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Tooth Extraction (tooth + extraction)
Selected AbstractsHistological and Histomorphometrical Alterations of the Periodontal Ligament in Gerbils Submitted to Teeth ExtractionANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 4 2008M. M. Iyomasa Summary This study verified the effect of unilateral teeth extraction on the periodontal ligament in gerbils (Meriones unguiculatus). Ten adult male gerbils weighing about 50 g had induced occlusal alterations by upper left molar extractions while the other ten animals, only submitted to surgical stress, were considered as controls. The periodontal ligament was characterized by qualitative and quantitative analysis, histological description and histomorphometric quantification. Significant alterations were observed on the left side of the experimental group (P < 0.05), the hypofunctional region, when it was compared with the contralateral side and the corresponding region of the control group. Two months after occlusal alterations induced by unilateral teeth extraction, atrophic histological alterations and a decrease in the periodontal space on the ipsilateral side characterized the periodontal ligament. In this study it was possible to conclude that the gerbil can be used in experimental models attempting to correlate the periodontium's biological response to various mechanical stresses, as the periodontal ligament was shown to be highly sensitive to occlusal alterations. [source] Childhood leukaemia: experiences of children and attitudes of parents on dental careEUROPEAN JOURNAL OF CANCER CARE, Issue 3 2008Ç.E. ÇUBUKÇU phd Parental perceptions in the importance of dental care and preferences with regard to its provision while profiling the level of dental health knowledge of parents of leukaemic children were elicited. The setting was the Paediatric Dental Care Unit located in Medical Faculty. Data were collected by means of a structured interview, employing a questionnaire. Level of knowledge on both dental facts and preventive dentistry of the participants was insufficient. Major source of dental care was the resident paediatric dentist both in prior to (78.2%) and following (100%) diagnosis. Tooth extraction (17.6%) was the only treatment provided prior to diagnosis. Following diagnosis, 60 (69%) of these children had received operative dental treatment. The source of preventive advice was inconsistent. Parents appeared to place a high level of importance on their children's dental care and the preference for this to be provided within the hospitals in which the child has been treated. There is clearly a need to establish dental care units in hospitals in which treatment of childhood malignancy is provided. The provision for the future should be the continuous education of dentists, physicians and nurses who work in hospitals and public health services. [source] Post-tooth extraction sepsis without locoregional infection , a population-based study in TaiwanORAL DISEASES, Issue 8 2009J-J Lee Objective:, To investigate the incidence and risk factors of post-tooth extraction sepsis in patients without locoregional infection. Subjects and Methods:, We assessed all claim records of the Taiwanese National Health Insurance program in 2005. Admissions for patients aged ,16 years containing a discharge diagnosis of sepsis, and who received tooth extraction within 14 days before the admission were identified. Patient charts were reviewed to confirm the diagnosis of sepsis and rule out other infection sources. The relationship between postextraction sepsis (PES) and clinical parameters was analyzed. Results:, Thirty-three of the 2 223 971 extraction cases met the criteria of PES, an incidence of 1.48 per 100 000, and seven patients (21.2%) died of the disease. Aging significantly increased the risk of PES (P < 0.001). Pre-existing comorbidities were found in 20 of the 33 cases, with diabetes mellitus and hematologic diseases the most common. The method, number, and position of extraction had no influence on PES incidence. Blood cultures were positive in 25 patients (75.8%) and isolates included species of the Streptococcus, Actinomyces, Klebsiella, Bacteroides, Prevotella, and Enterococcus genera. Conclusion:, Tooth extraction is associated with a low but significant risk of postoperative sepsis, especially in the elderly and patients with underlying diseases. [source] Histological and Histomorphometrical Alterations of the Periodontal Ligament in Gerbils Submitted to Teeth ExtractionANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 4 2008M. M. Iyomasa Summary This study verified the effect of unilateral teeth extraction on the periodontal ligament in gerbils (Meriones unguiculatus). Ten adult male gerbils weighing about 50 g had induced occlusal alterations by upper left molar extractions while the other ten animals, only submitted to surgical stress, were considered as controls. The periodontal ligament was characterized by qualitative and quantitative analysis, histological description and histomorphometric quantification. Significant alterations were observed on the left side of the experimental group (P < 0.05), the hypofunctional region, when it was compared with the contralateral side and the corresponding region of the control group. Two months after occlusal alterations induced by unilateral teeth extraction, atrophic histological alterations and a decrease in the periodontal space on the ipsilateral side characterized the periodontal ligament. In this study it was possible to conclude that the gerbil can be used in experimental models attempting to correlate the periodontium's biological response to various mechanical stresses, as the periodontal ligament was shown to be highly sensitive to occlusal alterations. [source] Change in supporting tissue following loss of a permanent maxillary incisor in childrenDENTAL TRAUMATOLOGY, Issue 6 2007Helen D. Rodd Abstract,,, Alveolar bone resorption is an inevitable consequence of tooth loss and may be detrimental to long-term dental aesthetics and function. The aim of the present study was to quantify the degree of tissue resorption following the loss of a permanent incisor in a young population. The study group comprised 11 boys and five girls who all required the extraction of a permanent maxillary central incisor due to trauma-related sequelae. Mean age at tooth loss was 10.8 years. Upper alginate impressions were taken at regular intervals following tooth loss and were cast in yellow dental stone. Study models were sectioned longitudinally through the mid-point of both the maxillary incisor socket and the contra-lateral incisor to provide a thin plaster section. Digital photographs were acquired of the edentulous (A1) and dentate (A2) surfaces of this section and image analysis software was employed to quantify the surface area of both A1 and A2. At 3 months postextraction, mean A1 was 15.7% less than mean A2. By 6 