Search

Objective: Surgical removal of third molars is often associated with complications. The aim of the present study was to analyze the incidence of complications following extraction of third molars relative to the risk factors. Method and Materials: This retrospective study included 463 patients who had mandibular third molar extraction (performed by a single surgeon, DSA) in the years 2001 to 2011. In total, 665 mandibular third molars were extracted. The average patient's age was 29 ± 11.30 years, median 26 years, and the patient age ranged from 13 to 75 years. Patients' records were obtained for medical/general data. Results: The overall prevalence of postsurgical complications was 17%. Dry sockets showed the highest incidence (11.6%). Partially impacted teeth showed the highest incidence of complications (67.3%). Cigarette smoking correlated with increased complications and dry sockets, and complications were more prevalent on the left side (62.8%). Conclusion: Complications after mandibular third molar extraction increase with age, level of impaction, side of extraction, and cigarette smoking. [ABSTRACT FROM AUTHOR]

Purpose: To assess the beneficial or harmful effects of systemic prophylactic antibiotics at extraction of teeth, apart from third molars, vs no antibiotic or placebo administration. Furthermore, if antibiotics are beneficial, to determine which type, dosage, duration and timing of administration is the most effective. Materials and Methods: The Cochrane Oral Health Group's Trials Register (to 30 January 2016) and MEDLINE (1 January 1950 to 30 January 2016) were searched. There were no language or date restrictions placed on the searches of the electronic databases. Randomised controlled trials (RCTs) of parallel group design, with a follow-up of at least 2 weeks, comparing the administration of various prophylactic antibiotic regimens vs no antibiotics to people undergoing extraction of teeth, not including third molars, were included. Outcome measures were postoperative complications/adverse events, post-operative pain and swelling. Screening of eligible studies, assessment of the risk of bias of the trials and data extraction were conducted in triplicate by three independent review authors. Results were to be expressed as risk ratios (RRs) using a random-effects model for dichotomous outcomes, with 95% confidence intervals (CIs). Heterogeneity, including both clinical and methodological factors, was to be investigated. Results: No relevant RCT was identified. Conclusions: There is no RCT to determine if the antibiotic therapy is needed at extraction of teeth, excluding third molars. Properly designed and conducted RCTs are needed to understand the role of the antibiotic therapy for tooth extraction. [ABSTRACT FROM AUTHOR]

Buccopalatal collapse of the postextraction ridge is a significant challenge in restorative and implant dentistry. A variety of ridge preservation techniques using tissue and augmentative materials have been proposed in the literature. A slightly different approach is to use the tooth itself. Root submergence has been reported in the literature for more than 4 decades, and it has been demonstrated that the submerged tooth root retains the periodontal tissues and preserves the bone in pontic sites or below dentures to retain the ridge. The socket-shield technique entails preparing a tooth root section simultaneous to immediate implant placement and has demonstrated histologic and clinical results that are highly promising to esthetic implant treatment. The pontic shield technique preserves the alveolar ridge at sites intended for pontic development where the root submergence technique is not possible. The aforementioned techniques collectively may be termed partial extraction therapies (PET), a term newly introduced into the literature and clinical environment. This article is a review of these ridge preservation therapies, providing a classification and a guide to their application. [ABSTRACT FROM AUTHOR]

