Leon Ardekian

Dental Implants in Patients With Type 2 Diabetes Mellitus: A Clinical Study

PurposeSystemic factors, such as diabetes mellitus, can influence the success rate of dental implants. The authors describe their experience using the MIS implant system (Medical Implant System, Shlomi, Israel) for retention of overdentures in patients with type 2 diabetes mellitus and provide data regarding the level of satisfaction of the patients, the improvement of function, mucosal and periimplant health, and bone level around implants in this group. MethodsThe study group consisted of 41 patients with type 2 diabetes mellitus who received 141 implants for retention of overdentures. ResultsThe success rate was 97.3% and 94.4% 1 and 5 years following implantation, respectively. The majority of patients reported improvement of function following the new treatment. A high correlation was observed between mucosal health and improvement of function. No correlation was found between failed implants and glucose level. ConclusionThe clinical outcome of dental implants in a selected group of patients with well-controlled type 2 diabetes mellitus is satisfying and encouraging. Further investigations and clinical trials over a longer period of time are needed to determine the long-term survival of implants in diverse groups of patients with diabetes mellitus.

Clinical and radiographic features of eosinophilic granuloma in the jaws: review of 41 lesions treated by surgery and low-dose radiotherapy.

Eosinophilic granuloma within the jaws may radiographically mimic other benign odontogenic cysts and tumors, and different protocols have been suggested in the literature for treating eosinophilic granuloma of the jaws. Forty-one lesions of eosinophilic granuloma, diagnosed in 25 patients, were reviewed retrospectively, and data were collected regarding age, gender, ethnic origin, location, symptoms, clinical appearance, radiographic features, treatment, and recurrence. The lesions were found in youngsters (18.1 +/- 4.7 years of age), mostly in the posterior parts of the mandible, and the most common presenting symptom was pain (92%), often accompanied by swelling. Approximately one half of the lesions were radiographically well defined without ossification. All patients were treated by enucleation (with or without peripheral ostectomy) and radiotherapy; 7.3% lesions recurred during follow-up (9.3 +/- 4.6 years). In addition, the different treatments suggested in the literature for eosinophilic granuloma of the jaws were reviewed.

Surgically-assisted orthopedic protraction of the maxilla in cleft lip and palate patients

Fourteen children, aged 8 to 13 years, with unilateral or bilateral cleft lip and palate, were treated by an incomplete Le Fort I osteotomy without down-fracturing the maxilla, followed by traction of the maxilla by face mask for twelve weeks. Our results revealed a mean maxillary forward movement of 7.2 mm after three weeks of traction, followed by a retention period of nine weeks for callus maturation. There was an associated minor downward movement of the maxilla that caused a slight increase in the lower facial height, which improved the facial esthetics of the patients. The advantages of this method are: i) it allows for early skeletal advancement of the maxilla with new bone formation in the osteotomy line, ii) there is no need for inter-maxillary fixation of young patients and no need for rigid fixation of the maxilla by miniplates that can damage teeth buds and roots at this age, and iii) it can be used in young patients to improve esthetic appearance, an important factor in the psychological development of adolescents.

Changing indications for tracheostomy in maxillofacial trauma

PURPOSE Tracheostomy is one of the most common surgical procedures, but not always without complications. The purpose of this article was to reevaluate the indications of maintaining the airway with the use of tracheostomy. MATERIALS AND METHODS A total of 399 patients with maxillofacial trauma, who were treated in the Maxillofacial Surgery Department from 1985 to 1992, were evaluated for the type of fracture and air-way problems. RESULTS Out of the 399 patients evaluated, 13 needed a tracheostomy. Of these, 6 had had a cricothyroidotomy on arrival, 3 required tracheostomy because of impending airway obstruction, 3 because of respiratory distress, and 1 due to difficulty in intubation. CONCLUSIONS The results of this study indicated that surgically securing the airway by tracheostomy should be revised compared to other available methods. In the era of rigid fixation of fractures and the possibility of leaving the patient with an open mouth, it is unnecessary to carry out tracheostomy for securing the airway as frequently as in the past.

Chronic Obstructive Parotitis Due to Strictures of Stenson's Duct—Our Treatment Experience With Sialoendoscopy

PURPOSE The present retrospective analysis was performed to assess the effectiveness of sialoendoscopic treatment of chronic obstructive parotitis. MATERIALS AND METHODS The study group included 87 parotid glands with stricture as the only cause of gland obstruction. After sialographic and sialoendoscopic evaluation, sialoendoscopic 4-step surgical treatments were performed. The treatment protocol was designed. RESULTS Sialoendoscopy proved to be a successful procedure in 94.7% of the affected parotid glands we treated. CONCLUSION The minimally invasive technique of sialoendoscopy for treatment of strictures of the salivary glands could be a welcome innovation, helping to avoid radical surgical treatment of salivary gland disease.