months mean A1 had further reduced and was 25.3% less than that of the corresponding dentate alveolus. However, at subsequent time intervals following tooth extraction (>6 months), tissue loss appeared to stabilise with an overall reduction in tissue area remaining at 22%. This reduction in supporting tissue area was found to be highly statistically significant (P = 0.002, anova). Furthermore, girls appeared to have an overall greater degree of tissue loss than boys (P = 0.015). Further research is indicated to explore factors influencing the degree of tissue loss following incisor extraction and the benefit of therapeutic interventions in limiting this resorption. [source] The prognosis and expected outcome of apical surgeryENDODONTIC TOPICS, Issue 1 2005SHIMON FRIEDMAN Clinicians should possess current knowledge about the prognosis and expected outcome of endodontic treatment, including apical surgery. This knowledge cannot be acquired by indiscriminate review of the many available studies because they vary in the level of evidence they provide. Therefore, seven studies that best comply with methodology criteria defining the levels of evidence were selected and used as the basis of this review. In spite of their methodological consistency, the outcomes reported in these studies still differ considerably, mainly because of differences in inclusion criteria. According to these studies, 37,91% of teeth can be expected to be healed, while up to 33% can still be healing several years after surgery. Importantly, 80,94% of teeth can remain in symptom-free function, even if they are not healed. Several pre-operative factors may influence the outcome of treatment; the outcome may be better in teeth with small lesions and excessively short or long root canal fillings, and it may be poorer in teeth treated surgically for the second time. With regard to intra-operative factors, the choice of the root-end filling material and the quality of the root-end filling may influence the outcome, while the retrograde retreatment procedure clearly offers a better outcome than the standard root-end filling. In summary, the expected outcome of apical surgery is good and therefore, before considering tooth extraction and replacement, apical surgery should be attempted when it is feasible. [source] Paediatric dentistry in outreach settings: an essential part of undergraduate curricula?EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 4 2009M. L. Hunter Abstract Introduction:, Although placements in primary care settings remote from dental schools are becoming a common feature of undergraduate dental curricula, little evidence is available regarding the experience of paediatric dentistry gained in this way. Materials and methods:, Treatment logs relating to salaried primary care placements undertaken by the Class of 2007 at Cardiff University School of Dentistry were examined, particular attention being paid to paediatric-specific procedures. Results:, Forty-nine logs relating to placements undertaken in South East Wales and 51 relating to those in North Wales were retrieved. In South East Wales, 90% of students gained experience of primary tooth restoration, 61% carrying out primary endodontics. Sixty-three percent of students undertaking placements in South East Wales and 69% of those placed in North Wales gained experience of primary tooth extraction under local anaesthesia. All but three students gained experience of administering inhalation sedation. Discussion:, The findings of this study should go some way towards reassuring those who have expressed concern that recruitment difficulties within dental schools inevitably lead to increasing numbers of students qualifying without clinical experience of paediatric dental procedures considered to be within the remit of a newly qualified dental practitioner. However, there remains wide variation in the breadth and depth of experience of individual students and it is still possible for some students to graduate without what might be considered core experience in paediatric dentistry. Conclusion:, Salaried primary care settings are ideally placed to provide students with experience of paediatric-specific procedures. Clinical education in paediatric dentistry should, therefore, incorporate the strengths of dental school and placement education. [source] Changes in the bucco-lingual thickness of the mandibular alveolar process and skeletal bone mineral density in dentate women: a 5-yr prospective studyEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 2 2005Grethe Jonasson After tooth extraction there is a great interindividual variation in the remodelling pattern of the alveolar process in edentulous areas, with some individuals losing little bone and others undergoing extensive resorption. However, little is known about possible longitudinal changes in the dentate region of the alveolar process of adults and if these are related to alterations in the skeletal bone mineral density (BMD). In a prospective study, on two occasions, 5-yr apart, the BMD of 117 women was determined in the distal forearm by using dual-energy X-ray absorptiometry, and the bucco-lingual thickness of the mandibular alveolar process was measured on dental casts by using a dial calliper. A decrease in the mean alveolar thickness, exceeding a cut-off value of 0.1 mm, was found in 60% of the women and an increase was found in 3% of the individuals. This decrease was 0.22 ± 0.20 mm in the posterior region and 0.16 ± 0.19 mm in the anterior region. The changes in alveolar thickness in the posterior region were significantly correlated to the BMD changes both on the mid-crestal level site and on the cervical level site. We conclude that the bucco-lingual thickness decreases with age in the dentate alveolar process, possibly owing to periosteal resorption related to skeletal bone loss. [source] Haemostatic management of intraoral bleeding in patients with congenital deficiency of ,2-plasmin inhibitor or plasminogen activator inhibitor-1HAEMOPHILIA, Issue 5 2004Y. Morimoto Summary., Haemostatic management of intraoral bleeding was investigated in patients with congenital ,2-plasmin inhibitor (,2-PI) deficiency or congenital plasminogen activator inhibitor- 1 (PAI-1) deficiency. When extracting teeth from patients with congenital ,2-PI deficiency, we advocate that 7.5,10 mg kg,1 of tranexamic acid be administered orally every 6 h, starting 3 h before surgery and continuing for about 7 days. For the treatment of continuous bleeding, such as post-extraction bleeding, 20 mg kg,1 of tranexamic acid should be administered intravenously, and after achieving local haemostasis 7.5 mg kg,1 of tranexamic acid should be administered orally every 6 h for several days. In addition, when treating haematoma caused by labial or gingival laceration or buccal or mandibular contusion, haemostasis should be achieved by administering 7.5,10 mg kg,1 of tranexamic acid every 6 h. Tranexamic acid can