Accuracy of computer-assisted, template-guided implant placement compared with conventional implant placement by hand-An in vitro study.

OBJECTIVES: To compare free-hand to computer-assisted implant planning and placement (CAIPP) regarding planned to achieved implant position. MATERIAL AND METHODS: Forty-eight cast/bone models were mounted in mannequin heads. On each side, a tooth gap of different sizes was created. In the test group (T), study implants were placed using a CAD-CAM guide based on virtual planning. In the control (C), free-hand implant placement was performed. After CBCT scanning, the implant position was compared with the planned position. Descriptive statistics were applied, and ANOVA was used to identify differences between groups and gaps. (p < .05). RESULTS: In C, mean lateral deviations at the implant base amounted to 0.7 mm (max. 1.8) (large gap) and 0.49 mm (1.22) (small gap). In T, 0.18 mm (0.49) and 0.24 mm (0.52) were recorded. At the apex, 0.77 mm (2.04) (large gap) and 0.51 mm (1.24) (small gap) were measured in C, and 0.31 mm (0.83)/0.34 mm (0.93) in T. Mean vertical deviations in C measured 0.46 mm (1.26) (large gap) and 0.45 mm (1.7) (small gap). In T, 0.14 mm (0.44) and 0.28 mm (0.78) were recorded. Mean angular deviations of 1.7° (3.2°) were observed in C (large gap) and 1.36° (2.1°) (small gap). In T, mean values were 1.57° (3.3°) and 1.32° (3.4°). Lateral and vertical deviations were significantly different between groups (not gaps), angular between gaps (not groups). CONCLUSIONS: CAIPP protocols showed smaller deviations irrespective of the size of the tooth gap. In C, the gap size had an influence on the error in angulation only.

A Randomized Controlled Clinical Trial Comparing Conventional And Computer-Assisted Implant Planning and Placement in Partially Edentulous Patients. Part 2: Patient Related Outcome Measures.

The objective of this study was to compare patient-related outcomes of conventional protocols with computer-assisted implant planning and template-guided implant placement (CAIPP) protocols. Partially edentulous patients (N = 73) were assigned to either surgical planning based on two-dimensional radiographs and freehand implant placement (control; n = 26) or using three-dimensional computer-tomography data and implant placement using a tooth-supported surgical guide (test groups T1 [n = 24] and T2 [n = 23]). The two test groups differed from each other in digital data acquisition, software functionality, and the guide-manufacturing process. All surgeries were performed as open-flap procedures. Patient-related outcome measures were evaluated using questionnaires. Statistical tests were performed to investigate differences between treatment groups. Before treatment, 53% of patients in the control group and 83% of patients in the test groups (T1: 88%, T2: 78%) were satisfied with their group allocation. In the control group, 37% of patients favored CAIPP technology, while only 11% in the test groups would have preferred a conventional procedure. After treatment, 50% of patients in the control and 86% in the test groups (T1: 76%, T2: 94%) were satisfied with their allocation. Twenty-one percent of control-group patients favored the CAIPP treatment, while 6% of the test-group patients would have preferred a conventional treatment. The quality-of-life parameters during and after surgery did not show significant differences between groups. More postoperative discomfort was reported after longer and more-complex surgeries including guided bone regeneration and surgeries with two surgical sites. Generally, patients preferred computer-based technologies. No differences in the intra- or postoperative discomfort were observed compared to control protocols. More-extensive surgical procedures negatively affected the intra-and postoperative quality of life, irrespective of the treatment group allocation.

A Randomized Controlled Clinical Trial Comparing Conventional and Computer-Assisted Implant Planning and Placement in Partially Edentulous Patients. Part 4: Accuracy of Implant Placement.

