Aluminum Chloride versus Electrocauterization in Periapical Surgery: A Randomized Controlled Trial.

INTRODUCTION: The aim of this study was to evaluate the efficacy of 2 hemostatic agents in periapical surgery and its relationship with patient- and tooth-dependent variables. METHODS: A prospective study was designed with 2 randomized parallel groups established according to the hemostatic agent used: aluminum chloride or electrocauterization. The surgeon and 2 independent blinded observers examined the initial and final bleeding and recorded it as 0 (no hemorrhage control), 1 (slight but apparent intermittent bleeding), or 2 (complete hemorrhage control). The following patient- and tooth-dependent variables were collected: sex, age, smoking habit, plaque index, and position. RESULTS: Sixty patients with a periapical lesion in the esthetic zone were enrolled in this study and divided into 2 groups of 30 patients. In the aluminum chloride group, complete hemorrhage control was achieved in 24 patients, and in the electrocauterization group, it was achieved in 18 patients (P < .05). A relationship between sex and the effectiveness of hemostasis was found; a female patient increases the possibility of achieving complete hemorrhage control. CONCLUSIONS: Hemorrhage control was better in the aluminum chloride group than in the electrocauterization group as well as in female patients compared with male patients.

Influence of Hemostatic Agents in the Prognosis of Periapical Surgery: A Randomized Study of Epinephrine versus Aluminum Chloride.

INTRODUCTION: Several variables have been associated with a better prognosis of periapical surgery. The aim of this study was to evaluate the influence of 2 hemostatic agents on the prognosis of periapical surgery at 12 months. METHODS: A prospective study was designed with 2 randomized parallel groups established depending on the hemostatic agent used: epinephrine or aluminum chloride. The analysis of the hemorrhage control was recorded as 0 (no hemorrhage control), 1 (slight but apparent intermittent bleeding persisted after application of the material), or 2 (complete hemorrhage control). At 12 months, periapical lesion healing was determined clinically and radiologically as success, improvement, or failure. RESULTS: Ninety-five patients (67 women and 28 men) with periapical lesions involving a single tooth were enrolled in this study; in 45 teeth, epinephrine was used and in 50 teeth aluminum chloride. In the epinephrine group, 28 teeth were classified as successes, 10 as improvements, and 7 as failures. In the aluminum chloride group, 34 teeth were classified as successes, 11 as improvements, and 5 as failures. No statistically significant difference was found. CONCLUSIONS: The present study found no association between the use of epinephrine or aluminum chloride as hemostatic agents on the prognosis of periapical surgery. The efficacy of hemostatic agents at the time of surgery showed no relationship with the healing outcome.

Hemostatic Agents in Periapical Surgery: A Randomized Study of Gauze Impregnated in Epinephrine versus Aluminum Chloride.

INTRODUCTION: Adequate bleeding control is essential for the success of periapical surgery. The aim of this study was to evaluate the effects of 2 hemostatic agents on the outcome of periapical surgery and their relationship with patient and teeth parameters. METHODS: A prospective study was designed with 2 randomized parallel groups, depending on the hemostatic agent used: gauze impregnated in epinephrine (epinephrine group) and aluminum chloride (aluminum chloride group). The analysis of the hemorrhage control was judged before and after the application of the hemostatic agents by the surgeon, and 2 examiners independently recorded it as adequate (complete hemorrhage control) or inadequate (incomplete hemorrhage control). RESULTS: Ninety-nine patients with a periradicular lesion were enrolled in this study and divided into 2 groups: gauze impregnated in epinephrine in 48 patients (epinephrine group) or aluminum chloride in 51 (aluminum chloride group). In epinephrine group adequate hemostasis was achieved in 25 cases, and in aluminum chloride group it was achieved in 37 cases (P < .05). CONCLUSIONS: The outcome was better in the aluminum chloride group than in the gauze impregnated in epinephrine group.

An Analysis of Frequency, Morphology, and Locations of Maxillary Sinus Septa Using Cone Beam Computed Tomography.

