Perioperative auricular electroacupuncture has no effect on pain and analgesic consumption after third molar tooth extraction.

BACKGROUND: Auricular acupuncture (AA) has been shown to alleviate acute and chronic pain. We investigated the effects of auricular electroacupuncture (AE) on pain and analgesic drug consumption in the first 48 h after unilateral mandibular third molar tooth extraction under local anesthesia in a prospective, randomized, double-blind, placebo-controlled study in 149 patients. METHODS: Patients received either AA with electrical stimulation (AE, n = 76) or without (AA, n = 37) electrical stimulation at an alternating frequency of 2/100 Hz or a sham AE with metal plates instead of needles and no electrical stimulation, no-needle (NN, n = 36) at the AA points 1 (tooth), 55 (Shen men) and 84 (mouth) during the entire study period. Regularly rated pain intensity (five-point verbal rating scale), consumption of acetaminophen 500 mg tablets and additional rescue medication with mefenamic acid 500 mg were assessed. RESULTS: The median fraction of time when pain was rated as moderate or worse (upper and lower quartile): AE: 33% (12%, 64%), AA: 22% (6%, 56%), NN: 30% (7%, 53%) did not differ significantly among the treatment groups. There were no significant differences in mean number of acetaminophen 500 mg tablets (range): AE: 5.2 (0-12), AA: 4.6 (0-11), NN: 5.4 (0-10) or percentage of patients requiring additional mefenamic acid: AE: 19%, AA: 18%, NN: 19%. CONCLUSION: We conclude that neither AE nor AA alone reduce either pain intensity or analgesic consumption in a molar tooth extraction model of acute pain.

Soluble RANKL in crevicular fluid of dental implants: a pilot study.

BACKGROUND: Receptor activator of NF-kappaB ligand (RANKL), a member of the tumor necrosis factor superfamily, is a key mediator of osteoclast formation, activation, and survival. Thus, it is reasonable to hypothesize that there might be a functional relationship between RANKL expression and peri-implantitis. PURPOSE: This pilot study was performed to determine the reference levels for soluble RANKL (sRANKL) in peri-implant crevicular fluid and to correlate them with the clinical parameters associated with inflammatory reactions and bone destruction. MATERIALS AND METHODS: The clinical parameters probing depth (PD), modified bleeding index (MBI), and modified plaque index (MPI) served as indicators for bone resorption and inflammation. Exclusion criteria for calculations were the detection limit of the immunoassay and the minimum acceptable crevicular volume for measurement. From the 84 collected samples of 16 patients, 30-84 years of age, with a total of 19 implants, 29 met these criteria. The absolute amount of sRANKL within crevicular fluid adsorbed to filter strips was a median of 0.18 femtomol (fmol; range, 0.08-0.53) and 0.26 nM (range, 0.09-1.21) when normalized by volume. PD was 4 mm in median and varied within a range between 2 and 12 mm. RESULTS: Absolute amounts of sRANKL showed no correlation with the adsorbed volume and the clinical parameters PD, MBI, and MPI. When sRANKL was normalized by volume, no correlation with the clinical parameters PD, MBI, and MPI was observed either. The patients' age was not associated with total sRANKL and the concentration of RANKL within crevicular fluid. Absolute levels of sRANKL and sRANKL concentration did not show any differences based on the sampling sites buccal and lingual, or on the patients' gender. A significant difference in sRANKL concentration was detectable when samples from maxillary implants (0.31 nM median; range, 0.12-1.21) were compared with samples from mandibular implants (0.21 nM median; range, 0.09-0.6) (p=.03). Absolute levels of sRANKL were not different between the maxilla and the mandible. CONCLUSION: Given the limited sample size, our data provide a basis for future prospective longitudinal studies on the possible relevance of sRANKL as a prognostic marker in peri-implantitis, and for an understanding of the pathophysiologic process of the disease as a prerequisite for the design of treatment strategies.

Cathepsin K levels in the crevicular fluid of dental implants: a pilot study.