The objective of this study was to compare the accuracy of conventional and computer-assisted implant planning and template-guided placement (CAIPP) protocols. Partially edentulous patients (N = 73) were randomly assigned to either a conventional implant planning and freehand placement protocol (control group, n = 26) or one of two different CAIPP protocols (stereolithographic guide [T1, n = 24] or 3D-printed guide [T2, n = 23]). The virtually planned and final implant positions were compared. Differences between the planned and the obtained implant position were evaluated as horizontal, vertical, and angular measurements. Descriptive statistics were calculated for overall deviation values and their fragmented mesiodistal and bucco-oral vectors at each evaluation plane. To study overall accuracy differences between study groups, analysis of variance (ANOVA) was used with Bonferroni post hoc test (Scheffé method). Possible confounding variables were analyzed using multiple linear regression with respect to treatment group. The mesiodistal or bucco-oral distribution of the positioning errors was evaluated with chi-square test. A multiple linear logistic regression was used to identify confounding variables. Inaccuracy at the level of the occlusal plane of the restoration averaged 0.65 ± 0.26 mm in the control group, 0.59 ± 0.4 mm in T1, and 0.76 ± 0.5 mm in T2. At the implant shoulder level, the inaccuracy amounted to 1.25 ± 0.62 mm, 0.97 ± 0.36 mm, and 0.72 ± 0.31 mm in the control group, T1, and T2, respectively. At the implant apex, mean deviations of 2.32 ± 1.24 mm were recorded in the control group, 0.97 ± 0.57 mm in T1, and 1.08 ± 0.57 mm in T2. Mean discrepancies in vertical direction measured 0.28 ± 1.01 mm (control), 0.2 ± 0.65 mm (T1), and -0.1 mm ± 1.0 mm (T2). Angular deviations of 7.36 ± 3.36 degrees (control), 4.23 ± 2.68 degrees (T1), and 3.13 ± 2.12 degrees (T2) were measured. Statistically significant differences were observed between the conventional and the two CAIPP groups for overall deviations at implant shoulder, apex, and implant angulation. CAIPP protocols seemed to provide a higher accuracy and precision compared to conventional freehand protocols. Still, the amount of inaccuracy using guides demands a safety margin. Moreover, intrasurgical verification during drilling and the implant placement procedure should be performed, including clinical parameters that may not be available from cone beam computed tomography data during the planning phase.

A Randomized Controlled Clinical Trial Comparing Conventional and Computer-Assisted Implant Planning and Placement in Partially Edentulous Patients. Part 3: Time and Cost Analyses.

This paper performed time and cost analyses and compared conventional vs computer-assisted implant planning and placement (CAIPP) protocols when placing single implants in partially edentulous patients. Partially edentulous patients were randomly allocated to one of three treatment groups: preoperative planning based on a conventional two-dimensional radiograph and free-hand implant placement (control [C], n = 26) or computer-assisted implant planning based on three-dimensional (3D) computer-tomography (test group 1 [T1], n = 24; test group 2 [T2], n = 23). A surgical guide was produced by stereolithography in T1 and by 3D printing in T2. In all patients, open-flap implant placement procedures were performed. Time and costs derived from each working step were recorded for each treatment protocol. Descriptive and analytic statistics were used to display the data and uncover differences between treatment groups. Overall office time was similar in all groups (C = 63.8 min; T1 = 77.2 min; T2 = 81.7 min). CAIPP and conventional protocols required similar times to perform the preoperative diagnosis, radiographic exam, and implant surgery. CAIPP protocols required longer surgical planning and template-production times. Overall economic costs were 31% (T1) to 20% (T2) higher for the CAIPP protocols due to the radiographic investigation and the surgical template production (C = Swiss francs [CHF] 1,567; T1 = CHF 2,268; T2 = CHF 1,946). In the present indication and methodologic set-up, computer-assisted protocols did not show an advantage over conventional protocols in terms of time or financial savings. The temporal and financial expenses should be put into perspective to potential benefits.

A Randomized Controlled Clinical Trial Comparing Conventional and Computer-Assisted Implant Planning and Placement in Partially Edentulous Patients. Part 1: Clinician-Related Outcome Measures.

