Steen Sindet-Pedersen

Mandibular Bone Grafts for Reconstruction of Alveolar Clefts

This study evaluated the effect of mandibular bone grafts for reconstruction of alveolar clefts. The study included 25 patients with cleft lip and alveolar process only and three patients with unilateral cleft lip and palate, with a median postoperative follow-up of 8 months (range, 6 to 17 months). The bone grafts were obtained from below the mandibular incisors and canines through an intraoral approach. The marginal bone level achieved was satisfactory in all cases evaluated by occlusal radiographs; the radiographs also demonstrated that the bone grafts were totally integrated after 6 months in all cases. The morphology of the reconstructed alveolar process was satisfactory in all cases evaluated and no periodontal complications were seen. The donor site appeared healed radiologically in all cases 6 months after surgery. The advantages gained by using a mandibular bone graft as compared to an iliac crest graft include reduced morbidity, reduced hospitalization time, reduced operating time, and avoidance of scarring at the donor site. The results of the present study demonstrate that the mandibular symphysis can be used as donor site for reconstruction of small alveolar clefts.

Comparative study of secondary and late secondary bone-grafting in patients with residual cleft defects. Short-term evaluation

This report is a comparative study of the treatment results after secondary and late secondary bone-grafting in cleft-palate patients with residual cleft in the alveolar process, operated with surgical technique as described by Krantz Simonsen. 293 bone-grafted cleft-palate patients are included in the study. Marginal bone-level, periodontal state of teeth adjacent to the cleft-region, recurrence of oro-nasal fistula together with possibility of total dental rehabilitation (i.e., morphology of alveolar process in cleft region and amount of attached gingiva) have been used for evaluation of the treatment results. The best results are seen in the youngest group of patients, and based on the results of the present study, bone-grafting is recommended immediately before eruption of the canine in the cleft-region.

Nerve transposition and implant placement in the atrophic posterior mandibular alveolar ridge

The results obtained with a modified surgical technique for transposition of the inferior alveolar nerve followed by immediate placement of endosseous implants in mandibles with moderate to severe atrophy are presented. Ten transpositions of the inferior alveolar nerve together with the installation of 21 implants were performed in six patients. The mean postoperative follow-up time was 23 months, with a range of 12 to 46 months. All implants with functioning pontics remained stable, with no mobility nor signs or symptoms of pain and infection during the follow-up period. Postoperative radiographic evaluation disclosed no pathologic bone loss around the implants. Neurosensory evaluation was performed using the two-point discrimination test. One patient with unilateral transposition had objective neurosensory dysfunction at 12 months postoperative, although all the nerve function were reported as normal by the patients. Strict patient selection criteria are necessary, with full awareness by the patient of the possibility of long-term or even permanent nerve paresthesia, when this procedure is contemplated.

Time to Onset of Analgesia and Analgesic Efficacy of Effervescent Acetaminophen 1000 mg Compared to Tablet Acetaminophen 1000 mg in Postoperative Dental Pain: A Single-Dose, Double-Blind, Randomized, Placebo-Controlled Study

This randomized, double‐blind, placebo‐controlled study compared the time to onset of analgesia and the analgesic efficacy of two formulations of acetaminophen 1000 mg—an effervescent solution and tablet—in 242 patients with moderate or severe pain following dental surgery. Onset of analgesia was determined using a two‐stopwatch procedure. Analgesia was assessed over a 4‐hour period. Treatments were compared using standard indexes of pain intensity and pain relief and summary measures. Both acetaminophen formulations were significantly more effective than their corresponding placebo for all efficacy assessments. The median time to onset of analgesia was significantly shorter with effervescent acetaminophen (20 minutes) compared to tablet acetaminophen (45 minutes). During the first 45 minutes after administration, effervescent acetaminophen was significantly more effective at each scheduled assessment time than tablet acetaminophen. The median time to meaningful pain relief was significantly shorter with effervescent acetaminophen (45 minutes) compared to tablet acetaminophen (60 minutes). At 4 hours after administration, the pain relief was significantly better with tablet acetaminophen than with effervescent acetaminophen. No other significant differences were observed between the active treatments. In conclusion, effervescent acetaminophen produces a significantly faster onset of analgesia than tablet acetaminophen.

Distribution of Tranexamic Acid to Plasma and Saliva After Oral Administration and Mouth Rinsing: A Pharmacokinetic Study

The objective of the study was to investigate the content of tranexamic acid in plasma and in mixed, unstimulated whole saliva after oral administration and mouth rinsing. Ten healthy volunteers each received 1 g of tranexamic acid orally, whereas 20 healthy volunteers rinsed their mouths with 10 mL of a 5% aqueous tranexamic acid solution for two minutes. Blood and saliva were collected 30, 60, 120, 240, 360, and 480 minutes after administration of tranexamic acid. Samples of blood and saliva were analyzed for tranexamic acid content by electron capture gas chromatography. After oral administration, the mean plasma concentration of tranexamic acid reached its maximum after 120 minutes at approximately 7 μg/mL, whereas none of the saliva samples contained tranexamic acid at detectable levels. After mouth rinse, the plasma concentrations remained below 2 μg/mL, whereas the concentrations found in saliva initially were very high (after 30 minutes mean concentration above 200 μg/mL) and remained at a therapeutic level for more than two hours. These findings indicate, that fibrinolysis in the oral cavity can be inhibited only by local administration of tranexamic acid. This finding may be of significance when the drug is used for prevention and treatment of Weeding in the oral cavity in patients with coagulation defects.

