Árpád Joób-Fancsaly

Effect of the Combination of Low-Speed Drilling and Cooled Irrigation Fluid on Intraosseous Heat Generation During Guided Surgical Implant Site Preparation: An In Vitro Study

Purpose: Investigating the effect of the combination of low-speed drilling and cooled irrigation fluid on intraosseous temperature rise during guided and freehand implant surgery. Materials and Methods: Bovine ribs were used as bone specimens. Grouping determinants were as follows: drill diameter (2.0, 2.5, 3.0, and 3.5 mm), irrigation fluid temperature (10°C, 15°C, and 20°C), and surgical method (guided and freehand). Drilling speed was 800 rpm. Results were compared with previous ones using 1200 rpm. Temperature measurements were conducted using K-type thermocouples. Results: No mean temperature change exceeded 1.0°C if irrigation fluid cooled to 10°C was used, regardless of the drill diameter or the surgical method, with the highest elevation being 2.10°C. No significant reduction was measured when comparing groups using 15°C and 20°C irrigation fluids, regardless of both drill diameter and surgical method. Conclusion: The use of irrigation fluid being cooled to 10°C combined with low-speed drilling (800 rpm) seems to be a safe method for implant site preparation and drilling through a drilling guide in terms of temperature control.

Intraosseous generation of heat during guided surgical drilling: an ex vivo study of the effect of the temperature of the irrigating fluid

We measured the rise in the intraosseous temperature caused by freehand drilling or drilling through a surgical guide, by comparing different temperatures of irrigation fluid (10°C, 15°C, and 20°C), for every step of the drilling sequence (diameters 2.0, 2.5, 3.0, and 3.5mm) and using a constant drilling speed of 1200rpm. The axial load was controlled at 2.0kg. Bovine ribs were used as test models. In the guided group we used 3-dimensional printed surgical guides and temperature was measured with a thermocouple. The significance of differences was assessed with the Kruskal-Wallis analysis of variance. Guided drilling with 10°C irrigation yielded a significantly lower increment in temperature than the 20°C-guided group. When compared with the 20°C freehand group, the reduction in temperature in the 10°C guided group was significantly more pronounced at all diameters except 3.5mm. Finally, when the 10°C-guided group was compared with the 15°C groups, the temperature rise was significantly less at 2.5 and 3.0mm than with the guided technique, and at 3.0mm compared with the freehand technique. We suggest that the use of 10°C pre-cooled irrigation fluid is superior to warmer fluid for keeping temperature down, and this reduces the difference between guided and freehand drilling.

Az alsó bölcsességfogak műtéti eltávolítását követő késői posztoperatív gyulladás (delayed-onset infection) vizsgálata

INTRODUCTION AND AIM Delayed-onset infection was defined as an infectious swelling and trismus accompained by pain or the presence of suppuration starting after the discharge of the patient, generally a week after surgery. Our aim was to describe incidence and possible risk factors of delayed-onset infection after lower wisdoom tooth removal. MATERIAL AND METHODS Retrospective study of 851 lower third molar surgeries, performed between January 2013 and August 2017 at Semmelweis University Faculty of Dentistry, Department of Oro-Maxillofacial Surgery and Stomatology, has been done. The teeth were removed by 2 surgeons. Under age of 26, a case-control study comprising a total of 150 lower third molar surgeries were done to indentify possible risk factors. RESULTS 10 delayed-onset wound infections were recorded after suture removal (1.17% of the patients). The mean time elapsing from surgery to delayed-onset infection was 30 days. Lower third molars with total soft tissue coverage, a bigger amount of bone coverage, a lack of distal space (Pell-Gregory class III), deeper impaction (Pell-Gregory classes B, C) or mesioangular tilt are associated with the development of this complication (p<0.05). Female sex and young age seem to be risk factors, too. CONCLUSION Patients with risk factors should be warned that infection may still occur several weeks after surgery. The clinicians should observe these patients longer and emphasize keeping their wound clean for a prolonged period. Orv Hetil. 2018; 159(31): 1278-1283.

A preoperatív antibiotikus és antiszeptikus kezelés hatása a műtéti úton eltávolított alsó bölcsességfogak sebgyógyulására – prospektív randomizált vizsgálat