The objectives of this study were to compare conventional and computer-assisted implant planning and placement (CAIPP) protocols regarding surgical planning predictability, intraoperative complications, and patient-centered outcomes. Partially edentulous patients (N = 73) were randomly allocated to one of three treatment groups: control (C, n = 26), with preoperative planning based on conventional radiography and freehand implant placement; and test 1 (T1, n = 24) and test 2 (T2, n = 23), with two different CAIPP protocols. The clinicians' predictions of the bony morphology, materials needed for surgery, and surgery duration were matched with intrasurgical findings using kappa tests. Complications or deviations from the surgical or prosthetic protocol were recorded. Descriptive statistics were used to study the sample sorted out by treatment group. Differences between groups were evaluated with chi-square test for qualitative variables and with nonparametric Kruskal-Wallis test for quantitative continuous variables. For post-hoc tests, the Bonferroni corrected (P < .016 = .05/3) Mann-Whitney test was used. CAIPP protocols showed better diagnostic potential than conventional protocols for the bone topography, need for simultaneous GBR procedures, membrane selection, and implant length predictions. The rate of surgical protocol deviations was similar in all groups, but their nature differed. Conventional protocols showed fewer splint-related incidences. Implant bed preparation and insertion could not be fully completed using the surgical splint in 3.8% of patients in C (1/26), 45.8% in T1 (11/24), and 47.8% in T2 (11/23). Deviation from the initial prosthetic plan was necessary in one case (T2; 4.4%). No biologic or technical complications were observed. CAIPP protocols showed a higher diagnostic potential than conventional protocols. A high incidence of intraoperative surgical protocol modifications to adjust suboptimal implant placements was reported for every group. Therefore, strict intraoperative implant position monitoring is mandatory for both treatment protocols.

Spectrophotometric and visual evaluation of peri-implant soft tissue color.

AIM: To spectrophotometrically and visually test whether the peri-implant mucosal color differs from the color of the natural gingiva. MATERIAL AND METHODS: Forty single implants in the incisor and premolar region of 40 patients were assessed 3-7 years after implant placement. The differences of the color components lightness, chroma along red-green axis, chroma along yellow-blue axis, and the total color difference ΔE between peri-implant mucosa and natural gingiva were measured with a spectrophotometer. The color difference between peri-implant mucosa and natural gingiva was visually evaluated by clinicians and rated as "clinically visible" or "clinically invisible" from speaking distance. The dimensions of peri-implant mucosa and gingiva at the mid-buccal aspect were evaluated by using cone-beam CT. Spearman analysis was performed to detect correlations between different variables. Two-sided t-test, ANOVA, Mann-Whitney, and Kruskal-Wallis tests were applied to detect differences between the groups. RESULTS: The spectrophotometrically assessed color difference ΔE between peri-implant mucosa and natural gingiva amounted to 7.0 ± 3.9. The peri-implant mucosa presented a significant dark, greenish and bluish discoloration in comparison with gingiva at control teeth. Clinical investigation revealed that in 60% of sites the color difference between peri-implant mucosa and natural gingiva was clinically visible from speaking distance. The threshold value ΔE for the extraoral clinical distinction of mucosal color differences measured 7.5. When comparing the groups with visible and invisible color differences with respect to the three color components, a significant difference was found only for chroma along yellow-blue axis. In the group with visible color difference, mucosa presented a bluish discoloration. Correlation analysis indicated that with an increase in mucosal thickness, a trend for smaller ΔE was found. CONCLUSION: The spectrophotometrically assessed color of the peri-implant mucosa revealed more dark, green and blue components compared to the natural gingiva. At 60% of the implants, peri-implant mucosal discoloration was visible from speaking distance. The sites with visible and those with invisible mucosal discolorations differed significantly only regarding the chroma along yellow-blue axis.

