Paul Sambrook

The Nature and Frequency of Bisphosphonate-Associated Osteonecrosis of the Jaws in Dental Implant Patients: A South Australian Case Series

PURPOSE To determine the number of bisphosphonate-associated cases of dental implant failure in South Australia. MATERIALS AND METHODS All general and specialist dentists who place dental implants in South Australia were contacted and asked to provide information on the total number of implants placed over the decade to December 2007. Cases of bisphosphonate-associated implant failure were identified. RESULTS All 46 practitioners involved in implant placement and the management of bisphosphonate-associated osteonecrosis of the jaws in South Australia were identified. Approximately 28,000 implants had been placed in 16,000 patients. We identified 7 cases of oral bisphosphonate-associated implant failure, with 3 cases of failure of osseointegration and 4 cases of successful implants losing integration after being placed on oral bisphosphonates. There were 5 women and 2 men, and the mean age was 65.7 years (range, 49-75 years). Only 1 was medically compromised, with steroids and diabetes. No cases of implant failure in intravenous bisphosphonate cases were identified. On the basis of the assumption that 5% of the patients were taking an oral bisphosphonate, 1 in 114 (0.89%) had implant failure. CONCLUSION In patients taking oral bisphosphonates, a failure to integrate or subsequent loss of integration may occur when oral bisphosphonates are started after successful implant placement. The rate of failure is low, at less than 1%.

A C-Terminal Crosslinking Telopeptide Test–Based Protocol for Patients on Oral Bisphosphonates Requiring Extraction: A Prospective Single-Center Controlled Study

PURPOSE Patients undergoing extraction are at risk for bisphosphonate-related osteonecrosis of the jaws (BRONJ). A C-terminal crosslinking telopeptide (CTX) level lower than 150 pg/mL has been suggested as a predictor of BRONJ risk. The authors aimed to increase the precision of estimates of the risk of BRONJ in osteoporosis after extraction and to assess value of CTX testing at extraction time in cases of BRONJ in a large prospective cohort. PATIENTS AND METHODS All patients on oral bisphosphonates for osteoporosis referred for extractions over a period of 6.5 years were included in a standard protocol. Pre-extraction fasted CTX levels were obtained. All patients were followed until healing. If the CTX level was lower than 150 pg/mL, they were offered a drug holiday. If they declined, if the CTX level was above 150 pg/mL at baseline, or after the drug holiday, they had extractions performed under local anesthesia. Age-matched controls not on bisphosphonates were identified. RESULTS Nine hundred fifty patients had 2,461 extractions. One hundred eighty-one patients had a CTX level lower than 150 pg/mL. Four patients developed BRONJ; all had a CTX level lower than 150 pg/mL. All were on alendronate. The case-control comparison approached significance (<150 pg/mL; P = .073). Alendronate was associated with a low CTX level (P < .05). A CTX level lower than 150 pg/mL had a sensitivity of 100% and specificity of 81%. Bayesian analysis yielded a population expected risk of BRONJ of 0.29% (95% confidence interval, 0.12-0.52); the expected risk was 0.42% for a CTX level lower than 150 pg/mL and 0.13% for a CTX level higher than 150 pg/mL. CONCLUSION The risk of BRONJ for patients with osteoporosis on bisphosphonates having extractions is approximately 0.2%. A CTX level lower than 150 pg/mL is sensitive and is associated with an approximately 3-fold greater risk of BRONJ.

University teaching of implant dentistry: guidelines for education of dental undergraduate students and general dental practitioners. An Australian consensus document.

Also published as a book chapter: Proceedings of the Australian Consensus Workshop on Implant Dentistry University Education, held on the Gold Coast, Australia 4-6 February 2010: pp.329-332

The healing of dental extraction sockets in patients with Type 2 diabetes on oral hypoglycaemics: a prospective cohort

BACKGROUND The aim of this study was to determine whether there is a difference in delayed healing following dental extractions for Type 2 diabetics on oral hypoglycaemics and non-diabetic patients. METHODS Prospective patients referred for dental extractions were recruited into two groups: known diabetics and non-diabetics with no conditions associated with poor healing. All had a random blood glucose level (BGL). Extractions were performed using local anaesthesia. Delayed healing cases were identified and statistical evaluation performed to identify risk factors. RESULTS There were 224 Type 2 diabetics on oral hypoglycaemics (BGL 7.51, range 4.1-17.4) and 232 non-diabetics. The diabetic group were older, more males and less smokers than the control group. Twenty-eight patients, 12 (5%) diabetic and 16 (7%) control group, had socket healing delayed for more than one week but all healed in four weeks. There were no statistical differences between delayed healing and age, gender, diabetic state, BGL or smoking. The younger control group had more healing problems. CONCLUSIONS The traditional view that diabetics have increased delayed healing was not supported. Type 2 diabetics on oral hypoglycaemics should be treated the same as non-diabetic patients for extractions.

