John W. Frame

Removal of oral soft tissue pathology with the CO2 laser

As the CO2 laser becomes more widely available in hospitals, the oral and maxillofacial surgeon will have greater opportunity to use it for the treatment of soft tissue pathologies of the mouth. This paper considers the advantages and disadvantages of the instrument together with indications for its use and reviews 118 patients who had 130 oral lesions removed with the CO2 laser.

Subperiosteal behaviour of alginate and cellulose wound dressing materials

A histological comparison was undertaken of the tissue response to a new sodium calcium alginate material (Kaltostat) and an oxidized regenerated cellulose wound dressing (Surgicel) when implanted between bone and periosteum in the jaws at intervals of up to 24 wk. Both biomaterials caused a foreign body reaction, persisting up to 12 wk after surgery. New bone formation occurred along the surface of the mandible in some specimens, but was not apparently related to the implants. It was concluded that the implantation of Kaltostat or Surgicel between bone and periosteum in the jaws caused a delay in wound healing, and had no effect on bone induction.

Ridge augmentation using solid and porous hydroxylapatite particles with and without autogenous bone or plaster

Edentulous areas of dog jaws were augmented with solid or porous particles of hydroxylapatite (HA) alone, or combined with either finely crushed autogenous bone or plaster of paris. At the end of the experiment (24 weeks), the augmented ridges were firm and stable and covered with healthy mucosa. The ridges augmented with only porous particles of HA demonstrated a greater amount of bone ingrowth compared with the solid, dense particles. The new bone formation occurred in those parts of the implants adjacent to the underlying alveolar bone. The addition of autogenous bone to the HA particles did not enhance bony deposition, and none of the autogenous bone chips survived for 24 weeks. The amount of new bone in the ridges augmented with plaster of paris and HA was similar to the other groups, and the plaster did not interfere with healing. There was evidence of resorption of the underlying cortical bone in many of the specimens.

Hydroxyapatite as a biomaterial for alveolar ridge augmentation

Hydroxyapatite is a useful biomaterial because of its excellent biocompatibility. It is extremely well tolerated by the hard and soft tissues of the mouth and jaws, and offers great potential for the future. This paper reviews the various physical forms of the material, both solid and porous, its biological behaviour in different implant sites, and the surgical techniques for its implantation. Some of the controversies and doubts about the material are discussed in relation to its use in alveolar ridge augmentation.

Tissue response to a haemostatic alginate wound dressing in tooth extraction sockets

Kaltostat is a new haemostatic wound dressing composed of non-woven sodium calcium alginate fibres, and was originally developed to cover exposed wounds of the skin. A histopathological study was undertaken to determine the tissue response to Kaltostat in healing tooth sockets, to obtain a comparison with oxidised regenerated cellulose (Surgicel). Tooth sockets filled with blood clot acted as controls. The results showed that both biomaterials delayed wound healing in the early phase (1-4 weeks), giving rise to foreign body reactions. At 12 weeks there was little difference between the control sockets and the sockets containing the test materials, although remnants of retained dressing materials were identified. Healing of the tooth sockets was complete at 24 weeks.

A comparison of ibuprofen and dihydrocodeine in relieving pain following wisdom teeth removal

Although dihydrocodeine (DF118) is widely prescribed by general dental practitioners, there is little evidence that it is successful in controlling post-operative dental pain. Ibuprofen is known to be effective in this situation. A single dose, double-blind study was carried out in 148 patients to compare 400 mg ibuprofen with 30 mg dihydrocodeine and placebo for treating moderate to severe pain following the removal of unilateral, impacted mandibular third molar teeth under local anaesthesia. An additional dose of either ibuprofen or dihydrocodeine was available after 2 hours. The post-operative ibuprofen reduced pain and produced more pain relief than dihydrocodeine or placebo. Furthermore, fewer patients receiving ibuprofen took additional analgesic at 2 hours. Patients who received ibuprofen as supplementary medication also experienced less pain and had greater pain relief than those receiving dihydrocodeine as supplementary medication, even when their post-operative treatment had been placebo. More patients reported the medication as having been effective if they took ibuprofen either post-operatively or as supplementary analgesia. Ibuprofen is an appropriate analgesic for treating post-operative dental pain

