Stephan Eitner

Radiographic evaluation of marginal bone levels adjacent to parallel-screw cylinder machined-neck implants and rough-surfaced microthreaded implants using digitized panoramic radiographs.

OBJECTIVE The purpose of this split-mouth study was to compare macro- and microstructure implant surfaces at the marginal bone level during a stress-free healing period and under functional loading. MATERIAL AND METHODS From January to February 2006, 133 implants (70 rough-surfaced microthreaded implants and 63 machined-neck implants) were inserted in the mandible of 34 patients with Kennedy Class I residual dentitions and followed until February 2008. The marginal bone level was radiographically determined, using digitized panoramic radiographs, at four time points: at implant placement (baseline level), after the healing period, after 6 months of functional loading, and at the end of follow-up. RESULTS The median follow-up time was 1.9 (range: 1.9-2.1) years. The machined-neck group had a mean crestal bone loss of 0.5 mm (range: 0-2.3) after the healing period, 0.8 mm after 6 months (range: 0-2.4), and 1.1 mm (range: 0-3) at the end of follow-up. The rough-surfaced microthreaded implant group had a mean bone loss of 0.1 mm (range: -0.4-2) after the healing period, 0.4 mm (range: 0-2.1) after 6 months, and 0.5 mm (range: 0-2.1) at the end of follow-up. The two implant types showed significant differences in marginal bone levels (healing period: P=0.01; end of follow-up: P<0.01). CONCLUSIONS Radiographic evaluation of marginal bone levels adjacent to machined-neck or rough-surfaced microthreaded implants showed that implants with the microthreaded design caused minimal changes in crestal bone levels during healing (stress-free) and under functional loading.

Evaluation of the difference in accuracy between implant placement by virtual planning data and surgical guide templates versus the conventional free-hand method – a combined in vivo – in vitro technique using cone-beam CT (Part II)

PURPOSE The purpose of this study was to assess the accuracy of implant placement after virtual planning of implant positions using cone-beam CT data and surgical guide templates, and to match the results with those achieved with the conventional free-hand method. MATERIALS AND METHODS Twenty-three implants were placed in 10 patients with a Kennedy Class II with 3-dimensional (3-D) planned surgical guide template. Manual implantation was performed in anatomical casts of the same patients by a prosthodontist and a maxillofacial surgeon. Postoperative images of casts were superimposed onto the preoperative image of virtual planned ideal position of the implant. RESULTS The 3-D surgical guide template produced significantly smaller variation between the planned and actual implant positions at the implant shoulder (0.9 mm (0-4.5)) and apex (0.6-0.9 mm (0.0-3.4)) compared with the free-hand implantation (2.4-3.5 mm (0.0-7.0); p=0.000 and 2.0-2.5 mm (0.0-7.7); p=0.002). Accuracy of axis was also significantly improved. CONCLUSIONS Accuracy of implant placement after virtual planning of implant position using cone-beam CT data and surgical templates is high and significantly more accurate than free-hand insertion. The demonstrated method of superimposing radiographic images of postoperative casts and virtual planning images is a useful method, which allows reduced patient radiation exposure.

“Hypnopuncture”—A Dental-Emergency Treatment Concept for Patients with A Distinctive gag reflex

Abstract The present case report describes a newly developed dental treatment concept for patients with a distinctive gag reflex. “Hypnopuncture” is a combination therapy of hypnosis and acupuncture. Its simple, fast, and effective application autonomous of the cause makes it a valuable tool for dental-emergency treatment procedures. Physiologic and psychological aspects of gagging are influenced at the same time. The protocol is illustrated in the case of a 76-year-old patient with a severe gag reflex who was successfully treated by this combination approach. Necessary and effective therapeutic measures from both acupuncture and hypnosis are portrayed.