Third Molars on the Internet: A Guide for Assessing Information Quality and Readability

Background Directing patients suffering from third molars (TMs) problems to high-quality online information is not only medically important, but also could enable better engagement in shared decision making. Objectives This study aimed to develop a scale that measures the scientific information quality (SIQ) for online information concerning wisdom tooth problems and to conduct a quality evaluation for online TMs resources. In addition, the study evaluated whether a specific piece of readability software (Readability Studio Professional 2012) might be reliable in measuring information comprehension, and explored predictors for the SIQ Scale. Methods A cross-sectional sample of websites was retrieved using certain keywords and phrases such as “impacted wisdom tooth problems” using 3 popular search engines. The retrieved websites (n=150) were filtered. The retained 50 websites were evaluated to assess their characteristics, usability, accessibility, trust, readability, SIQ, and their credibility using DISCERN and Health on the Net Code (HoNCode). Results Websites’ mean scale scores varied significantly across website affiliation groups such as governmental, commercial, and treatment provider bodies. The SIQ Scale had a good internal consistency (alpha=.85) and was significantly correlated with DISCERN (r=.82, P<.01) and HoNCode (r=.38, P<.01). Less than 25% of websites had SIQ scores above 75%. The mean readability grade (10.3, SD 1.9) was above the recommended level, and was significantly correlated with the Scientific Information Comprehension Scale (r=.45. P<.01), which provides evidence for convergent validity. Website affiliation and DISCERN were significantly associated with SIQ (P<.01) and explained 76% of the SIQ variance. Conclusion The developed SIQ Scale was found to demonstrate reliability and initial validity. Website affiliation, DISCERN, and HoNCode were significant predictors for the quality of scientific information. The Readability Studio software estimates were associated with scientific information comprehensiveness measures.

Management of severe odontogenic infections in pregnancy

BACKGROUND The objective of this study was to review the management of patients presenting with severe odontogenic infections and who are also pregnant. METHODS A retrospective clinical audit was conducted of all female patients admitted to the Royal Adelaide Hospital by the Oral and Maxillofacial Surgery Unit from 1999 to 2009 with severe odontogenic infections. Pregnant patients were identified and their age, medical history, previous obstetric and gynaecological history, stage of current pregnancy, presenting infection, diagnosis and management were recorded, as well as the outcome of the pregnancy. RESULTS A total of 346 female patients were admitted to the Royal Adelaide Hospital under the care of the Oral and Maxillofacial Surgery Unit with an admission diagnosis of severe odontogenic infection and five were pregnant. Besides surgical and anaesthetic assessment, mother and foetus were assessed by the Obstetric and Gynaecology Unit. In all, five with severe infection were successfully resolved and four proceeded to a normal delivery with a healthy child. The remaining patient had an already planned therapeutic abortion. CONCLUSIONS Pregnant patients with severe odontogenic infections require urgent referral to a tertiary hospital with full surgical, anaesthetic and obstetric services. This allows appropriate management of the complex requirements of mother and foetus.

Endoscopically Assisted Intraoral Removal of an Ectopic Third Molar in the Mandibular Subcondylar Region

Abstract The ectopic placement of mandibular third molars in the subcondylar region is an uncommon phenomenon. Most patients are asymptomatic but can present with acute infection or associated pathology necessitating surgical intervention. Surgical approaches have been described utilizing both extraoral and intraoral approaches to the region. This paper presents a clinical report of a patient presenting with acute fascial space infection arising from an ectopic third molar in the mandibular subcondylar region, managed with surgical removal via an endoscopically assisted intraoral approach.

Dental note: Antimicrobial prophylaxis for dental surgery

Antibiotic prophylaxis for most dental and oral surgical procedures is not needed, especially if the patient is fit...