PURPOSE: To evaluate the frequency, morphology, and locations of maxillary sinus septa using cone beam computed tomographic (CBCT) imaging of the entire maxillary sinus and to analyze factors influencing the presence or absence of septa. MATERIALS AND METHODS: CBCT images of the maxilla taken during a 1-year study period (October 1, 2012, to September 30, 2013) were evaluated for the presence and type of septa as well as the health or pathology of the maxillary sinus. Differences in age, gender, type of dentition, septa location, and sinus pathology with regard to the incidence of sinus septa were analyzed statistically. RESULTS: The study included 294 maxillary sinuses in 212 patients (126 women and 86 men) with a mean age of 53.8 years. Sinus septa were present in 141 patients (66.5%) and in 166 of 294 sinuses (56.5%). The most common orientation of the septa was coronal (61.8%), 7.6% were oriented axially, and 3.6% were aligned sagittally. Most septa were located on the floor of the maxillary sinus (58.6%), commonly (60.7%) in the region of the first and second molars. The maxillary sinuses were diagnosed in 36.4% of cases as healthy and without thickening of the sinus membrane. Sex was a significant variable in the health of the maxillary sinus; 57.7% of the sinuses in women and 72.3% in men were diagnosed as pathologic. CONCLUSION: Septa are common anatomical structures and are most often found in the first or second molar region on the floor of the maxillary sinus. To prevent possible complications during sinus floor elevation procedures, a thorough three-dimensional radiographic examination of the sinus prior to surgery is recommended.

Influence of hemostatic agents upon the outcome of periapical surgery: Dressings with anesthetic and vasoconstrictor or aluminum chloride

Objective: To evaluate the effects of different hemostatic agents upon the outcome of periapical surgery. Design: A retrospective study was made of patients subjected to periapical surgery between 2006-2009 with the ultrasound technique and using MTA as retrograde filler material. We included patients with a minimum follow-up of 12 months, divided into two groups according to the hemostatic agent used: A) dressings impregnated in anesthetic solution with adrenalin; or B) aluminum chloride paste (Expasyl™). Radiological controls were made after 6 and 12 months, and on the last visit. The global evolution scale proposed by von Arx and Kurt (1999) was used to establish the outcome of periapical surgery. Results: A total of 96 patients (42 males and 54 females) with a mean age of 40.7 years were included. There were 50 patients in the aluminum chloride group and 46 patients in the anesthetic solution with vasoconstrictor group. No significant differences were observed between the two groups in terms of outcome after 12 months - the success rate being 58.6% and 61.7% in the anesthetic solution with vasoconstrictor and aluminum chloride groups, respectively (p>0.05).Conclusion: The outcome after 12 months of follow-up was better in the aluminum chloride group than in the anesthetic solution with vasoconstrictor group, though the difference was not significant (AU)

Inflammatory implant periapical lesion prior to osseointegration: a case series study.

PURPOSE: To report 20 cases with implant periapical pathology diagnosed during the osseointegration phase, evaluating retrospectively the efficacy of the treatment with implant periapical surgery. MATERIALS AND METHODS: A retrospective chart review was conducted of all patients in whom implant periapical surgery was performed between 1996 and 2010. The criteria for diagnosing implant periapical pathology and, accordingly, performing implant periapical surgery were: (1) acute pain during the osseointegration period (8 weeks after implant placement) located in the area of the affected implant or presence of mucous fistula in relation with the implant apex; (2) absence of implant mobility; (3) non-dull percussion of nonsubmerged implants; and (4) presence or absence of implant periapical radiolucency. RESULTS: Twenty-two implants were diagnosed with periapical pathology in 20 patients (13 women and 7 men) with a mean age of 54.3 years (range, 32 to 70 years) and were consecutively treated by a surgical approach. In 19 implants, the diagnosis was acute apical peri-implantitis (nonsuppurated in 7 cases and suppurated in 12), as based on the symptoms and radiographic sign, and in 3 cases it was subacute apical peri-implantitis, as based on the presence of a fistula. After a minimum follow-up of 1 year, 20 implants remained functional, with no clinical or radiologic alterations; the survival rate of the treated implants was 91%. CONCLUSION: The early diagnosis of inflammatory implant periapical lesions during the osseintegration phase, and their prompt surgical treatment, led to a survival rate of the treated implants of 91%.

