A comparative study of patient satisfaction about anesthesia with dexmedetomidine for ambulatory dental surgery.

OBJECTIVE: Intranasal administration of dexmedetomidine for monitored anesthesia care (MAC) appears to be an effective, safe, and appropriate alternative to general anesthesia (GA) for ambulatory dental surgery. Based on the available evidence we evaluated a new MAC protocol with intranasal dexmedetomidine as the primary choice. To assess a difference in patient satisfaction and anesthesia-related discomfort between GA and MAC in ambulatory dental surgery, a study was conducted among patients undergoing various dental procedures. Patient satisfaction and anesthesia-related discomfort were assessed on the first postoperative day using the Bauer patient satisfaction questionnaire. RESULTS: Although the differences were small, patients in the MAC group were overall more satisfied with the general care compared to the GA group (p < 0.02). Patients in the MAC group reported more postoperative drowsiness compared to the GA group (p < 0.05), but less postoperative hoarseness and sore throat (p = 0.005 and p < 0.001, respectively). Moreover, postoperative thirst was more common in the GA group (p = 0.002). In conclusion, the differences in patient satisfaction and anesthesia-related discomfort between GA and MAC in this implementation study were small but appeared to favor MAC with intranasal dexmedetomidine over GA as anesthesia method during dental ambulatory surgery.

Prevalence of systemic conditions in an orthognathic surgery population: A 20-year single-center study.

OBJECTIVE: To describe the prevalence and characteristics of patients with systemic conditions in an orthognathic surgery population. STUDY DESIGN: A retrospective review was conducted of 1653 patients undergoing orthognathic surgery between 2001 and 2020. Patients were grouped per category of systemic condition and relevant information was retrieved from medical records. Clinical and perioperative characteristics were compared between patients with and without systemic conditions using χ2 tests and 95% confidence intervals. Age was compared using a cumulative logit model. RESULTS: The proportion of patients with systemic conditions undergoing orthognathic surgery was 16% (272 of 1653 patients). Patients with systemic conditions were on average 6 years older than patients without systemic conditions (P < .001). Significant differences in age compared to healthy patients were found for endocrinological (12 years; 95% confidence interval [CI], 8-16 years), gastrointestinal (10 years; 95% CI, 3-18 years), pneumological (5 years; 95% CI, 2-13 years), and cardiovascular disorders (17 years; 95% CI, 12-21 years). CONCLUSION: Nearly 1 out of 6 patients undergoing orthognathic surgery has a systemic condition. Knowledge of the prevalence and characteristics of these patients creates awareness among surgeons and a foundation for future studies on perioperative management.

Tranexamic acid and bleeding in patients treated with non-vitamin K oral anticoagulants undergoing dental extraction: The EXTRACT-NOAC randomized clinical trial.

BACKGROUND: Oral bleeding after dental extraction in patients on non-vitamin K oral anticoagulants (NOACs) is a frequent problem. We investigated whether 10% tranexamic acid (TXA) mouthwash decreases post-extraction bleeding in patients treated with NOACs. METHODS AND FINDINGS: The EXTRACT-NOAC study is a randomized, double-blind, placebo-controlled, multicenter, clinical trial. Patients were randomly assigned to 10% TXA or placebo mouthwash and were instructed to use the mouthwash once prior to dental extraction, and thereafter for 3 times a day for 3 days. The primary outcome was the number of patients with any post-extraction oral bleeding up to day 7. Secondary outcomes included periprocedural, early, and delayed bleeding, and the safety outcomes included all thrombotic events. The first patient was randomized on February 9, 2018 and the last patient on March 12, 2020. Of 222 randomized patients, 218 patients were included in the full analysis set, of which 106 patients were assigned to TXA (74.8 (±8.8) years; 81 men) and 112 to placebo (72.7 (±10.7) years; 64 men). Post-extraction bleeding occurred in 28 (26.4%) patients in the TXA group and in 32 (28.6%) patients in the placebo group (relative risk, 0.92; 95% confidence interval [CI], 0.60 to 1.42; P = 0.72). There were 46 bleeds in the TXA group and 85 bleeds in the placebo group (rate ratio, 0.57; 95% CI, 0.31 to 1.05; P = 0.07). TXA did not reduce the rate of periprocedural bleeding (bleeding score 4 ± 1.78 versus 4 ± 1.82, P = 0.80) and early bleeding (rate ratio, 0.76; 95% CI, 0.42 to 1.37). Delayed bleeding (rate ratio, 0.32; 95% CI, 0.12 to 0.89) and bleeding after multiple extractions (rate ratio, 0.40; 95% CI, 0.20 to 0.78) were lower in the TXA group. One patient in the placebo group had a transient ischemic attack while interrupting the NOAC therapy in preparation for the dental extraction. Two of the study limitations were the premature interruption of the trial following a futility analysis and the assessment of the patients' compliance that was based on self-reported information during follow-up. CONCLUSIONS: In patients on NOACs undergoing dental extraction, TXA does not seem to reduce the rate of periprocedural or early postoperative oral bleeding compared to placebo. TXA appears to reduce delayed bleeds and postoperative oral bleeding if multiple teeth are extracted. TRIAL REGISTRATION: ClinicalTrials.gov NCT03413891 EudraCT; EudraCT number:2017-001426-17; EudraCT Public website: eudract.ema.europa.eu.

Bone-anchored maxillary protraction to correct a class III skeletal relationship: A multicenter retrospective analysis of 218 patients.

