Thermal necrosis-aided dental implant removal: A rabbit model pilot study.

BACKGROUND: The significant advances in the materials and biological aspects of dental implants haven't completely eradicated the implant failures. The removal of osseointegrated but otherwise failed implants present several challenges including adjacent tissues damage and necessity of bone augmentation for reimplantation. Controlled thermal necrosis has emerged as an alternative technique to aid removal of osseointegrated dental implants with minimal to no defect to healthy bone or surrounding tissues. This study aimed to evaluate the thermal necrosis-aided implant removal method in a rabbit osseointegration model. MATERIAL AND METHODS: A total of 8 male New Zealand rabbits were used in the study. Two dental implants were placed on each femur of the rabbits. Heating of the implants was performed after 7 weeks following the implantation. Heating was done by contacting the tip of an electrosurgey tool in monopolar mode at different power settings and contact durations (5W - 2 seconds, 5W - 10 seconds, and 10 W - 10 seconds). No heating was done on the control group. Implant stability right after implantation, before heat application and after heat application was determined using an Osstell™ Mentor Device. Following the removal of implants histological analyses were performed to determine the effects of heat application at cellular level. RESULTS: ISQ values of the 10W-10s group was significantly lower compared to the other groups (p<0.001). No indication of progressive necrosis or irreversible damage was observed in any of the groups. However, the percent of empty-apoptotic lacunae were statistically higher in the 5W-10s and the 10W-10s groups compared the control and the 5W-2s groups. CONCLUSIONS: Within the conditions of this study, we conclude that heat application with an electrosurgery tool using monopolar mode at 10W power for 10 seconds is optimal for reversing osseointegration with no extensive or progressive damage to the bone.

Is arthrocentesis plus platelet-rich plasma superior to arthrocentesis plus hyaluronic acid for the treatment of temporomandibular joint osteoarthritis: a randomized clinical trial.

A randomized clinical trial was implemented in adult patients with temporomandibular joint osteoarthritis (TMJ OA). The sample comprised 49 osteoarthritic joints in 31 consecutive patients. Patients were divided randomly into two groups according to the treatment technique applied: the platelet-rich plasma (PRP) group patients underwent initial arthrocentesis plus PRP injection and then four consecutive PRP injections; the hyaluronic acid (HA) group patients underwent one session of arthrocentesis plus HA injection. The predictor variable was the treatment technique. The outcome variables included visual analogue scale (VAS) evaluations and maximum inter-incisal opening (MIO) measurements. Outcome variables were recorded preoperatively and at 12 months postoperative. Descriptive and bivariate statistics were computed and significance was set at P<0.05. The PRP group included 32 joints in 18 subjects, and the HA group included 17 joints in 13 subjects. No statistically significant difference was observed between the groups for any of the changes in VAS parameters or MIO measurements. Both treatment techniques resulted in significant clinical improvements in all VAS parameters and painless MIO. These findings suggest that arthrocentesis plus PRP injections is not superior to arthrocentesis plus a single HA injection; thus PRP injection should not be considered as the first line treatment. Arthrocentesis plus HA injection would appear to be more acceptable for patients.

Is dextrose prolotherapy superior to placebo for the treatment of temporomandibular joint hypermobility? A randomized clinical trial.

A randomized clinical trial involving adult patients with bilateral temporomandibular joint (TMJ) hypermobility referred for treatment was implemented. The sample comprised 30 consecutive patients, who were divided randomly into two groups. The TMJ hypermobility was treated with either saline (placebo group) or dextrose injections (study group). The solution was injected into five different TMJ areas in three sessions at monthly intervals. The predictor variable was the treatment technique. The outcome variables were visual analogue scale (VAS) evaluations and maximum inter-incisal opening (MIO). Outcome variables were recorded preoperatively and at 12 months postoperatively. Descriptive and bivariate statistics were computed, and significance was set at a P-value of <0.05. The follow-up sample comprised 26 subjects: 12 in the placebo group and 14 in the study group. Masticatory efficiency increased and general pain complaints and joint sounds decreased significantly in both groups. MIO decreased significantly only in the study group. Insignificant changes in the other parameters were found for both groups. After estimating differences between follow-up and baseline outcomes, the mean change in primary outcome variables showed no statistically significant difference between the two groups. These findings suggest that dextrose prolotherapy is no more effective than placebo treatment for any of the outcome variables of TMJ hypermobility assessed.