Palatal wound healing using a xenogeneic collagen matrix - histological outcomes of a randomized controlled clinical trial.

AIM: The aim of this study was to test whether or not a collagen matrix can improve early wound healing compared to spontaneous healing based on histological and immunohistologic analyses. METHODS: In 20 volunteers, 6 mm punch biopsies were harvested at the palate. A xenogeneic collagen matrix (XCM) was sutured in one site; the other one was left untreated (control). Biopsies with a diameter of 8 mm were subsequently obtained at 4, 8, 15 and 29 days and histological and immunohistologic analyses were performed. RESULTS: At day 4, wound bed keratinization amounted to 12.4 ± 7.5% (control) and 18.0 ± 10.2% (XCM). This increased up to day 8 (19.7 ± 25.5% control; 29.1 ± 8.0% XCM) and reached complete keratinization at day 15 in both groups. The quantitative analyses of the superficial compartment measured an increase in the amount of granulation tissue (32-88% control; 14-41% XCM) from day 4 to day 8. Angiogenesis was first detected at 8 days. At day 29, the amount of connective tissue in all compartments reached values similar to the native tissue at baseline. CONCLUSIONS: The application of a XCM as a wound dressing on palatal wounds might be beneficial in the early stages of wound healing. Further research with a larger sample size is needed to confirm these results.

Advanced smile diagnostics using CAD/CAM mock-ups.

Diagnostics are essential for predictable restorative dentistry. Both patient and clinician must agree on a treatment goal before the final restorations are delivered to avoid future disappointments. However, fully understanding the patient's desires is difficult. A useful tool to overcome this problem is the diagnostic wax-up and mock-up. A potential treatment outcome is modeled in wax prior to treatment and transferred into the patient's mouth using silicon indexes and autopolymerizing resin to obtain the patient's approval. Yet, this time-consuming procedure only produces a single version of the possible treatment outcome, which can be unsatisfactory for both the patient and the restorative team. Contemporary digital technologies may provide advantageous features to aid in this diagnostic treatment step. This article reviews opportunities digital technologies offer in the diagnostic phase, and presents clinical cases to illustrate the procedures.

In vitro assessment of artifacts induced by titanium, titanium-zirconium and zirconium dioxide implants in cone-beam computed tomography.

AIM: The aim of this study was to test whether or not the intensity of artifacts around implants in cone-beam computed tomography (CBCT) differs between titanium, titanium-zirconium and zirconium dioxide implants. MATERIALS AND METHODS: Twenty models of a human mandible, each containing one implant in the single-tooth gap position 45, were cast in dental stone. Five test models were produced for each of the following implant types: titanium 4.1 mm diameter (Ti4.1 ), titanium 3.3 mm diameter (Ti3.3 ), titanium-zirconium 3.3 mm diameter (TiZr3.3 ) and zirconium dioxide 3.5-4.5 mm diameter (ZrO3.5-4.5 ) implants. For control purposes, three models without implants were produced. Each model was scanned using a CBCT device. Gray values (GV) were recorded at eight circumferential positions around the implants at 0.5 mm, 1 mm and 2 mm from the implant surface (GVT est ). GV were assessed in the corresponding volumes of interest (VOI) in the control models without implants (GVC ontrol ). Differences of gray values (ΔGV) between GVT est and GVC ontrol were calculated as percentages. One-way ANOVA and post hoc tests were applied to detect differences between implant types. RESULTS: Mean ΔGV for ZrO3.5-4.5 presented the highest absolute values, generally followed by TiZr3.3 , Ti4.1 and Ti3.3 implants. The differences of ΔGV between ZrO3.5-4.5 and the remaining groups were statistically significant in the majority of the VOI (P ≤ 0.0167). ΔGV for TiZr3.3 , Ti4.1 and Ti3.3 implants did not differ significantly in the most VOI. For all implant types, ΔGV showed positive values buccally, mesio-buccally, lingually and disto-lingually, whereas negative values were detected mesially and distally. CONCLUSIONS: Zirconium dioxide implants generate significantly more artifacts as compared to titanium and titanium-zirconium implants. The intensity of artifacts around zirconium dioxide implants exhibited in average the threefold in comparison with titanium implants.

