Dental Implant Placement in Patients on Bisphosphonate Therapy: a Systematic Review.

OBJECTIVES: The review aims to study dental implant placement purposefulness for patients who have been treated or are on treatment with bisphosphonate medication. MATERIAL AND METHODS: Structured search strategy was applied on electronic databases: MEDLINE, PubMed, PubMed Central and ResearchGate. Scientific publications in English between 2006 and 2017 were identified in accordance with inclusion, exclusion criteria. Publication screening, data extraction, and quality assessment were performed. Outcome measures included implant failure or implant-related osteonecrosis of the jaw. RESULTS: In total, 32 literature sources were reviewed, and 9 of the most relevant articles that are suitable to the criteria were selected. Heterogeneity between the studies was found and no meta-analysis could be done. Five studies analysed intraoral bisphosphonate medication in relation with implant placement, three studies investigated intravenous bisphosphonate medication in relation with implant placement and one study evaluated both types of medication given in relation with implant placement. Patients with intraoral therapy appeared to have a better implant survival (5 implants failed out of 423) rate at 98.8% vs. patients treated intravenously (6 implants failed out of 68) at 91%; the control group compared with intraoral bisphosphonate group appeared with 97% success implant survival rate (27 implants failed out of 842), showing no significant difference in terms of success in implant placement. CONCLUSIONS: Patients treated with intravenous bisphosphonates seemed to have a higher chance of developing implant-related osteonecrosis of the jaw. The intraorally treated patient group appeared to have more successful results. Implant placement in patients treated intraorally could be considered safe with precautions.

Influence of leukocyte- and platelet-rich fibrin (L-PRF) on the outcomes of impacted mandibular third molar removal surgery: A split-mouth randomized clinical trial.

OBJECTIVES: The purpose of this study was to evaluate the influence of leukocyte- and platelet-rich fibrin (L-PRF) on impacted mandibular third molar (IMTM) extraction wound healing, patient postoperative discomfort, and incidence of alveolar osteitis. METHOD AND MATERIALS: Thirty-four patients (20 female, 14 male) who met the inclusion criteria for this split-mouth randomized clinical trial were enrolled and 30 patients completed the study. Patients were randomized and underwent bilateral IMTM surgical extractions. Following extraction, one socket randomly received L-PRF, and the other socket served as a regular blood clot control. Postoperatively, the soft tissue healing index (HI), pain according to visual analog scale (VAS), facial swelling using a horizontal and vertical guide, and incidence of alveolar osteitis were evaluated 1, 3, 7, and 14 days after surgery. RESULTS: Sites treated with L-PRF resulted in improved HI (P = .001) and lower pain VAS scores (P = .001) in the first postoperative week. Significant reduction of facial swelling was recorded on first (P = .035) and third (P = .023) postoperative days in L-PRF sites versus controls, ceasing to nonsignificant difference at day 7 (P = .224). None of the L-PRF sites and four control sites were affected by alveolar osteitis (P = .001). CONCLUSION: Within the limitations of this split-mouth study, L-PRF improved soft tissue healing and reduced postoperative pain, swelling, and incidence of alveolar osteitis after IMTM surgical extractions.

Validation of Universal Scale in Oral Surgery (USOS) for Patient's Psycho-emotional Status Rating.

OBJECTIVES: There aren't any objective methods that may help in standard evaluation of oral surgery patient's psycho-emotional status. Without any standardized evaluation, two main problems appear: heterogeneity between studies and ineffective patient's evaluation. Therefore, Universal Scale in Oral Surgery (USOS) for patient's psycho-emotional status rating has previously been proposed by authors. The aim of present study is to assess the clinical effectivity and validate the Universal Scale in Oral Surgery in case of outpatient tooth extraction for adult healthy patients. MATERIAL AND METHODS: Clinical trial to validate the USOS for patient's psycho-emotional status rating was performed. In total 90 patients, that came for outpatient dental extraction to Lithuanian University of Health Sciences Oral and Maxillofacial Surgery Department ambulatory, were enrolled in clinical trial. Patients filled self-reported questionnaires before the procedure. Operating surgeon rated USOS for patient's psycho-emotional status rating doctor's part questionnaire after the procedure. 4 - 6 weeks later all patients were asked to fill USOS for patient's psycho-emotional status rating questionnaire retrospectively. RESULTS: According to the statistical analysis, the final composition of USOS for patient's psycho-emotional status rating that would fit to reliability coefficient should be composed from 6 patient part questions and 3 general doctor part questions. CONCLUSIONS: Universal Scale in Oral Surgery for patient's psycho-emotional status rating is a novel, doctor and patient rated scale which is suitable for clinical and scientific usage.