The evaluation of the changes in blood pressure and pulse rate of hypertensive patients during tooth extraction.

The purpose of this investigation was to evaluate the changes in blood pressure and the pulse rate of hypertensive patients having dental extraction under a local anesthetic containing a vasopressor. The study included 64 patients (42 female and 22 male), 38 to 78 years of age. Twenty-six of the patients were normotensive, 38 were hypertensive patients. The hypertensive patients were identified as those patients who had histories of medically diagnosed high blood pressure and baseline recordings of blood pressures higher than 140/90 mm Hg. Articain HCl with 0.012 mg epinephrine hydrochloride, was used as the local anesthetic for all patients and one tooth was extracted from each patient. Blood pressure and pulse rate measurements were recorded immediately prior to anesthesia, just before extraction and 5 minutes after extraction. The data were analyzed by a two-way ANOVA with repeated measures. Analysis of the data indicated no statistically significant changes in the systolic and diastolic blood pressures and pulse rate for all interval measurements in both normotensive and hypertensive patients (P > 0.05). In this study, it was determined that there were no significant changes in the blood pressures and the pulse rate of hypertensive patients during surgical procedure, and one cartridge local anesthetic with articain HCl containing 0.012 mg pinephrine may be used safely in hypertensive patients with blood pressure equal or smaller than 154/99 mm Hg.

Evaluation of the mandible as an alternative autogenous bone source for oral and maxillofacial reconstruction.

The objective of this study was to quantify the amount of bone graft material present in the different regions of the mandible while avoiding the inferior alveolar neurovascular bundle, mental foramen and tooth injury. The study was carried out on 16 samples of dry, cadaverous skull. The dimensions of the anterior part of ascending ramus, mandibular symphysis and mandibular body in these samples were evaluated. The osteotomy lines in the anterior part of the ascending ramus were made in front of the mandibular canal from the mandibular notch to 3 mm posterior of the root of the third molar. The osteotomy line in the mandibular body was made just medial to the external oblique ridge from the ascending ramus to approximately 3 mm posterior to the mental foramen. Vertical osteotomy lines were then made from the cut ends of the first osteotomy down to the lower border of the mandible. The osteotomy lines in the mandibular symphysis were performed on the mandible with 5-mm safety margins caudal to the expected position of the mandibular dentition, anterior to the position of the mental foramen, and cephalad to the inferior border of the mandible. It was determined that the dimensions of the anterior part of the ascending ramus were 37.60 mm x 33.17 mm x 22.48 mm x 9.15 mm, and the thickest part of the graft material was 12.23 mm. The average horizontal length of the mandibular body bone was 35.10 mm, and the average vertical length was 19.13 mm. The dimensions of the bone graft obtained from the mandibular symphysis were 45.36 mm x 10.31 mm, and the average thickness was 9.63 mm. Based on the results of this study, it is apparent that the different regions of the mandible can reliably be selected as the harvest site in a variety of oral and maxillofacial reconstructive procedures.

Generalized gingival hyperplasia occurring during pregnancy.

In this report, we present a case of generalized gingival hyperplasia related to pregnancy causing chewing, speaking, breathing and cosmetic problems. The patient was a 26-year-old woman in the fourth month of her second pregnancy, with generalized gingival hyperplasia affecting both buccal and lingual aspects of the maxilla and mandible. The hyperplastic tissues, together with mobile teeth, were excised completely; no recurrence was observed for the remainder of the pregnancy. Hormonal changes occurring during pregnancy have long been known to be associated with generalized gingival hyperplasia. Pregnancy does not cause the condition, but altered tissue metabolism in pregnancy accentuates the response to local irritants. This case was of clinical interest because of the extent of tissue proliferation, with the teeth in both the upper and lower jaw completely submerged.