Allen L. Sisk

Complications following removal of impacted third molars: The role of the experience of the surgeon

The incidence of complications associated with the removal of impacted third molars in a group of 500 patients treated by oral surgery faculty were compared with the incidence of complications in 208 patients treated during the same period by residents of oral and maxillofacial surgery. The results show that complications were more numerous after the removal of third molars classified as partial bony or complete bony impactions, and that less-experienced surgeons had a significantly higher incidence of such complications.

A comparison of preoperative and postoperative naproxen sodium for suppression of postoperative pain

Using a within-subject, crossover experimental design, this study compared the efficacies of a nonsteroidal anti-inflammatory drug, naproxen sodium, 550 mg, administered either 30 minutes preoperatively or 30 minutes postoperatively to 36 patients undergoing the removal of impacted third molar teeth. Pain intensity was assessed postoperatively for 8 hours. Treatment with naproxen sodium, 550 mg, 30 minutes following completion of surgery was just as effective as presurgical administration in controlling postoperative pain. Administration of naproxen sodium in the immediate postoperative period may be indicated for optimum postoperative analgesia for patients in whom preoperative oral intake is contraindicated.

Evaluation of methylprednisolone and flurbiprofen for inhibition of the postoperative inflammatory response.

The ideal anti-inflammatory agent for use in third molar surgery should control pain, reduce swelling and trismus, and have no unwanted side effects. This investigation evaluated and compared the efficacy of corticosteroids, nonsteroidal anti-inflammatory agents, and placebo for reduction of the acute postoperative inflammatory response and its undesirable sequelae in patients undergoing the surgical removal of impacted third molars. Corticosteroids appeared to have maximal effect in controlling edema but had minimal analgesic effects. Nonsteroidal anti-inflammatory agents appear to be effective analgesics. A combination of these agents may be necessary to control the sequelae of oral surgical procedures most effectively.

Comparison of preoperative and postoperative diflunisal for suppression of postoperative pain.

Despite the demonstrated therapeutic advantage of preoperatively administered nonsteroidal anti-inflammatory agents (NSAIAs) in suppressing postoperative pain, clinicians are reluctant to administer these drugs orally before surgical procedures performed using sedation or general anesthesia. Using a within-subject, crossover experimental design, this study compared the analgesic efficacies of an NSAIA, diflunisal 1,000 mg, administered either 30 minutes preoperatively or 30 minutes postoperatively to 20 patients undergoing the removal of impacted third molars. Pain intensity was assessed preoperatively and postoperatively for eight hours using category-rating and visual analog scales. Treatment with diflunisal 30 minutes after completion of surgery proved to be just as effective in suppressing postsurgical pain as presurgical administration. Administration of an NSAID in the immediate postoperative period may be indicated for optimum postoperative analgesia for patients in whom preoperative oral intake is contraindicated.

Ultrastructural analyses of the attachment (bonding) zone between bone and implanted biomaterials

This report presents transmission electron and high voltage transmission electron microscopic observations of bone and associated remodeling tissues directly interfacing with endosteal dental implants. Undecalcified interfacial tissues were serially sectioned from mandibular samples encasing 60 implants placed into 30 dogs. Two-dimensional ultrastructural analyses and three-dimensional stereology showed that osteogenesis adjacent to dental implants is a dynamic interaction of osseous cells and a collagenous fiber matrix. This study showed that the interfacial bone consists of a mineralized collagen fiber matrix associated with an inorganic (hydroxylapatite) matrix. This study suggested that an unmineralized collagen fiber matrix initially is laid down directly at the implant surface, and that this matrix then is mineralized. Osteoblasts interacted with this matrix, eventually becoming encased within developing lacunae during the remodeling process. This process formed the cellular (osteocyte) aspects of the developed bone. Osteocyte processes extended through canaliculi directly to the implant surface. Apparently, these processes also were entrapped within canaliculi during the mineralization events. At times, these processes paralleled the implant surface. The bone-implant interfacial zone was primarily fibrillar (both mineralized and unmineralized) in morphology, with an electron-dense, ruthenium positive deposition. This electron-dense material was approximately 20 to 50 nanometers in thickness, and only this thin layer separated the remodeled mineralized bone from the implant.

Intramuscular hemangioma of the mentalis muscle.

