Reconstruction of the alveolar cleft: effect of preoperative extraction of deciduous teeth at the sites of clefts on the incidence of postoperative complications.

Our objective was to find out if the extraction of deciduous teeth at the sites of clefts 3-8 weeks before alveolar bone grafting (ABG) would reduce the number of postoperative complications. Chart reviews were reviewed retrospectively of patients who had had ABG from March 2006 to June 2009. To reduce variables only healthy, non-syndromic, cooperative patients were included. Eleven patients had had their deciduous teeth extracted at the cleft sites 3-8 weeks before ABG and 10 patients had had the extractions done intraoperatively at the same time as ABG. There was a single case of postoperative infection and no wound dehiscence in the preoperative extraction group, and there were no delays in postoperative orthodontic treatment. In the intraoperative group there were 3 cases of local wound infection and 6 cases of minor dehiscence, and orthodontic treatment was delayed for 3-6 months in all patients with complications. All patients had successful ABG, eruption of teeth, and orthodontic treatment; but patients who had their deciduous teeth at the cleft sites extracted preoperatively had fewer wound complications than patients whose extractions were done at the same time as the ABG.

Effects of surgical removal of mandibular third molar on the periodontium of the second molar.

OBJECTIVE: The effects on periodontal tissues of adjacent second molars after semi-impacted mandibular third molar surgery were evaluated. The influence of flap design was studied. METHODS: Twenty volunteers randomly underwent the three-cornered flap technique (group A) or the distal wedge flap technique (group B). The periodontal probing depth was measured by using a 'Williams'-type probe just prior to surgery and three months post-operatively. Six sites, mesio-buccal, buccal, disto-buccal, disto-lingual, lingual and mesio-lingual, around the second molar were selected for measurement. Kruskal-Wallis test and Dunn test (post hoc) were used. Significance level was set at 5%. RESULTS: There were no complications (oedema, alveolitis, etc.) in any of the patients of the study. The results showed that both methods caused shallow pocket depth (P > 0.05) and there were no statistically significant differences between the flap techniques (P > 0.05). Flap design was not an important factor affecting the periodontal status of the second molar. CONCLUSION: The decision to use any of the various flap designs for access to mandibular third molars should be based on operator preference rather than on the assumption that periodontal health of the adjacent second molar will be improved.

Anatomy of the lingual nerve in relation to possible damage during clinical procedures.

Damage to the lingual nerve, resulting in transient or permanent paraesthesia or anaesthesia, is a common undesirable complication of surgical interventions to the lower third molar region. The anatomy of the nerve, as it travels from its origin high in the infra-temporal fossa, to the floor of the mouth is quite variable. The most critical part of its course is where it enters the sublingual region just alongside the lingual alveolar plate of the lower third molar. A significant number of lingual nerves are located above the alveolar bone in the gingival tissues, or very close to the bone. Retraction of the lingual mucosa can lead to lingual nerve trauma. There is no doubt that the lingual nerve is extremely vulnerable in this region and clinicians must assume that it is closely adjacent to the lingual region of the lower third molar, in all cases, in order to minimize possible damage.

The effect of tramadol on dento-alveolar surgical pain.

The aim of the study was to assess the analgesic effect of tramadol in the relief of pain after dentoalveolar operations that involve the removal of bone and suturing. Four-hundred and fifty-two patients over the age of 18 years who were to undergo removal of impacted teeth (n = 362), removal of root (n = 79), or alveolectomy, enucleation of cysts, or removal of soft tissue (n = 11) under local anesthesia were studied. Patients were randomly allocated to receive tramadol 100 mg or 50 mg four times daily, or 50 mg twice daily, or placebo. Median pain scores on the day of operation in the three tramadol groups were similar (2 in each group, ranges 1-5, 1-4.8, and 1-5 respectively) and were all significantly lower than that in the placebo group (2.3 range 1-4.2). The median number of Paracetamol tablets taken by patients in the three tramadol groups was 2 (ranges 0-8, 0-12 and 0-8 respectively), and were all significantly less than in the placebo group (4, range 0-12). More patients given tramadol reported complete pain relief than the placebo group. The advantages of tramadol continued over the next 2 days. There were no serious or unexpected adverse effects. It is concluded that tramadol is an effective analgesic after dentoalveolar operations.

A comparison of 2 analgesic regimens for the control of postoperative periodontal discomfort.