Tilted implants for the restoration of posterior mandibles with horizontal atrophy: an alternative treatment.

PURPOSE: Horizontal atrophy in the posterior mandible presents serious limitations on conventional implant placement. The purpose of this study was to evaluate the use of tilted implants angled in a buccolingual direction for restoring atrophic posterior mandibular sectors. MATERIALS AND METHODS: A cohort study was performed of 25 patients who had partial prostheses supported by more than 1 implant (≥ 1 tilted and 1 axial implant) to restore molar areas in the mandible. When the bone thickness was at least 5 mm, axial implants were placed; when the alveolar ridge was narrower, the implant was placed with tilted angulation. The beds for these tilted implants were prepared using a lingual approach, tipping the implant apex toward the vestibule. Twelve months after loading, bone loss was evaluated and the success rates of the tilted and axial implants were calculated. RESULTS: The study included 20 women and 5 men (mean age, 54.8 yr) who received 67 implants in the posterior mandibular sectors. Thirty-nine implants were placed with a buccal angulation and 28 implants were placed vertically. Mean bone losses of 0.59 ± 0.26 mm among the tilted implants and 0.48 ± 0.34 mm among the axial implants were observed 1 year after loading. The success rate of the tilted implants was 94.9%, and that of the axial implants was 100%. No significant differences in success rates or in bone loss between the tilted and axial implants were found at 12 months after loading. CONCLUSIONS: Twelve months after loading, tilted implants provided good results for the restoration of posterior mandibles with horizontal atrophy and no significant differences in success rates or marginal bone loss between tilted and axial implants were observed.

Influence of hemostatic agents upon the outcome of periapical surgery: dressings with anesthetic and vasoconstrictor or aluminum chloride.

OBJECTIVE: To evaluate the effects of different hemostatic agents upon the outcome of periapical surgery. DESIGN: A retrospective study was made of patients subjected to periapical surgery between 2006-2009 with the ultrasound technique and using MTA as retrograde filler material. We included patients with a minimum follow-up of 12 months, divided into two groups according to the hemostatic agent used: A) dressings impregnated in anesthetic solution with adrenalin; or B) aluminum chloride paste (Expasyl). Radiological controls were made after 6 and 12 months, and on the last visit. The global evolution scale proposed by von Arx and Kurt (1999) was used to establish the outcome of periapical surgery. RESULTS: A total of 96 patients (42 males and 54 females) with a mean age of 40.7 years were included. There were 50 patients in the aluminum chloride group and 46 patients in the anesthetic solution with vasoconstrictor group. No significant differences were observed between the two groups in terms of outcome after 12 months - the success rate being 58.6% and 61.7% in the anesthetic solution with vasoconstrictor and aluminum chloride groups, respectively (p > 0.05). CONCLUSION: The outcome after 12 months of follow-up was better in the aluminum chloride group than in the anesthetic solution with vasoconstrictor group, though the difference was not significant.

Implant periapical lesion: Diagnosis and treatment

The implant periapical lesion is the infectious-inflammatory process of the tissues surrounding the implant apex. It may be caused by different factors: contamination of the implant surface, overheating of bone during drilling, preparation of a longer implant bed than the implant itself, and pre-existing bone disease. Diagnosis is achieved by studying the presence of symptoms and signs such us pain, swelling, suppuration or fistula; in the radiograph an implant periapical radiolucency may appear. A diagnostic classification is proposed to establish the stage of the lesion, and determine the best treatment option accordingly. The following stages are distinguished: acute apical periimplantitis (non-suppurated and suppurated) and subcacute (or suppurated-fistulized) apical periimplantitis. The most adequate treatment of this pathology in the acute stage and in the subacute stage if there is no loss of implant stability is apical surgery. In the subacute stage, if there is implant mobility, the extraction of the implant is necessary (AU)

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Implant periapical lesion: diagnosis and treatment.

