Long-term Follow-up for Apical Microsurgery of Teeth with Core and Post Restorations.

INTRODUCTION: Orthograde retreatment was recommended before apical surgery to achieve high success rates. The aim of this study was to determine the success rates of apicoectomy of core and post-restored teeth without prior root canal retreatment followed for up to 13 years. METHODS: Seventy-three patients with 87 teeth with apical periodontitis underwent apical microsurgery from 2004 to 2006 at the Department of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria. After 1.5-5 years and 10-13 years, 85 and 49 teeth, respectively, were followed up by 4 independent, calibrated examiners. Absolute and relative frequencies of the dichotomous outcome (healed vs nonhealed) were analyzed considering patient-, tooth-, and treatment-related factors. The significance of the obtained values was determined with the chi-square and Fisher exact tests. RESULTS: All of the 85 (100%) investigated teeth were in situ 1.5-5 years after surgery, whereas only 49 of 62 analyzed teeth (79%) remained after 10-13 years. Radiologically documented periapical healing was 97.6% (83/85 teeth) for the first follow-up period but decreased to 75.8% (47/62 teeth) by the second follow-up. Smokers showed significantly worse results after 10-13 years. None of the other investigated potential influencing factors significantly affected results. CONCLUSIONS: This clinical study showed that apical microsurgery on teeth with core and post restoration using Intermediate Restorative Material (Dentsply Caulk, Milford, DE) as filling material achieves excellent results after 1.5-5 years (97.6%) and still shows good results after 10-13 years (75.8%). Accordingly, it is a reliable alternative to root canal retreatment, eliminating the risk of post removal-related complications.

The influence of particulated autogenous bone on the early volume stability of maxillary sinus grafts with biphasic calcium phosphate: a randomized clinical trial.

BACKGROUND: It is unknown whether autogenous bone impacts the grafts' stability when added to biphasic calcium phosphate (BCP) within the first six months of maxillary sinus augmentation (MSA). PURPOSE: To investigate the volume stability of BCP alone and in mixtures with autogenous bone for MSA. MATERIALS AND METHODS: Bilateral maxillary sinus augmentation was performed in eight patients in a split-mouth design using BCP at the control site and adding particulated autologous bone at the test site (BCPAB). Based on 16 computed tomography (CT) the volumetric changes were evaluated using the Voxim® software (version 6.3, IVS Technology GmbH, Chemnitz, Germany) by comparing the graft volumes within two weeks of the sinus lift procedure with CT data obtained six months later. Changes of the graft volumes were calculated and statistically significant differences between the two groups were evaluated. RESULTS: Overall, the volumes decreased by 15% for BCP and 18% for BCPAB. The time-dependent decreases were statistically significant in both groups. Differences between the two groups were not statistically significant (p = .065). CONCLUSIONS: An evident decrease of graft volume over the first 6 months of healing has to be expected irrespective of bone graft composite. Autogenous bone seems to have no evident impact on the volume decrease when added to BCP.

Human cadaver study evaluating a new measurement technique for graft volumes after sinus floor elevation.

PURPOSE: Volumetric data can be used as complementary information to characterize grafting materials. The aim of this cadaveric study was to analyze a noncommercial measurement technique based on the novel concept of an "interactive rigid registration algorithm" (IRRA). Parameters analyzed included the reproducibility of IRRA measurements and their reliability in comparison with the established measurement technique of "region growing segmentation thresholding" (RGST). MATERIALS AND METHODS: Three human skulls were used to simulate a total of 18 sinus grafts, using three incremental grafting procedures in each sinus (three skulls ×t wo sinuses × three grafting increments). Radiopaque impression material was used for the simulated grafts, whose volumes were recorded by computed tomography from three different tilt angles. The reproducibility of IRRA measurements and the reliability of volumetric results obtained with both the IRRA and RGST techniques were evaluated by appropriate intraclass correlation coefficient (ICC) and Bland-Altman analysis. RESULTS: ICC greater than 0.9 indicated close to perfect agreement of the results obtained with both methods and good reproducibility of the IRRA measurements. Bland-Altman analysis demonstrated good inter-method and intramethod agreement. CONCLUSIONS: The IRRA measurement technique can be recommended as a noninvasive tool to evaluate graft volumes in human maxillary sinuses.

Immediate provisional restoration of single-piece zirconia implants: a prospective case series - results after 24 months of clinical function.