Purpose: To compare epithelial connective tissue graft vs porcine collagen matrix for sealing postextraction sockets grafted with deproteinised bovine bone. Materials and methods: A total of 30 patients, who needed a maxillary tooth to be extracted between their premolars and required a delayed, fixed, single implant-supported restoration, had their teeth atraumatically extracted and their sockets grafted with deproteinised bovine bone. Patients were randomised according to a parallel group design into two arms: socket sealing with epithelial connective tissue graft (group A) vs porcine collagen matrix (group B). Outcome measures were: implant success and survival rate, complications, horizontal and vertical alveolar bone dimensional changes measured on Cone Beam computed tomography (CBCT) scans at three levels localised 1, 3, and 5 mm below the most coronal aspect of the bone crest (levels A, B, and C); and between the palatal and buccal wall peaks (level D); and peri-implant marginal bone level changes measured on periapical radiographs. Results: 15 patients were randomised to group A and 15 to group B. No patients dropped out. No failed implants or complications were reported 1 year after implant placement. Five months after tooth extraction there were no statistically significant differences between the 2 groups for both horizontal and vertical alveolar bone dimensional changes. At level A the difference was 0.13 ± 0.18; 95% CI 0.04 to 0.26 mm (P = 0.34), at level B it was 0.08 ± 0.23; 95% CI -0.14 to 0.14 (P = 0.61), at level C it was 0.05 ± 0.25; 95% CI -0.01 to 0.31 mm (P = 0.55) and at level D it was 0.13 ± 0.27; 95% CI -0.02 to 0.32 mm (P = 0.67). One year after implant placement there were no statistically significant differences between the 2 groups for peri-implant marginal bone level changes (difference: 0.07 ± 0.11 mm; 95% CI -0.02 to 0.16; P = 0.41). Conclusions: When teeth extractions were performed atraumatically and sockets were filled with deproteinised bovine bone, sealing the socket with a porcine collagen matrix or a epithelial connective tissue graft showed similar outcomes. The use of porcine collagen matrix allowed simplification of treatment because no palatal donor site was involved. [ABSTRACT FROM AUTHOR]

Conflict-of-interest statement: None declared. This review is based on a Cochrane systematic review entitled 'Interventions for replacing missing teeth: dental implants in fresh extraction sockets (immediate, immediate-delayed and delayed implants)' published in The Cochrane Library (see http://www.cochrane.org/ for information). Cochrane systematic reviews are regularly updated to include new research, and in response to comments and criticisms from readers. If you wish to comment on this review, please send your comments to the Cochrane website or to Marco Esposito. The Cochrane Library should be consulted for the most recent version of the review. The results of a Cochrane review can be interpreted differently, depending on people's perspectives and circumstances. Please consider the conclusions presented carefully. They are the opinions of the review authors, and are not necessarily shared by the Cochrane Collaboration. Purpose: To evaluate success, complications, aesthetics and patient satisfaction among immediate, immediate-delayed and delayed implants in post-extractive sockets and whether and when augmentation procedures are necessary and which is the most effective augmentation technique. Materials and methods: The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched up to the 2nd of June 2010 for randomised controlled clinical trials (RCTs) with a follow-up of at least 1 year in function comparing immediate, immediate-delayed and delayed implants, or comparing various bone augmentation procedures around the inserted implants. Outcome measures were prosthesis and implant failures, complications, patient satisfaction and preference including aesthetics, aesthetics evaluated by a dentist, peri-implant marginal bone level changes, etc. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. The statistical unit of the analysis was the patient. Results were expressed as fixed effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CIs). Results: Fourteen eligible RCTs were identified but only seven trials could be included. Four RCTs evaluated implant placement timing. Two RCTs compared immediate versus delayed implants in 126 patients and found no statistically significant differences. One RCT compared immediate-delayed Copyright by versus delayed implants in 46 patients. After 2 years, patients in the immediate-delayed group perceived the time to functional loading significantly shorter, were more satisfied and an independent blinded assessor judged the level of the peri-implant marginal mucosa in relation to that of the adjacent teeth as more appropriate (RR = 1.68; 95% CI 1.04 to 2.72). These differences disappeared 5 years after loading, and significantly more complications occurred in the immediatedelayed group (RR = 4.20; 95% CI 1.01 to 17.43). One RCT compared immediate with immediately delayed implants in 16 patients for 2 years and found no differences. Three RCTs evaluated different techniques of bone grafting for implants immediately placed in extraction sockets. No statistically significant differences were observed when evaluating whether autogenous bone is needed in postextractive sites (one trial with 26 patients) or which was the most effective augmentation technique (two trials with 56 patients). Conclusions: There is insufficient evidence to determine the possible advantages or disadvantages of immediate, immediate-delayed or delayed implants, therefore these preliminary conclusions are based on few underpowered trials often judged to be at high risk of bias. There is a suggestion that immediate and immediate-delayed implants may be at a higher risk of implant failure and complications than delayed implants, on the other hand the aesthetic outcome might be better when placing implants just after tooth extraction. There is not enough reliable evidence supporting or refuting the need for augmentation procedures at immediate implants placed in fresh extraction sockets or whether any of the augmentation techniques is superior to the others. [ABSTRACT FROM AUTHOR]

