Åke Nordenram

Pathological changes related to long-term impaction of third molars. A radiographic study.

Pathological changes related to impacted 3rd molars (ITM) were studied in a radiographic investigation of 2128 randomly selected patients. In radiographs from 644 patients, 1211 ITM were noted. Pathological changes were observed in 25 of 477 (5.2%) maxillary ITM and in 59 of 734 (8%) mandibular ITM. A pathologically widened pericoronal space (indicating a dentigerous cyst) was observed in 5 of 477 maxillary and 43 of 734 mandibular ITM (p less than 0.001). Other pathologic changes observed were resorption of the 2nd molars (1% in the maxilla, 1.5% in the mandible) or loss of marginal bone on the distal aspect of the second molars (4% in the maxilla, 1% in the mandible). The risk of pathological sequelae because of ITM, apparently, is low. Prophylactic surgical removal should, therefore, be regarded with some reserve, particularly in view of the high frequency of deep impactions, with greater risk for surgical complications.

Metal release from plates used in jaw fracture treatment. A pilot study

This study investigated the occurrence of corrosion associated with the use of metallic implants to stabilize jaw fractures. Three different types of plates, Co-Cr and Ni-Cr alloys and Titanium, were connected in vivo to the mandibular bone surface of monkeys (Cercopithecus aethiops). The animals were killed after 3 and 6 months. The mucous membrane and bone tissue were analysed for concentrations of Co, Cr, Ni, Mo, Al, and Ti by atomic absorption spectrophometry and a radiochemical neutron activation technique. With the exception of Ti, higher concentrations of all the above elements were found in the tissue near the implants when compared with contralateral controls. However, no signs of corrosion, macroscopic or microscopic, were observed on the surface of the implants.

Postoperative complications after surgical removal of mandibular third molars: Effects of penicillin V and chlorhexidine

A random material of 112 patients, was investigated after surgical removal of impacted lower third molars. 2 experimental groups and 1 control group were studied. Prophylactic medication with penicillin V combined with preoperative rinsing using 0.2% chlorhexidine gluconate (Hibitane) was found to reduce postoperative symptoms, when compared with preoperative rinsing alone. In both cases, patients were compared with the control group.

Prevention of postoperative symptoms by general antibiotic treatment and local bandage in removal of mandibular third molars

Abstract The investigation was performed on a random material consisting of 329 patients in whom impacted mandibular third molars had been removed surgically. The effectiveness of generally administered antibiotics (lincomycin and V-penicillin) and a local bandage (gauze sponge) saturated with Whiteheads varnish in preventing postoperative symptoms was evaluated. The results revealed a most significant improvement among patients treated with a local bandage in comparison with a control group. Lincomycin and V-penicillin also improved the results significantly. Lincomycin tended to be somewhat more effective. However, the local bandage was significantly more effective than the antibiotics and consequently must be preferred, especially in view of the drawbacks of these drugs. Another observation in this investigation was that an operation time longer than 10 min resulted in significantly more postoperative discomfort. The same effect was noticed when unerupted teeth were extirpated compared to partly erupted ones.

Glass-ionomer cement as retrograde filling material: An experimental investigation in monkeys

The tissue reaction following the use of glass-ionomer and amalgam, as retrograde filling materials was investigated in an experimental study using 8 monkeys. After apicectomy of the upper central incisors, amalgam and glass-ionomer cement was used at random as retrograde filling material. 2 animals at a time were sacrificed after 2 weeks, 1, 3 and 6 months. Irrespective of the length of time, the tissue reactions were similar for the 2 materials. 2 weeks after surgery, a vascular granulation tissue containing lymphocytes, plasma cells and polymorpho-nucleated leukocytes was observed close to the retrograde fillings. 1 month after surgery, good healing was found, the granulation tissue being replaced by new osteoid or bone formation. After 3 and 6 months, there was complete healing with no inflammatory reaction and a mature alveolar bone surrounding the apicectomized roots.