OBJECTIVE: Aim of this prospective case series was to evaluate the outcome of immediately provisionalized single-piece zirconia implants. MATERIAL AND METHODS: A total of 20 zirconia implants were inserted in single-tooth gaps in the maxilla (11) and mandible (9) of 20 patients. Implants were restored with all-ceramic CAD/CAM provisionals without occlusal contacts immediately after placement. Permanent all-ceramic restoration was performed 4 months after surgery. Plaque index (PI), bleeding on probing (BOP), Periotest(®) (PV), pink aesthetic score (PES), mean radiographic marginal bone levels (MBL), implant survival and success were evaluated up to 24 months. RESULTS: Assessment of PI at baseline and follow-ups after 6, 12, 18 and 24 months revealed 27% (±5.3), 24% (±6), 23% (±6.1), 23% (±5.3) and 22% (±6.4), respectively. Evaluation of BOP revealed 25% (±5.6), 21% (±6), 21% (±7.2), 18% (±5.9) and 15% (±5.5), respectively. Implants presented stable at follow-ups (PV). PES improved, but not statistically significant from 8.13 (±1.5) at baseline to 10 (±2) 24 months after implantation. Measurements of MBL showed a significant bone loss of 1.01 mm within the first year after placement (P < 0.001) and 1.29 mm 24 months post-implant insertion, not reaching further statistically significant levels (P > 0.05). One implant was lost 4 months after placement, resulting in a survival and success rate of 95%. CONCLUSION: Clinical and radiographic parameters demonstrated a 95% integration of immediately loaded zirconia single-piece implants. A long-term randomized-controlled clinical trial was initiated to confirm evidence of this protocol.

Beneficial effect of methylprednisolone after mandibular third molar surgery: a randomized, double-blind, placebo-controlled split-mouth trial.

OBJECTIVES: Third molar (M3) removal is the model most frequently used for pain trials in oral surgery. Corticosteroids are frequently administered to reduce trismus and swelling after dentoalveolar surgical procedures. The purpose of this investigation was to evaluate the influence of a single, preoperative oral application of methylprednisolone on postoperative trismus, pain intensity, and the subjective need for analgesic medication after surgical removal of impacted mandibular M3 (LM3). MATERIALS AND METHODS: Sixteen healthy patients requiring similar bilateral surgical LM3 removal were included in a prospective, randomized, placebo-controlled, double-blind study in a split-mouth design. At random, each patient received either weight-dependent methylprednisolone (40-80 mg) or a placebo orally 1 h prior to surgery. In each case, the right and left LM3 were treated in independent visits. Trismus, swelling, pain measured on a 100-mm visual analog scale, and the postoperative demand of analgesics were assessed. RESULTS: Statistical analysis indicates a significant reduction of trismus, swelling, pain intensity, and patient-controlled intake of analgesics during the whole postsurgical period of investigation (first to seventh day). CONCLUSIONS: The results of this study suggest that a single preoperative weight-dependent administration of methylprednisolone is a safe and effective concept for diminishing postoperative discomfort, pain intensity, and the total intake of analgesics after wisdom tooth extractions. CLINICAL RELEVANCE: In case of missing contraindications, the preoperative administration of methylprednisolone is recommended, a routine medication for more extended procedures in oral surgery.

Immediate provisional restoration of screw-type implants in the posterior mandible: results after 5 years of clinical function.

OBJECTIVE: The aim of this prospective study was to evaluate the outcome of immediately provisionally restored implants in the posterior mandible after a minimum of 60 months in function. MATERIAL AND METHODS: Twenty-four patients were treated with 40 screw-type implants replacing mandibular molars and premolars. Implants were provisionalized immediately after placement. Radiographic coronal bone levels, implant survival and success were evaluated 12, 24, 36, 48 and 60 months after the final restoration. RESULTS: Measurements of the mean marginal bone levels around immediately loaded implants after 12 months showed a significant bone loss (P<0.001) within the first year after the final restoration. Measurements of coronal bone levels after 24, 36, 48 and 60 months, respectively, showed no further significant increase of bone resorption. Two implants were lost within the first year after the final restoration, resulting in an overall survival rate of 95%; a total of three implants were recorded as failures (two implant losses and one excessive bone resorption above 50%), resulting in an overall success rate of 92.5 after an implant observation period of up to 8 years. CONCLUSION: The present data revealed results comparable to conventionally loaded implants. Careful patient selection in combination with high primary stability seem to be key factors for immediately loaded implants. Larger long-term randomized clinical trials are needed to confirm the final evidence of this protocol as the standard treatment concept for the partially edentulous mandible.