Conflict-of-interest statement: Marco Esposito is the first author of two of the included studies; however, he was not involved in the quality assessment of these trials. This review is based on a Cochrane systematic review entitled 'Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications' published in The Cochrane Library (see http://www.cochrane.org for more information). Cochrane systematic reviews are regularly updated to include new research, and in response to comments and criticisms from readers. If you wish to comment on this review, please send your comments to the Cochrane website or to Marco Esposito. The Cochrane Library should be consulted for the most recent version of the review. The results of a Cochrane Review can be interpreted differently, depending on people's perspectives and circumstances. Please consider the conclusions presented carefully. They are the opinions of the review authors, and are not necessarily shared by the Cochrane Collaboration. Purpose: To assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement versus no antibiotic/placebo administration and, if antibiotics are of benefit, to find which type, dosage and duration is the most effective. Materials and methods: The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched up to 2 June 2010 for randomised controlled clinical trials (RCTs) with a follow-up of at least 3 months comparing the administration of various prophylactic antibiotic regimens versus no antibiotics to patients undergoing dental implant placement. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc.). Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Meta-analyses were conducted. Results: Four RCTs were identified: three comparing 2 g of preoperative amoxicillin versus placebo (927 patients) and the other comparing 1 g of preoperative amoxicillin plus 500 mg four times a day for 2 days versus no antibiotics (80 patients). The meta-analyses of the four trials showed a statistically significantly higher number of patients experiencing implant failures in the group not receiving antibiotics: risk ratio = 0.40 (95% confidence interval (CI) 0.19 to 0.84). The number needed to treat (NNT) to prevent one patient having an implant failure is 33 (95% CI 17-100), based on a patient implant failure rate of 5% in patients not receiving antibiotics. The other outcomes were not statistically significant, and only two minor adverse events were recorded, one in the placebo group. Conclusions: There is some evidence suggesting that 2 g of amoxicillin given orally 1 h preoperatively significantly reduce failures of dental implants placed in ordinary conditions. No significant adverse events were reported. It might be sensible to suggest the use of a single dose of 2 g prophylactic amoxicillin prior to dental implant placement. It is still unknown whether post-operative antibiotics are beneficial, and which is the most effective antibiotic. [ABSTRACT FROM AUTHOR]

The achievement of optimal esthetics around anterior dental implants has been a major challenge for many clinicians. The key to an esthetically pleasing appearance lies in the clinician's ability to properly manage the soft tissue profile around dental implants. Hence, the purpose of this case report is to describe a new technique that uses the patient's own natural tooth for the provisional implant restoration to develop soft tissue architecture that is almost identical to the patient's original immediately after tooth extraction. Ten consecutively treated patients were included in this series. Clinical measurements included soft tissue height, papilla appearance, and probing pocket depths. Other parameters such as radiographic bone levels and quality-of-life ratings were also recorded. Results from this study showed that all patients achieved a normal or Class 1 papilla appearance similar to the original appearance of the natural tooth. All patients were very happy with the treatment outcome. This newly suggested approach for restoring an anterior implant can be valuable and esthetically pleasing. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and tolerance of azithromycin in the prevention of postextraction alveolar osteitis (dry socket) in women according to their use of tobacco and oral contraceptives. Method and Materials: A clinical trial was conducted in 400 women who underwent tooth extraction, stratified into 4 risk groups according to their use of tobacco (yes/no) and oral contraceptives (yes/no). Each stratum (n = 100) was randomly divided into 2 groups: a study group that received azithromycin 500 mg once daily for 3 days after extraction and a control group that received physiologic saline 3 times daily from 24 hours after extraction for 7 days. Results: Azithromycin was significantly superior to conventional postextraction treatment with physiologic saline. There were no significant interactions with the use of either tobacco or oral contraceptives, and these variables had no confounding effects. Conclusion: Azithromycin is a safe and efficacious treatment for the prevention of dry socket in women. [ABSTRACT FROM AUTHOR]

