Soft tissue exposure of endosseous implants between stage I and stage II surgery as a potential indicator of early crestal bone loss.

Implants are well accepted as a means of dental rehabilitation. While integration success rates are high, crestal bone loss can occur, and it may not become apparent until stage II surgery and implant uncovering. The purpose of this study was to quantify the relationship between exposure of implants through the oral mucosa between stage I and stage II implant surgery and early changes in crestal bone height. Bone levels were measured during placement of 275 implants in the maxillae of 50 subjects. Repeated bone height measurements were obtained at implant uncovering. Fourteen implants in 7 patients were exposed to the oral cavity through the mucosa at stage II surgery. Patients with 1 or more exposed sites demonstrated a likelihood of bone loss 3.9 times greater than patients with nonexposed sites (Fisher exact test, P = .0003). These results suggest that exposure of an implant between stage I and stage II implant surgery might serve as a potential indicator of the occurrence of early bone loss.

A prospective pilot study to evaluate a new dental assessment and treatment paradigm for patients scheduled to undergo intensive chemotherapy for cancer.

BACKGROUND: Patients scheduled to receive chemotherapy frequently undergo pretherapy dental treatment to eliminate potential sources of odontogenic infection. A prospective study was conducted to assess a new protocol emphasizing minimal pretherapy dental treatment. METHODS: Forty-eight consecutive patients diagnosed with solid or hematologic neoplasms underwent dental examination prior to intensive chemotherapy. All chronic dental pathology was scored as either mild-to-moderate or severe based on the likelihood of conversion to an acute state during chemotherapy. No pretherapy dental treatment was given to patients with chronic dental disease. Intertherapy dental complications and the overall impact on chemotherapy outcomes were assessed. RESULTS: Thirty-eight patients (79%) were diagnosed with pretherapy chronic dental pathology. Twenty-one of these patients (44% of the total population) were identified as having severe pathology and considered at risk for acute intertherapy dental complications. Two patients (4%) experienced acute intertherapy episodes, each presenting as oral abscesses. In both cases, resolution was achieved with antibiotics without interruption of chemotherapy. Oncologic treatment outcomes for all patients were judged to be unaffected by either the presence of chronic pretherapy dental disease or acute intertherapy exacerbations of these disease states. CONCLUSIONS: These results demonstrate that patients with chronic dental pathology can safely proceed with chemotherapy without dental intervention, as conversion of chronic dental disease to an acute state during chemotherapy occurs infrequently. If intertherapy dental infections do arise, they can be managed effectively without interrupting therapy or adversely affecting oncologic treatment outcomes.

Osteoradionecrosis of the jaws as a risk factor in radiotherapy: a report of an eight-year retrospective review.

Osteoradionecrosis of the jaws is a severe complication of radiotherapy in the treatment of the head and neck neoplasms. The literature indicates a recent decline in the reported incidence of this complication. The purpose of this study was to further assess the incidence rate for osteoradionecrosis. Factors previously associated with an increased risk for osteoradionecrosis were evaluated to determine possible relationships. A retrospective chart review was conducted for 193 patients treated with radiotherapy for malignant head and neck tumors over an eight-year period. Recorded diagnoses of osteoradionecrosis were noted. Factors previously correlated with the development of osteoradionecrosis were assessed. Of the 193 charts reviewed, 9 diagnoses of osteoradionecrosis of the jaws were made representing an incidence rate of 4.7% for the period evaluated. No single factor was noted to be associated with the development of osteoradionecrosis. The results indicate a low incidence rate for osteoradionecrosis as a post-radiation treatment complication. No single causative factor could be identified suggesting a multifactorial interaction responsible for osteoradionecrosis.

The use of percutaneous implants for the prosthetic rehabilitation of orbital defects in irradiated cancer patients: a report of clinical outcomes and complications.

This retrospective study evaluated the use of percutaneous craniofacial implants for the prosthetic rehabilitation of patients with a history of orbital exenteration and irradiation for oncologic tumors of the head and neck. A total of 24 implants were placed in six patients. All implants were determined to be osseointegrated at the time of uncovering. Three implants were subsequently resubmerged beneath the soft tissue because of positional interferences with prosthesis fabrication. The remaining 21 implants were ultimately used to retain six orbital prostheses. Two implants failed to maintain osseointegration during the follow-up period and were subsequently removed without complications. This represents an overall integration success rate of 90.5% over a mean follow-up period of 32.8 months (range = 11 to 68 months). The significance of these findings and their relationship to comparable reports in the literature are discussed.

A longitudinal clinical assessment of spark erosion technology in implant-retained overdenture prostheses: a preliminary report.

STATEMENT OF PROBLEM: As adapted for the dental profession, spark erosion technology permits precise machining of retentive metal overdenture frameworks for use in implant prosthetics. PURPOSE: The resultant prostheses are retentive and provide a number of benefits offered by both conventional overdenture and fixed prosthetic designs. MATERIAL AND METHODS: Preliminary data collected from an ongoing 5-year clinical trial were reviewed to qualitatively assess the clinical results obtained from 25 spark eroded implant-retained overdenture prostheses placed in 24 subjects. RESULTS: Throughout an evaluation period of 13.33 months (range 4 to 19 months), subject responses measured by questionnaire were uniformly good. Few complications were encountered and were limited to resin denture base/tooth fractures or retentive component failures that were easily repaired. CONCLUSION: Overdenture prostheses retained by spark eroded milled frameworks offer an acceptable treatment alternative for patients undergoing dental implant therapy.