also be used for haemostatic management of intraoral bleeding in patients with congenital PAI-1 deficiency, but is less effective when compared with use in patients with congenital ,2-PI deficiency. Continuous infusion of 1.5 mg kg,1 h,1 of tranexamic acid is necessary for impacted tooth extraction requiring gingival incision or removal of local bone. [source] Effect of tooth loss on spatial memory and trkB-mRNA levels in ratsHIPPOCAMPUS, Issue 6 2008Kaoruko Yamazaki Abstract The mechanism by which tooth loss accelerates spatial memory impairment is unknown. The purpose of this study was to test the hypothesis that tooth loss affects trkB-mRNA levels and leads to an accelerated decrease in the hippocampal cell density in rats. A radial maze was used to evaluate the spatial memory of male Wistar rats that were categorized based on the number of extracted molar teeth. Number of hippocampal pyramidal cells and the trkB-mRNA expressions in the amygdala, perirhinal cortex, thalamus, and the hippocampal CA1, CA3, and CA4 areas, were evaluated using molecular biological techniques. Seven weeks after tooth extraction, maze performance was significantly lower in each tooth loss group than in the control group, and the number of extracted teeth was inversely proportional to the induction of the trkB-mRNA and the hippocampal cell density. The average weight of rats increased by controlled feeding throughout the experiment without showing a significant difference between the control and experimental groups. The results indicated that, in rats, the spatial memory-linked trkB-mRNA was reduced in association with the tooth loss; this supports the hypothesis and suggests that teeth have a role in the prevention of spatial memory impairment. © 2008 Wiley-Liss, Inc. [source] An in vitro investigation of the bulk flow of fluid through apical foramina during simulated tooth extraction: a potential confounder in microbiological studies?INTERNATIONAL ENDODONTIC JOURNAL, Issue 4 2001A. Kapalas Aim,The ,pumping action' induced during tooth extraction may cause bacteria suspended in tissue fluids to be transposed from one anatomical compartment to another. Apart from causing bacteraemia, this may lead to inaccuracies in studies evaluating the presence and distribution of bacteria in and around tooth apices. The aim was to investigate the bulk flow of fluid through apical foramina during simulated extraction of teeth in an in vitro model. The influence of the presence or absence of a coronal restoration was also evaluated. Methodology,Twenty extracted single-rooted, human, mature, permanent teeth were used. Standard access cavities were prepared and the root canals located. Standardized micrographs of the apical foramina were obtained and their area (µm2) was calculated by image analysis software. The teeth were then set and sealed into polyvinylsiloxane (rubber base) impression material. Crystal violet dye was inoculated into the coronal half of the root canal system. Tooth extraction movements were simulated in the impression matrix and the leakage of dyes with and without the presence of a coronal restoration was examined. The procedure was repeated, following application of safranin dye in a coronal trough within the simulated rubber base gingival margin at the CEJ. The results were analysed statistically with the independent-samples t -test and the McNemar test. Results,In the absence of a coronal restoration crystal violet leaked out of the apical foramina in 18/20 teeth; conversely safranin leaked into the teeth through the apical foramina in 11/20 cases when applied to the external root surface. In the presence of an intact coronal restoration crystal violet dye leaked out in 6/20 teeth and conversely safranin leaked into 7/20 teeth. The presence of a coronal restoration significantly reduced (P = 0.002) dye leakage out of the root canal system. No associations were found for leakage of dye into the root canal system when applied externally. In addition, the amount of dye leakage was positively correlated with the area of the apical foramen in the presence of a coronal restoration (P = 0.009). Conclusion,The presence of a coronal restoration significantly reduced leakage of dye out of the apical foramen. Microbiological studies on root canals and periapical lesions using extracted teeth should take potential contamination from this source into account. [source] Description of a clinical technique for tooth extraction in the cleft lip and palate areaINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 2 2001G.S. Dalben Cleft lip and palate are relatively common congenital malformations, which may require specialist paedodontic treatment. In this article, the case of a 9-year-old boy with bilateral complete cleft lip and palate is presented. He attended the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC) for routine examination, during which the presence of pre-canine supernumeraries bilaterally in the cleft area was seen. The extraction of these dental elements was justified by extensive carious lesions and because they represented a potential problem during secondary palatoplasty. The precautions needed in tooth extraction in patients with cleft lip and palate are described, together with illustrations of the clinical procedure. [source] Immediate implants at fresh extraction sockets: an experimental study in the beagle dog comparing four different implant systems.JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2010Soft tissue findings de Sanctis M, Vignoletti F, Discepoli N, Muñoz F, Sanz M. Immediate implants at fresh extraction sockets: an experimental study in the beagle dog comparing four different implant systems. Soft tissue findings. J Clin Periodontol 2010; 37: 769-776 doi: 10.1111/j.1600-051X.2010.01570.x. Abstract Objectives: To evaluate whether different implants placed immediately upon tooth extraction may affect the dimension and composition of the peri-implant soft tissues. Material and Methods: Eight beagle dogs received implants randomly installed into the distal socket of 3P3 and 4P4. Four commercially available implant systems were evaluated: 3i Osseotite Certain straight; Astra MicroThreadÔ -OsseoSpeedÔ; Thommen SPI Element®; and Straumann ITI standard. Each animal provided four test implant sites. All animals were sacrificed 6 weeks after implant placement, providing specimens for the evaluation of the soft tissue dimensions by histometric analysis. Results: The biological width at 6 weeks after implant placement consisted of a junctional epithelium measuring between 2 and 2.7 mm and a connective tissue component between 1 and 1.8 mm with no statistical differences among the four implant systems. Conclusion: This study failed to demonstrate differences in the soft tissue healing outcome when placing four different implant systems into fresh extraction sockets. Nevertheless, the length of the epithelium achieved with the four implant systems is longer