Total reconstruction of the atrophic maxilla with intraoral bone grafts and biomaterials: a prospective clinical study with cone beam computed tomography validation.

PURPOSE: To perform a preliminary validation with cone beam computed tomography (CBCT) of the combined use of intraoral bone blocks and biomaterials for total reconstruction of the atrophic maxilla. MATERIALS AND METHODS: Consecutive cases of total edentulism of the maxilla (Cawood and Howell classes IV or V) treated with bilateral sinus floor elevation, mandibular bone block grafts, and biomaterials were evaluated prospectively. Implants were placed 14 to 16 weeks after grafting. Each patient received a CBCT scan preoperatively, immediately after bone augmentation, and at reentry. A three-dimensional reconstruction of the maxilla with volumetric calculations was obtained at each stage. RESULTS: Fourteen patients participated. Successful graft integration occurred in all cases, with no major complications. Mean preoperative volume was 11,312 mm3. Mean postoperative volume was 19,997 mm3 immediately after surgery and 19,042 mm3 before implant insertion. The average percentage volumetric increase between the preoperative condition and the situation at reentry was 71.99%. One hundred eight implants were inserted. Immediate loading was possible with 81 implants in 10 patients. CONCLUSIONS: The rehabilitation of the severely resorbed maxilla remains a formidable challenge. The results of this study suggest that the use of mandibular bone blocks in combination with biomaterials is an effective, reliable procedure for the rehabilitation of the severely resorbed maxilla. Significant volume increases and adequate stability of the augmented areas at reentry were found with CBCT analysis. The grafted bone provided sufficient mechanical support to permit provisionalization and immediate loading. This technique enabled the restoration of function and esthetics with a fixed rehabilitation at 4 months.

In vitro assessment of artifacts induced by titanium dental implants in cone beam computed tomography.

OBJECTIVE: The objective of this study was to evaluate the geometric pattern and the intensity of artifacts around titanium implants in cone beam computed tomography (CBCT) using an in vitro model. MATERIAL AND METHODS: Ten test models, each containing one 4.1-mm-diameter titanium implant, were cast from a human mandible using silicone impression material and dental stone. Each model contained an implant in one of the following single-tooth gaps: 37, 36, 34, 33, 31, 41, 43, 44, 46, and 47. For control purposes, three models without implants were produced. Each model was scanned five times using a CBCT scanner. Gray values (GV) were recorded at eight circumferential positions around the implants at 0.5 mm, 1 mm, and 2 mm from the implant surface (GVTest ). GV were measured in the corresponding volumes of interest (VOI) in the models without implants (GVControl ). Differences of gray values (ΔGV) between GVTest and GVControl were calculated as percentages. To detect differences between GVTest and GVControl , the 95% confidence interval (CI) was computed for the values of ΔGV. Repeated measures ANOVA was used for the comparison of ΔGV at 0.5 mm, 1 mm, and 2 mm from the implant surface. RESULTS: Artifacts reflected by altered GV were always present in the proximity of titanium implants, regardless of the implant position. When comparing GVTest and GVControl , increased GV were found at the buccal and lingual aspects of the implant sites, whereas regions with reduced GV were located along the long axis of the mandibular body of the test models. A significant decrease in artifact intensity was found with increasing distance from the buccal implant surface (ΔGV0.5 mm : 45 ± 10% [SD], ΔGV1 mm : 28 ± 14% [SD], ΔGV2 mm : 14 ± 7% [SD]) (P < 0.001). CONCLUSION: Artifacts around titanium implants in CBCT images were distributed according to a geometrical pattern.