The transmandibular implant: A 13-year survey of its use

During the period from August 1976 until July 1989 the transmandibular implant was introduced in a total of 31 oral and maxillofacial surgery departments in the Netherlands and 1,466 patients were treated. This study includes 1,356 treated patients from 28 departments. The treatment course of 1,201 patients (89.6%) was uneventful. Of the 157 complications, 58 related to the anatomic contour of the mandible, 49 to the surgery, 25 to the prosthetic reconstruction, 8 to the psychosocial attitude of the patient, 8 to the use of medication, 5 to trauma, and 4 to the presence of a skin graft. Treatment of the complications included removal of the implant in 44 patients; in 106 patients the complication was treated satisfactorily. In the remaining 7 patients, hypesthesia was present. The reasons for the removal of the 44 implants were infection (11), operative error (5), premature loading of the implant (3), insufficient width of the mandible after a visor osteotomy (1), loss of osseointegration caused by the prosthesis (14), psychological problems (4), trauma (3), drug-related gingival hyperplasia (2), and inexplicable pain (1). The present survey shows a consistent success rate of 96.8%.

Combined orthodontic-surgical treatment of alveolar clefts.

After more than four years of postoperative follow-up, 224 patients receiving secondary bone grafting of alveolar clefts were examined. Patients were classified into three groups according to age and eruption stage of the cleft side canine tooth at surgery. Each group was then subdivided according to the diagnoses cleft lip alveolar process only, unilateral cleft lip and palate, and bilateral cleft lip and palate. The treatment results were evaluated with respect to bone level in the cleft area, gingival and periodontal condition, orthodontic treatment result, growth of the jaws after surgery, and complications.The best results were achieved when the bone grafting was performed before eruption of the cleft side canine. In half of these patients orthodontic treatment could be finished with a closed dental arch without the need for prosthodontic treatment. The sagittal growth of the jaws was unaffected by the bone grafting, whereas the anterior height of the maxilla was reduced apparently without any clinical significance.

Osseointegrated implants for prosthetic reconstruction in a patient with scleroderma: Report of a case

Progressive systemic sclerosis, or scleroderma, is regarded as an autoimmune disease of unknown etiology, characterized by inflammatory, vascular, and fibrotic changes of the skin and various internal organs. Individual patients may show considerable variations in manifestations of the disease and its rate of progression. Oral manifestations of systemic sclerosis include impaired mouth opening; telangiectasia; xerostomia; increased frequency of diseased, missing, and filled teeth; periodontal disease; increased periodontal ligament width; and bone resorption located at the angle of the mandible.‘** The reduced mouth opening is of clinical significance because it may impair oral hygiene and make conventional prosthodontic treatment of edentulous patients impossible.3 Surgical correction with bilateral commissurotomies4,5 and oral augmentation programs6-’ have been described for management of the microstomia. However, mucosal pain located in the denture-bearing area may impair the adaptation to dentures and thus reduce the possibilities of restoring masticatory function. Due to the complex oral problems that may develop in patients with scleroderma, a very conservative approach should be applied to preserve as many teeth as possible. In the present case, however, an unusual feature not previously described in association with scleroderma developed (multiple external and internal root resorptions), for which reason all teeth had to be removed. This report describes the use of osseointegrated implants for reconstruction in this patient.

A double-blind, randomized study of naproxen and acetylsalicylic acid after surgical removal of impacted lower third molars

100 patients had an impacted lower 3rd molar surgically removed in a double-blind study. Naproxen (500 mg b.i.d.) or acetylsalicylic acid (ASA) (1 g t.i.d.) were administered to the patients. Paracetamol was allowed as escape medication. 49 patients received naproxen and 51 ASA. 4 patients from each group were excluded because they took other analgesics, took too few tablets, were lost to follow-up or had misunderstood the instructions. There was a significantly better over all analgesic effect of naproxen than ASA (p = 0.004). More patients in the naproxen group than in the ASA group (p less than 0.01) would accept treatment with the same drug again. 4 patients, all from the ASA group, complained spontaneously about side effects.

Bony ankylosis of the temporomandibular joint: Case report of a child treated with delrin condylar implants

primary fibrinolysis. This theory gained further acceptance after the demonstration of high levels of plasminogen activator in prostatic tissue.6 It is believed that this excess plasminogen activator is produced as a result of surgical trauma to prostatic tissue, resulting in a hypocoagulability of the blood.7 More recent clinical studies have suggested that thromboplastins released from prostatic tumor cells initiate a disseminated intravascular coagulation (DIC) syndrome, with fibrinolysis occurring secondarily. It is estimated that 25% of cases of chronic DIC have an underlying carcinoma of the prostate.8 DIC was ruled out in this case. Systemic use of l -aminocaproic acid, a drug that can effectively prevent clot dissolution by inhibiting the activation of plasminogen by plasminogen activators, was considered in the treatment of the patient. However, it was not used because of the consulting physician’s fears that it could contribute to systemic thrombosis and because the patient’s condition appeared to be improving. However, the local or systemic use of an antifibrinolytic agent for such cases warrants further investigation.