than what has been reported when placing implants in healed-ridge experimental models. [source] Hard tissue alterations after socket preservation with additional buccal overbuilding: a study in the beagle dogJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2009Stefan Fickl Abstract Objectives: The aim of this study was to histometrically assess alterations of the ridge following socket preservation alone and socket preservation with additional buccal overbuilding. Material and Methods: In five beagle dogs four extraction sites were randomly subjected to one of the following treatments: Tx 1: The socket was filled with BioOss Collagen® and covered with a free gingival graft from the palate. Tx 2: The buccal bone plate was augmented using the GBR-technique, the socket was filled with BioOss Collagen® and covered with a free gingival graft. Tx 3: The buccal bone plate was forced into a buccal direction using a manual bone spreader. The socket was filled with BioOss Collagen® and covered with a free gingival graft from the palate. Tx 4: The socket was filled with BioOss Collagen® and a combined free gingival/connective tissue graft was used to cover the socket and for buccal tissue augmentation. For each experimental site, two histological sections were subjected to histometric analysis and evaluated for (i) vertical bone dimensions and (ii) horizontal bone dimensions. Results: All treatment groups showed horizontal and vertical bone loss. The mean vertical bone loss of the buccal bone plate was significantly lower in Tx 4 than in the other groups, while no statistical significant differences could be detected among the groups in the horizontal dimension. Conclusion: Overbuilding the buccal aspect in combination with socket preservation does not seem to be a suitable technique to compensate for the alterations after tooth extraction. [source] Tissue alterations after tooth extraction with and without surgical trauma: a volumetric study in the beagle dogJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2008Stefan Fickl Abstract Objectives: The aim of this study is to evaluate whether tooth extraction without the elevation of a muco-periosteal flap has advantageous effects on the resorption rate after tooth extraction. Material and Methods: In five beagle dogs polyether impressions were taken before the surgery. The roots of the first and second pre-molars (P1 and P2) were extracted and the sites were assigned to one of the following treatments: treatment group (Tx) 1, no treatment; Tx 2, surgical trauma (flap elevation and repositioning); Tx 3, the extraction socket was filled with BioOss Collagen® and closed with a free soft-tissue graft; Tx 4, after flap elevation and repositioning, the extraction socket was treated with BioOss Collagen® and a free soft-tissue graft. Impressions were taken 2 and 4 months after surgery. The casts were scanned, matched together with baseline casts and evaluated with digital image analysis. Results: The "flapless groups" demonstrated significant lower resorption rates both when using socket-preservation techniques and without. Furthermore, socket-preservation techniques yielded better results compared with not treating the socket. Conclusion: The results demonstrate that leaving the periosteum in place decreases the resorption rate of the extraction socket. Furthermore, the treatment of the extraction socket with BioOss Collagen® and a free gingival graft seems beneficial in limiting the resorption process after tooth extraction. [source] Long-term effect of full-mouth tooth extraction on the responsiveness of peripheral blood monocytesJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2003Schelte J. Fokkema Abstract Background: As some residual inflammation may remain after periodontal therapy, the present pilot study investigated the long-term effect of full-mouth tooth extraction therapy on the responsiveness of peripheral blood monocytes in a case with generalized terminal adult periodontitis. Methods: Before and 3, 9, 20 and 32 months after therapy, venous blood was collected. Total and differential white blood cell counts were determined and whole blood cell cultures (WBCC) were incubated with lipopolysaccharide (LPS) to stimulate the production of inflammatory mediators by monocytes. Results: After full-mouth tooth extraction, the numbers of total peripheral white blood cells and neutrophils decreased over time. The release of the chemokines interleukin (IL)-8 and macrophage chemoattractant protein (MCP)-1 in the cultures decreased twofold over time, whereas no changes were seen for the other studied cytokines, chemokines and prostaglandin E2. Conclusion: On the basis of previous studies and the present case, the high production of IL-8 and MCP-1 by monocytes in LPS-stimulated WBCC from periodontitis patients is most likely acquired, as their levels decrease over time when the periodontal infection is controlled. The possible connection between periodontitis and atherosclerosis through IL-8 and MCP-1 is discussed. Zusammenfassung Hintergrund: Da nach der parodontalen Therapie eine restliche Entzündung zurückbleiben kann, untersucht die vorliegende Studie den Langzeiteffekt einer vollständigen Zahnextraktion auf die Ansprechbarkeit der peripheren Blutmonozyten in einem Fall mit generalisierter unheilbarer Erwachsenen-Parodontitis. Methoden: Vor und 3, 9, 20 und 32 Monaten nach der Therapie wurde venöses Blut gesammelt. Der totale und differenzierte weiße Blutzellgehalt wurden bestimmt, und eine gesamte Blutzellkultur (WBCC) wurde mit Lipopolysaccharid inkubiert, um die Produktion von Entzündungsmediatoren durch Lymphozyten zu stimulieren. Ergebnisse: Nach der vollständigen Zahnextraktion verringerte sich die Zahl der totalen peripheren weißen Blutzellen und der Neutrophilen über die Zeit. Die Freisetzung des Chemokins Interleukin 8 (IL-8) und des Makrophagen chemoattraktanten Proteins (MCP) ,1 in den Kulturen verringerte sich zweifach über die Zeit, während für die anderen beobachteten Cytokine, Chemokine und Prostaglandin E2 keine Veränderungen festgestellt wurden. Schlussfolgerung: Auf der Basis vorheriger Studien und des vorliegenden Falls ist die hohe Produktion von IL-8 und MCP-1 durch Monozyten in LPS stimulierten WBCC von Parodontitis-Patienten sehr wahrscheinlich anzunehmen, da ihr Level über die Zeit abnimmt, wenn die parodontale Infektion kontrolliert ist. Die mögliche Verbindung zwischen Parodontitis und Arteriosklerose durch IL-8 und MCP-1 wird diskutiert. Résumé Contexte: Puisqu'après traitement parodontal, une inflammation résiduelle peut subsister, cette étude se propose de rechercher les effets à long terme de l'extraction complète des dents sur la réponse des monocytes périphériques dans un cas de parodontite de l'adulte terminale généralisée. Méthodes: Des prélèvements sanguins veineux ont été réalisés avant et 3, 9, 20 et 32 mois après traitement. Les comptages totaux et relatifs des cellules blanches