The use of autologous bone for augmentation procedures leads to low prevalence of peri-implantitis-a retrospective study over a 20-year period.

The aim of this study was to compare the prevalence of peri-implantitis in implants inserted into pristine bone (control) to implants where autologous bone was used for grafting procedures (study). All patients who underwent implant surgery during a 20 years interval by one maxillofacial implant surgeon and received a prosthodontic rehabilitation afterwards were eligible for inclusion in the study. Periimplant bone resorption and periimplant disease were assessed. Of 421 patients 384 (91.2%) patients responded to a recall after having been treated over a 20-year period by one maxillofacial surgeon and several dentists. A total of 110 patients had 239 implants in pristine bone, and 274 patients had 607 implants placed in combination with autologous bone grafting procedures. Mean time in function was 74 months (range 15-236 months). In all, 342 implants (34.8%) were in function for longer than 7 years. A total of 64 implant sites (7.6%) in 39 patients (10.2%) showed signs of peri-implant mucositis. In addition, 17 implants (2.0%) in 14 patients (3.6%) revealed signs of peri-implantitis, of which five implants were in the control group (2.09%) whereas 12 implants were in the study group (1.98%), with no statistically significant difference (p = 0.8405). More than half of the patients with peri-implantitis had a history of periodontitis. Three implants were lost due to peri-implantitis and four implants failed for other reasons, resulting in an overall success rate of 99.2% in 846 implants. CONCLUSIONS: Within the limitations of the study it seems that the use of autologous bone still is a relevant option when performing augmentation procedures because of the low prevalence of peri-implantitis.

Status report on dental implantology in Switzerland. An updated cross-sectional survey.

A status report of dental implantology in Switzerland has already been performed in 1994 and 2006. The present study, based on these former surveys, aimed to update these results for the year 2016. To this end, a questionnaire was sent to all dentists in Switzerland who were members of the Swiss Dental Society (SSO) at the time of the survey. The questionnaire asked for personal background data and obtained information about the dentists' knowledge and concepts when using implants, the extent to which they used implants and about specific implant systems, which were selected based on the previous surveys. Out of 3,168 questionnaires, 1,446 were returned (return rate: 45.6%). Approximately 91% of the responding dentists had a practical involvement in implantology (implant placement only, superstructure insertion only, or both). Just over half of them (53%) placed more than twenty implants per year. Good handling was chosen by all dentists (100%) as a selection criterion for the implant system they used preferably. The current data suggested that the range of indications had widened, yet that the edentulous mandible was still the indication of choice. The percentage of dentists engaged in dental implantology doubled from 1994 to 2006 (1994: 42.2%, 2006: 82.2%). An increase of almost 10% in dentists involved in dental implantology was also apparent from 2006 to 2016 (2006: 82.2%, 2016: 91%). Our data show that, whilst the relative number of implant users had greatly increased among Swiss dentists, their rationale to place implants has remained similar.

[The Interdisciplinary Stomatology Service at the Department of Oral Surgery and Dental Imaging, University Center for Dental Medicine and the University Hospital Basel, Switzerland - Results from 2003 - 2013]. / Rückschau auf 10 Jahre interdisziplinäre Stomatologie-Sprechstunde an den Universitätszahnkliniken in Basel.

The Interdisciplinary Stomatology Service at the Department of Oral Surgery and Dental Imaging, University Center for Dental Medicine and the University Hospital Basel, Switzerland - Results from 2003 - 2013 Abstract. Stomatological problems are common, but rarely diagnosed in private dental practice. Even for oral surgeon's diagnosis and therapy of these disorders could be challenging. Stomatological problems can indicate general health problems. Hence, the oral cavity is also known as the «mirror of systemic diseases¼. To tackle this problem, an interdisciplinary stomatological service in a specialized dental clinic was established in 1999 at the Center for Dental Medicine, University of Basel, Switzerland. A board of specialists (Dermatologists, Otorhinolaryngologists, Oral- and Maxillofacial surgeons) was summoned monthly to perform interdisciplinary consultations of selected patients with complex oral and medical disorders. The specific knowledge of each specialist helped to ensure a diagnosis, even of rare systemic disorders and symptoms. Networking with a variety of specialists built the foundation for synoptic therapy approaches. Thus, the center was able to provide appropriate care for patients suffering from severe, chronic and complex stomatological findings. The results presented in this article are part of a dissertation based on the analysis of 154 patients who were seen in the interdisciplinary consultations in 2003 - 2013.

