessary surgeries and postoperative complications. There is a dire need to define similar guidelines in Pakistan pertaining to the local needs

Pathogenesis and management of dry socket [alveolar osteitis]

Alveolar osteitis is a common post extraction complication developing within 1-4 days following surgery.1-3. It is characterized by intense pain that is not relieved by analgesics. 1 The most frequent site of occurrence is the mandibular third molar region. Females are known to show a higher incidence of occurrence. 4 Studies indicate smoking, traumatic extractions, leaving tooth and bone debrisin extraction sockets, excessive irrigation of socket, compromised blood supply and use of contraceptives, as possible predisposing factors.5-25. Inflammation of the socket is believed to be a result of dislodgment or disintegration of the blood clot that forms within the socket immediately after extraction. 11, 26-27 Dry socket can be prevented by ensuring sterile surgery and by the use of numerous non-pharmacological measures; good history, identification and elimination of risk factors, and pharmacological agents; systemic antibiotics, antiseptics, antifibrinolytics, obtundant dressings and photodynamic therapy.8,28-34 Once the condition develops it is treated symptomatically and by use of obtundant dressings. Initial results of a study carried out in Khyber College of Dentistry, Peshawar are showing promising results with surgical management. This literature review summarizes the current understanding of etiology, pathogenesis, prevention and management of alveolar osteitis

Lingual, inferior alveolar and mylohyoid nerves sensory impairment following removal of mandibular third molars

The objectives of this study were to investigate the incidence of sensory impairment of the lingual, inferior alveolar and mylohyoid nerves following lower third molar removal and to compare the outcome with the results of other studies with the intention of implementing any change in the treatment protocol, if indicated and to predict the need for routine postoperative follow up and it's cost implications. A total of 2456 mandibular third molars were removed from 1275 patients of which 585 were operated under general anaesthesia and 690 received local anaesthesia with or without sedation. Of the 1275 patients, 58 [4.57%] experienced transient sensory impairment affecting single or a combination of the above nerves. Only 15 [1.18%] patients had anaesthetic impairment and the rest 43 [3.42%] patient's injury was paraesthetic in nature. All of these resolved completely during the period of study except one patient who suffered permanent impairment of the lingual nerve functions and this occurred in general anaesthetic group. No permanent sensory impairment was recorded for inferior alveolar and mylohyoid nerves. Surgical criteria and treatment justification with appropriate patient information sheet and the need for follow up is discussed