sanguines furent déterminés et les cultures complètes de cellules sanguines (WBCC) furent incubées avec du lipopolysaccharide pour stimuler la production des médiateurs de l'inflammation par les monocytes. Résultats: Après l'extraction complète des dents, les nombres de cellules sanguines blanches totales périphériques et des neutrophiles diminuaient au cours du temps. Le relargage des chimiokines interleukine (IL)-8 et protéine chimio-attractante du macrophage (MCP)-1 dans les cultures diminuait deux fois au cours du temps, alors qu'aucun changement n'était observé pour les autres cytokines étudiées, chimiokines et prostaglandine E2. Conclusion: Sur la base d'études préalables, et les résultats issus de ce cas présent, la forte production d'IL-8 et de MCP-1 par les monocytes dans les WBCC stimulés par le LPS chez des patients atteints de parodontite semble être vraisemblablement acquise puisque leurs niveaux diminuent lorsque l'infection parodontale est contrôlée. La relation possible entre parodontite et l'athérosclérose par IL-8 et MCP-1 est discutée. [source] Post-tooth extraction sepsis without locoregional infection , a population-based study in TaiwanORAL DISEASES, Issue 8 2009J-J Lee Objective:, To investigate the incidence and risk factors of post-tooth extraction sepsis in patients without locoregional infection. Subjects and Methods:, We assessed all claim records of the Taiwanese National Health Insurance program in 2005. Admissions for patients aged ,16 years containing a discharge diagnosis of sepsis, and who received tooth extraction within 14 days before the admission were identified. Patient charts were reviewed to confirm the diagnosis of sepsis and rule out other infection sources. The relationship between postextraction sepsis (PES) and clinical parameters was analyzed. Results:, Thirty-three of the 2 223 971 extraction cases met the criteria of PES, an incidence of 1.48 per 100 000, and seven patients (21.2%) died of the disease. Aging significantly increased the risk of PES (P < 0.001). Pre-existing comorbidities were found in 20 of the 33 cases, with diabetes mellitus and hematologic diseases the most common. The method, number, and position of extraction had no influence on PES incidence. Blood cultures were positive in 25 patients (75.8%) and isolates included species of the Streptococcus, Actinomyces, Klebsiella, Bacteroides, Prevotella, and Enterococcus genera. Conclusion:, Tooth extraction is associated with a low but significant risk of postoperative sepsis, especially in the elderly and patients with underlying diseases. [source] Immediate Provisional for Single-Tooth Implant Replacement with Brånemark System: Preliminary ReportCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2001Edward Hui MDS, FDSRCS, FRCDC Abstract: Background: The success of osseointegrated implants ad modum Brånemark for single-tooth restorations is documented. Future developments should aim at improving the benefits to patients by decreasing treatment time, minimizing surgical stages, and maximizing esthetic outcomes. Using knowledge from studies of immediate implant placement, one-stage, immediate loading protocols, the authors developed the immediate provisional. Purpose: The purpose of this study was to develop a protocol to provide an immediate solution for restoring a single missing tooth in the esthetic zone. The protocol should be simple, predictable, cost effective, and allow the use of other techniques to improve esthetic outcome. Materials and Method: This prospective clinical study included 24 patients treated from August 1999 to October 2000. Single-tooth implant replacement was done according to immediate provisional protocol. Thirteen of the 24 patients had immediate implant placement after tooth extraction. All implants were placed in the esthetic zone. During surgery, emphasis was placed on obtaining primary stability by achieving bicortical anchorage and maximum insertion torque of at least 40 Ncm. CeraOne (Nobel Biocare) abutments were used, and provisional crowns were fabricated immediately before wound closure. The occlusion was protected by adjacent teeth. Results: Within the follow-up period of between 1 month and 15 months, all fixtures in the 24 patients were stable. Crestal bone loss greater than one thread-width was not detected. The esthetic result was considered satisfactory by all patients. Conclusions: The implant placement and restoration protocol used in this study showed promising initial results for both the immediate implant and healed extraction site groups. The desirable goals of patient satisfaction, excellent esthetic outcomes, and no increase in treatment cost were achieved in this protocol. Further studies to elucidate the potential of the immediate provisional protocol are justified. [source] Effects of Implant Design and Surface on Bone Regeneration and Implant Stability: An Experimental Study in the Dog MandibleCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 1 2001Lars Rasmusson DMD ABSTRACT Background: Previous experimental studies have shown a higher degree of bone-implant contact for surface-enlarged implants compared with machined implants. Yet, there is insufficient evidence that such implants show higher stability and an increased survival rate. Purpose: The purpose of this investigation was to study the integration and stability of grit-blasted implants with retention elements on the implant neck, with and without marginal bone defects, compared with machined implants without retention elements. Materials and Methods: After tooth extraction of the mandibular premolars in six dogs, two grit-blasted, partly microthreaded Astra Tech implants and one standard Branemark implant were bilaterally placed in each dog. On one side, 3 ± 3 mm large buccal defects were created, to expose three to four implant threads. The contralateral side served as control, and no defects were made. The animals were sacrificed after 4 months of healing. Implant stability was measured using resonance frequency analysis at implant installation and after 4 months of healing. Histologic and histomorpho-metric evaluation was made after 4 months of healing. Results: Resonance frequency analysis indicated that all implants in the test and control groups were osseointegrated after 4 months, with a tendency toward higher implant stability for the Astra Tech implants. There was a statistically significant higher increase in resonance frequency for the Astra test implants compared with their corresponding controls. Histology and histomorphometry showed well-integrated implants with varying degrees of bone repair at the defect sites. The greater bone-implant contact for the Astra implants was statistically significant. No significant difference between the implants in amount of bone filling the threads was recorded. Conclusions: The Astra Tech implants tested showed a higher degree of bone,implant contact and higher level of bone regenerated at