Significance of osteoporosis in craniomaxillofacial surgery: a review of the literature.

Osteoporosis is a common problem in orthopedic surgery. The purpose of this review of the literature was to examine whether osteoporosis is also an important factor in patient treatment in the field of craniomaxillofacial surgery. Emphasis was given to the consequences of osteoporosis for the maxilla and mandible, the influence of osteoporosis on fracture treatment, the use of dental implants, the importance of soft tissues and the effect of osteoporosis therapies. It was found that osteoporosis does affect the bones of the skull. The effect of osteoporosis on treatment, however, is controversial and necessitates better ways of quantifying bone loss. Large inter-individual and site-specific differences in bone density, as well as other effects such as removal of teeth, periodontitis, implant insertion, augmentation procedures and altered loading with dystrophic consequences need to be considered in future studies. Special attention should be given to osteoporosis during fracture treatment.

Clinical update: a nonhealing fractured mandible.

Bisphosphonates have shown significant clinical benefit in reducing skeletal fractures in patients with multiple myeloma or bone: penicillin VK 500 mg or amoxicillin 500 mg; both 4 times daily (QID) initially and twice daily (BID) for maintenance, If penicillin allergic: 1. Clindamycin 150 to 300 mg QID. 2. Vibramycin 100 mg once daily (QD). 3. Erythromycin ethylsuccinate 400 mg 3 times daily (TID). 4. Antifungals when required: 5. Nystatin oral suspension 5 to 15 mL QID or 100,000 IU/mL. 6. Mycelex troches (clotrimazole 10 mg) x 5/day. 7. Fluconazole 200 mg initially, then 100 mg QD. 8. Other potential systemic antifungals include itraconazole or ketoconazole. 9. Antivirals, if required: 10. Acyclovir 400 mg BID. 11. Valacyclovir hydrochloride 500 mg to 2g BID.

Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries -- a review article.

Based on an analysis of the literature concerning parameters influencing the prognosis of traumatic dental injuries, few studies were found to have examined possible relationships between treatment delay and pulpal and periodontal ligament healing complications. It has been commonly accepted that all injuries should be treated on an emergency basis, for the comfort of the patient and also to reduce wound healing complications. For practical and especially economic reasons, various approaches can be selected to fulfill such a demand, such as acute treatment (i.e. within a few hours), subacute (i.e. within the first 24 h), and delayed (i.e. after the first 24 h). In this survey the consequences of treatment delay on pulpal and periodontal healing have been analyzed for the various dental trauma groups. Applying such a treatment approach to the various types of injuries, the following treatment guidelines can be recommended, based on our present rather limited knowledge of the effect of treatment delay upon wound healing. Crown and crown/root fractures: Subacute or delayed approach. Root fractures: Acute or subacute approach. Alveolar fractures: Acute approach (evidence however questionable). Concussion and subluxation: Subacute approach. Extrusion and lateral luxation: Acute or subacute approach (evidence however questionable). Intrusion: Subacute approach (evidence however questionable). Avulsion: If the tooth is not replanted at the time of injury, acute approach; otherwise subacute. Primary tooth injury: Subacute approach, unless the primary tooth is displaced into the follicle of the permanent tooth or occlusal problems are present; in the latter instances, an acute approach should be chosen. These treatment guidelines are based on very limited evidence from the literature and should be revised as soon as more evidence about the effect of treatment delay becomes available.

Hard palate deformation in an animal model following quasi-static loading to stimulate that of orthodontic anchorage implants.

The aim of the present investigation was to identify adequate implant treatment for young patients. In an animal model palate deformation was investigated by acute quasi-static loading. Three series of tests (with newborn, young and adult pigs) were performed, each with two groups (one or two-point stress) and 5-7 animals per group. Discs with a diameter of 3 and 5 mm were placed in group 1 in the suture area, and in group 2 at both the right and left sides of the suture. Deformation was analysed by a computerized three-dimensional (3D) photo-imaging evaluation system. In young animals the one-point load at a significantly lower force level led to fractures in comparison with the two-point load (P < 0.001). Similar results were measured by an increase in the size of one disc from 3 to 5 mm (P < 0.001). In contrast, adult pigs showed stable results with both methods. In general, a larger disc diameter led to less instability. The one-point load seems to be suitable for adult animals, whereas a two-point load might be favourable during ossification. The advantage of the two-point load is the generation of a higher stress and therefore improved control of dental fixation. However, further tests are necessary to investigate the long-term effects.

An analysis of 58 traumatically intruded and surgically extruded permanent teeth.

Fifty-eight traumatically intruded and mainly surgically extruded permanent teeth were followed up for 3 years and 4 months (mid-term results: 29 teeth) and 9 months (short-term results: 29 teeth) on average. Statistically, the mid-term results showed more cases of severe crown discoloration (54%) than the short-term results (9%), but no difference in pulpal and periodontal healing. Three teeth (5%) were lost. Factors which positively influenced pulpal healing were shallow intrusion depth, intact crown and immaturity of the root. Factors which positively influenced periodontal healing were shallow intrusion depth and minimal surgical manipulation. Alveolar bone healing was positively influenced only by shallow intrusion depth.

The management of dento-alveolar trauma--a review.

The clinician faced with the management of an insult to the masticatory system involving the dentition, its alveolar housing and the investing tissues often faces a formidable task. The restitution of traumatic derangement of oral-facial structures mandates a systematic approach to hard and soft tissue management with particular reference to the unique biological characteristics of this environment. A decidedly improved prognosis may be offered to the patient when basic principles are followed and the indicators for successful long term stabilization are realized. Awareness of these practical principles renders the dentist in general practice able to provide primary or referral care.

Direct and indirect bone healing after operative fracture treatment.

The knowledge of the entire spectrum of differing healing patterns should help the surgeon to judge the progress of fracture healing. To be able to recognize an abnormal course and deviating patterns will help the surgeon to avoid risks and to improve the mechanical and biologic conditions necessary for successful fracture treatment.

Cranio-maxillary fixation using supra-orbital pins.

This paper compares the forces which external frames, used for cranio-maxillary fixation, can resist. Clinically, several frames using supra-orbital pins have been proven satisfactory. By quantifying the resistance forces, a more objective assessment of their effectiveness is made. The resistance to backward displacement of the maxilla is measured and compared for 3 frames. Two frames are used for comparison of resistance to occlusal forces.