The implant periapical lesion is the infectious-inflammatory process of the tissues surrounding the implant apex. It may be caused by different factors: contamination of the implant surface, overheating of bone during drilling, preparation of a longer implant bed than the implant itself, and pre-existing bone disease. Diagnosis is achieved by studying the presence of symptoms and signs such us pain, swelling, suppuration or fistula; in the radiograph an implant periapical radiolucency may appear. A diagnostic classification is proposed to establish the stage of the lesion, and determine the best treatment option accordingly. The following stages are distinguished: acute apical periimplantitis (non-suppurated and suppurated) and subcacute (or suppurated-fistulized) apical periimplantitis. The most adequate treatment of this pathology in the acute stage and in the subacute stage if there is no loss of implant stability is apical surgery. In the subacute stage, if there is implant mobility, the extraction of the implant is necessary.

Pain and swelling after periapical surgery related to the hemostatic agent used: Anesthetic solution with vasoconstrictor or aluminum chloride

Objective: To assess pain and swelling in the first 7 days after periapical surgery and their relationship with the agent used for bleeding control. Study Design: A prospective study was conducted between October 2006 and March 2009. Patients subjected to root surgery, who completed the questionnaire and who consented to the postoperative instructions were included in the study. The subjects were divided into two groups according to the hemostatic agent used: A) gauze impregnated with anesthetic solution with vasoconstrictor; or B) aluminum chloride. The patients were administered a questionnaire, and were asked to record the severity of their pain and swelling on a plain horizontal visual analog scale (VAS). Data were recorded by the patients on the first 7 postoperative days. In addition, the patients were asked to record analgesic consumption. Results: A total of 76 questionnaires (34 in group A and 42 in group B) were taken to be correctly completed. Pain was reported to be most intense two hours after surgery. At this point 52.6% of the patients had no pain. Seventy-five percent of the patients consumed analgesics in the first 24 hours. There were no significant differences between the two groups in terms of the intensity of pain or in the consumption of analgesics. Swelling reached its maximum peak on the second day; at this point, 60.6% of the patients suffered mild or moderate swelling. The Expasyl™ group showed significantly greater swelling than the gauzes group. Conclusion: The type of hemostatic agent used did not influence either the degree of pain or the need for analgesia among the patients in this study. However, the patients belonging to the Expasyl™ group suffered greater swelling than the patients treated with gauzes impregnated with anesthetic solution with vasoconstrictor (AU)

Peripheral giant cell granuloma associated with dental implants: clinical case and literature review.

Peripheral giant cell granuloma (PGCG) associated to dental implants is a very infrequent peri-implant soft-tissue complication, with only 11 cases recorded in the literature to date. The present study describes a 54-year-old woman presenting a swelling of the alveolar margin in the fourth quadrant in relation to a fixed prosthesis cemented over implants. Treatment consisted of complete resection of the lesion with implantoplasty of the exposed implant threads. The diagnosis of PGCG was confirmed by histological study, and no relapse has been recorded after 12 months of follow-up.

Survival of implants placed with the osteotome technique: An update

A literature review is made to analyze the survival of imA literature review is made to analyze the survival of implants placed with the osteotome technique. A PubMed search was made based on the key words "osteotome AND dental implants", corresponding to publications between 1998-2008. The inclusion criteria were: a) a minimum of 10 patients; b) a minimum follow-up of 6 months; c) implants placed using the osteotome technique with or without indirect sinus lift; and d) specification of the implant number and survival rate. Sixty-four articles were identified, of which 20 met the inclusion criteria. A total of 2006 implants were placed in 1312 patients using the osteotome technique. The duration of follow-up after prosthetic loading ranged from 6-144 months. Indirect sinus lift was carried out in all but one of the studies. The residual crest height ranged from 2.8-12 mm, with a mean gain in bone after sinus lift of 2.5-5.1 mm. The time from implant placement to prosthetic loading varied from 1.5-9 months. The percentage implant survival rate was 85.1-100%. The survival rate of implants placed with the osteotome technique is high and does not differ with respect to implant placement with the conventional technique (AU)

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Comparison of immediate and delayed implants in the maxillary molar region: a retrospective study of 123 implants.