defect sites compared with the Brånemark implants. Resonance frequency analysis demonstrated a significantly higher increase in the Astra test implants compared with their control groups than did the Brånemark test implants versus their controls. [source] Alveolar ridge preservation with guided bone regeneration and a synthetic bone substitute or a bovine-derived xenograft: a randomized, controlled clinical trialCLINICAL ORAL IMPLANTS RESEARCH, Issue 7 2010Nikos Mardas Abstract Objectives: The aim of this randomized, controlled clinical trial was to compare the potential of a synthetic bone substitute or a bovine-derived xenograft combined with a collagen membrane to preserve the alveolar ridge dimensions following tooth extraction. Methods: Twenty-seven patients were randomized into two treatment groups following single tooth extraction in the incisor, canine and premolar area. In the test group, the alveolar socket was grafted with Straumann Bone Ceramic® (SBC), while in the control group, Bio-Oss® deproteinized bovine bone mineral (DBBM) was applied. In both groups, a collagen barrier was used to cover the grafting material. Complete soft tissue coverage of the barriers was not achieved. After 8 months, during re-entry procedures and before implant placement, the horizontal and vertical dimensions of the residual ridge were re-evaluated and trephine biopsies were performed for histological analysis in all patients. Results: Twenty-six patients completed the study. The bucco-lingual dimension of the alveolar ridge decreased by 1.1±1 mm in the SBC group and by 2.1±1 in the DBBM group (P<0.05). Both materials preserved the mesio-distal bone height of the ridge. No differences in the width of buccal and palatal bone plate were observed between the two groups. The histological analysis showed new bone formation in the apical part of the biopsies, which, in some instances, was in direct contact with both SBC and DBBM particles. The coronal part of the biopsies was occupied by a dense fibrous connective tissue surrounding the SBC and DBBM particles. Conclusion: Both biomaterials partially preserved the width and the interproximal bone height of the alveolar ridge. To cite this article: Mardas N, Chadha V, Donos N. Alveolar ridge preservation with guided bone regeneration and a synthetic bone substitute or a bovine-derived xenograft: a randomized, controlled clinical trial. Clin. Oral Impl. Res. 21, 2010; 688,698. [source] ,-tricalcium phosphate in the early phase of socket healing: an experimental study in the dogCLINICAL ORAL IMPLANTS RESEARCH, Issue 4 2010Mauricio G. Araújo Abstract Objectives: The aim of this experiment was to analyze processes involved in the incorporation of ,-tricalcium phospate (TCP) particles in host tissue during healing following tooth extraction and grafting. Material and methods: Five beagle dogs were used. Four premolars in the maxilla (3P3, 2P2) were hemi-sected, the distal roots were removed and the fresh extraction socket filled with TCP. The tooth extraction and grafting procedures were scheduled in such a way that biopsies representing 1 and 3 days, as well as 1, 2, and 4 weeks of healing could be obtained. Tissue elements such as cells, fibers, vessels, leukocytes and mineralized bone were determined. In deparaffinized sections structures and cells that expressed Tratarate resistant acid phosphate, alkaline phosphatase, and osteopontin were identified by the use of markers. Results: The porosities of the TCP particles were initially filled with erythrocytes that subsequently were replaced with mineralized bone. Some of the graft material was invaded by mesenchymal and inflammatory cells and disintegrated. Thus, small membrane bound granules appeared in the granulation tissue and the provisional matrix. In the process of hard tissue formation, partly mineralized (modified) TCP particles became surrounded by ridges of woven bone. Conclusions: It was demonstrated that the early healing of an extraction socket that had been grafted with ,-TCP involved (i) the formation of a coagulum that was (ii) replaced with granulation tissue and a provisional matrix in which (iii) woven bone could form. In this process the biomaterial was apparently involved. To cite this article: Araújo MG, Liljenberg B, Lindhe J. ,-tricalcium phosphate in the early phase of socket healing: an experimental study in the dog. Clin. Oral Impl. Res. 21, 2010; 445,454. doi: 10.1111/j.1600-0501.2009.01876.x [source] A prospective, randomized-controlled clinical trial to evaluate bone preservation using implants with different geometry placed into extraction sockets in the maxillaCLINICAL ORAL IMPLANTS RESEARCH, Issue 1 2010Mariano Sanz Abstract Aim: The primary objective of this study was to determine the association between the size of the void established by using two different implant configurations and the amount of buccal/palatal bone loss that occurred during 16 weeks of healing following their installation into extraction sockets. Material and methods: The clinical trial was designed as a prospective, randomized-controlled parallel-group multicenter study. Adults in need of one or more implants replacing teeth to be removed in the maxilla within the region 15,25 were recruited. Following tooth extraction, the site was randomly allocated to receive either a cylindrical (group A) or a tapered implant (group B). After implant installation, a series of measurements were made to determine the dimension of the ridge and the void between the implant and the extraction socket. These measurements were repeated at the re-entry procedure after 16 weeks. Results: The study demonstrated that the removal of single teeth and the immediate placement of an implant resulted in marked alterations of the dimension of the buccal ridge (43% and 30%) and the horizontal (80,63%) as well as the vertical (69,65%) gap between the implant and the bone walls. Although the dimensional changes were not significantly different between the two-implant configurations, both the horizontal and the vertical gap changes were greater in group A than in group B. Conclusions: Implant placement into extraction sockets will result in significant bone reduction of the alveolar ridge. To cite this article: Sanz M, Cecchinato D, Ferrus J, Pjetursson EB, Lang NP, Jan L. A prospective, randomized-controlled clinical trial to evaluate bone preservation using implants with different geometry placed into extraction sockets in the maxilla. Clin. Oral Impl. Res. 21, 2009; 13,21. [source] Tooth extraction decision model in periodontitis patientsCLINICAL ORAL IMPLANTS RESEARCH, Issue 1 2010A. Popelut Abstract Objective: The purpose of this study was to build, around several types of input data, a decision analysis model for dental extraction strategy in periodontitis patients. Materials and methods: The decision analysis was based on the following scenario: a fictitious adult chronic periodontitis patient with no chief