The application of leukocyte- and platelet-rich fibrin (L-PRF) in maxillary sinus augmentation.

BACKGROUND: Since the introduction of sinus augmentation in the 1970s the procedure has been performed with or without biomaterials. Autologous blood products (ABPs) for use in sinus augmentation was first introduced in the 2000s, to aid potentially in bone and soft tissue healing. METHODS: Three different applications of leukocyte- and platelet-rich fibrin (L-PRF) in maxillary sinus augmentation are presented in this case series. In case 1, L-PRF is used in bilateral sinus augmentation to support placement of implants to support a maxillary hybrid denture. Case 2 highlights the use of L-PRF in a complication associate with Schneiderian membrane elevation. Case 3 provides histology taken at the time of implant placement 6 months following L-PRF/xenograft sinus augmentation. RESULTS: All cases resulted in the successful placement of dental implants. In case 2, an osseodensification procedure was performed with freeze-dried bone allograft, which provided an approximate 4 mm of additional vertical height for implant placement. Histology from case 3 at 6 months post sinus augmentation demonstrated the presence of new vital bone in contact with the xenograft. CONCLUSION: To date, there is only a limited amount of evidence reporting on platelet-rich fibrin (PRF) or L-PRF use in maxillary sinus augmentation. Bone gain from either product has ranged from 3.2 to 11.8 mm, with the percentage of newly formed bone reported in case series as 33% ± 5%. Despite the lack of strong evidence, L-PRF appears to have beneficial effects on bone regeneration when used in sinus augmentation.

The Surgical Anatomy of the Greater Palatine Artery: A Human Cadaver Study.

Identifying the accurate location of the greater palatine artery (GPA) can be challenging. The purpose of the present cadaver study was to determine the location of the GPA from the cementoenamel junction (CEJ) of the maxillary canine to second molar teeth and to define its relationship with the palatal vault height (PVH) in Caucasian cadavers. Sixty-six sections from fully or partially dentate cadavers were examined. The location of the GPA from the CEJ ranged from a minimum of 8.7 ± 2.1 mm at the canine to 14.5 ± 1.3 mm at the second molar. The minimum distance of the GPA to the CEJ in different PVH ranged from 6 to 12 mm. There was a significant difference between male and female cadavers regarding shallow PVH. Only the PVH as an independent variable had a significant correlation with the GPA location. The present study is the first to identify the different PVHs with customized stents and to correlate them with the distance of the GPA to the CEJ of maxillary teeth.

Cost and complications associated with implant-supported overdentures with a resilient-attachment system: A retrospective study.

STATEMENT OF PROBLEM: Implant-supported overdentures with a splinted or nonsplinted attachment system have been a successful treatment option for edentulous mandibles with excessive hard tissue resorption. Currently, the 2 most common treatment approaches for an implant overdenture uses either a bar attachment system (splinted) or resilient (LOCATOR)-attachment system (nonsplinted). The LOCATOR-attachment system is often chosen for the lower initial cost. However, whether the ongoing maintenance costs of the LOCATOR-attachment system increase the overall cost of this system is unclear. PURPOSE: The purpose of this retrospective study was to investigate the frequency of maintenance procedures, complications, and costs associated with the LOCATOR-supported overdenture treatment. MATERIAL AND METHODS: The retrospective data of 75 patients who had received implant-supported overdentures with LOCATOR-attachments at the University of Colorado School of Dental Medicine in the previous 10 years were collected and screened to evaluate the number of maintenance visits, type of complications, and cost (actual fees for the service) of the maintenance visits. The data were analyzed, and the mean values calculated. RESULTS: The average number of maintenance visits was 7.7 in the mean observation time of 5.2 years. Replacement of the attachment was the most frequent complication (63%). The average maintenance cost charged to the patient for maintenance was 56.2% ($795) of the initial cost over the average 5.2 years of follow-up. The average total maintenance cost (actual fees for the service) was 95.4% ($1349) of the initial cost over the average of 5.2 years of follow-up. The average maintenance cost adjusted or lost over the 5.2 years follow-up was 39.2%. CONCLUSIONS: The 5-year costs for the maintenance of mandibular overdentures with a LOCATOR-attachment system were equal to or higher than the initial cost of the treatment. The number of maintenance visits and the cost were higher for patients who were older than 75 years.

Five different solutions to mitigate overprescribing opioid medications.

PURPOSE: The University of Colorado School of Dental Medicine took 5 distinct actions to mitigate the amount of opioids prescribed at the dental school between the years 2016-2020. METHODS: This retrospective study evaluated a comprehensive 5-step quality improvement strategy which was implemented to decrease opioid prescribing. a) development of a Dental Pain Management Protocol, b) implementation of the protocol with pre-doctoral students, c) incorporating the results of a Master's project that determined the actual postoperative pain after periodontal/oral surgical procedures, d) development of a favorite electronic prescription list, and e) creation of patient instructions to allow for information on nonopioid analgesic use after dental procedures to be disseminated to the patient. RESULTS: There was a significant decrease (P = 0.05) in the opioid prescribing trend with the implementation of these 5 actions, resulting in an overall 68.8% decrease for prescription writing of opioids and a 78.6% decrease of opioid pills over this 3 year period. CONCLUSION: Simple guidelines and protocols resulted in a drastic decrease in opioid prescribing, with limited negative feedback from faculty and patients.