SADMFR guidelines for the use of Cone-Beam Computed Tomography/ Digital Volume Tomography.

Cone-Beam Computed Tomography (CBCT) has been introduced in 1998. This radiological imaging procedure has been provided for dentistry and is comparable to computed tomography (CT) in medicine. It is expected that CBCT will have the same success in dental diagnostic imaging as computed tomography had in medicine. Just as CT is responsible for a significant rise in radiation dose to the population from medical X-ray diagnostics, CBCT studies will be accompanied by a significant increase of the dose to our patients by dentistry. Because of the growing concern for an uncritical and consequently rapidly increasing use of CBCT the Swiss Society of Dentomaxillofacial Radiology convened a first consensus conference in 2011 to formulate indications for CBCT, which can be used as guidelines. In this meeting, oral and maxillofacial surgery, orthodontics and temporomandibular joint disorders and diseases were treated and the most important and most experienced users of DVT in these areas were asked to participate. In general, a highly restrictive use of CBCT is required. Justifying main criterion for CBCT application is that additional, therapy-relevant information is expected that should lead to a significant benefit in patient care. All users of CBCT should have completed a structured, high-level training, just like that offered by the Swiss Society of Dentomaxillofacial Radiology.

20 years of cleft lip and palate missions.

Volunteer missions for cleft lip and palate (CLP) care in Indonesia (1991-1992), India (1994-2003), Bhutan (2005-2010), and Kenya (2011), took place always at the same Hospital in each country. Altogether over a thousand patients were operated using a conservative protocol: Safety first - no experiments. Five months and 5 kg were the basic rules. For the native doctors, training help for self-help was priority. In the announcements, patients with CLP were primarily addressed. Burns, contractions, tumors, and trauma-cases were the second priority. Fresh trauma was done in night shifts with the local surgeons in order not to interfere. Besides facial esthetics speech was the number one issue, following priorities fell into place. Cultural aspects played a certain role in the different countries and continents.

Antidepressants relevant to oral and maxillofacial surgical practice.

BACKGROUND: Depression is commonly associated with a high-carbohydrate diet, lack of interest in proper oral hygiene and xerostomia connected to the use of antidepressants. Patients often consult their dentists as a result of changes affecting the hard dental substance and the soft-tissues. AIM: The aim of this study was to identify adverse drug interactions between the antidepressants and medications commonly administered in dentistry in order to give practicing dentists an overview of the scientific literature. OBJECTIVE: The objective is to identify the adverse drug interactions between antidepressants and medication commonly administered in dentistry. STUDY DESIGN: The literature search was performed using PubMed, Cochrane and the specific search items. The review (1984-2009) focused on medicines used in dental practice (vasoconstrictors, non-opioid analgesics, non-steroidal anti-inflammatory drugs, antibiotics, antifungals and benzodiazepines). RESULTS: There are various drug interactions between antidepressants and medicines used in dentistry. When two or more drugs are co-administered, a drug interaction must always be anticipated though many of the interactions are potential problems, but do not seem to be real clinical issues. CONCLUSION: The probability of a drug interaction can be minimized by careful history-taking, skillful dose adjustment and safe administration of the therapeutic agent.

Prescription of antibiotics in the dental practice: a survey of dentists in Switzerland.

In dentistry, antibiotics are prescribed both for prophylactic and therapeutic purposes. Their unwarranted use, however, may lead to the selection of resistant microorganisms. The aim of this study was to evaluate the indications and the extent of antibiotic prescription by dentists in Switzerland. A questionnaire was sent to 800 dentists during the winter of 2008/2009. Responses to the questionnaire were received from 20% of them. Many respondents indicated that they tried to prescribe antibiotics in a selective and cautious manner. Nevertheless, uncertainties existed regarding the indications. For example, the frequency of prescribing an antibiotic when it was not absolutely necessary was related to the respondents' uncertainty regarding the correct diagnosis and therapy. Not surprisingly, two-thirds of the respondents would prefer to have precise guidelines for the use of these drugs.