PURPOSE: The purpose of this study was to compare marginal bone loss and success rates 1 year after implants had been placed in maxillary molar sites, either immediately postextraction or after the extraction sites had healed (delayed). MATERIALS AND METHODS: A retrospective case study was made of subjects treated with immediate or delayed dental implants in the maxillary molar region between January 2006 and December 2008. A protocol was prepared in which patient age, sex, implant length and diameter, type of prosthesis, buccal plate width, and use of bone grafting were recorded. After 12 months, data relating to the clinical and radiologic conditions of the implants and the success rate according to the criteria of Buser et al were recorded. The variables were analyzed statistically (Student t test, Pearson correlation, Games-Howell test). RESULTS: The study included 123 implants placed in 70 patients; 35 implants were immediate and 88 were delayed. Two immediate and six delayed implants failed, resulting in success rates of 94.3% and 93.2%, respectively. Average marginal bone loss was 0.56 mm for immediate implants and 0.67 mm for delayed implants. CONCLUSIONS: The placement of immediate implants in maxillary molar sites achieved similar results to implants placed in healed sites in the same region after 12 months. No statistically significant differences were found between implant survival rates or average marginal bone loss.

Survival of implants placed with the osteotome technique: an update.

A literature review is made to analyze the survival of implants placed with the osteotome technique. A PubMed search was made based on the key words "osteotome AND dental implants", corresponding to publications between 1998-2008. The inclusion criteria were: a) a minimum of 10 patients; b) a minimum follow-up of 6 months; c) implants placed using the osteotome technique with or without indirect sinus lift; and d) specification of the implant number and survival rate. Sixty-four articles were identified, of which 20 met the inclusion criteria. A total of 2006 implants were placed in 1312 patients using the osteotome technique. The duration of follow-up after prosthetic loading ranged from 6-144 months. Indirect sinus lift was carried out in all but one of the studies. The residual crest height ranged from 2.8-12 mm, with a mean gain in bone after sinus lift of 2.5-5.1 mm. The time from implant placement to prosthetic loading varied from 1.5-9 months. The percentage implant survival rate was 85.1-100%. The survival rate of implants placed with the osteotome technique is high and does not differ with respect to implant placement with the conventional technique.

A retrospective comparison of 1,022 implants: immediate versus nonimmediate.

PURPOSE: The aim of this study was to compare the survival of implants placed in mature bone with the survival of implants placed in fresh extraction sockets in the same patients. MATERIALS AND METHODS: A retrospective study of patients treated simultaneously with at least one immediate and one nonimmediate implant was carried out for the period 2005 to 2008. Data were recorded for patient age and sex; implant length, diameter, and position; and, for postextraction implants, distance between the implant and the alveolar bone. RESULTS: One thousand twenty-two implants were placed in 150 patients; 480 were placed immediately and 542 were placed in mature bone. The mean implant survival rate was 93.4%; survival rates were 93.8% for immediate implants and 93.2% for nonimmediate implants. The failure rate in the maxilla was 5.2% and in the mandible it was 2.8%. The failure rate for immediate implants in the posterior maxilla was 8.5%, which was statistically significantly higher than for implants placed elsewhere. Of the failed implants, 72% were early failures. CONCLUSIONS: The survival rate of implants placed in fresh extraction sockets was similar to that of implants placed in mature bone. A statistically significantly higher failure rate was seen with immediate implants placed in the posterior maxilla.

