Dental Medicine and Infective Endocarditis: Current guidelines for antibiotic prophylaxis and recommendations for daily clinical practice.

Surgical interventions in the dental practice as well as interventions in the ear, nose and throat area, the skin, the respiratory, gastrointestinal or urogenital tract can lead to transient bacteremia. As a result, an infectious endocarditis (IE) may occur. Overall, this is a rare occurrence, but it is associated with high morbidity and mortality. Individuals with a history of IE, implanted valve prostheses and certain congenital heart defects are at the highest risk for IE. In dental medicine, there is a controversial debate as to whether bacteremia can occur already by chewing or brushing the teeth. Antibiotic prophylaxis for prevention of endocarditis should only be given to those patients who are at the highest risk for IE. This article discusses novelties and Swiss recommendations for antibiotic prophylaxis for highrisk patients for IE in the dental practice. In this context, antibiotic prophylaxis has gained importance for dentists, which is also reflected by the fact that the recommendations on the new endocarditis card are limited solely to dental interventions.

[Conduction anesthesia of the infraorbital nerve - A guide to intraoral nerve block anesthesia of the infraorbital nerv]. / Leitungsanästhesie des Nervus infraorbitalis.

In order to be able to perform major oral surgery in the upper jaw, sufficient local analgesia is indispensable. While the inferior alveolar nerve is often blocked for dental treatments in the lower jaw, block anesthesia in the upper jaw is less common. This article gives pragmatic advice on how to block the infraorbital nerve. By using this method patients comfort is significantly improved and the surgeon can focus on the treatment at hand.

Cone beam computed tomography artefacts around dental implants with different materials influencing the detection of peri-implant bone defects.

OBJECTIVES: To investigate the diagnostic accuracy of cone beam computed tomography (CBCT) for the diagnosis of peri-implant bone defects of titanium (Ti), zirconium dioxide (ZrO2 ) or titanium-zirconium (Ti-Zr) alloy implants. MATERIALS AND METHODS: Ti, Ti-Zr or ZrO2 implants with two diameters (3.3 mm, 4.1 mm) and one length (10 mm) were inserted in the angle of the mandible of six fresh defrosted pig jaws. Out of the 12 implants inserted, 6 served in the test group with standardized buccal peri-implant bone defects, whereas 6 served as control without bone defects. CBCTs were performed with three acquisition protocols (standard, high and low dose) using two devices. Four observers analysed CBCTs as follows: (a) presence of a peri-implant defect; (b) presence of peri-implant artefacts and impact on defect diagnosis; and (c) linear measurements of buccal peri-implant defect including height and width (in mm). RESULTS: CBCT device, CBCT settings, implant material, implant diameter and observer background did not significantly influence diagnostic accuracy. The sensitivity and specificity values were high for defect detection. ZrO2 led to a lower than average diagnostic accuracy (0.781). The linear measurements of peri-implant defect were underestimated by <1 mm on average. The subjective impact of artefacts on defect diagnosis was significantly affected by implant material and observer background. CONCLUSIONS: CBCT showed high diagnostic accuracy for peri-implant bone defect detection regardless of the device, imaging setting or implant material used. If CBCT is indicated to assess peri-implant bone disease, low dose protocols could be a promising imaging modality.

Comparative evaluation of SPECT/CT and CBCT in patients with mandibular osteomyelitis and osteonecrosis.

OBJECTIVES: Therapy of osteomyelitis and osteonecrosis very often requires surgery. Proper preoperative radiological evaluation of a lesion's localization and extent is a key in planning surgical bone resection. This study aims to assess the differences between single-photon emission computed tomography and cone beam computed tomography when detecting an osteomyelitis/osteonecrosis lesion as well as the lesion's qualitative parameters, extent, and localization. MATERIAL AND METHODS: Identification of candidates was performed retrospectively following a search for patients with histologically or clinically confirmed osteomyelitis or osteonecrosis. They were matched with a list of patients whose disease extent and localization had been evaluated using single-photon emission computed tomography and cone beam computed tomography in the context of clinical investigations. Subsequently, two experienced examiners for each imaging technique separately performed de novo readings. Detection rate, localization, extent, and qualitative parameters of a lesion were then compared. RESULTS: Twenty-one patients with mandibular osteomyelitis and osteonecrotic lesions were included. Cone beam computed tomography detected more lesions than single-photon emission computed tomography (25 vs. 23; 100% vs. 92%). Cone beam computed tomography showed significantly greater depth, area, and volume, whereas length and width did not differ statistically between the two groups. CONCLUSION: Both single-photon emission computed tomography and cone beam computed tomography could sensitively detect osteomyelitis/osteonecrosis lesions. Only single-photon emission computed tomography showed metabolic changes, whereas cone beam computed tomography seemed to display anatomic morphological reactions more accurately. The selection of the most adequate three-dimensional imaging and the correct interpretation of preoperative imaging remains challenging for clinicians. CLINICAL RELEVANCE: In daily clinical practice, three-dimensional imaging is an important tool for evaluation of osteomyelitis/osteonecrosis lesions. In this context, clinicians should be aware of differences between single-photon emission computed tomography and cone beam computed tomography when detecting and assessing an osteomyelitis/osteonecrosis lesion, especially if a surgical bone resection is planned.

Is the pneumatisation of the maxillary sinus following tooth loss a reality? A retrospective analysis using cone beam computed tomography and a customised software program.