Oral status among seniors in nine nursing homes in Styria, Austria.

OBJECTIVE: To investigate the oral state in participants cared for in residences for senior citizens in Styria, Austria. MATERIALS AND METHODS: Four hundred and nine participants in Styria from nine homes for senior citizens were examined employing parameters in accordance with those of Folstein's Mini Mental Status (MMS), DMFT, basic periodontal examination, the modified oral hygiene index, pain experienced during the preceding year, the subjective and objective need for treatment, and also requirements involving surgical and prosthetic treatment. Furthermore, the habitual methods of maintaining oral hygiene were examined establishing by whom this was carried out - whether by the patient, the nurse, or by patient and nurse together. RESULTS: Four hundred and nine participants were examined, 48.3% were found to have retained on average 4.9 of their own teeth while 69% were fitted with dentures; however, 81% of the participants required prosthetic treatment. 28.9% of the participants had experienced acute dental pain during the preceding year and surgical treatment was found to be necessary in 47.7% of those with original teeth. Eighty-four per cent of the participants showed acute inflammation of the periodontium while the state of oral hygiene, measured on a scale of 0-4, reached an average of 2.43. Oral hygiene was carried out by the nurses in only 7.46% of the cases which showed an average MMS measurement of 18. CONCLUSION: The results compared with those reported in other recent surveys and our data show an urgent need in Austria to improve the standards in dental care for the hospitalised elderly. Regular dental checks, carried out in the actual home by a dental surgeon should be introduced, whilst the nursing staff should be made fully aware of the problems caused by insufficient oral care and receive regular support from specialised oral hygiene assistants. The results of this survey also suggest that nursing staff should be equipped with simple instruments in order to judge to the extent to which the patient is capable of carrying out oral care independently and then according to the results to supplement this with additional care.

Modified iliac bone harvesting--morbidity and patients' experience.

PURPOSE: The aim of the present retrospective study was to evaluate the postoperative morbidity and patients' satisfaction after harvesting a bicortical bone graft from the anterior iliac wing using a modified surgical technique. MATERIALS AND METHODS: Between 1996 and 2006, 36 patients underwent bicortical bone block harvesting procedures from the ilium with subsequent bone augmentation of the jaws under general anesthesia at the Department of Oral Surgery, Medical University Graz. A modification of the harvesting technique proposed by Tayapongsak et al was used. Of the 36 patients, 32 participated in the present retrospective study. The clinical trial was based on the evaluation of the clinical records, a follow-up examination of the donor site, and the patient's personal assessment of the course of therapy. RESULTS: Apart from 1 postoperative hematoma, 1 infected wound, and 1 postoperative seroma that had to be treated, no intra- or postoperative complications developed. At 3 to 14 days (mean 11.06) after the surgical procedure, the patients were free of pain. Gait disturbance was present for an average of 14 days. The clinical follow-up examination at the donor region was without any pathologic findings. The patients' personal assessment of the therapy course revealed high acceptance: 84% would agree to the same treatment if they had to choose, and 87% would recommend this treatment to other patients. On a pain scale of 1 to 10, the overall therapy course was assessed at an average of 1.77. CONCLUSIONS: Iliac bone grafts are the treatment of choice to reconstruct extensive maxillary defects. This retrospective evaluation revealed minor complications and morbidity and high patient acceptance, supporting its use.

Oral rehabilitation of adult twins with severe lack of bone due to hypohidrotic ectodermal dysplasia--a 12-month follow-up.

