ABSTRACT
Background@#Moderate sedation is an integral part of dental care delivery. Target-controlled infusion (TCI) has the potential to improve patient safety and outcome. We compared the effects of using TCI to administer remifentanil/manual bolus midazolam with manual bolus fentanyl/midazolam administration on patient safety parameters, drug administration times, and patient recovery times. @*Methods@#In this retrospective chart review, records of patients who underwent moderate intravenous sedation over 12 months in a private dental clinic were assessed. Patient indicators (pre-, intra-, and post-procedure noninvasive systolic and diastolic blood pressure, respiration, and heart rate) were compared using independent t-test analysis. Patient recovery time, procedure length, and midazolam dosage required were also compared between the two groups. @*Results@#Eighty-five patient charts were included in the final analysis: 47 received TCI-remifentanil/midazolam sedation, and 38 received manual fentanyl/midazolam sedation. Among the physiological parameters, diastolic blood pressure showed slightly higher changes in the fentanyl group (P = 0.049), respiratory rate changes showed higher changes in the fentanyl group (P = 0.032), and the average EtCO 2 was slightly higher in the remifentanil group (P = 0.041). There was no significant difference in the minimum SpO 2 levels and average procedure length between the fentanyl and remifentanil TCI pump groups (P > 0.05). However, a significant difference was observed in the time required for discharge from the chair (P = 0.048), indicating that patients who received remifentanil required less time for discharge from the chair than those who received fentanyl. The dosage of midazolam used in the fentanyl group was 0.487 mg more than that in the remifentanil group; however, the difference was not significant (P > 0.05). @*Conclusion@#The combination of TCI administered remifentanil combined with manual administered midazolam has the potential to shorten the recovery time and reduce respiration rate changes when compared to manual administration of fentanyl/midazolam. This is possibly due to either the lower midazolam dosage required with TCI remifentanil administration or achieving a stable, steady-state low dose remifentanil concentration for the duration of the procedure.
ABSTRACT
Objective: Several medications have been used for sedation in children in dentistry and intra-nasal route has been reported to be an efficient way regarding patient cooperation. The aim of the present study was to compare the changes in physiologic parameters following intra-nasal midazolam and ketamine administration
Methods: In this randomized cross-over double-blind trial, 17 uncooperative 3-6 years old children requiring at least two dental treatments were selected randomly and received intra-nasal ketamine [0.5 mg/kg] and midazolam [0.2 mg/kg] prior to the treatment using the other drug in the next visit. Physiologic parameters including blood pressure, heart rate, respiratory rate and O[2] saturation were measured and compared during the different time intervals using two way repeated measure ANOVA
Results: The patients showed higher blood pressure and heart rate following ketamine administration compared to midazolam [p<0.001]. No significant difference was found between the drugs at different time intervals regarding respiratory rate and O[2] saturation. [p>0.05]
Conclusion: In spite of significant differences between midazolam and ketamine regarding heart rate and blood pressure, both drugs can b e used as effective sedative medications without treatment interruption in children
ABSTRACT
Failure of teeth to erupt from gingival tissues at usual developmental time is called delayed tooth eruption [DTE]. Delayed tooth eruption lead to prolonged fixed orthodontic treatment and its eventual complications. The purpose of the present study was to evaluate the effect of laser-assisted [808 nm] surgical uncovering, on the tooth emergence and orthodontic treatment of DTE. A total of 16 orthodontic patients were included in this study and were equally assigned to an experimental and a control group. Subjects for experiment consisted of eight patients [6 girls and 2 boys] with a mean age of 14 +/- 0.9 years. All patients exhibited delayed second premolar eruption. The laser wavelength was 810 nm and it was set in a continuous wave mode at a power output of 1.6 watt with a 0.3-mm diameter fiber tip. When the target tissue was sufficiently anesthetized, the tip was directed at an angle of 10 to 20 degrees to the tissue [light contact mode]; and was applied continuously for approximately 12 Seconds until an acceptable tooth exposure area was visible. The facial axis of the clinical crown [FACC] line represents the most prominent portion of the facial central lobe for premolars. All orthodontic brackets are aligned along this reference and are located on FA [Facial Axis] point. The standard for adequate tooth eruption was the accessibility of facial axis of the clinical crown [FACC] for bonding the brackets. Data gathered from the patients were statistically surveyed and compared by means of Tukey's Test and Analysis of Variance [ANOVA]. All patients showed good gingival status, no significant bleeding during or immediately after the surgery, and acceptable level of healing after laser surgery. The biologic width of the teeth was preserved and no violation of this important periodontal parameter was observed. The average time for accessing the FA point in experimental group was 11 +/- 1.1 weeks and the mentioned period was increased to 25 +/- 1.8 weeks in control group. The data analysis showed that in patients with DTE, laser intervention significantly accelerated tooth eruption [P < 0.05]. Laser-assisted surgical removal of the fibrous tissue over erupting premolars [DTE] with appropriate irradiation parameters appears to be a promising adjunct to orthodontic treatment for bringing the premolar to the aligned and leveled dental arch
ABSTRACT
Corticotomy-facilitated orthodontics provides a means for rapidly moving teeth purportedly with little damaging effects to the periodontium and with greatly reduced treatment time. The aim of this study was to enhance the orthodontic tooth movement by reducing the cortical bone layer [resistant to bone re-sorption relative to spongious bone] following Erbium, Chromium doped Yttrium Scandium Gallium Garnet [Er-Cr: YSGG] laser irradiation, without reflection of surgical soft tissue flap. In the present experimental study, 8 New Zealand Male rabbits were the samples for the research. The right first premolar of each rabbit [experiment group] underwent treatment for mesial movement with 75 gram of orthodontic force by using closed Ni-Ti coil spring [Dentaurum [R]]. Coil spring was fixed in the cervical region of first premolars by means of ligature wire and No-Mix composite [Dentaurum[R]] and also activated to the cervical site of incisors. The left first premolars of the subjects were considered as the control group. Laser corticotomy was performed in anesthetized rabbits. Samples were sacrificed for determination of tooth movement after initiating premolar protraction on the 21[th] day. The amount of orthodontic tooth movement was assessed by using a metal feeler gauge with the precision of 0.01 mm, between mesial surface of the second premolars and distal surfaces of the first premolars. The statistical package of SPSS [Kolmogorov - Smirnov and ANOVA test] was used for analytical evaluation of the measurements. The amount of orthodontic tooth movement in the experimental group [mean=1.653 +/- 0.34 mm] was significantly [p<0.001] greater than that of the control group [mean=0.936 +/- 0.28 mm]. The innovated laser assisted corticotomies enhanced the rate of orthodontic tooth movement on the intervention side, significantly [p<0.001]. The innovated method of laser assisted flapless corticotomy is a useful procedure for reducing treatment time and damage to periodontium. It also eliminates the necessity of more invasive intervention of flap surgery