complaint, being referred to make a decision of extraction on one single tooth presenting a periodontal defect that may affect the decision-making process. A decision tree was used to identify the treatment options within the next 5 years. Scientific evidences were based on probabilities given by a literature analysis using a systematic approach. Clinical expertize was based on subjective utilities (SUs) assigned by an experts' panel. Expected utilities (EUs) were used to rank the following options: no treatment (EU1) or periodontal treatment (EU2); extraction followed by a tooth-supported fixed partial denture , FPD , (EU3) or an implant-supported single crown , ISC , (EU4). Results: The robustness analysis calculation indicates that the probability of tooth survival needed to be equal to 0.78 in order that the passive option becomes optimal. However, EU1 was impossible to calculate due to the lack of available probabilities. The EU intervals were 79,96, 86,89 and 94,95 for EU2, EU3 and EU4, respectively. Consequently, the FPD option is dominated by the ISC option, and it is not possible to conclude to a difference between the periodontal and the ISC therapy. Conclusions: Within the limits of this model, tooth extraction followed by FPD is the worst strategy compared with ISC or periodontal therapies. To cite this article: Popelut A, Rousval B, Fromentin O, Feghali M, Mora F, Bouchard P. Tooth extraction decision model in periodontitis patients. Clin Oral Impl Res. 21, 2010; 80,89. [source] Clinical outcome of submerged vs. non-submerged implants placed in fresh extraction socketsCLINICAL ORAL IMPLANTS RESEARCH, Issue 12 2009Luca Cordaro Abstract Aim: The aim of this study was to compare the clinical outcome of submerged vs. non-submerged tapered implants placed into fresh extraction sockets. Materials and methods: A prospective, controlled, multicenter, randomized, clinical trial has been performed in two centers in Rome and Torino (Italy). Thirty healthy patients were recruited according to the following inclusion criteria: need for an immediate post extraction implant, ages between 18 and 70, horizontal defect depth <2 mm, smokers <10 cigarettes/day and absence of any circumstance or condition that could represent contraindications to implant surgery. The patients were randomly allocated to submerged or non-submerged treatment groups immediately after flap elevation and tooth extraction. Submerged implants were exposed 8 weeks after the first surgery; all implants were loaded with provisional restorations 12 weeks after the first surgery and with definitive restoration 12 weeks thereafter. Clinical and radiographic parameters were evaluated at baseline, at implant loading and at the 1-year follow-up visit. Results: The results showed statistically significant differences between the two groups in the mean value of keratinized tissue (KT) height after surgery that was significantly reduced for submerged implants when compared with transmucosal implants (mean reduction of KT at year follow-up: T group 0.2 mm, S group 1.3 mm; P=0.007). Conclusion: Similar outcomes were found for submerged and non-submerged implants placed in fresh extraction sockets with a horizontal peri-implant defect smaller than 2 mm, except for a reduction of KT in the submerged group. Either with a submerged or a non-submerged procedure, 1 mm of mean soft tissue recession is seen after 1 year when compared with the pre-extraction situation. [source] What influence do anticoagulants have on oral implant therapy?CLINICAL ORAL IMPLANTS RESEARCH, Issue 2009A systematic review Abstract Objectives: This systematic review aims to assess the risks (both thromboembolic and bleeding) of an oral anticoagulation therapy (OAT) patient undergoing implant therapy and to provide a management protocol to patients under OAT undergoing implant therapy. Material and methods: Medline, Cochrane Data Base of Systematic Reviews, the Cochrane Central Register of Controlled Trials and EMBASE (from 1980 to December 2008) were searched for English-language articles published between 1966 and 2008. This search was completed by a hand research accessing the references cited in all identified publications. Results: Nineteen studies were identified reporting outcomes after oral surgery procedures (mostly dental extractions in patients on OAT following different management protocols and haemostatic therapies). Five studies were randomized-controlled trials (RCTs), 11 were controlled clinical trials (CCTs) and three were prospective case series. The OAT management strategies as well as the protocols during and after surgery were different. This heterogeneity prevented any possible data aggregation and synthesis. The results from these studies are very homogeneous, reporting minor bleeding in very few patients, without a significant difference between the OAT patients who continue with the vitamin K antagonists vs. the patients who stopped this medication before surgery. These post-operative bleeding events were controlled only with local haemostatic measures: tranexamic acid mouthwashes, gelatine sponges and cellulose gauzes's application were effective. Post-operative bleeding did not correlate with the international normalised ratio (INR) status. In none of the studies was a thromboembolic event reported. Conclusions: OAT patients (INR 2,4) who do not discontinue the AC medication do not have a significantly higher risk of post-operative bleeding than non-OAT patients and they also do not have a higher risk of post-operative bleeding than OAT patients who discontinue the medication. In patients with OAT (INR 2,4) without discontinuation, topical haemostatic agents were effective in preventing post-operative bleeding. OAT discontinuation is not recommended for minor oral surgery, such as single tooth extraction or implant placement, provided that this does not involve autogenous bone grafts, extensive flaps or osteotomy preparations extending outside the bony envelope. Evidence does not support that dental implant placement in patients on OAT is contraindicated. [source] Ridge alterations following tooth extraction with and without flap elevation: an experimental study in the dogCLINICAL ORAL IMPLANTS RESEARCH, Issue 6 2009Mauricio G. Araújo Abstract Background: Different approaches were advocated to preserve or improve the dimension and contour of the ridge following tooth extraction. In some of studies, socket ,flapless extraction' apparently had a successful outcome. Aim: The objective of the present experiment was to compare hard tissue healing following tooth extraction with or without the prior elevation of mucosal full-thickness flaps. Material and methods: Five mongrel dogs were used. The two second mandibular premolars (2P2) were hemi-sected. The mesial roots were retained. By random selection the distal root in one side was removed after the elevation of full-thickness flaps while on the contralateral side, root extraction