Is the Schneiderian membrane thickness affected by periodontal disease? A cone beam computed tomography-based extended case series.

OBJECTIVE: The aim was to assess the thickness of Schneiderian membranes (SM) in patients with advanced periodontal disease. METHODS: 17 dentate patients (DG) scheduled for periodontal surgery on maxillary molars were consecutively recruited and cone beam computed tomographies performed for preoperative diagnosis. Twenty-one patients (EG) requiring cone beam computed tomography-based planning of implant placement in the edentulous posterior maxilla served as controls. RESULTS: Schneiderian membrane thickness measured from cone beam computed tomography was significantly greater in the dentate group compared to the edentulous group, both in the first (p = 0.028) and second (p < 0.001) molar position. In the dentate group, clinical signs of periodontal destruction (increased probing pocket depth or furcation involvement) were not associated with Schneiderian membrane thickness. Additional findings, such as periapical lesions (p = 0.008), and the distance between root tips and maxillary sinus revealed a significant association (p = 0.036) with Schneiderian membrane thickness. CONCLUSION: In molar regions with periodontal destruction, Schneiderian membrane thickening occurred, particularly in combination with small bone layers above the root tips or periapical lesions.

Recognizing calcifications of the carotid artery on panoramic radiographs to prevent strokes.

Panoramic radiographs are made routinely in dentistry and are regarded as a standard component of an initial dental examination. Often, these radiographs show opacities in the carotid artery territory (CAT), which frequently arise as a result of calcification in the internal (ICA) or external carotid artery (ECA). This study details the examination of patients with suspected calcifications in the carotid artery (CA), using a sonographic examination based on the panoramic radio graphs to confirm or rule out a possible stenosis in the cervical bloodvessels. Thirty-three patients were examined sonographically. Based on the ultrasound investigation in 4 patients, hemodynamic stenoses were detected. Eighteen patients had an atheroma in the ICA, but no hemodynamic stenosis, and 5 patients showed no sign of calcification. Three patients were not examined sonographically at the University Hospital in Basel and were therefore excluded from the evaluation. Three patients did not attend the sonographic examination. The diagnosis of panoramic radiographs should not be restricted to teeth and jaws; especially in patients over 50 years old and in those with health risk factors, greater attention should be paid to the lateral areas. Using the radiographs they already have, dentists can also contribute.

Bisphosphonate-related osteonecrosis of the jaws--a review.

The aim was to evaluate the knowledge about bisphosphonate-related osteonecrosis of the jaws (BRONJ). A bibliographic search in Medline, PubMed and the Cochrane Register of controlled clinical trials was performed between 2003 and 2010 by using the terms bisphosphonate and osteonecrosis of the jaw. The amount of publications per year, the type of journal for publication, and the evidence level of the trial were evaluated. Next to this the incidences and the success of treatment strategies for BRONJ were identified. A total of 671 publications were reviewed. Since 2006 more than 100 publications on BRONJ per year (with an upward trend) have been published, mostly in dental journals. The evidence level could be determined for 176 publications and only one grade Ia study was found. The studies showed a wide variety in design, most of them being retrospective. The incidence of BRONJ is strongly dependent on oral or intravenous application and varies between 0.0% and 27.5%. There is no scientific data to sufficiently support any specific treatment protocol for the management of BRONJ. Further clinical studies are needed to evaluate the incidence and treatment strategies at a higher level of evidence. Therefore uniform study protocols would be favourable.

Thermal conduction of titanium implants under CO2 laser irradiation in vitro.

OBJECTIVE: The surgical exposure of dental implants can be performed by means of scalpel, punch, or, with less bleeding, by means of CO2 laser. Possible overheating of the peri-implant bone tissue should be avoided. The goal of this study was to examine the temperature changes on implants under CO2 laser irradiation (Luxar CO2 20 SP laser from POLYMED, Glattbrugg, Switzerland). STUDY DESIGN: Straumann(®) implants were irradiated with continuous wave (cw), continuous wave with super-pulse (cw/sp), and pulsed wave (pw). The irradiation power was 4, 5, 6, 7, 8, 9, and 10 W and the irradiation times were 10, 20, 30, and 60 s. Similar temperature changes occurred in cw/sp mode and cw mode, but substantially higher temperatures appeared in pulsed wave mode. RESULTS: The quickest temperature changes were observed with cw/sp irradiation (+0.5°C to +41.1°C, depending on the irradiation parameters). Beyond 20 s and 8 W irradiation, a rise exceeding 10°C on the implant surface was found. CONCLUSIONS: Implant diameter and length as well as the setting parameters of the CO2 laser (irradiation power, irradiation time, and irradiation mode) are important factors to consider so that risk-free implant exposure can be accomplished. Ignoring these factors causes a risk of pathological heating of the irradiated implants and thus the surrounding tissue, which can result in the loss of an implant.