Central granular cell odontogenic tumor: case report and review of literature.

Central granular cell odontogenic tumor (CGCOT) is a rare lesion that consists of densely packed granular cells with numerous scattered strands of odontogenic epithelium interspersed throughout the tissue.ls2 Initially, this neoplasm was regarded as a variant of ameloblastic fibroma, but later the World Health Organization classification considered CGCOT to possess specific clinical and histopathologic features. They separated this odontogenic tumor from ameloblastic and odontogenic fibroma,2 because it most likely represents a distinct tumor of mesenchymal origin3 The histologic features of the CGCOT have been well documented and discussed in the literature, but its clinical and radiographic features are still controversial.le5 We present a new case of CGCOT with emphasis on its clinical and radiologic features and critically review and analyze previously published case reports.

Incidence and type of cervical spine injuries associated with mandibular fractures.

The incidence of facial fractures accompanied by spinal injuries, while low, is of significant concern to the craniomaxillofacial surgeon. There are conflicting reports on the association between facial fractures and concomitant spinal damage. This retrospective study of 424 patients with mandibular fractures examines the relationship of mandibular fractures and concomitant spinal injuries. The incidence of concurrent mandibular and cervical fractures was 2.6%, predominantly associated with motor vehicle accidents. The purpose of this study is to examine the incidence of cervical spine injury associated with mandibular fractures, in order to improve the diagnosis and treatment of spinal injury associated with mandibular fractures.

Carcinoma of the dorsum of the tongue

Squamous cell carcinoma (SCC) of the anterior two thirds of the tongue is the second most common oral cancer, with the lateral border being the most common location. Squamous cell carcinoma of the dorsum of the tongue is exceedingly rare and has been described in the past as a myth or misdiagnosis. The clinical diagnosis of SCC on the dorsum of the tongue is difficult because it may be mimicked by a wide variety of benign and premalignant lesions, including granular cell myoblastoma, erosive lichen planus, medial rhomboid glossitis, and amyloidosis. In this study we re‐evaluate the entity of SCC of the dorsum of the tongue.

The Treatment of Large Sialoliths by Sialendoscopic Combined Approach

PURPOSE To investigate the advantages, disadvantages, and complications of the combined surgical technique for removing large sialoliths from the salivary glands. MATERIALS AND METHODS This retrospective study analyzed 37 patients with obstructive sialadenitis caused by sialolithiasis who could not undergo surgery using a purely sialendoscopic technique because of the stone size or because of a tight distal stricture obstructing the passage of stone removal by an endoscope. RESULTS Six patients had parotid gland obstruction, and the other 31 patients had submandibular gland obstruction. The calculi varied in size from 5 to 45 mm (average, 10.4 mm). Twenty-three stones were located at the hilar part of the gland or in the proximal part of the duct close to the hilum. The other 14 stones were located in the middle third of the duct. Thirty patients had no complications and were free of symptoms, with normal saliva secretion checked by milking the gland. Five patients developed minor complications that were treated under local anesthesia. Only 2 patients developed severe ductal restenosis and required further sialadenectomy. CONCLUSIONS The combined technique showed good results for removing large sialoliths or proximally located sialoliths that could not have been removed by sialendoscopy alone. The use of an endoscope enables further exploration of the remaining duct, allowing for the removal of further sialolith and reconstruction of the duct after sialolith removal. The technique is not limited to stone size or location along the duct.

Complications associated with the placement of dental implants

Replacing missing teeth with osseointegrated dental implants is a predictable technique, as evidenced by an overall 5-year implant survival rate that ranges between 93% and 97% [1–3]. Few studies, however, systematically have addressed the frequency or natural history of complications related to the use of dental implants [4–7]. Reported complication rates range so widely (ie, 1%–40%) as to be rendered clinically meaningless [4,6,8]. Differences in reported rates may be attributable to differing definitions of complications. Even less has been written about risk factors for developing surgical complications related to the use of dental implants [5,9]. Knowledge regarding the type and frequency of complications that can occur with implants is an important aspect of treatment planning, surgeonpatient communication, informed consent, and posttreatment care. The purposes of this article are to (1) summarize the reported types and frequencies of implant-associated complications, (2) identify risk factors for developing complications associated with the use of dental implants, and (3) suggest strategies to avoid complications.