An alternative method to match planned and achieved positions of implants, after virtual planning using cone-beam CT data and surgical guide templates – A method reducing patient radiation exposure (part I)

OBJECTIVES The present study describes a new method of evaluating the precision of surgically placed dental implants compared after virtual planning of implant positions using cone-beam computed tomography (CT) data and surgical guide templates. This method reduces radiation exposure for patients participating in scientific studies. MATERIALS AND METHODS Twenty-three implants in 10 patients with a unilateral free-end gap in the mandible (Kennedy Class II) were evaluated. After three-dimensional planning of implant position, the implant bed was prepared with a surgical guide template and transmucosal drilling. Preoperative cone-beam CT images were matched with postoperative images of the master cast with implant replicas. Deviations between planned and achieved positions were measured in position and axis. RESULTS On average, the match between planned and placed implant axis was within 4.2 degrees (range, 0.0-10.0). The mean difference in distance at the implant shoulder was 0.9 mm (range, 0.0-4.5). The mean difference in distance at the implant apex was 0.6mm (range, 0.0-2.7) in the lateral/medial direction and 0.9 mm (range, 0.0-3.4) in the anterior/posterior direction. CONCLUSIONS This alternative matching method provides reliable postoperative evaluation of differences in position and axis of planned and placed implants while reducing patient radiation exposure.

Radiographic evaluation of marginal bone levels during healing period, adjacent to parallel‐screw cylinder implants inserted in the posterior zone of the jaws, placed with flapless surgery

OBJECTIVE The purpose of this study was to compare changes at the marginal bone level adjacent to implants placed with flapless surgery and flap surgery during a stress-free healing period. MATERIAL AND METHODS Seven hundred and eighty-five implants were placed in 417 patients with a flapless approach and 459 implants were placed in 227 patients using flap techniques. The marginal bone level was determined radiographically, using digitized panoramic radiographs, at two time points: at implant placement (baseline) and after the healing period. RESULTS The median follow-up time was 0.5 years (SD, 1.2; range: 0.3-0.7). Implants placed with flapless surgery had a mean crestal bone loss of 0.5 mm (SD, 0.5; range: -0.7-2.4) and implants placed with flap surgery had a mean bone loss of 0.5 mm (SD, 0.7; range: -2.0-3.0) after healing. Differences in bone level changes between smokers and non-smokers were statistically significant for the flapless group (P<0.01). CONCLUSIONS A radiographic evaluation of marginal bone levels adjacent to implants showed comparable results for implants placed with flapless surgery and flap surgery. Appropriate case selection after virtual planning of the implant position and a sound surgical protocol is necessary for flapless surgery. Smoking habits may compromise the efficacy of flapless implant procedures.

Comparative study on interactive computer-aided-learning and computer-aided-testing in patient-based dental training in maxillofacial surgery.

AIM The objective of this comparative study was to validate, through empirical data, the use of interactive, problem-oriented computer-aided-learning (CAL) and computer-aided-testing (CAT) in dental studies by directly comparing these methods with conventional teaching. METHOD A total of 95 students from the third and fourth clinical semesters participated in an interdisciplinary seminar on oral maxillofacial implantology; 47 of these were taught using conventional teaching methods, while the remaining 48 students were taught using mobiTED, a CAL/CAT-based interactive communication system that can be used patient- and problem-oriented. An examination was given at the end of the course to evaluate student learning. A students interest/attentiveness, involvement, knowledge gain, and the course attractiveness and quality were evaluated with visual analogue scales (VAS) in a subjective experience protocol. RESULTS The study group taught using the CAL/CAT-based interactive communication system showed statistically significant better results in the examination, with a median score of 89.2%, while the conventional teaching study group achieved a median score of 76.0%. A VAS-based analysis of subjective experiences also revealed statistically significant differences between the two study groups. CONCLUSION Use of the CAL/CAT system for interactive, problem-oriented learning in patient-based dental training led to increased levels of attentiveness, of student acceptance and of the perceived attractiveness of the seminar. CAL/CAT-mediated instruction also led to increased communication, with a subsequent improvement in the qualitative and quantitative parameters of knowledge transfer and cognitive knowledge assimilation. Use of CAL/CAT also facilitated the acquisition, appraisal, and understanding of complex medical data.