Quality of life following third molar removal under conscious sedation

Aim: The aim of this study was to assess quality of life (QoL) and degree of satisfaction among outpatients subjected to surgical extraction of all four third molars under conscious sedation. A second objective was to describe the evolution of self-reported pain measured in a visual analogue scale (VAS) in the 7 days after extraction. Study design: Fifty patients received a questionnaire assessing social isolation, working isolation, eating and speaking ability, diet modifications, sleep impairment, changes in physical appearance, discomfort at suture removal and overall satisfaction at days 4 and 7 after surgery. Pain was recorded by patients on a 100-mm pain visual analogue scale (VAS) every day after extraction until day 7. Results: Thirty-nine patients fulfilled correctly the questionnaire. Postoperative pain values suffered small fluctuations until day 5 (range: 23 to 33 mm in a 100-mm VAS), when dicreased significantly. A positive association was observed between difficult ranked surgeries and higher postoperative pain levels. The average number of days for which the patient stopped working was 4.9. Conclusion: The removal of all third molars in a single appointment causes an important deterioration of the patient’s QoL during the first postoperative week, especially due to local pain and eating discomfort (AU)

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Quality of life following third molar removal under conscious sedation.

AIM: The aim of this study was to assess quality of life (QoL) and degree of satisfaction among outpatients subjected to surgical extraction of all four third molars under conscious sedation. A second objective was to describe the evolution of self-reported pain measured in a visual analogue scale (VAS) in the 7 days after extraction. STUDY DESIGN: Fifty patients received a questionnaire assessing social isolation, working isolation, eating and speaking ability, diet modifications, sleep impairment, changes in physical appearance, discomfort at suture removal and overall satisfaction at days 4 and 7 after surgery. Pain was recorded by patients on a 100-mm pain visual analogue scale (VAS) every day after extraction until day 7. RESULTS: Thirty-nine patients fulfilled correctly the questionnaire. Postoperative pain values suffered small fluctuations until day 5 (range: 23 to 33 mm in a 100-mm VAS), when dicreased significantly. A positive association was observed between difficult ranked surgeries and higher postoperative pain levels. The average number of days for which the patient stopped working was 4.9. CONCLUSION: The removal of all third molars in a single appointment causes an important deterioration of the patient's QoL during the first postoperative week, especially due to local pain and eating discomfort.

Bupivacaine 0.5 % versus articaine 4 % for the removal of lower third molars. A crossover randomized controlled trial

Objective: To compare the anesthetic action of 0.5% bupivacaine in relation to 4% articaine, both with 1:200,000 epinephrine, in the surgical removal of lower third molars. As a secondary objective hemodynamic changes using both anesthetics were analyzed.Study Design: Triple-blind crossover randomized clinical trial. Eighteen patients underwent bilateral removal of impacted lower third molars using 0.5% bupivacaine or 4% articaine in two different appointments. Preoperative, intraoperative and postoperative variables were recorded. Differences were assessed with McNemar tests and repeated measures ANOVA tests. Results: Both solutions exhibited similar latency times and intraoperative efficacy. Statistical significant lower pain levels were observed with bupivacaine between the fifth (p=0.011) and the ninth (p=0.007) postoperative hours. Bupivacaine provided significantly longer lasting soft tissue anesthesia (p<0.05). Systolic blood pressure and heart rate values were significantly higher with articaine.Conclusions: Bupivacaine could be a valid alternative to articaine especially due to its early postoperative pain prevention ability (AU)

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Systematic review of parameters and methods for the professional assessment of aesthetics in dental implant research.

