Nuray Yilmaz Altintas

Evaluation of sedation in oral and maxillofacial surgery in ambulatory patients: failure and complications

OBJECTIVES This study evaluated the failure and complication rates of sedation in ambulatory patients undergoing oral and maxillofacial surgery. MATERIALS AND METHODS This retrospective cohort study was carried out among 619 patients who had undergone maxillofacial surgical procedures under intravenous sedation with midazolam and fentanyl. Each patients age, American Society of Anesthesiologists (ASA) classification, systemic condition, surgical procedure, complications, and failures were recorded for evaluation. RESULTS A total of 400 patients with ASA I, 199 with ASA II, and 20 with ASA III between the ages of 9 months and 84 years were included in the study. The most common systemic disorders in our patients were mental retardation (35%), hypertension (19%), and epilepsy (15%). Evaluation of the cases revealed 9 complications (1.4%) and 9 sedation failures (1.4%). The complications were bradycardia, postoperative agitation and hallucination, drug reaction, vomiting and nausea, desaturation, and hypotension. CONCLUSIONS Our results in the oral and maxillofacial surgery clinic revealed low complication and failure rates.

Six-Year Survival of a Mini Dental Implant-Retained Overdenture in a Child with Ectodermal Dysplasia

Patients with ectodermal dysplasia (ED) experience several problems caused by abnormal development and functioning of the head and neck region. In addition to developmental nasal cartilage abnormalities and absence of sweat glands, hair, and eyebrows, edentulism or developmental disorders of teeth (cone-shaped teeth) are commonly observed in these types of patients. ED is also characterized by underdeveloped alveolar ridges, a decreased occlusal vertical dimension, reduced salivary secretion, and dry oral mucosa, which make prosthetic rehabilitation difficult. Few studies of intraosseous dental implant-retained prostheses have described adverse effects on craniofacial growth and esthetic and functional disadvantages, while some researchers have described the advantages of this treatment option as an alternative option in these cases. Due to the associated alveolar bone deficiency, dental mini-implant therapy may be a treatment option for these patients; however, there are isolated cases in the literature regarding the rehabilitation of ED patients with mini-implant-supported overdentures. This clinical report describes the rehabilitation of a 6-year-old child with ED using a maxillary removable partial prosthesis and a mini-implant-retained mandibular overdenture. The clinical and radiographic findings of this prosthetic rehabilitation during the 6-year follow-up are also presented.

Immediate implant placement in fresh sockets versus implant placement in healed bone for full-arch fixed prostheses with conventional loading.

This retrospective study assessed the success of immediate and non-immediate implants installed in patients undergoing planned extraction of all remaining teeth and rehabilitation with implant-supported full fixed prostheses. Patients in need of dental implants for full fixed prostheses to replace teeth extracted in the maxilla and mandible were included in this study. Dental implants were installed in the same surgical procedure, immediately at the extraction site, or in healed bone. Implant success, complications, and failures were recorded during follow-up. Forty-one patients with 512 implants were included in the study. Healing progressed uneventfully for 501 installed implants, but nine implants were lost in the non-immediate group and two were lost in the immediate group, during a mean follow-up of 44.9 months. All failures in both groups were observed in the maxilla. The success rate was the same in both groups, at 97.8%. This retrospective analysis showed that with thorough patient evaluation, the extraction of all residual teeth and implant installation in a single surgical procedure is a safe and predictable treatment modality for the successful rehabilitation of the edentulous patient with a fixed prosthesis.

Oral Rehabilitation with Implant-Retained Overdenture in a Patient with Down Syndrome.

Down syndrome, known as trisomy 21, is the most common chromosomal disorder. The disorder affects mental and systemic development as well as oral structure, including dental anomalies, high susceptibility of periodontal disease, and poor quality of alveolar bone. This report presents a case of dental rehabilitation by means of dental implants of a patient with Down syndrome. Two titanium dental implants were placed in the maxilla, and three titanium dental implants were installed in the mandible. One implant was lost during the osseointegration period. The prosthetic rehabilitation was performed with implant-retained maxillary and mandibular overdentures with the Locator attachment system. After a 2-year follow-up period, the patient was doing well, and all implants were clinically stable with no signs of bone loss or inflammation. The present study emphasizes that implant-retained overdentures with Locator attachment system could be a therapeutic option even for patients with Down syndrome. This therapy prevents crestal bone loss around the implants, improves functional and esthetic outcomes, and provides optimum oral hygiene for patients with mild mental impairment. Careful patient selection and education of patients and caregivers are essential considerations for a successful and safe treatment with dental implants in Down syndrome patients.

Novel Retromandibular Subparotideomasseteric Fascial Approach for Placement of a Temporomandibular Joint Prosthesis

For placement of a temporomandibular joint prosthesis, preauricular and retromandibular approaches are used. The main complication of the retromandibular approach is marginal mandibular nerve damage. In this technical study, the retromandibular subparotideomasseteric fascial approach is introduced as an alternative to avoid the complications of the conventional retromandibular approach.

Is a Fixed Hybrid Prosthesis with Distal Cantilever Appropriate for Maxillofacial Defects? A Report of Two Patients.

The most important objectives in restoring the maxillofacial patient are the restoration of function and psychological improvement through esthetics. Acquired maxillary and mandibular defects due to significant trauma or surgery represent a major challenge for the clinician and patient. Dental implant-retained prostheses represent a well-documented and reliable treatment option and can also help patients with maxillofacial defects by eliminating denture instability and improving function. Full-arch fixed dental hybrid prostheses provide functional and psychological advantages and also reduce the load on vulnerable soft and hard tissues in the reconstruction area. Two clinical reports are presented describing the prosthetic rehabilitation using dental implant-supported fixed hybrid prostheses with clinical and radiographic follow-up of 3 years.

Oral bifosfonat tedavisi görmüş olan bir hastanın dental implant destekli protez ile rehabilitasyonu: Olgu sunumu

Bifosfonatlar kemik metabolizmasinda osteoklastik inhibitor etkileri nedeniyle bircok kemik ile ilgili hastalikta yaygin olarak kullanilmaktadir. Son yillarda intravenoz (IV) ve oral yolla alinan bifosfonatlarin, ciddi bir yan etkisi olan bifosfonata bagli cenelerde gorulen osteonekroz (BRONJ) hakkinda bir cok vaka rapor edilmistir. BRONJ olusturma riski yuksek olmasi nedeniyle IV bifosfonat kullanimi, dental implant uygulamalarinda kesin kontraendikasyon oldugu bildirilmistir. Ancak oral bifosfonat kullanan hastalarda dental implant yapilmasi ile ilgili oneriler sinirli verilere dayanmaktadir. Bu olgu raporunda, osteoporoz nedeniyle 3 yil bifosfonat tedavisi gormus olan hastanin dental implant destekli protez ile rehabilitasyonu sunulmustur.