A Long-Term Therapeutic Treatment For Patients With A Severe Gag Reflex

Abstract “Hypnopuncture,” a combination treatment of hypnosis and acupuncture, provides a therapeutic treatment plan for long-term therapy for patients with a distinctive gag reflex. The treatment is applied independently of the cause. In cases of emergency treatment in dentistry, the immediate compliance of a patient is of utmost importance. The long-term goal of any therapeutic measure is control of the gag reflex. A new treatment protocol is illustrated in the case of a 50-year-old patient with a severe gag reflex. After only 5 visits, dental treatment could be conducted without any auxiliary means. Hypnosis is applied in the form of hypnosedation (not as psychotherapy), while stereognosis occupies a central position for desensitization.

Neurophysiologic and Long-Term Effects of Clinical Hypnosis in Oral and Maxillofacial Treatment — A Comparative Interdisciplinary Clinical Study

Abstract This prospective comparative clinical study evaluated the effectiveness of clinical hypnosis and its long-term effect in oral and maxillofacial treatment. A total of 45 highly anxious and nonanxious subjects were evaluated by subjective experience and objective parameters. Parameters were EEG, ECG, heart rate, blood pressure, blood oxygen saturation, respiration rate, salivary cortisol concentration, and body temperature. During and subsequent to the operative treatment, hypnosis led to a significant reduction of systolic blood pressure, and respiration rate and to significant changes in the EEG. The subjective values of the parameters evaluated existing anxiety mechanisms and patterns and possible strategies to control them, whereas the objective parameters proved the effectiveness of hypnosis and its long-term effect.

Awareness and education of patients receiving bisphosphonates.

BACKGROUND Bisphosphonates are used to fight osteoporosis and for treating malignancies. In 2003, the first case reports appeared that described bisphosphonate-induced osteonecrosis of the jaw (BONJ). The aim of this study was to assess patient awareness of the adverse effects of bisphosphonates in order to improve cooperation among doctors and between doctors and patients. METHODS Patients with symptoms of osteoporosis, prostate cancer, or breast cancer were surveyed to determine their knowledge of bisphosphonates. The questionnaire comprised 12 questions that covered sociographic data, kind of medication, level of information, and side effects experienced. Out of 142 patients contacted, 55 participated in the study. RESULTS 62% of patients received most of their knowledge about the prescribed drug from the package insert. Despite knowledge that the patient was under treatment with bisphosphonates, 80% of dental treatments were continued without modifications. Only 32% of patients that received intravenous bisphosphonate treatment were aware of the possible risks of developing BONJ. CONCLUSION The level of information is poor concerning the side effects of bisphosphonates, particularly the risk of BONJ. Clinicians should aim to sensitize the relevant people about the risks before treatment.

Lingual concavities in the mandible: a morphological study using cross-sectional analysis determined by CBCT.

BACKGROUND Lingual undercuts are common in the edentulous mandible and pose the risk of perforating the lingual cortical bone during insertion of dental implants, which may lead to hemorrhage or infections of the parapharyngeal space. The aim of our study was to determine the occurrence and extent of lingual undercuts in the molar and premolar/canine region of the mandible. METHODS We analyzed 716 cross-sections of the edentulous molar region and 215 cross-sections of the edentulous first premolar/canine region. Mandibular morphology was classified into a U-configuration (undercut), P-configuration (parallel), and C-configuration (convex), depending on the shape of the alveolar ridge. Depth of the lingual concavity, concavity angle, and further parameters were measured to describe the mandibular morphology. RESULTS Lingual undercuts had a prevalence of 68% in the molar region. The prevalence was significantly higher in the second molar region (90%) than in the first molar region (56%). A deep position of the inferior alveolar nerve close to the basal cortical bone was significantly associated with the presence of lingual undercuts. CONCLUSION Lingual undercuts are a frequent in the edentulous mandible. Cross-sectional analysis of three-dimensional radiographs provides the opportunity to determine a lingual undercut and to prevent complications of perforating the lingual cortical bone.