Biologic basis for interpositional autogenous bone grafts to the mandible

Interpositional autogenous bone grafting procedures were performed in the mandibles of 12 beagle dogs to assess cell survival within the graft and the superiorly repositioned alveolus, and to monitor the remodeling process. Histologic and radiologic results indicated that the grafts were well accepted and that new bone was rapidly laid down on their trabeculae. However, the osteocytes within the autografts generally did not survive. There was no evidence of necrosis of the superiorly displaced alveolus, nor any resorption of its surface cortex, and it rapidly united with the autograft and the mandible to produce a stable structure. This study confirms that the lingual pedicle of soft tissue is adequate to maintain the viability of the superiorly repositioned alveolus or segment and to allow rapid remodeling of the autogenous bone graft.

The versatility of hydroxyapatite blocks in maxillofacial surgery

There is considerable interest at present in the potential role of calcium hydroxyapatite as a biomaterial for bone augmentation in oral and maxillofacial surgery. Most of the published work has been on the particulate form, mainly in alveolar ridge procedures. However, hydroxyapatite is also available as solid or porous blocks. The blocks are more predictable in their use than are the particles, and are adaptable and versatile. This paper reviews the biological behaviour of the material and discusses the role of hydroxyapatite blocks in alveolar ridge augmentation and orthognathic surgery.

Participation of UK dentists in continuing professional development

Introduction This paper reports participation of dentists in continuing professional development (CPD) and factors affecting participation.Method All general dental practitioners (GDPs) in three deaneries in England were surveyed. The overall response rate was 54% (n = 2082); by deanery it was 68% West Midlands, 45% South West and 44% Anglia. Findings across deaneries were remarkably similar. Comparisons with national data show no notable bias in the sample for gender, owners/partners and age/experience.Results Most frequent forms of CPD were journal reading and courses in which almost all engaged. A score based on individual participation in CPD over the 12-month period was calculated. The mean score (hours) for participation in verifiable CPD was 31 (median 25) and for general, 29 (median 29). In terms of the GDCs Lifelong Learning Scheme, 57% were already undertaking 50 hours. Net of other effects, those less likely to be doing 50 hours are those with more years in practice and single-handed practitioners. Greater access to courses and media-based CPD is desired.Conclusion Certain groups of dentists will need support to meet the requirements of the GDCs Lifelong Learning Scheme. Statutory peer review or clinical audit will significantly alter the CPD profile of most dentists. This has implications for facilitators.

In vivo surface analysis of titanium and stainless steel miniplates and screws

This study was undertaken to characterize the surfaces of Champy titanium and stainless steel miniplates and screws that had been used to stabilize fractures of the mandible in an animal model. Miniplates and screws were retrieved at 4, 12, and 24 weeks after surgery. Low-vacuum scanning electron microscopy (SEM) of autoclaved unused (control) and test miniplates from the same production batches was undertaken. Energy-dispersive X-ray (EDX) analysis was used to identify compositional variations of the miniplate surface, and Vickers hardness testing was performed. At autopsy, clinical healing of all fractures was noted. SEM analysis indicated no perceptible difference in the surface characteristics of the miniplates at all time intervals. Aluminium and silicon deposits were identified by EDX analysis over the flat surfaces. There was extensive damage to some screw heads. It is concluded that there were no significant changes in the surface characteristics of miniplates retrieved up to 24 weeks after implantation in comparison with controls. Damage to the screws during insertion due to softness of the materials may render their removal difficult. There was no evidence to support the routine removal of titanium or stainless steel miniplates because of surface corrosion up to 6 months after implantation.