Effect of azidocillin, erythromycin, clindamycin and doxycycline on postoperative complications after surgical removal of impacted mandibular third molars

Treatment of osteitis after surgical removal of the third molar of the mandible is still a clinical problem. A total of 140 patients undergoing operations for removal of an impacted third molar of the mandible, were included in a double-blind study. Placebo or antibiotics - azidocillin, erythromycin, clindamycin and doxycycline - were given to the patients preoperatively and for the following 7 days. The concentrations in serum, alveolar serum and mandibular bone were measured and the postoperative courses - pain, trismus, swelling and wound-healing - were recorded. No correlation was obtained between the antibiotic concentration and the postoperative complaints, except in the azidocillin group on day 2, in which fewer complaints were noticed in patients with high concentrations of the drug at the time of operations. The 80 patients in the antibiotic groups responded significantly better with respect to wound-healing than the 60 patients in the placebo groups. Only 15 operations lasted more than 15 min and the three of them which subsequently resulted in alveolitis were in the placebo groups. Antibiotics significantly reduced pain on day 7 postoperatively. In general, no statistically significant differences in trismus and swelling could be demonstrated between the patient groups. However, there was a significant difference between the placebo and doxycycline groups with respect to swelling (day 2 postoperative, P < 0.01; day 5 postoperative, P < 0.05). Thus systemically administered antibiotics offered only slight advantages in routine operations of impacted third mandibular molars, but could decrease the rate of infections after traumatic operations.

Endosseus titanium implants in extraction sockets: An experimental study in monkeys

Abstract In a series of monkeys, titanium implants (Xenodent®) were installed in the sockets of mandibular incisors. The animals were sacrificed 7 and 12 weeks after the implantations. The healing was studied by histological and microradiographical techniques. A gradual osseointegra-tion free from adverse interference could be noticed.

Positional variations of the impacted upper canine: A clinical and radiologic study

Abstract It was mentioned at the beginning of this article that retention of the upper canine is most frequent. Only a few studies dealing with positional variations of the tooth have been published. The present report is based on our findings in 374 patients admitted to the Department of Oral Surgery, Central Hospital, Karlstad, Sweden. The positional variations of a total of 500 teeth were determined by clinical and radiologic examination. Retention was found to be more common among women, but no great differences in positional relationship could be established between the sexes. The most frequent position of the retained canine crown was palatal to the longitudinal axis of the tooth in an inclined position in relation to the sagittal plane, and at a retention level with the tip of the cuspid between the apex and the cervix of the lateral incisor.

Arthroscopy of the temporomandibular joint: Examination of 2 patients with suspected disk derangement

2 patients with a history of reciprocal temporomandibular joint (TMJ) clicking were visually examined with arthroscopy of their right side TMJs. Clinical and radiographic examination revealed no signs of arthrosis deformans. One patient with significantly reduced opening ability combined with occasional disappearance of TMJ clicks showed advanced arthrotic changes of cartilage which were not visible radiographically. The other patient with unimpaired function also had a severe arthrotic lesion in the clicking joint. In neither case did the disk appear to be displaced. It is concluded that arthroscopy yields additional information for TMJ diagnosis which cannot be achieved by clinical and radiographic examination alone.

Long-acting local anaesthetics in oral surgery: Clinical evaluation of bupivacaine and etidocaine for mandibular nerve block

2 long-acting local anaesthetics, bupivacaine and etidocaine, have been compared to lidocaine with regard to effect during surgical removal of impacted mandibular third molars and effect upon the immediate postoperative pain. It can be concluded from this study that both bupivacaine and etidocaine as well as lidocaine were highly effective and without significant difference with regard to pain blocking during surgery. Both long-acting solutions were significantly superior to lidocaine in providing an extended duration of postoperative pain control. Comparing the 2 long-acting solutions, patients in the bupivacaine group had a significantly longer pain-free period than patients in the etidocaine group.