Hemangiomas of skeletal muscle are relatively uncommon and often difficult to diagnose. In the head and neck, the masseter and trapezius muscles are most commonly reported as being involved. The cause of these lesions is unknown, although theories of development include trauma and abnormal sequestration of embryonic tissue. Treatment has included corticosteroids, sclerosing agents, radiation therapy, embolization, and surgical excision. A review of the literature and the first case report of hemangioma involving the mentalis muscle are presented.

Evaluation of the Akinosi mandibular block technique in oral surgery

The Akinosi mandibular block technique for administration of local anesthesia was compared with conventional nerve block techniques in patients undergoing the removal of impacted third molars using a within-subject experimental design. Success rates were equivalent, and both techniques resulted in acceptable quality of anesthesia. Buccal nerve anesthesia was achieved with the Akinosi technique in 80% of cases. The Akinosi technique appears to be a successful alternative to traditional mandibular block techniques for oral surgery.

The biologic tissue responses to uncoated and coated implanted biomaterials.

Ultrastructural examination of the morphology and morphometry of the bone supporting uncoated titanium and ceramic implants was assessed in an experimental animal model involving 120 implants placed into the mandibles of 30 adult mongrel dogs. Further, preliminary morphologic and morphometric observations of the bone supporting uncoated and hydroxylapatite-coated endosteal titanium implants was evaluated in a second investigation involving 72 implants placed into the mandibles and maxillae of 6 additional dogs. A densely mineralized collagen fiber matrix was observed directly interfacing with uncoated implants. The only material interposed between the implant and bone matrix was a 20- to 50-nm electron-dense material suggestive of a proteoglycan. Also seen in these same osseointegrated implants were narrow unmineralized zones interposed between the implant and bone matrix. In these zones of remodeling bone, numerous osteoblasts were observed interacting with the collagen fiber matrix. It was shown that a normal homeostasis of anabolic osteoblastic activity and catabolic osteoclastic activity resulted in bone remodeling and the resultant osseointegration of the implants. Hydroxylapatite-coated implants intimately interfaced with healthy bone. The mineralized matrix extended into the microporosity of the HA coating. This matrix contained viable osteocytes.

A light and electron microscopic comparison of osseointegration of six implant types.

This study compared six commercially available implants placed in an animal model for 5 months. Twelve of the implants were used for light microscopic analysis, and the remaining 12 were used for scanning electron microscopic analysis. With the exception of one implant, newly formed bone was evident in direct apposition to portions of all control implants. The light microscopic and scanning electron microscopic evaluations of the tissues surrounding the six commercially available implant types indicated that initial osseointegration is likely with all types. Implant design, material, and submergibility do not appear to be essential for initial osseointegration to occur as long as a biocompatible material is selected and the implant is placed using minimally traumatic surgical techniques.

Light microscopic and scanning electron microscopic retrieval analyses of implanted biomaterials retrieved from humans and experimental animals.

This paper reports analysis obtained from 200 implant cases retrieved from humans and submitted to the American Academy of Implant Dentistry Research Foundation, Medical College of Georgia implant retrieval center. The samples that were not decalcified were embedded in polymethylmethacrylate and examined with scanning electron microscopy and routine light, polarized, or Nomarski microscopy. Cases included both orthopedic and dental implants, as well as entire mandibles and portions of maxillae obtained at autopsy. A significant number of submitted implants had substantial amounts of adhered bone, which permitted evaluation of human bone remodeling to osseointegrated implants. These implants failed because of implant fracture. As was observed with animal studies, healthy bone supported these implants, with the bone containing an interdigitating canaliculi network that provided communication between interfacial osteocytes and osteocytes deeper within the remodeled osteonal and trabecular bone. Early dental implants containing a coating of beads showed a connective tissue interface, which corresponded to the bead surface of specific orthopedic implants that underwent some degree of micromovement. This is in contrast with the excellent response reported for successful contemporary beaded implants. Significant numbers of osseointegrated fractured hydroxyapatite (HA)-coated dental implants demonstrated the adequate serviceability of these implants before biomaterial fracture. In contrast, the HA coating was dissociated from retrieved orthopedic implants, leading to extensive cup loosening and case failure. This study, therefore, underscores the need for evaluation of failed human dental and orthopedic implants. Correlations can be drawn between human retrieval and experimental animal studies.