Delayed-onset infections after lower third molar surgery: a Hungarian case-control study.

OBJECTIVE: Delayed-onset infection is defined as infectious swelling and trismus accompanied by pain or the presence of suppuration starting approximately 30 days after surgery. This study aimed to describe the occurrence and potential predisposing factors of delayed-onset infection. STUDY DESIGN: A retrospective case-control study of 223 lower third molar surgeries was performed. Participants were selected from among 1102 outpatients who underwent surgery between January 2013 and June 2018 at Semmelweis University. The inclusion criterion for the case group was inflammation of the operated area after suture removal. Patients in the control group were healthy nonsmokers <26 years old who healed without complication. Statistical analysis was performed using the Shapiro-Wilk test, the Mann-Whitney U test, and Fisher's exact test. RESULTS: Complications occurred only in patients <26 years old approximately 29.5 days after surgery. A significantly higher risk was observed for younger age, total soft tissue coverage, deeper impaction, lower Nolla stage (P < .001), mesioangular direction (P = .002), and full bone coverage (P < .05). Distal space was inversely correlated with complications (P < .001). CONCLUSIONS: Lower Nolla stage, total soft tissue coverage, lack of distal space, deeper impaction, or mesioangular tilt may promote delayed-onset infection. Follow-up of at-risk patients and the maintenance of oral hygiene are recommended.

The early loading of different surface-modified implants: a randomized clinical trial.

BACKGROUND: Various surface treatment options have been adopted with the aim to improve osseointegration, reducing the overall treatment time. Implant stability of early loaded implants with different modified surfaces was compared in the present study. METHODS: Patients were selected from the Department of Oro-Maxillofacial Surgery and Stomatology at Semmelweis University. Patients randomly received SA (alumina sandblasted and acid-etched), NH (bioabsorbable apatite nanocoating) or SLA (large-grit sandblasted and acid-etched) surface implants. Outcome measures were: implant success, implant stability, and periodontal parameters. The implant stability was measured at the time of implant placement (primary stability) and six weeks after (prothesis delivery, secondary stability). Osstell and Periotest were applied to take all the measurements. The primary and secondary stability were compared in the three study groups Finally the periimplant probing depth appearing after three months of loading was checked on 6 points around to the implant-supported prostheses. Shapiro-Wilk and Mann-Whitney tests were used for the comparison between the study groups. RESULTS: A total of 75 implants with different length and diameter were inserted into various positions. One implant failed spontaneously at the fourth week after implant placement. The survival rate was 98,7%. Comparing the primary and secondary stability values, the data were significantly improved in every groups. The difference was the highest in the NH group, however, this difference was not significant compared to the two other groups. Good periodontal parameters were experienced in all the tested implants, independently by the groups. CONCLUSIONS: With the limitation of the present study, all the implants showed improved stability six weeks after implant placement. A trend of higher result was found for the NH group. Further studies with longer follow-up are needed to confirm this preliminary results. TRIAL REGISTRATION: Current Controlled Trials ISRCTN13181677; the date of registration: 04/03/2021. Retrospectively registered.

[Changes in the "classical" factors influencing dental implant-osseointegration in recent decades]. / A fogászati implantátumok csontbeépülését befolyásoló "klasszikus" tényezok változásai az elmúlt évtizedekben.

Nowadays, it is almost naturally taken among dentists that seemed unimaginable a few decades ago, namely that an inorganic material (titanium) inserted in an organic environment (bone) can be integrated and become a permanent pillar of prosthetics. Bone integration - meaning a structural and functional connection between the implant and the bone - itself was discovered and described in the late 1960s. This provides the basis of dental implantology. In those days, the conditions affecting the positive or negative course of bone integration have been formulated. This process is investigated at the level of basic research and rarely mentioned in the daily clinical practice. The material, form, and surface of the implant all contribute to success if we design well and apply the correct surgical technique. Our goal is to present the changes that have taken place over the past decades, which have resulted in an increasingly perfect integration and clinical success of implants. Orv Hetil. 2019; 160(37): 1455-1463.

[Incidence and case-control study of delayed-onset infection after lower third molar surgery]. / Az alsó bölcsességfogak mutéti eltávolítását követo késoi posztoperatív gyulladás (delayed-onset infection) vizsgálata.

INTRODUCTION AND AIM: Delayed-onset infection was defined as an infectious swelling and trismus accompained by pain or the presence of suppuration starting after the discharge of the patient, generally a week after surgery. Our aim was to describe incidence and possible risk factors of delayed-onset infection after lower wisdoom tooth removal. MATERIAL AND METHODS: Retrospective study of 851 lower third molar surgeries, performed between January 2013 and August 2017 at Semmelweis University Faculty of Dentistry, Department of Oro-Maxillofacial Surgery and Stomatology, has been done. The teeth were removed by 2 surgeons. Under age of 26, a case-control study comprising a total of 150 lower third molar surgeries were done to indentify possible risk factors. RESULTS: 10 delayed-onset wound infections were recorded after suture removal (1.17% of the patients). The mean time elapsing from surgery to delayed-onset infection was 30 days. Lower third molars with total soft tissue coverage, a bigger amount of bone coverage, a lack of distal space (Pell-Gregory class III), deeper impaction (Pell-Gregory classes B, C) or mesioangular tilt are associated with the development of this complication (p<0.05). Female sex and young age seem to be risk factors, too. CONCLUSION: Patients with risk factors should be warned that infection may still occur several weeks after surgery. The clinicians should observe these patients longer and emphasize keeping their wound clean for a prolonged period. Orv Hetil. 2018; 159(31): 1278-1283.

