Delayed removal of a maxillary third molar accidentally displaced into the infratemporal fossa.

The removal of an impacted maxillary third molar is an easy procedure for an oral and maxillofacial surgeon. The most commonly seen complications associated with this type of surgery are excessive hemorrhage, infection, pain, swelling, trismus, and root fractures. Although rarely encountered, unexpected complications may also arise during this procedure, such as the displacement of the tooth into an anatomic space. In this article, a case of a maxillary left third molar accidentally displaced into the infratemporal fossa is presented, and the delayed removal of the tooth after 3 weeks from the initial unsuccessful attempt is described, along with the correlating reasons. The role of the radiologic analysis in determining the localization of the tooth, including the routine panoramic radiographs and more importantly the volumetric computed tomographic scans, is stated. The different surgical treatment options are classified, and the potential for morbidity in the surgical removal of the tooth from the infratemporal fossa is presented by ranging the vital anatomic structures running through it.

A retrospective analysis of sandblasted, acid-etched implants with reduced healing times with an observation period of up to 5 years.

PURPOSE: The aim of this study was to evaluate the success rate of 2 different implant systems with sandblasted and acid-etched modified surfaces loaded after reduced healing periods. MATERIALS AND METHODS: One-hundred seventeen patients with a mean observation period of 3.75 years (24 to 61 months) were included in this evaluation. Chart reviews of a standardized recall program were evaluated. All 532 placed implants showed an unloaded healing time of 6 weeks in the mandible and 12 weeks in the maxilla. At abutment placement a torque value of 35 Ncm was one of the primary variables, and the success of the implants over time was determined by the criteria of Buser et al. The survival was analyzed using Kaplan-Meier method, and the probability of an event within 1 group independent of time was evaluated using the chi-square test and Fisher exact test. RESULTS: Of the 532 implants, 235 were placed in female and 297 in male patients; 448 implants were located in the maxilla and 84 in the mandible. Three implants were lost prior to abutment connection in 3 patients. Life table analyses show an overall success rate of 99.4% at 5 years, as no implants were lost after abutment connection. There was no significant association of the implant type (P = .185), gender (P = .99), or jaw (maxilla/mandible; P = .06) and the survival of the implants within this study. CONCLUSION: Based on the data found in this investigation, it can be concluded that implants with sandblasted, acid-etched surfaces can be restored after a 6- to 12-week healing period with a high predictability of success.

Histomorphometric evaluation and clinical assessment of endosseous implants in iliac bone grafts with shortened healing periods.

PURPOSE: In the present study solid monocortical hipbone onlay grafts of the maxilla were analyzed histologically after a healing period of 3 months. The clinical success of the implants placed in the grafted bone was evaluated. MATERIALS AND METHODS: Nineteen patients underwent augmentation with avascular iliac bone. A 2-stage procedure was performed with a 3-month healing period between graft and implant placement. At implant placement bone biopsy samples were taken at the proposed implant sites. RESULTS: Of the 117 implants placed, 1 was not osseointegrated at the time of abutment connection. No implants were lost after loading during an observation period of up to 3 years. Clinical appearance of the augmented bone after 3 months showed a dense cortical layer with good blood perfusion. Histologic specimens were analyzed quantitatively and showed an average of 43.2% newly formed bone. DISCUSSION: Histomorphometry showed that the amount of newly formed bone after 3 months was comparable to that found after a healing period of 4.5 months. The clinical success of the implants placed after the shortened healing period was comparable to that found in nonaugmented bone. CONCLUSION: This study showed that after avascular iliac bone grafting, 3 months of revascularization was sufficient to ensure the secure placement of dental implants in second-stage surgery for this patient population.

Implant survival in mandibles of irradiated oral cancer patients.

OBJECTIVE: The aim of this study was to analyze long-term implant survival in the mandible after radiotherapy and radical surgery in oral cancer patients. STUDY DESIGN: Between 1990 and 2003, 71 patients (15 females, 56 males; average age 57.8 years, range 16-84.1 years) were treated with dental implants after radiochemotherapy and ablative surgery of oral cancer. Radiation therapy was delivered in daily fractions of 2 Gy given on 25 days (total dose of 50 Gy). Oral defects were reconstructed microsurgically with jejunal, iliac crest or radial forearm grafts. Thereafter 316 dental implants were placed in the non-irradiated residual bone (84; 27%), irradiated residual bone (154; 49%) or grafted bone (78; 25%) at various intervals (mean interval 1.41 (+/- 1.01) years, range 0.34-6.35 years). RESULTS: The mean follow-up time after implant insertion was 5.42 (+/- 3.21) years (range 0.3-13.61 years). The overall 2-, 3-, 5-, and 8-year survival rates of all implants were 95%, 94%, 91% and 75%. Forty-four implants were lost in 21 patients during the observation period. Irradiation of the mandibular bone showed significantly (P = 0.0028) lower implant survival compared with non-irradiated mandibular bone. The 8-year survival rate in the non-irradiated residual bone (two loss), irradiated residual bone (29 loss) or grafted bone (13 loss) were 95%, 72% and 54%, respectively. Time of implantation after irradiation showed no statistically significant influence. Implant brand, length or diameter or the incidence of resective surgery on the mandible and gender of patients had no statistically significant influence on implant survival. CONCLUSION: Radiation therapy with 50 Gy was significantly related to shorter implant survival in mandibular bone. Survival was lowest in grafted bone. Time of implant placement had no statistically significant influence on survival under the conditions of this study. Although implant survival is lower in irradiated mandibles, implants significantly facilitate prosthodontic treatment and enhance outcome of oral rehabilitation in cancer patients.

Effects of sinus membrane perforations on the success of dental implants placed in the augmented sinus.

BACKGROUND: Maxillary sinus lifting procedure enables clinicians to place implant-supported prostheses even in cases with very limited vertical bone height of the maxillary sinus. The aim of this study was to evaluate the implant success with regard to effects of the sinus membrane perforations that occurred during sinus lifting surgery. METHODS: The study group consisted of 91 patients (29 females and 54 males) with edentulous posterior maxilla. Implant placement combined with sinus lifting surgery was performed, and 259 implants were inserted. Sinus membrane perforations were detected in 12 sinus sites. After proper treatment of perforations, 26 implants were placed into perforated sinus areas. Baseline panaromic radiographs were taken before the beginning of prosthetic treatment. Panaromic radiographs taken at the last recall were used for evaluation and compared to the baseline panaromic radiographs using image analysis software to reveal the peri-implant resorption rate for the implants placed in perforated and non-perforated sinus area. The modified sulcus bleeding index and plaque index were used for the assessment of soft tissue conditions. RESULTS: Eleven implants were lost during the follow-up period, resulting in an overall survival rate of 95.9%. Two failures occurred in the group with sinus perforations. There was no statistically significant difference regarding peri-implant bone resorption (P = 0.778) and soft tissue conditions for implants placed into perforated-augmented sinus areas and augmented sinus areas. CONCLUSION: Within the limits of this study, perforation of the sinus membrane did not compromise the osseointegration process or the success of dental implants placed in the augmented maxillary sinus.

Accidental displacement of a mandibular third molar: a case report.

This report describes the rare case of an impacted mandibular third molar that was displaced into the submandibular region. Upon locating the tooth, successful extraction was performed. Healing was unincidental.