OBJECTIVES: To compare the dimensions of maxillary sinuses in dentate and edentulous patients using cone beam computed tomography (CBCT) scans and a customised software program. MATERIALS AND METHODS: This study comprised CBCTs of 50 dentate and 50 edentulous posterior maxillae. The observers drew two planar curves in all included sinuses in the frontal, sagittal and axial planes of the respective CBCT scans. The volume (mm3), surface (mm2) and maximum diameter (mm) of the sinuses were calculated using a custom-made software program. The variables analysed were the influence of the state of dentition on sinus dimensions (primary outcome) and the influence of age, gender and side on sinus dimensions; the time needed for analysis; and the intra- and inter-observer agreement (secondary outcomes). RESULTS: There was no difference in sinus dimensions between dentate and edentulous posterior maxillae. Males had significantly (p < 0.05) greater volume, surface and diameter than females. Strong intra- and inter-observer agreement (Pearson correlation) was found for the calculated sinus dimensions. The time needed per analysis was less than 4 min for both observers. CONCLUSIONS: Being edentulous did not have an impact on the sinus dimensions, suggesting that there is no ongoing pneumatisation in the sinus after tooth loss. Males had larger sinuses than females in a population older than 30 years. CLINICAL RELEVANCE: Following tooth loss in the posterior maxilla, vertical bone height is primarily lost due to resorption of the alveolar crest, and not due to pneumatisation of the maxillary sinus. The customised software program was found to be user-friendly and efficient.

Evaluating Maxillary Sinus Septa Using Cone Beam Computed Tomography: Is There a Difference in Frequency and Type Between the Dentate and Edentulous Posterior Maxilla?

PURPOSE: To analyze and compare the frequency, type, and location of maxillary sinus septa in patients with a dentate and an edentulous posterior maxilla using cone beam computed tomography (CBCT) imaging. MATERIALS AND METHODS: The study consisted of 100 maxillary sinuses: 50 from patients with a dentate and 50 from patients with an edentulous posterior maxilla. The aim was to assess the frequency, morphology, and location of maxillary sinus septa in axial, sagittal, and coronal CBCT images. Images were only included in this study provided that patients were older than 30 years of age, at least one maxillary sinus was completely visible in the field of view (FOV), and the sinus membrane exhibited a mucosal thickening of a maximum 4 mm. Differences regarding age, sex, side, septa location, and type of dentition (dentate/edentulous posterior maxilla) were analyzed. RESULTS: The mean age of the 100 patients (66 women, 34 men) was 58.3 years. A total of 60 sinus septa were found in exactly half of the evaluated sinuses. The major part of the septa was found on the floor of the maxillary sinus (n = 34/56.7%). Of these, the majority was located in the posterior maxilla in the region of the second molars (n = 27/79.4%). The most common orientation of the septa was coronal (63.3%), followed by septa in relation to the infraorbital canal (23.3%). Regarding the status of the dentition in the posterior maxilla in relation to the distribution of sinus septa, septa were present in 26 (52%) dentate and in 24 (48%) edentulous regions. Thus, for a potential influence of the status of the dentition in the posterior maxilla on the frequency of sinus septa, no significant impact was found (P = .69). CONCLUSION: Sinus septa are frequent anatomical structures, and are found equally often in patients with a dentate and an edentulous posterior maxilla. This is of clinical relevance, as patients with missing teeth in the posterior area of the maxilla are often in need of a sinus floor elevation (SFE) procedure when dental implant placement is intended. As sinus septa are reported to be an important reason for surgical complications during SFE, a three-dimensional radiographic examination using CBCT prior to surgery might be helpful for diagnostic evaluation and treatment planning.

Bacterial leakage through temporary fillings in core buildup composite material - an in vitro study.

PURPOSE: To evaluate the ability of the provisional filling material Cavit-W alone or in combination with different restorative materials to prevent bacterial leakage through simulated access cavities in a resin buildup material. MATERIALS AND METHODS: LuxaCore resin cylinders were subdivided into 4 experimental groups (n = 30), plus a positive (n = 5) and a negative (n = 30) control group. One bore hole was drilled through each cylinder, except those in the negative control group (G1). The holes were filled with Cavit-W (G2), Cavit-W and Ketac-Molar (glassionomer cement, G3), Cavit-W and LuxaCore bonded with LuxaBond (G4), Cavit-W and LuxaCore (G5), or left empty (G6). Specimens were mounted in a two-chamber leakage setup. The upper chamber was inoculated with E. faecalis. An enterococci-selective broth was used in the lower chamber. Leakage was assessed for 60 days and compared using Fisher's exact test (α < 0.05) corrected for multiple testing. RESULTS: Bacteria penetrated specimens in the positive control group within 24 h. All specimens in the negative control group resisted bacterial leakage for 60 days. Twenty-seven specimens in G2, 26 in G3, and 16 specimens in G5 showed bacterial leakage by the end of the experiment. G4 prevented bacterial penetration completely. The statistical comparison revealed significant differences between G4 and all other experimental groups. CONCLUSION: Under the current conditions, Cavit-W alone or combined with a glass-ionomer cement did not prevent bacterial leakage through a resin buildup material for two months. In contrast, covering Cavit-W with a bonded resin material resulted in a bacteria-tight seal for two months.