PURPOSE: Patients with x-linked hypohidrotic ectodermal dysplasia (XLHED, OMIM 305100) often present with exceptional oral conditions, because alveolar ridges can remain severely hypotrophic due to oligo- or anodontia in the primary and/or permanent dentition. This can seriously disable a young person physically and psychologically, and lead to sociopsychological isolation. PATIENTS AND METHODS: The oral rehabilitation of fraternal male twins with XLHED, one with severe hypodontia and the other with anodontia is described. The treatment of both patients comprised augmentation of the jaws using bicortical corticocancellous bone blocks from the medial aspect of the anterior hip, delayed implantation, and restoration of the occlusion with bar-retained overdentures. The multidisciplinary team approach included an oral and maxillofacial surgeon, a prosthodontist, and a speech therapist. RESULTS: After uneventful healing, the 12-month follow-up showed that sufficient osseointegration of the implants for optimized function was obtained by creating adequate de novo bone volume in the underdeveloped jaw regions. Full regular masticatory function was achieved, and esthetics were improved considerably in both patients. CONCLUSION: Augmentation and implant placement prior to prosthetic rehabilitation appears to be a suitable treatment option for adult patients with XLHED.

Evaluation of three-dimensional changes after sinus floor augmentation with different grafting materials.

OBJECTIVE: The aim of this retrospective investigation was to assess the dimensional stability of different grafting materials after maxillary sinus floor augmentation with computed tomography (CT) scans. MATERIALS AND METHODS: Two postoperative CT scans were available from 16 patients who had undergone maxillary sinus lift procedures. The first scan was made within a few days after the surgical intervention and the second one >6 months later. A total of 25 maxillary sinuses were augmented with different materials before implant insertion by lateral antrostomy in a staged approach. The volume of bone formation was calculated using the Somaris Sienet Magic View software. RESULTS: Based on volumetric measurements of the augmented domes derived from the image sections, shrinkage was about 26%. The mean of the augmented bone volume was 3.02 cm(3) (1.4-5.56 cm(3); SD+/-1.18 cm(3)) as determined in the first CT scan. The respective mean volume in the second CT scan amounted to 2.28 cm(3) (0.92-4.46 cm(3); SD+/-1.07 cm(3)). CONCLUSION: Within the limits of our descriptive and analytic study, the results indicate a significant reduction of the graft volume after maxillary sinus augmentation. Further prospective studies will have to evaluate the quantitative changes of different bone graft materials for maxillary sinus augmentation procedures in order to improve long-term implant stability.

Surgical factors influencing mesiodistal implant angulation.

OBJECTIVES: The aim of this experimental study was to identify relevant surgical parameters influencing the mesiodistal angular deviation of dental implants. MATERIAL AND METHODS: Pilot drillings of 2 mm diameter were performed in bovine ribs with a parallelometer. The subsequent preparation of the implant socket was performed freehand. Utilizing six different implant systems, at least 80 drillings per system of different diameters were performed. The pilot drillings were marked with 2 mm steel pins and cephalometric radiographs were taken. The mesiodistal angle between the longitudinal implant axis and the marked pilot drillings was measured and evaluated by a blinded investigator. To evaluate the influence of the surgeons' experience, their drillings were compared with those of a group of unexperienced surgeons. Additionally, the influence of drilling speed and size of bur steps on drilling accuracy were evaluated. RESULTS: The difference between the lowest value of 0.91 degrees of mesiodistal angular deviation found for 3i implants and the highest of 1.36 degrees for Ankylos implants was of low statistical significance (P=0.065). Drillings of experienced surgeons showed less deviation compared with those of a beginners group (P<0.0001). Higher deviations were measured when a bur size was skipped. Drillings performed at high speed showed significantly higher deviations than those with fewer rewinds per minute. CONCLUSION: In order to achieve precise implant angulation, all bur diameters available should be used. Utilizing low drilling speeds results in less mesiodistal deviation. The surgeon's experience seems to be the most relevant factor in precise implant placement.

Immediate provisional restoration of XiVE screw-type implants in the posterior mandible.

OBJECTIVES: This prospective study evaluated the clinical outcome of immediately restored screw-type implants for the replacement of mandibular (pre)molars. The results were based on survival, clinical stability and on changes of bone levels from implant placement to delivery of the definitive superstructure 6 months after insertion. MATERIAL AND METHODS: In this study, 24 patients were treated according to an immediate loading protocol. Forty XiVE implants were placed in the mandibular (pre)molar regions for single-tooth restoration and the treatment of free-end situations. Radiographic bone levels in relation to implant margins were measured at the time of insertion and recorded. All implants were provided with a transfer coping and restored with provisional crowns within 7 days. After 6 months, the final restorations were fabricated. At this time, survival, Periotest value and radiographic bone levels were assessed. RESULTS: A total of 40 XiVE implants were placed with an insertion torque value of at least 45 N cm. The median Periotest value 6 months post-insertion was -5 (maximum -2, minimum -7). The mean radiographic coronal bone level at prosthetic delivery was 1.4 mm (SD+/-0.57) compared with 0.47 mm (SD+/-0.37) at the time of insertion. No implant failures were observed up to prosthetic restoration 6 months post-insertion. CONCLUSION: The present data of immediately loaded implants in the posterior mandible are comparable to results with conventional loaded implants. Additional long-term data will be necessary to include this protocol as a standard procedure in our treatment concepts for the edentulous posterior mandible.