A prospective clinical study of polycarboxylate cement in periapical surgery

Objective: To evaluate the clinical efficacy of polycarboxylate cement as retrograde filling material. Design: A prospective clinical study was made of 25 patients subjected to periapical surgery with ultrasound and magnifying loupes, in which polycarboxylate cement was used as retrograde filling material. Measurements were made of the area and diameter of the lesions pre- and postoperatively, and 6 and 12 months after the operation. The apical resection and retrograde filling areas were also measured, and the prognosis following surgery was recorded. Results: A total of 23 patients with 31 apicoectomized teeth were studied (2 patients being lost to follow-up). The mean area of the periapical lesions before surgery was 52.25 mm2, with a mean major diameter of 6.1 mm and a mean lesser diameter of 4.8 mm. The success rate after 12 months was 54.7%, according to the criteria of VonArx and Kurt. The prognosis was poorer in females, in larger lesions, and in cases with larger retrograde fillingareas. Conclusions: Polycarboxylate cement offers good results, with important bone regeneration after periapical surgery (AU)

Pain and swelling after periapical surgery related to the hemostatic agent used: anesthetic solution with vasoconstrictor or aluminum chloride.

OBJECTIVE: To assess pain and swelling in the first 7 days after periapical surgery and their relationship with the agent used for bleeding control. STUDY DESIGN: A prospective study was conducted between October 2006 and March 2009. Patients subjected to root surgery, who completed the questionnaire and who consented to the postoperative instructions were included in the study. The subjects were divided into two groups according to the hemostatic agent used: A) gauze impregnated with anesthetic solution with vasoconstrictor; or B) aluminum chloride. The patients were administered a questionnaire, and were asked to record the severity of their pain and swelling on a plain horizontal visual analog scale (VAS). Data were recorded by the patients on the first 7 postoperative days. In addition, the patients were asked to record analgesic consumption. RESULTS: A total of 76 questionnaires (34 in group A and 42 in group B) were taken to be correctly completed. Pain was reported to be most intense two hours after surgery. At this point 52.6% of the patients had no pain. Seventy-five percent of the patients consumed analgesics in the first 24 hours. There were no significant differences between the two groups in terms of the intensity of pain or in the consumption of analgesics. Swelling reached its maximum peak on the second day; at this point, 60.6% of the patients suffered mild or moderate swelling. The Expasyl group showed significantly greater swelling than the gauzes group. CONCLUSION: The type of hemostatic agent used did not influence either the degree of pain or the need for analgesia among the patients in this study. However, the patients belonging to the Expasyl group suffered greater swelling than the patients treated with gauzes impregnated with anesthetic solution with vasoconstrictor.

Virtual articulator for the analysis of dental occlusion: An update

The future of dental practice is closely linked to the utilization of computer-based technology, specifically virtual reality, which allows the dental surgeon to simulate true life situations in patients. The virtual articulator has been designed for the exhaustive analysis of static and dynamic occlusion, with the purpose of substituting mechanical articulators and avoiding their errors. These tools will help both odontologists and dental prosthetists to provide the best individualized treatment for each patient. The present review analyzes the studies published in the literature on the design, functioning and applications of virtual articulators. A Medline-Pub Med search was made of dental journals, with the identification of 137 articles, of which 16 were finally selected. The virtual articulator can simulate the specific masticatory movement of the patient. During mandibular animation, the program calculates the sites where the opposing teeth come into contact. The studies made to assess the reliability of the virtual articulator show good correspondence in visualization of the number and position of the dynamic contacts. The virtual articulator is a precise tool for the full analysis of occlusion in a real patient (AU)

Virtual articulator for the analysis of dental occlusion: an update.

The future of dental practice is closely linked to the utilization of computer-based technology, specifically virtual reality, which allows the dental surgeon to simulate true life situations in patients. The virtual articulator has been designed for the exhaustive analysis of static and dynamic occlusion, with the purpose of substituting mechanical articulators and avoiding their errors. These tools will help both odontologists and dental prosthetists to provide the best individualized treatment for each patient. The present review analyzes the studies published in the literature on the design, functioning and applications of virtual articulators. A Medline-PubMed search was made of dental journals, with the identification of 137 articles, of which 16 were finally selected. The virtual articulator can simulate the specific masticatory movement of the patient. During mandibular animation, the program calculates the sites where the opposing teeth come into contact. The studies made to assess the reliability of the virtual articulator show good correspondence in visualization of the number and position of the dynamic contacts. The virtual articulator is a precise tool for the full analysis of occlusion in a real patient.