Evaluation of the need to prescribe opioid medication to control post-surgical pain of different periodontal/oral surgeries.

BACKGROUND: To determine the level of perceived pain after different types of periodontal/oral surgical procedures, and the differences in patients' selection of pain management, over the counter (OTC) versus opioid, based on procedure type. METHODS: Patients undergoing surgical procedures were asked to complete a pain questionnaire at four time points: 1) before surgery 2) first dose of analgesic at home, 3) 24 hours postoperatively, and 4) 72 hours postoperatively. The questionnaire consisted of numerical and descriptive scales to describe the perceived pain. RESULTS: A total of 198 patients completed the questionnaire. All surgical procedures were grouped into five major categories: bone augmentation procedures (11% BAP), teeth extractions (26% EXT), surgical implant placement (25% IP), mucogingival surgeries (21% MGS), and pocket elimination procedures (17%). IP surgery was associated with significantly less pain compared with MGS and EXT (P <0.05). There was a statistically significant difference for taking any medication based on type of surgical procedure at 24 hours (P <0.05). CONCLUSIONS: IP is associated with significantly lower perceived pain compared with EXT and MGS surgery. Analgesic consumption was generally parallel to pain perception. A considerable number of patients elected to control the post-surgical pain using OTC medication up to 72 hours. Periodontal/oral surgery procedures vary in the amount of perceived postoperative pain. Tailoring postoperative medications to the type of periodontal/oral surgery performed will help prevent overprescribing of opioids.

Evaluation of Different Dental Lasers' Ability to Congeal Pooled Blood: An In Vitro Study.

Most dental lasers claim that they can aid in hemostasis during oral and periodontal surgery. To date, there are no studies that compare different lasers' ability to congeal pooled blood. The aim of the study was to see if there was a difference in dental lasers' ability to congeal pooled human blood in vitro. Whole blood was collected from donors, with 0.5 mL (premolar socket volume for all tests) aliquoted into microcentrifuge tubes. Different dental lasers (810-nm diode, 940-nm diode, 1,064-nm Nd:YAG, 2,790-nm Er,Cr:YSGG, 2,940-nm Er:YAG, and 10,600-nm CO2) were applied to the whole blood for 0, 15, 30, and 45 seconds. The sample tubes were centrifuged, and the supernatant color was scored to assess the degree of congealing. Additional samples of blood were tested for time needed for maximum congealing and temperature change. Analysis of supernatant colors showed that there were significant differences in the degrees of congealing for the 810-nm diode, 940-nm diode, and 2,790-nm Er,Cr:YSGG lasers when compared to the 1,064-nm Nd:YAG, 2,940-nm Er:YAG, and 10,600-nm CO2 lasers, but not within those groupings. Additionally, the 1,064-nm Nd:YAG laser increased the temperature of the blood samples more than the other lasers and had a shorter time for maximum congealing. There were differences in the dental lasers' ability to congeal pooled human blood in an in vitro model. Nd:YAG, Er:YAG, and 10,600-nm CO2 lasers were able to achieve a greater degree of congealing at an earlier time point. The Nd:YAG laser produced the most heat and was the fastest to complete coagulation.

Antimicrobial Activity of an Amnion-Chorion Membrane to Oral Microbes.

OBJECTIVE: The aim of this study was to evaluate wound biomodification by assessing antimicrobial properties present within a human-derived composite amnion-chorion membrane (ACM). METHODS: Membranes analyzed were the human-derived ACM BioXclude™ and the porcine-derived collagen membrane Bio-Gide®. Paper discs with and without tetracycline served as positive and negative controls, respectively. The same number of colony-forming units per milliliter for each bacterial species (Aggregatibacter actinomycetemcomitans, Streptococcus mutans, and Streptococcus oralis) was inoculated on each of the discs. Discs from each group were removed at 12 and 24 hours and sonicated to remove the bacteria off the membranes. A serial dilution was performed to quantify bacterial growth. RESULTS: The ACM inhibited growth at all time points, with all bacterial strains, identical to the negative control tetracycline discs. The collagen membrane and positive controls did not inhibit growth of any of the bacterial species throughout the 24-hour study period. P < 0.05 for microbial growth on ACM or negative control vs. either collagen membrane or positive control. CONCLUSION: ACM was proven to be as bactericidal as paper discs inoculated with tetracycline at its minimum bactericidal concentration. The ACM bactericidal property may be beneficial in the early wound healing process.

A root volume study of the adult dentition for ridge preservation purposes.

Ridge preservation has become a common practice to preserve the remaining alveolar bone volume after tooth extraction. The most common volume of graft material in commercially available vials is between 0.50 and 1.00 mL. The clinician must estimate how much grafting material is needed after extracting a tooth. The aim of this study is to provide the clinician with a volumetric guide for selection of graft material for ridge preservation after tooth extraction. Fifteen sets of permanent teeth, each representing a full adult dentition excluding the third molars, were selected at random from a collection of extracted teeth. Teeth were submerged in a polyvinyl siloxane impression material to record the negative impression of the root. Water was then used to fill this space and measure the root volume. For the majority of the teeth, 0.50 mL of graft material was adequate for grafting the socket. A volume greater than 0.50 mL was required to preserve the maxillary and mandibular first molars. Overestimation or underestimation of the amount of grafting material necessary postextraction may result in unnecessary expense.