Harvesting of cancellous bone from the proximal tibia under local anesthesia: donor site morbidity and patient experience.

PURPOSE: The objective of this retrospective study was to evaluate postoperative morbidity, risk of complications, and patient discomfort after ambulatory tibial bone harvesting procedures under local anesthesia. PATIENTS AND METHODS: Between 2000 and 2005, bone was harvested from the head of the tibia for internal or external maxillary augmentation in 79 patients. A medial osteoplastic approach to the donor region was used. All patients' records were reviewed. Forty-five of the 79 patients later came in for follow-up examination. A traumatologist examined the donor region both clinically and radiologically. Subjective disorders and experiences of the patients were documented using a standardized questionnaire. RESULTS: The patient records revealed that 80% did not report significant complaints or gait disturbances after bone harvesting, and only 5% reported postoperative complaints or gait disturbances lasting longer than 2 weeks. In 1 case, a nondisplaced fracture healed without further complications. Clinical and radiologic examinations of 45 patients revealed full regeneration of the donor region in all cases. Some 91% of the patients described the outpatient bone harvesting procedure under local anesthesia as "not distressing" and would undergo such an intervention again if required. CONCLUSIONS: This study demonstrates that both complaints and risk of complications after outpatient bone harvesting from the proximal tibia under local anesthesia can be considered very low, especially as far as outpatient maxillary augmentation (eg, sinus floor elevation) is concerned.

Evaluation of a muscle relaxant on sequelae of third molar surgery: a pilot study.

OBJECTIVE: The aim of this preliminary study was to evaluate the influence of the muscle relaxant tizanidine following third molar surgery on the main variables trismus and pain as well as on swelling. STUDY DESIGN: Fifty healthy patients participated in this prospective clinical study. The test group received tizanidine (4 mg in the evenings for the first 2 postoperative days) in addition to antibiotic and antiinflammatory medications. Postoperatively, 1 independent investigator performed clinical examinations. Appropriate statistical analysis was used to evaluate data. RESULTS: There was no statistically significant difference in facial pain and swelling between the two groups. Statistically significant improvement was detected when the groups were compared for mouth opening ability at days one and three. CONCLUSION: The results of this trial indicate that the influence of tizanidine on trismus, pain, and swelling does not justify prescription of the additional medication.

Influence of low-level laser treatment on bone regeneration and osseointegration of dental implants following sinus augmentation. An experimental study on sheep.

OBJECTIVES: The aim of this experimental study was to evaluate if low-level laser treatment (LLLT) enhances bone regeneration and osseointegration of dental implants in a sinus graft model. MATERIAL AND METHODS: Twelve sheep underwent a bilateral sinus floor elevation procedure with cancellous bone from the iliac crest. Implant insertion followed 4 weeks (six sheep) and 12 weeks (six sheep) later. Sixteen weeks after second-stage surgery, animals were sacrificed. Unilaterally, the grafted sinus and during the second-stage surgery the implant sites were irradiated intraoperatively and three times during the first postoperative week with a diode laser (75 mW, 680 nm). The overall energy density per irradiation was 3-4 J/cm(2). Biopsies of the augmented area were obtained during implant insertion and after scarification. RESULTS: Bone regeneration within the grafted sinus histomorphometric analysis hardly differed between control and test side both 4 and 12 weeks after sinus grafting. Osseointegration measurements resulted in a significantly higher bone/implant contact (BIC) on the test side (P=0.045). Further evaluation of peri-implant bone tends to amount in significant higher percentage on the laser side (P=0.053). CONCLUSION: The presented experimental study on sheep did not confirm a positive LLLT effect on bone regeneration within a cancellous sinus graft. Nevertheless, LLLT possibly has a positive effect on osseointegration of dental implants inserted after sinus augmentation.