INTRODUCTION AND AIM The study compares the antibiotic prophylaxis combined with postoperative antibiotic therapy to preoperative chlorhexidine rinse combined with postoperative antibiotic therapy in preventing complications after surgical removal of a mandibular third molar. METHOD 71 healthy patients in four groups were enrolled in the study: I. prophylactic dose of 2000 mg of amoxicillin clavulanate, continued with amoxicillin clavulanate postoperatively; II. prophylactic dose of 600 mg of clindamycin, continued with clindamycin postoperatively; III. prophylactic chlorhexidin rinsing, continued randomized amoxicillin clavulanate or clindamycin postoperatively; IV. control, with clindamycin postoperatively. RESULTS The pain was smaller in the prophylaxis groups. Alveolitis occurred only in the control group: 2 patients. Wound opening occurred in 22,2 % in group IV., 14,2 % in group II, 10 % in group I., 5 % in group III. CONCLUSION We consider completing the indicated postoperative antibiotic prescription with antibiotic or antiseptic prophylaxis. Chlorhexidin prophylaxis could have the same positive effect. Orv. Hetil., 2017, 158(1), 13-19.Absztrakt: Bevezetes es celkitűzes: Vizsgalatunkban az also bolcsessegfog műteti eltavolitasat kovető sebgyogyulassal foglalkozunk. A posztoperativ antibiotikus terapia kiegeszitesekent profilaktikusan alkalmazott antibiotikum es oralis antiszeptikum hatasossagat hasonlitottuk ossze. Modszer: A vizsgalatban a klinika 71 egeszseges betege vett reszt. A preoperativ terapiat illetően pacienseinket negy vizsgalati csoportba osztottuk: I. profilaxis amoxicillin-klavulansavval; II. profilaxis clindamycinnel; III. profilaxis klorhexidinnel; IV. kontroll. Posztoperativan a terapiat az I. es II. csoportban a profilaktikus antibiotikummal, a III. csoportban random valasztas szerint, a IV. csoportban clindamycinnel folytattuk. Vizsgaltuk az arcduzzanatot, a szajnyitasi korlatozottsagot, a seb gyogyulasat es a posztoperativ eletminőseget. Eredmenyek: A profilaxisban reszesult betegek posztoperativ szakasza zavartalanabbnak bizonyult. Alveolitis csak a kontrollcsoportban alakult ki, ket alkalommal. A kontrollcsoportba...

Effect of pre-drilling on intraosseous temperature during self-drilling mini-implant placement in a porcine mandible model.

This in vitro study investigated intraos seous heat production during insertion, with and without pre-drilling, of a self-drilling orthodontic mini-implant. To measure temperature changes and drilling times in pig ribs, a special testing apparatus was used to examine new and worn pre-drills at different speeds. Temperatures were measured during mini-implant placement with and without pre-drilling. The average intraosseous temperature increase during manual mini-implant insertion was similar with and without pre-drilling (11.8 ± 2.1°C vs. 11.3 ± 2.4°C, respectively; P = 0.707). During pre-drilling the mean temperature increase for new drills was 2.1°C at 100 rpm, 2.3°C at 200 rpm, and 7.6°C at 1,200 rpm. Temperature increases were significantly higher for worn drills at the same speeds (2.98°C, 3.0°C, and 12.3°C, respectively), while bone temperatures at 100 and 200 rpm were similar for new and worn drills (P = 0.345 and 0.736, respectively). Baseline bone temperature was approximated within 30 s after drilling in most specimens. Drilling time at 100 rpm was 2.1 ± 0.9 s, but was significantly shorter at 200 rpm (1.1 ± 0.2 s) and 1,200 rpm (0.1 ± 0.03 s). Pre-drilling did not decrease intraosseous temperatures. In patients for whom pre-drilling is indicated, speeds of 100 or 200 rpm are recommended, at least 30 s after pilot drilling.

A gyógyszer indukálta vérzékeny betegek fogorvosi, szájsebészeti ellátása: a 2015-ös hazai szakmai ajánlás alkalmazása és értékelése

Absztrakt Bevezetes: A Magyar Arc-, Allcsont- es Szajsebeszeti Tarsasag es a Magyar Fogorvosok Implantologiai Tarsasaga altal 2015-ben elfogadasra kerult „A gyogyszer indukalta verzekeny betegek fogorvosi ellatasa” szakmai ajanlas. Celkitűzes: A szerzők celja volt az ajanlasban leirt lokalis verzescsillapitasi modszerek hatekonysaganak, megbizhatosaganak ellenőrzese. Modszer: Az oralis antithromboticus kezelesben reszesulő betegeiknel vizsgaltak a fogorvosi, szajsebeszeti ellatasukat kovető utoverzesek előfordulasat, retrospektiv modon. Eredmenyek: 263, verzessel jaro beavatkozas tortent (186 betegnel), amelyből 138 K-vitamin-antagonista, 97 thrombocytaaggregacio-gatlo es 6, ugynevezett uj tipusu oralis antikoagulans kezelesben reszesulő betegeknel. Osszesen 6 (2,3%) esetben tapasztaltak utoverzest az egyoras kontrollnal, mig ugyeletbe 1 beteg jott vissza utoverzes miatt (0,5%). Ezzel szemben 86-an jelentkeztek ugyeletukon, akiknel az ajanlast nem vettek figyelembe, kozuluk K-vitamin-antagonista gyogyszer...

Chemical Etching of Ultrafine Grained Titanium Surfaces to Optimise Cell Attachment

The goal of this research was to create a surface topography that would promote cell attachment onto Ultrafine-grained Grade 2 Titanium. Morphologies that assist the deposition of bone tissue and reduce colonisation by unwelcome bacteria onto dental implant surfaces are created most often by sand-blasting, chemical etching, or these two in combination. Discs of thickness 2 mm from the machined base material were prepared for this study. After machining, the samples were chemically etched. Three etchants were used: 30 % HCl and 85% H3PO4, and the two in combination. The etching temperatures were 20 °C, 40 °C, and 60 °C, the etching times were 5 minutes and 120 minutes. The surface morphologies of the discs were examined by confocal microscope and scanning electron microscope (SEM), and compared to the machined-only samples as reference values. Samples treated in the 30% HCl solution at 40 °C for 120 minutes and then in the 85 % H3PO4 solution at the same temperature and time altered macro and micromorphology together in ways which assist the attaching of bone.