OBJECTIVE: The purpose of the present systematic review was to evaluate the scientific literature regarding the professional assessment of aesthetics in implant dentistry. MATERIAL AND METHODS: An electronic search of Medline database and Cochrane Central Register of Controlled Trials was performed, and complemented by a manual search. Clinical or validation studies (Part 1) and randomized-controlled trials (RCTs) (Part 2) reporting parameters and methods for the assessment of aesthetics were included. The information regarding the assessment of aesthetics was extracted. The methodological quality of RCTs was evaluated by means of the Cochrane Collaboration's Tool for assessing risk of bias. RESULTS: The search yielded 149 and 32 publications in Part 1 and Part 2, respectively. A great diversity with regard to parameters, methods and measurement units used for the assessment of aesthetics was found among the included studies. With respect to time points of assessment there were significant differences between the RCTs. Only two RCTs fulfilled all the criteria of the The Cochrane Collaboration's Tool for assessing risk of bias. CONCLUSIONS: Due to the differences of the study designs, parameters and methods used for the assessment of aesthetics, comparisons between studies should be interpreted with caution. Only a limited number of RCTs offer sound evidence on aesthetic outcomes in implant dentistry.

A prospective, randomized, triple-blind comparison of articaine and bupivacaine for maxillary infiltrations

Objectives: To compare the clinical anesthetic efficacy of 0.5% bupivacaine and 4% articaine (both with 1:200.000adrenaline) for anterior maxillary infiltration in healthy volunteers. Material and methods: A triple-blind split-mouth randomized clinical trial was carried out in 20 volunteers. A supraperiosteal buccal injection of 0.9 ml of either solution at the apex of the lateral incisor was done in 2 appointments separated 2 weeks apart. The following outcome variables were measured: latency time, anesthetic efficacy(dental pulp, keratinized gingiva, alveolar mucosa and upper lip mucosa and tissue) and the duration of anesthetic effect. Hemodynamic parameters were monitored during the procedure. Results: Latency time recorded was similar for both anesthetic solutions (p>0.05). No statistically significant differences were found in terms of anesthetic efficacy for dental pulp, keratinized gingiva or alveolar mucosa. Articaine had a significant higher proportion of successful anesthesia at 10 minutes after infiltration in lip mucosa and lip skin (p=0.039). The duration of anesthesia was 336 minutes for bupivacaine and 167 minutes for articaine. (p<0.001). No significant hemodynamic alterations were noted during the procedure. Conclusions: Articaine and bupivacaine exhibited similar anesthetic efficacy for maxillary infiltrations. The duration of anesthesia was longer with the bupivacaine solution, but lip anesthesia was better with articaine (AU)

Bupivacaine 0.5% versus articaine 4% for the removal of lower third molars. A crossover randomized controlled trial.

OBJECTIVE: To compare the anesthetic action of 0.5% bupivacaine in relation to 4% articaine, both with 1:200,000 epinephrine, in the surgical removal of lower third molars. As a secondary objective hemodynamic changes using both anesthetics were analyzed. STUDY DESIGN: Triple-blind crossover randomized clinical trial. Eighteen patients underwent bilateral removal of impacted lower third molars using 0.5% bupivacaine or 4% articaine in two different appointments. Preoperative, intraoperative and postoperative variables were recorded. Differences were assessed with McNemar tests and repeated measures ANOVA tests. RESULTS: Both solutions exhibited similar latency times and intraoperative efficacy. Statistical significant lower pain levels were observed with bupivacaine between the fifth (p=0.011) and the ninth (p=0.007) postoperative hours. Bupivacaine provided significantly longer lasting soft tissue anesthesia (p<0.5). Systolic blood pressure and heart rate values were significantly higher with articaine. CONCLUSIONS: Bupivacaine could be a valid alternative to articaine especially due to its early postoperative pain prevention ability.

Impact of a collagen matrix on early healing, aesthetics and patient morbidity in oral mucosal wounds - a randomized study in humans.