OBJECTIVE: To determine the concentration of cathepsin K secreted into the crevicular fluid around dental implants and its correlation with clinical parameters of healthy implants and implants showing clinical signs of peri-implantitis. MATERIAL AND METHODS: Nineteen patients with 40 implants with and without peri-implantitis were enrolled in the study. Peri-implantitis was diagnosed by the pocket probing depth (PD), the modified bleeding index (MBI), the modified plaque index (MPI) and by radiographic signs of bone loss. Gingival crevicular fluid collected from the buccal and lingual sites was adsorbed to filter strips. Cathepsin K levels and total protein within the crevicular fluid were determined by immunoassay and the bicinchoninic method, respectively. RESULTS: Cathepsin K per filter strip normalized to the time of collection was 10.1 (0-33.5) pmol/sample around control implants and 22.4 (3.7-56.3) pmol/sample in the peri-implantitis group. The difference between the medians was significant (p < 0.01). Absolute cathepsin K levels in the crevicular fluid of all implants investigated showed a positive correlation with PD (R = 0.25; p = 0.03), MPI (R = 0.28; p = 0.01) and MBI (R = 0.32; p < 0.01). Absolute cathepsin K levels in the crevicular fluid also correlated with the adsorbed volume of gingival crevicular fluid (R = 0.51; p < 0.01). When normalized to the adsorbed volume of gingival crevicular fluid, the concentration of cathepsin K was 2.2 (0.01-6.4) nM around control implants and 1.7 (0.4-4.6) nM in the peri-implantitis group (p = 0.33). Patients' age correlated with sample volume and with cathepsin K normalized to the adsorbed volume of gingival crevicular fluid (R = 0.39; p < 0.01). Moreover, significant differences between male and female (p < 0.01, p < 0.01), and between mandible and maxilla (p < 0.05, p < 0.01), but not between buccal and lingual sites (p = 0.99, p= 0.93), were observed when analysed for the parameters adsorbed volume and absolute cathepsin K levels. CONCLUSION: Clinical parameters of peri-implantitis are associated with a higher amount of cathepsin K and a higher volume adsorbed to filters strips. To establish cathepsin K as a biochemical parameter to monitor peri-implant tissue health, age, sex and collection site should be considered to avoid interfering influences because of sample inhomogenity. Also a prospective study over time including more patients would be necessary.

Bony press-fit closure of oro-antral fistulas: a technique for pre-sinus lift repair and secondary closure.

PURPOSE: To evaluate the use of intra-oral bone grafts for closing chronic oro-antral fistulas (OAFs), for providing a sound basis for subsequent conventional sinus lifting and for preserving the teeth adjacent to OAFs. PATIENTS AND METHODS: Twenty-one patients with oro-antral fistulas of variable origin were treated with monocortical bone blocks harvested from the retromolar or interforaminal regions of the mandible. The preoperative treatment, the surgical procedure for both hard and soft tissue closure, and the postoperative management are reviewed in detail. RESULTS: Press-fit closure for repair of the bony sinus floor was sufficient in 17 patients. Four of them needed additional internal fixation. In all 21 patients adequate closure of the fistulas was obtained, although 3 patients (14.3%) developed wound dehiscences at the grafted sites, which healed by secondary intention. Meanwhile, 3 patients underwent successful sinus lifting. CONCLUSION: The use of monocortical bone grafts harvested at intra-oral donor sites is a safe and easy technique for repairing defects of the maxilla, especially OAFs in need of secondary closure. It provides a sound basis for subsequent conventional sinus lifting and preserves the teeth adjacent to OAFs.

The effect of platelet-rich plasma upon implant stability measured by resonance frequency analysis in the lower anterior mandibles.

Using a one-stage surgical protocol, a total of 34 Brånemark Mk-III Ti-Unite implants with a length of 13 mm and a diameter of 3.75 mm were inserted in 10 edentulous mandibles. Of these, seven patients received four and three patients two interforaminal implants. All implants were followed with repeated stability measurements by means of resonance frequency analysis at different time interval: 0, 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44 days. In quadrant III platelet-rich plasma (PRP) was instilled locally before implant placement, while no PRP was added in quadrant IV to serve as control group (split-mouth design). Results showed no statistically significant difference between the two groups. Nonetheless, both groups (PRP+control) showed a highly significant reduction of the implant stability quotient (P<0.001) between days 0 and 4. However, no difference was noted between the two groups after day 4, it may be concluded that the instillation of PRP during implant placement in the lower anterior mandible did not add additional benefit.

Representative marketing-oriented study on implants in the Austrian population. II. Implant acceptance, patient-perceived cost and patient satisfaction.

Oral implantology is an established subspecialty of restorative dental and oral surgery. While an extensive body of evidence on the fundamentals of osseointegration and associated factors has been published, marketing-oriented analyses based on representative public opinion polls of implant acceptance, patient-perceived cost and patient satisfaction are scarce. In this study, an attempt was made to address these points by questioning a representative sample of 1000 adults in the household setting. The interviewees were presented with 14 questions. Of those familiar with implants as one of the treatment alternatives, 61% reported they would accept implants if the need arose. Implant acceptance was highest among males and interviewees below the age of 30 years. The interest in implants increased with increasing family incomes. Four percent of those questioned already had implants. Twenty-five percent knew someone who had undergone implant treatment. All those questioned found implant-supported rehabilitation to be very expensive. Many of them blamed the dentists for the high cost. One detail was particularly evident: satisfaction among implanted patients was clearly higher than satisfaction rates perceived by them from what they were told about implants by others. First-hand experiences with implants proved to be less biased than reported second-hand information.