[Immediately loaded MonoType implants in the edentulous mandible]. / Sofort belastete MonoType-Implantate im zahnlosen Unterkiefer.

Results of immediately loaded implants are presented. 34 patients with 136 interforaminal MonoType implants (Straumann,Basel, Switzerland) were included in the study. The bar retention was manufactured fter the operation, inserted and covered with a hybrid prosthesis. 28 patients showed up for the follow-up study, the average time range was three years. Five implants were rated as failures, the cumulative six-year success rate being 94%. Interforaminal immediately loaded MonoType implants in edentulous patients showed very good results, comparable to similar studies with different systems.

Oral care.

Adequate dental and oral hygiene may become a challenge for all users and especially for elderly people and young children because of their limited motor skills. The same holds true for patients undergoing/recovering from chemo-/radiotherapy with accompanying sensitive mucosal conditions. Poor dental hygiene can result in tooth decay, gingivitis, periodontitis, tooth loss, bad breath (halitosis), fungal infection and gum diseases. The use of a toothbrush is the most important measure for oral hygiene. Toothbrushes with soft bristles operated carefully by hand or via an electric device help to remove plaque and to avoid mucosal trauma. A handlebar with a grip cover can be helpful for manually disabled patients or for those with reduced motor skills. In case of oral hygiene at the bedside or of patients during/after chemo-/radiotherapy a gauze pad can be helpful for gently cleaning the teeth, gums and tongue. The use of fluoride toothpaste is imperative for the daily oral hygiene. Detergents such as sodium lauryl sulphate improve the cleaning action but may also dehydrate and irritate the mucous membrane. The use of products containing detergents and flavouring agents (peppermint, menthol, cinnamon) should therefore be avoided by bedridden patients or those with dry mouth and sensitive mucosa. Aids for suitable interdental cleaning, such as dental floss, interdental brushes or dental sticks, are often complicated to operate. Their correct use should be instructed by healthcare professionals. To support dental care, additional fluoridation with a fluoride gel or rinse can be useful. Products further containing antiseptics such as chlorhexidine or triclosan reduce the quantity of bacteria in the mouth. For patients undergoing or having undergone radio-/chemotherapy, a mouthwash that concomitantly moisturizes the oral mucosa is advisable.

Cardiovascular monitoring and its consequences in oral surgery.

OBJECTIVE: Higher life expectancy has lead to an increase of elderly patients in dental practices, thus also causing an increase in high-risk cardiovascular patients. STUDY DESIGN: In all, 3012 patients had oral surgery with local anesthesia at the Department of Oral Surgery, Oral Radiology and Oral Medicine at the University of Basel. The Colin BP 306 compact monitor was used during these surgeries. The patient's heart rate, blood pressure, and oxygen saturation were routinely checked, both before and during the procedure. RESULTS: The oral surgical procedure had to be discontinued 17 times, because the patient developed significantly elevated blood pressure. Twice, the procedure had to be discontinued due to cardiac arrhythmia. The average age of these 19 patients was 63.5 years. CONCLUSIONS: Pre-and intraoperative monitoring allows the dentist to identify patients with high-risk diagnostic findings and to reduce problematic cardiovascular situations.

Status report on dental implantology in Switzerland in 2006. A cross-sectional survey.