An analysis of etiological factors for traumatic mandibular osteomyelitis.

OBJECTIVE: The aim of this study was to analyze the factors that were associated with the development of osteomyelitis during the treatment of mandibular fractures. MATERIAL AND METHODS: The data of 3188 patients with mandibular fractures treated during 2002-2009 were analyzed. Traumatic osteomyelitis of the mandible was diagnosed in 207 patients. The background factors of complications were studied and compared with the control group (100 patients) not having complications after treatment of mandibular fractures. The data of clinical, roentgenologic, microbiological, and immunological investigations were analyzed. A logistic regression model was developed to identify the factors for osteomyelitis development. RESULTS: The treatment in 6.5% of patients was complicated with osteomyelitis; 88.5% of these patients were men, and more than 80% of patients were younger than 50 years. In 86.8% of cases, Staphylococcus species were isolated, with Staphylococcus aureus accounting for 69.1% of cases. The following factors were found to be associated with osteomyelitis development: immunity dysfunction, caries-affected teeth at the fracture line, mobile fractured bones, bone fixation after more than 7 days following trauma, healthy teeth at the fracture line, insufficient bone reposition, and bone fixation after 3-7 days following trauma. CONCLUSION: Comparative analysis of factors influencing the treatment results revealed a great importance of immunological and dental status and microflora at the affected site. Insufficient or late reposition and fixation of fractured bone fragments play a significant role in the healing process.

Classification of extraction sockets based upon soft and hard tissue components.

BACKGROUND: The aim of this study was to present and validate a new classification system for the maxillary anterior extraction socket based upon soft and hard tissue parameters. METHODS: Twenty-five maxillary anterior teeth from 25 subjects (15 men and 10 women; aged 18 to 51 years; mean age = 32.4 years) were used to validate the new proposed classification system. Two independent surgeons recommended a treatment approach based upon the classification proposed. These suggestions were verified at the time of surgery. Weighted Cohen's kappa was used to calculate interobserver reliability. Statistical analysis was performed using the paired t, Kolmagorov-Smirnov, and marginal homogeneity tests. RESULTS: Interobserver agreement and weighted Cohen's kappa were 96% and 0.94, respectively. This indicated a high reliability for the proposed classification system. No peri-implant soft tissues were classified as deficient when the newly developed classification was used to recommend treatment. Overall, 80% of sockets were graded as adequate based on soft tissue parameters (P <0.001). CONCLUSION: The extraction socket classification proposed here is an objective and helpful tool for socket assessment and for promoting future implant esthetics.

[Post-traumatic infraorbital nerve neuropathy]. / Potraumine paakiduobinio nervo neuropatija.

The authors have investigated functional state of infraorbital nerve of 479 patients with zygomatic fractures. The degree of nerve damage was evaluated according to changes of pain threshold during damaged nerve stimulation. It was estimated that in 64.3% of zygomatic fractures the infraorbital nerve was affected. The nerve damage degree could be mild, moderate and severe. In 43.18% of moderate and severe nerve damage cases the neuropathy develops. The symptoms, signs and treatment of neuropathy have been described. The neuropathy with clinical symptoms as permanent soreness and paresthesias (itch, "running ant", fibrillations of cheek tissues etc.) in the infraorbital nerve innervation zone occur to 43.18% of the patients after moderate and severe damage of the nerve. The treatment of neuropathy was analysed. In cases of moderate and severe nerve damages, authors recommend to perform decompression of the nerve, because if not applied, the function of nerve does not recover.