A single blind study of 24 patients compared the postoperative periodontal pain relief and adverse effects associated with a pretreatment regimen with etodolac, a nonsteroidal anti-inflammatory drug (NSAID), to a typical pro re nada (prn) regimen with a combination of acetaminophen with hydrocodone. Patients selected required one or more periodontal osseous surgeries that were judged to involve relatively similar degrees of surgical manipulation. Patients in the etodolac group received two 300 mg capsules 30 minutes prior to surgery and then redosed themselves prn. Patients who received the combination drug were not premedicated and followed a prn regimen. The subjects used a verbal analogue scale to report levels of pain hourly for the first 8 hours (starting 30 minutes prior to surgery) and also indicated any side effects experienced during the first week after surgery. Specific parameters monitored were the mean sum of hourly pain scores, mean hourly pain scores, time to first medication, number of postoperative doses, and adverse effects. Of the parameters studied, the only one that showed a statistically significant difference was the time to first medication. The time span from 30 minutes prior to the beginning of surgery to the first postsurgical dose was greater for etodolac than for the combination drug. However, the total number of medications taken under both regimens was similar. The side effects were minimal for both of the drugs studied. It was concluded that the analgesic regimens tested under clinical practice conditions were comparable in providing analgesia with minimum side effects in uncomplicated periodontal osseous surgery. Studies with larger numbers of patients are needed to definitively address whether these regimens are truly equivalent.

Incidence of nerve damage following third molar removal: a West of Scotland Oral Surgery Research Group study.

A survey was carried out to record both initial and longterm effects on the lingual and inferior alveolar nerves following third molar removal. Eight hundred and twenty five patients were included from eight West of Scotland Oral Surgery Units, and had 1339 third molars removed. Changes in sensation were recorded by direct questioning at 6 to 24 h and 7 to 10 days, and by postal questionnaire at 12-18 months. The incidence of lingual nerve damage was found to be 15% of operated sides at 6 to 24 hours, 10.7% at 7 to 10 days, and 0.6% after 1 year. The incidence of inferior alveolar nerve damage was 5.5% of operated sides at 6 to 24 h, 3.9% at 7 to 10 days, and 0.9% after 1 year. These results are proposed as an indication of the likely incidence of nerve damage complicating third molar removal in the general circumstances of current United Kingdom practice and are presented as a basis for discussion of patient information and current prudent practice. Since one in four patients suffered at least temporary sensory deficit, we believe the case for effective warning of all patients undergoing impacted third molar removal is overwhelming.

[Tissue lesions in dental displacement]. / Les lésions tissulaires des déplacements dentaires.

Following the observation of alveolar, periodontal and dental lesions following dental displacement, the authors performed histological examinations. Lacunae of root resorption were observed in the pressure zones. The ligamentous fibres were less organised and, when strong pressures were exerted, they became parallel to the tooth. Osteoclasts and bone resorption were observed in the alveolar bone. Osteoblasts and bone apposition were observed in areas of stretched ligaments. These tissue reactions were not always reversible; dental displacement should be considered to be a high risk procedure.

The effect of electrosurgery on alveolar bone.

The facial marginal alveolar bone of dogs was exposed with a full-thickness flap and touched by an activated electrosurgery electrode for periods of 0, 1, 5 and 10 seconds. Microscopic results were evaluated after periods ranging from 0 hours to 28 days. Various electrode exposure times produced similar changes in bone and periodontal ligament. The extent of the destruction was greater than that found in surgical areas not exposed to electrosurgery; healing and remodeling phases were also delayed in the electrosurgical sites.

Histometric evaluation of periodontal surgery. III. The effect of bone resection on the connective tissue attachment level.

The purpose of this study was to evaluate the effect of surgical elimination of the osseous walls of angular bony defects on the connective tissue attachment and alveolar bone levels. Using a Rhesus monkey model, 36 periodontal pockets in four animals were operated on while the contralateral pockets served as unoperated controls. Plaque control was maintained until the animals were killed 1 year after surgery. Following routine processing, the interdental tissues were analyzed histometrically. Comparing measurements of surgically treated and untreated sites, resection of the osseous walls of interdentally located angular bony defects caused not only a reduction in the height of the alveolar bone but also a significant loss of connective tissue attachment. The procedure also resulted in the elimination of angular bony defects, intrabony pockets, and in addition, reduced the height of the interdental soft tissue.

Subcutaneous emphysema during periodontal surgery: report of a case.

Subcutaneous emphysema (S.E.) of the facial region is an uncommon complication of dental procedures. A case is presented which details the development of S.E. following use of an air-water syringe during periodontal surgery. Differential diagnosis of the condition depends upon accurate historical data and the finding of crepitus on palpation of the involved tissues. Treatment is supportive in nature, although prophylactic antibiotic coverage is suggested. The etiology of S.E. is discussed and judicious use of compressed air or gas-producing medicaments during dental treatment is stressed.