An evaluation of a dentifrice containing salivary peroxidase elements for the control of gingival disease in patients with irradiated head and neck cancer.

Patients who have undergone irradiation for head and neck tumors commonly have xerostomia. Loss of the protective constituents normally found in saliva leaves patients at greater risk for development of significant dental pathologic disorders, including gingival and periodontal disease. Periodontal disease and tooth extractions are currently accepted as etiologic factors for the development of osteoradionecrosis. This double-blind crossover trial was conducted to assess the efficacy of a dentifrice containing salivary peroxidase elements in the reduction of gingivitis in a population of patients with irradiated cancer. Subjects were instructed to brush with the dentifrice provided. Plaque and gingival index values were obtained and statistically compared with baseline values. A weak positive effect was found between use of the dentifrice and a reduction in gingival inflammation. Patient compliance was a limiting factor in this treatment effect. The results suggest possible efficacy for the dentifrice in augmenting traditional measures of postradiation oral health maintenance.

Implant-retained prosthetic rehabilitation of orbital defects.

OBJECTIVE: To evaluate the use of endosseous transcutaneous implants to retain removable facial prostheses for the rehabilitation of orbital defects. SETTING: Tertiary referral center. PATIENTS: Six patients with a history of facial defects secondary to orbital exenteration for cancer ablation. OUTCOME MEASURES: Clinically noted functional and cosmetic results, patient reports of satisfaction, and complications encountered. RESULTS: Twenty-three of 25 implants were integrated (postoperative period, 13 to 65 months; mean, 44.2 months), representing an integration success rate of 92%. All patients were successfully wearing implant-retained prostheses after 48.3 months (post-prosthesis delivery period, 1 to 48.3 months; mean, 24.5 months). Overall patient satisfaction was very high. CONCLUSIONS: Implant-retained prosthetics represent a safe and effective treatment option. It is anticipated that this treatment will become the standard of rehabilitative care for patients with orbital defects.

Microflora associated with percutaneous craniofacial implants used for the retention of facial prostheses: a pilot study.

Craniofacial implants have been used successfully for the retention of facial prostheses. However, complications occur that can lead to the loss of implant integration. One such complication is infection possibly resulting from crevicular microflora activity. As part of an ongoing study, samples from crevicular sites surrounding 17 craniofacial implants were collected and submitted for microbiological assay. The results demonstrated the presence of opportunistic pathogens in many sites regardless of subjects' hygiene efforts. The significance of the findings is reviewed.

Evaluation of the substantivity of a chlorhexidine oral rinse in irradiated head and neck cancer patients.

A trial was conducted to evaluate the substantivity of chlorhexidine in a population of patients who had undergone primary or adjunctive radiation therapy for tumors of the head and neck. Subjects were instructed to first rinse with 0.12% chlorhexidine as per manufacturer instructions, followed by a releasing rinse provided 1 minute, 1 hour, and 4 hours later. All expectorants were collected, pH adjusted, and introduced to the test microorganism. Zones of bacterial inhibition were then measured and recorded. The results suggest that 0.12% chlorhexidine is retained in the oral cavity for at least 4 hours after an initial rinsing and that the property of substantivity remains active in spite of radiation-induced changes in the oral cavity and salivary glands.

Splint appliance for the management of posttrauma lip deformities: technical note and case reports.

Trauma sustained to the commissures of the lips will result in perioral tissue deficits. Without intervention, this will lead to functional and esthetic deformities. Splinting devices have proven to be an effective and economical means of treatment. Reviews have appeared in the literature describing techniques and treatment regimens for the use of such oral commissure splints. Each has specific advantages and disadvantages in application. A variation of these previously described splints now in use at the University of Chicago Hospitals is presented. Three case histories are presented with discussion of the uses and advantages of this appliance.

Aneurysmal bone cysts of the jaws: a case study and review of the literature.

Although first documented in 1958, the definitive explanation of the etiology and pathogenesis of the aneurysmal bone cyst has yet to be elucidated. This may be attributable to the relatively small number of cases contained within the literature. The following report and review of the pertinent literature is presented to add to the current body of knowledge on the subject.

A variation in the anatomic position of the pterygomandibular raphe: report of case.

A literature review of the anatomic position of the pterygomandibular raphe discloses no reports of possible variations in the attachment of this structure. A case study is presented describing such a variation from the typical anatomic description. The treatment regimen and factors related to denture retention are discussed.

Use of a palatal reservoir in denture patients with xerostomia.

Dentures that included a reservoir for saliva substitute in the palate of the maxillary denture were constructed for three xerostomic patients. Results were obtained through examinations and interviews. All patients found that the reservoir system helped control the xerostomia. Details of design and function were reviewed and general applications were discussed.