[Prospective randomized study regarding the effect of the preoperative antibiotic and chlorhexidine rinse on wound healing after mandibular third molar surgery]. / A preoperatív antibiotikus és antiszeptikus kezelés hatása a mutéti úton eltávolított alsó bölcsességfogak sebgyógyulására ­ prospektív randomizált vizsgálat.

INTRODUCTION AND AIM: The study compares the antibiotic prophylaxis combined with postoperative antibiotic therapy to preoperative chlorhexidine rinse combined with postoperative antibiotic therapy in preventing complications after surgical removal of a mandibular third molar. METHOD: 71 healthy patients in four groups were enrolled in the study: I. prophylactic dose of 2000 mg of amoxicillin clavulanate, continued with amoxicillin clavulanate postoperatively; II. prophylactic dose of 600 mg of clindamycin, continued with clindamycin postoperatively; III. prophylactic chlorhexidin rinsing, continued randomized amoxicillin clavulanate or clindamycin postoperatively; IV. control, with clindamycin postoperatively. RESULTS: The pain was smaller in the prophylaxis groups. Alveolitis occurred only in the control group: 2 patients. Wound opening occurred in 22,2 % in group IV., 14,2 % in group II, 10 % in group I., 5 % in group III. CONCLUSION: We consider completing the indicated postoperative antibiotic prescription with antibiotic or antiseptic prophylaxis. Chlorhexidin prophylaxis could have the same positive effect. Orv. Hetil., 2017, 158(1), 13-19.

[Guidelines on the pharmacotherapy of the dental patient during pregnancy]. / A várandós nok gyógyszeres kezelésének irányelvei a fogorvosi gyakorlatban.

Physiological differences occuring in pregnancy modify certain steps of dental treatments. Since in our everyday practice we meet expectant patients, we have to be aware of what kind of changes does this transitional state require from the dentist, how to do a good timing in the course of dental treatment, which are those medicaments that can be used safely and those which should be avoided. The summerized data in the article are to contribute the safe choice of the possibly necessary antibiotics during the treatments. Besides, dental care should not be delayed due to our doubts about local anestetics, because it may carry serious consequences later. Relying on the most up-to-date facts, moreover, we mention the guidelines of the use of analgesics during pregnancy in dentistry. The treatment of pregnant women does not differ to a high degree from those who are non-pregnant, yet some of its viewpoints need special attention and we have to take them into consideration in order to do the appropriate medical work. Basically, in our opinion, before every dental and dental surgical intervention it is essential to consult with the patient's gynaecologist and in agreement with him/her to determine the course of the medicinal treatment.

[Carbon/carbon implants in oral and maxillofacial surgery--Part 2]. / Karbon/karbon implantátumok az arc- és állcsontsebészetben--2. rész.

In their previous report, the authors presented observations regarding the long-term application of carbon/carbon implants. After evaluating the good functional and aesthetic results, the effect of the human body on the structure and morphology of the implants was investigated with state of the art methods. An implant retrieved from the body after eight years was compared to implants which were sterilized but not implanted (reference). Carbon and oxygen were the main components of both implants, however, as a result of the interaction with the human body the amount of oxygen increased 3-4 times and phosphorus, sulphur, calcium and iron were detectable as trace elements on the surface. The width of the carbon fibres (5-7 µm) building up the implants was not changed during the interaction with the human body. The surface of the implant retrieved from the human body was covered with a 15-17 µm thick layer, not present on the reference implant, having a similar composition to that of the carbon fibres (high amount of calcium that is typical to bone tissue was not detected). According to these results, the structure and the morphology of the implants were not altered notably by the human body.

[Replantation of the second molar in the mandible after unsuccessful endodontic treatment]. / Második nagyôrlô replantációja sikertelen endodonciai kezelést követôen. Esetismertetés.

A mandibular second molar after several unsuccessful attempts for orthograde endodontic therapy has been treated by a combined endodontic-surgical approach. The tooth has been atraumatically extracted and a retrograde root canal obturation was performed followed by the reposition of the tooth into its own socket. Wire ligature was used for fixation and the tooth was taken out of the occlusion. After the wire splint was removed the stabilization of the tooth was regularly controlled in the beginning monthly and later on four times a year. Four years after replantation patient has no complaint and the tooth is symptomless. The presented case is one of good examples of the various surgical possibilities, to save seemingly hopeless cases and maintain the natural tooth.