Impaction of a maxillary canine is common. Orthodontic realignment is not always the therapy of choice. Instead, the impacted tooth can be extracted and replaced by an implant. The replacement of a single tooth with an implant in the anterior maxilla is a topic of interest for clinicians because of its esthetic implications, mostly when immediate loading has been planned. This article describes a clinical case in which an impacted maxillary canine was replaced by an immediately restored osseointegrated implant. A 21-year-old woman with a palatally impacted maxillary canine and the corresponding primary tooth still remaining in the arch was treated. Both the primary and permanent teeth were surgically extracted. A conical-shaped blasted implant was immediately placed into the socket of the primary canine. A self-contained osseous defect remained on the palatal aspect and was filled with bovine bone mineral. The implant achieved excellent primary stability, so it was immediately restored with a provisional acrylic resin crown in light centric occlusion. After 6 months, the definitive metal-ceramic crown was placed. The therapy provided an excellent esthetic result, maintaining ideal soft tissue contours and papillary height. No signs of radiolucency were visible at the 1-year evaluation. The case presented supports the use of single implants for the replacement of extracted primary teeth, especially in areas where esthetics is a high priority. Furthermore, because the prosthetic restoration was done immediately, the overall time needed to restore the patient was considerably reduced in comparison with the time required for the conventional approach. [ABSTRACT FROM AUTHOR]

This paper demonstrates the successful reconstruction of alveolar bone destroyed by advanced periodontitis and endodontic failure. It offers a staged approach that is predictable and is superior to extracting the tooth and simultaneously placing an implant fixture, or to extracting the tooth and not performing a ridge enhancement procedure. Four cases using guided tissue regeneration in combination with bone grafts prior to the placement of endosseous dental implants are discussed. [ABSTRACT FROM AUTHOR]

Displacement of impacted third molars is frequently mentioned in oral and maxillofacial surgery textbooks but rarely reported. However, should this complication arise in general practice, the clinician should not embark on potentially complicated and hazardous surgical procedures to retrieve the displaced tooth. Administration of prophylactic broad spectrum antibiotics and urgent referral to an oral and maxillofacial surgeon is recommended. [ABSTRACT FROM AUTHOR]

Diplopia caused by local anesthesia at the superior posterior alveolar nerve for the removal of the maxillary third molar is a rare complication. The diplopia is due to facial palsy of the oculomotor muscles of the globe. This paper describes the case of a 22-year-old woman, in whom diplopia was observed after an overall uncomplicated removal of the semi-impacted third molar. Possible causes of the anesthetic effects are reported. The most accepted explanation is that the anesthetic diffuses on the abducent nerve in the cavernous sinus. The necessary actions that the dental surgeon must perform are reported. [ABSTRACT FROM AUTHOR]

The article analyzes the complications which may arise in the maxillary sinus during dental restorations, by illustrating several cases in which teeth have become lodged in the antrum during extraction attempts. The antrum, as stated, may be opened during extractions. It is stated that, as restorative material may be forced into the maxillary sinus during the filling of a root canal of a posterior tooth, chronic apical inflammation of a devitalized tooth may spread occasionally to the mucosa lining the sinus, where it may cause accessory sinus inflammation. An example is presented in which a dentist perforated the sinus during the extraction of a molar but neglected to close the injury, and thus permitted impression material to pass into the sinus when an impression was being made.

The article discusses the common complications of tooth extraction such as delayed bleeding and interference with wound healing. It notes that vascular bleeding and parenchymatous bleeding from bone and mucosa are the two types of complications after tooth extraction categorized under delayed bleeding. It furthers that the interference with wound healing after a tooth extraction also happens in cases of blood diseases such as tumors, leukemia, and post-radiation therapy of tumor patients.

The article focuses on the diagnosis and treatment of oroantral fistula. For diagnosis, the dentists use the "nose-blowing" test. In unclear situations, they insert a sterile probe into the alveolus, to probe for sinus perforation. To treat the disease, the maxillary sinus is perforated relatively usually following tooth extraction in the posterior region of the upper jaw. There are often casing of sinus perforations that are detected only when the patient complains of foul taste in the mouth.

The article presents a solution for the occurrence dry socket used in dentistry, by the use of saltwater cleansing. It is stated that when dentists use forceful lavage with sterile saltwater after tooth extractions, the number of dry sockets is largely reduced. Dry sockets, which is called localized osteitis develop two to three days after extraction, in which the original clot is lost and dentists have a hard time controlling it.