was performed in a flapless procedure. The soft tissue wound was closed with interrupted sutures. After 6 months of healing, the dogs were euthanized and biopsies were sampled. From each experimental site, four ground sections , two from the mesial root and two from the healed socket , were prepared, stained and examined in the microscope. Results: The data showed that the removal of a single tooth (root) during healing caused a marked change in the edentulous ridge. In the apical and middle portions of the socket site minor dimensional alterations occurred while in the coronal portion of the ridge the reduction of the hard tissue volume was substantial. Similar amounts of hard tissue loss occurred during healing irrespective of the procedure used to remove the tooth was, i.e. flapless or following flap elevation. Conclusion: Tooth loss (extraction) resulted in marked alterations of the ridge. The size of the alveolar process was reduced. The procedure used for tooth extraction , flapless or following flap elevation , apparently did not influence the more long-term outcome of healing. [source] Modeling of the buccal and lingual bone walls of fresh extraction sites following implant installationCLINICAL ORAL IMPLANTS RESEARCH, Issue 6 2006Mauricio G. Araújo Abstract Objective: To determine whether the reduction of the alveolar ridge that occurs following tooth extraction and implant placement is influenced by the size of the hard tissue walls of the socket. Material and methods: Six beagle dogs were used. The third premolar and first molar in both quadrants of the mandible were used. Mucoperiostal flaps were elevated and the distal roots were removed. Implants were installed in the fresh extraction socket in one side of the mandible. The flaps were replaced to allow a semi-submerged healing. The procedure was repeated in the contra later side of the mandible after 2 months. The animals were sacrificed 1 month after the final implant installation. The mandibles were dissected, and each implant site was removed and processed for ground sectioning. Results: Marked hard tissue alterations occurred during healing following tooth extraction and implant installation in the socket. The marginal gap that was present between the implant and the walls of the socket at implantation disappeared as a result of bone fill and resorption of the bone crest. The modeling in the marginal defect region was accompanied by marked attenuation of the dimensions of both the delicate buccal and the wider lingual bone wall. Bone loss at molar sites was more pronounced than at the premolar locations. Conclusion: Implant placement failed to preserve the hard tissue dimension of the ridge following tooth extraction. The buccal as well as the lingual bone walls were resorbed. At the buccal aspect, this resulted in some marginal loss of osseointegration. [source] Social inequality in tooth extraction in a Brazilian insured working populationCOMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 5 2007Joaquim Murilo Silveira Neto Abstract,,, Objectives:, Given the scant evidence of the socioeconomic gradient in tooth loss incidence, the purpose of this study was to compare the odds of individuals of distinct social strata being subjected to tooth extraction. Methods:, We undertook a case,control study at the head office of a large Brazilian company whose employees had access to dental care through the company's dental insurance. Results:, During 2 years of observation, 264 teeth were extracted and the distribution of such extractions was rather unequal. A strong suggestion of a social gradient was noted and the odds of tooth extraction occurring per social strata, adjusted by age and gender, were five times higher in employees pertaining to the lowest social stratum, when compared with those at the highest. Conclusions:, We concluded that lower social strata were strongly associated with increased risk of having teeth extracted. Dental insurance was not able to equalize the chances of tooth extraction among different social strata, in a population of employed adults. [source] Co-morbidity in the ageing haemophilia patient: the down side of increased life expectancyHAEMOPHILIA, Issue 4 2009E. P. MAUSER-BUNSCHOTEN Summary., Because of an increased life expectancy, (age-related) co-morbidity is becoming a common occurrence in haemophilia patients. In this review, haemophilia-related and non-haemophilia-related medical problems, treatment recommendations and psychosocial consequences in ageing haemophilia patients are discussed. Haemophilic arthropathy is an important cause of pain and disability, and a frequent indication for surgery in haemophilia patients. In addition, many adult patients are infected with hepatitis C or HIV, the consequences and treatment of which can add to physical and mental discomfort. Moreover, inhibitors against factor VIII can also develop in adulthood, especially in patients with mild haemophilia. Hypertension is reported to occur more often in haemophilia patients than in the general population. Other internal problems, like renal abnormalities, overweight, diabetes mellitus and hypercholesterolemia are discussed. Haemophilia seems to protect against cardiovascular disease, although the incidence is increasing. Recommendations are given on dealing with tooth extractions, surgical interventions and sexuality problems in patients with haemophilia. In addition to haemophilia in itself, co-morbidity has a major psychological impact, and an important effect on quality of life. It can also result in complex treatment regimens, in which coordination between health care workers is essential. [source] Tooth loss and cognitive impairmentJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 7 2009Hans Joergen Grabe Abstract Objectives: Chronic subclinical inflammation may elevate the risk of cognitive impairment. Periodontitis is associated with subclinical inflammation and accounts in part for tooth loss. The hypothesis was tested that periodontitis and tooth loss as a proxy of chronic periodontitis is associated with cognitive impairment in the elderly. Subjects and Methods: The population-based Study of Health in Pomerania comprises 1336 subjects (60,79 years). Cognitive impairment was assessed with the Mini-Mental Status Examination (MMSE). Tobit regression analyses were adjusted for potential confounders. Results: A decreased number of teeth was associated with lower MMSE scores in females (p<0.001) and males (p=0.007) in age-adjusted models. In the fully adjusted models, tooth loss was associated with cognitive impairment in females (p=0.002) but not in males (p=0.825). Conclusions: A significant association between tooth loss and cognitive impairment was found in females that was not accounted for by potential confounders. Former periodontitis may account for this association as periodontitis was frequently the cause for tooth extractions. [source] | |||||||||||||||||||||||||