This study evaluated the impact of class III correction by elastic traction on four miniplates and the failure rate of bone-anchored miniplates in nonsyndromic patients. A total of 218 patients (112 males and 106 females; average 11.4 years), treated by 38 orthodontists, received four miniplates (total 872 miniplates) from 2008 to 2016 at three maxillofacial centers in two countries. Factors affecting the success and failure of the miniplates were retrospectively examined and skeletal changes on cephalometric radiographs examined for 52 patients. Elastic traction was performed for 22.9 months, on average. The miniplate survival rate was 93.6%; 25.7% of the patients suffered failure of one of the miniplates. Postoperative antibiotics and placement of the neck of the miniplate in the attached gingiva significantly improved the success rate. Miniplate failure was six times higher in the maxilla and occurred more in younger patients. Self-drilling screws were significantly better than self-tapping screws for fixing the miniplate. Small cephalometric changes were seen: SNA (+1.9°), SNB (+0.4°), ANB (+1.4°), Wits analysis (+1.3 mm). In conclusion, bone-anchored maxillary protraction on four miniplates is an effective method for correcting a class III relationship, but has less skeletal effect than previously reported in the literature.

Elevation of the maxillary sinus membrane for de-novo bone formation: First results of a prospective study in humans.

PURPOSE: Sinus floor elevation via the lateral window approach represents a reliable technique for bone augmentation in the atrophic posterior maxilla. It is known that sinus membrane elevation leads to new bone formation. This prospective clinical study compared a specific technique in sinus membrane elevation with a conventional sinus floor augmentation (xenogenous/autogenous bone) in a human split mouth model. METHODS: Five edentulous patients with highly atrophic posterior maxillae were included in this study. On one maxillary side a degradable PDLLA-membrane was placed to create a space underneath the sinus membrane. Contralateral a mixture of autogenous and xenogenous bone was used for sinus floor augmentation. A two-stage procedure was carried out. The following variables were assessed: bone regeneration on cone-beam computed tomography (cone-beam CT), implant success, prosthetic comfort and patient satisfaction. Bone biopsies were taken with simultaneous implant placement. The samples were histologically analyzed. RESULTS: Cone-beam CTs revealed new bone formation on both sides. Thirty implants were placed, 15 in the augmented region and 15 in the non-augmented side. Thirty bone biopsies were taken and evaluated. Vital new bone was detected on the experimental side (osteoinductivity). On the conventional side a mixture of autogenous and residual bone substitute material was seen (osteoconductivity). Implant survival was 100% so far. Patient's satisfaction was high and prosthetic complications were not encountered. CONCLUSION: As it provides the highest rate of bone formation, autogenous bone in combination with bone substitute material can be considered as a very reliable standard procedure in sinus floor augmentation. The specific sinus membrane elevation technique as presented here showed satisfying results and might be a suitable alternative for maxillary sinus augmentation.

In vitro comparison of the sagittal split osteotomy with and without inferior border osteotomy.

PURPOSE: By adding an osteotomy of the inferior border of the mandibular body to the classic sagittal split osteotomy, the authors expected to prevent unfavorable splits and damage to the inferior alveolar nerve. MATERIALS AND METHODS: Thirty-five human mandibles were used to perform 70 sagittal split osteotomies as an in vitro study. Conducted as a split-mouth model, each mandible was split at the midline. One side of the mandible was split using the traditional Obwegeser-Dal Pont technique, and the other side was split in the same manner with an additional osteotomy of the inferior mandible border. The torque used to split the mandible was measured, and the fracture line of the mandible was recorded. RESULTS: The average torque associated with the original technique was 1.38 Nm (standard deviation, 0.60 Nm), with a fracture line along the mandibular canal. The average torque required to split the hemimandible with the modified technique was 1.02 Nm (standard deviation, 0.50 Nm), a significant (P < .001) difference, with a fracture line parallel to the posterior ramus of the mandible. The fracture pattern depended significantly on the technique used (P < .001), but not on the applied torque force. CONCLUSION: By adding an osteotomy of the inferior mandibular border to the sagittal split osteotomy, less torque was needed to split the mandible. The fracture line was more predictable, even when all the surgical manipulations were performed at a safe distance from the inferior alveolar nerve.

The modifications of the sagittal ramus split osteotomy: a literature review.

BACKGROUND: In 1953, the sagittal ramus split osteotomy was introduced by Obwegeser. For many years, and in some countries still, this technique has defined the term oral and maxillofacial surgery. METHODS: The basic design of the sagittal ramus split surgical procedure evolved very quickly. The original operation technique by Obwegeser was shortly after improved by Dal Pont's modification. The second major improvement of the basic technique was added by Hunsuck in 1967. Since then, the technical and biological procedure has been well defined. Resolution of the problems many surgeons encountered has, however, taken longer. Some of these problems, such as the unfavorable split or the damage of the inferior alveolar nerve, have not been satisfactorily resolved. RESULTS: Further modifications, with or without the application of new instruments, have been introduced by Epker and Wolford, whose modification was recently elaborated by Böckmann. The addition of a fourth osteotomy at the inferior mandibular border in an in vitro experiment led to a significant reduction of the torque forces required for the mandibular split. CONCLUSIONS: The literature was reviewed, and the last modifications of the successful traditional splitting procedure are presented narrowly. It indicates the better the split is preformatted by osteotomies, the less torque force is needed while splitting, giving more controle, a better predictability of the lingual fracture and maybe less neurosensory disturbances of the inferior alveolar nerve.