PURPOSE: To present results of a survey on the status of implantology in Switzerland in 2006. MATERIALS AND METHODS: A questionnaire was sent to all SSO (Swiss Dental Society) members asking for personal (anonymous) background data and their implantology concepts. Specific questions dealt with level of recognition of implants, use of implants, superstructures, success and failure rates, recall and training. RESULTS: A total of 1568 (47.3%) of the 3315 questionnaires were returned. Straumann, Nobel Biocare, 3i, SPI and Frialit were the most commonly used implant systems in Switzerland. Almost two-thirds (63.8%) of the dentists placed more than 20 implants per year. Long-term prognosis was the crucial factor, whereas material costs played a minor role. The edentulous mandible was the indication of choice, whereas the edentulous maxilla applied less. Almost every dentist active in implantology followed continuing educations programs in the field. CONCLUSIONS: Compared to a study undertaken 12 years ago, the number of dentists engaged in implantology doubled, meaning at least one-third of non-hospital dentists in Switzerland were involved in dental implantology. Overall, willingness to extend the therapeutic range has greatly increased.

[Status report on dental implantology in Switzerland]. / Daten zum Stand der zahnärztlichen Implantologie in der Schweiz.

PURPOSE: To present results of a survey on the status of implantology in Switzerland. MATERIALS AND METHODS: A questionnaire was sent to all SSO (Swiss Dental Society) members asking for personal (anonymous) background data and their implantology concepts. Specific questions dealt with level of recognition of implants, use of implants, superstructures, success and failure rates, recall and training. RESULTS: Straumann, Nobel Biocare, 3i, SPI and Frialit are the most commonly used implant systems in Switzerland. Almost two thirds (63.8%) of the dentists place more than 20 implants per year. Long-term prognosis is the crucial factor, whereas material costs play a minor role. The edentulous lower jaw is the indication of choice, whereas the edentulous upper jaw applies less. Almost every dentist active in implantology follows continuing education programs in the field. CONCLUSION: Compared to a study undertaken twelve years ago the number of dentists engaged in implantology doubled, meaning at least one third of non-hospital dentists in Switzerland are involved in dental implantology. Overall the willingness to extend the therapeutic range has greatly increased.

[Soft tissue calcifications in panoramic radiography. A risk factor for cerebrovascular accidents?]. / Weichgewebskalzifikationen auf der Panoramaschichtaufnahme. Ein Risiko für zerebrovaskuläre Insulte?

Panoramic radiography is a basic diagnostic tool in the dental field where calcifications are seen occasionally in the lateral parts of the x-ray. The differential diagnosis are carotid artery atheromas, calcified submandibular lymphnodes and sialoliths of the submandibular gland. 4007 panoramic radiographs (100%) from patients >40 years were scanned retrospectively. Special emphasis was given to the carotid artery territory (CAT). 225 soft tissue calcifications were found (5.6%). 144 patients had calcifications in the CAT (3.6%), 73 showed calcified submandibular lymphnodes (1.8%), and 8 (0.2%) sialoliths. The female to male ratio was 54.7%:45.3%. Pneumatic diseases were beside hypertension and smoking a risk factor for CAT calcification. Carotid artery atheromas are the main risk for cerebrovascular insults. Dentists can help to detect patients at risk for stroke. Their patients can be referred for further diagnostics (ultrasound).

[Cervicofacial actinomycosis: two case reports]. / Zervikofaziale Aktinomykose: zwei Fallberichte.

Infectious diseases transmitted by actinomycosis species cause severe destructive lesions. This rare and specific infection is mainly found in the orofacial regions. Causes of any hard tissue swelling in the jaw have, thus, to be assessed carefully. When actinomycosis is identified, a surgical intervention with curettement, draining and long-term antibiosis is required. The aim of the current article is to describe two clinical cases and to show the necessity of both, microbiological and histological laboratory diagnostics, to hedge the clinic diagnosis.

Antibiotic prophylaxis and therapy in oral surgery: a review.

Antibiotics are used for prophylactic and therapeutic purposes. Since bacterial resistances constantly change the existing conditions, the patient's therapy needs to be monitored periodically and adjusted to the changed conditions. Clinicians should be very careful about prescribing antibiotics for prophylactic purposes. But with regard to risk patients--especially when there is a risk of endocarditis--antibiotic prophylaxis is essential. Antibiotic therapy is absolutely necessary as a supporting treatment for primary surgery if the patient has acute osteomyelitis, transmitted abscesses, or multiple space abscesses. It might also become necessary to refer the patient to an appropriately equipped center or clinic.