AIM: To test whether a collagen matrix (CM) can improve early wound healing and aesthetics, and decrease wound sensitivity compared with spontaneous healing. METHODS: In 15 volunteers, 6-mm punch biopsies were harvested at both palatal sites. A CM was sutured in one site; the other one was left untreated (control). Measurements included the remaining defect area, the colour match to surrounding tissue and somatosensory parameters at various time-points (pre-operative, post-operative, 4, 8, 15, 29 days). RESULTS: The defect area decreased over time for both treatments. Re-epithelization was completed in all subjects by day 15. The defect area was significantly smaller for CM (mean ± SD: 19.3 ± 3.4 mm(2)) compared with control (21.3 ± 3.3 mm(2)) at day 4 (p < 0.05), and at day 8 (CM: 11.7 ± 2.5 mm(2) ; control: 13.6 ± 2.9 mm(2) ; p < 0.01). The colour match was more favourable for CM at day 4, 8 and 29 (p > 0.05). Somatosensory measurements revealed slightly lower wound sensitivity at day 4 for CM compared with control. CONCLUSIONS: The use of CM can enhance wound healing compared with spontaneous healing during the first week. This was mainly documented by a faster re-epithelization. Colour match and wound sensitivity measurements did not reach statistical significance between CM and control sites.

Analysis of the antibiotic prophylaxis prescribed by Spanish Oral Surgeons

Aim: To identify prophylactic antibiotic prescription practices among Spanish dentists with preferential dedicationto Oral Surgery in different types of tooth extraction surgeries.Method: Members of the Spanish Oral Surgery Society were surveyed on antibiotic prophylaxis use in 4 differenttooth extraction modalities scaled according to their surgical invasiveness.Results: Sixty-nine of the 105 distributed questionnaires were returned completed. Thirteen percent of the surveyedsurgeons would prescribe antibiotics to prevent postoperative wound infection when confronted with conventionaltooth extraction lasting less than 5 minutes. In the case of surgery lasting more than 5 minutes, thepercentage of participants that would prescribe antibiotics increased to 39%. When a mucoperiosteal flap waselevated or an ostectomy was performed, 87% and 100%, respectively, would prescribe antibiotic prophylaxis.Amoxicillin and its combination with clavulanic acid were the most commonly prescribed antibiotics. All participantswould prescribe the antibiotic orally, starting after surgery and with a duration that ranged from 2-8 days.Conclusions: The results obtained suggest that antibiotic prophylaxis for preventing local odontogenic infectionis not being correctly implemented in Spain. This can generate new bacterial resistances, facilitate adverse drugreactions and favor opportunistic infections. Better designed studies are needed in order to clarify the role of antibioticsin the prevention of postsurgical wound infection (AU)

Analysis of the antibiotic prophylaxis prescribed by Spanish Oral Surgeons.

AIM: To identify prophylactic antibiotic prescription practices among Spanish dentists with preferential dedication to Oral Surgery in different types of tooth extraction surgeries. METHOD: Members of the Spanish Oral Surgery Society were surveyed on antibiotic prophylaxis use in 4 different tooth extraction modalities scaled according to their surgical invasiveness. RESULTS: Sixty-nine of the 105 distributed questionnaires were returned completed. Thirteen percent of the surveyed surgeons would prescribe antibiotics to prevent postoperative wound infection when confronted with conventional tooth extraction lasting less than 5 minutes. In the case of surgery lasting more than 5 minutes, the percentage of participants that would prescribe antibiotics increased to 39%. When a mucoperiosteal flap was elevated or an ostectomy was performed, 87% and 100%, respectively, would prescribe antibiotic prophylaxis. Amoxicillin and its combination with clavulanic acid were the most commonly prescribed antibiotics. All participants would prescribe the antibiotic orally, starting after surgery and with a duration that ranged from 2-8 days. CONCLUSIONS: The results obtained suggest that antibiotic prophylaxis for preventing local odontogenic infection is not being correctly implemented in Spain. This can generate new bacterial resistances, facilitate adverse drug reactions and favor opportunistic infections. Better designed studies are needed in order to clarify the role of antibiotics in the prevention of postsurgical wound infection.