Wendell A. Edgin

Preservation of soft tissue contours with immediate screw-retained provisional implant crown.

When a patient with a missing or failing maxillary anterior tooth desires immediate tooth replacement, fabrication of a provisional restoration can be challenging. Due to individual anatomical variations in tooth shape, size, and supporting soft and hard tissue structures, there are no premanufactured components with an anatomical emergence profile that universally suits all individual situations. This article describes the fabrication of a screw-retained immediate provisional restoration that fulfills anatomic, biologic, and esthetic requirements.

Immediate Restoration of Single Tapered Implants with Nonoccluding Provisional Crowns: A 5-Year Clinical Prospective Study

BACKGROUND Dental literature has limited number of publications regarding long-term outcome data of immediate restoration of single missing teeth with an implant-supported provisional crown. PURPOSE This 5-year study evaluated hard and soft tissue responses to the immediate placement of single implant-supported provisional crowns. MATERIALS AND METHODS Twenty patients received one dental implant restored immediately with a provisional acrylic resin screw-retained crown. Crestal bone loss was evaluated from standardized periapical radiographs collected at 3-month intervals for the first 21 months followed by a 5-year evaluation. Historical controls acquired from available dental literature were used for comparison. RESULTS One implant failed within 2 months of surgical placement, presenting with pain and mobility. The remaining implants demonstrated no infection, pain, or radiolucencies. Nineteen implants were clinically immobile, osseointegrated, and asymptomatic at 21 months. At 5 years, one patient died, three patients were noncompliant, and 15 implants were evaluated as functional. Mean bone loss (MBL) at 1 year and 21 months was approximately 0.5 ± 0.5 mm and 0.70 ± 0.26 mm at 5 years. There was no statistically significant difference between MBLs at p < 0.05. CONCLUSIONS Immediate provisionalization of single dental implants compares favorably with conventional loading protocols. Long-term data suggest that immediate provisionalization of single dental implants is a viable treatment option.

Immediate restoration of single tapered implants with nonoccluding provisional crowns

BACKGROUND Dental literature has limited number of publications regarding long-term outcome data of immediate restoration of single missing teeth with an implant-supported provisional crown. PURPOSE This 5-year study evaluated hard and soft tissue responses to the immediate placement of single implant-supported provisional crowns. MATERIALS AND METHODS Twenty patients received one dental implant restored immediately with a provisional acrylic resin screw-retained crown. Crestal bone loss was evaluated from standardized periapical radiographs collected at 3-month intervals for the first 21 months followed by a 5-year evaluation. Historical controls acquired from available dental literature were used for comparison. RESULTS One implant failed within 2 months of surgical placement, presenting with pain and mobility. The remaining implants demonstrated no infection, pain, or radiolucencies. Nineteen implants were clinically immobile, osseointegrated, and asymptomatic at 21 months. At 5 years, one patient died, three patients were noncompliant, and 15 implants were evaluated as functional. Mean bone loss (MBL) at 1 year and 21 months was approximately 0.5 ± 0.5 mm and 0.70 ± 0.26 mm at 5 years. There was no statistically significant difference between MBLs at p < 0.05. CONCLUSIONS Immediate provisionalization of single dental implants compares favorably with conventional loading protocols. Long-term data suggest that immediate provisionalization of single dental implants is a viable treatment option.

Pemphigus Vulgaris and Paraneoplastic Pemphigus

The history, epidemiology, pathophysiology, clinical presentation, diagnostic work-up, histopathology, and treatment of PV and PNP have been presented. These life-threatening, autoimmune, mucocutaneous bullous conditions may be encountered first by oral health providers and, therefore, deserve keen understanding and attention by the oral and maxillofacial surgeon. Great diagnostic and management strides have been made, but morbidity and life quality issues remain a reality for these chronically ill patients.

Alfentanil for general anesthesia in oral and maxillofacial surgery.

This study evaluated alfentanil (Alfenta, Janssen Pharmaceutica, Piscataway, NJ) as an analgesic supplement to oxygen/nitrous oxide anesthesia for outpatient oral and maxillofacial surgical procedures. Fifty American Society of Anesthesiology (ASA) class I and II patients were induced and maintained with an established regimen. Parameters measured included anesthetic properties, orientation time, recovery time, and presence of side effects. The results indicated that alfentanil provides acceptable anesthesia with minimal recovery time, but occasional side effects such as nausea and vomiting occurred postoperatively. This drug, when properly used, is a welcome addition to other established general anesthetic agents in oral and maxillofacial surgery.

Comparison of implant and provisional placement protocols in sinus-augmented bone: a preliminary report.

PURPOSE To evaluate preliminary data on clinical outcomes associated with timing of placement of single implant-supported provisional crowns and implants in augmented bone. MATERIALS AND METHODS Twenty patients underwent sinus elevation bone grafting followed by a 6-month healing period before implant placement and immediate placement of a provisional crown (group [G] 1); 20 patients received sinus elevation bone grafting at the time of implant placement and immediate placement of a provisional crown (G2); 20 patients required no bone augmentation before implant placement and immediate placement of a provisional crown (G3); and 20 patients received sinus elevation bone grafting followed by a 6-month healing period before implant placement followed by a 6-month healing period before restoration (G4). The height of the crestal bone was measured and recorded to determine mean bone changes, and success rates were determined. RESULTS Mean bone level comparisons were made between G2 and G3, G2 and G4, and G3 and G4. No statistically significant differences were found between the groups (P < .05). G1 was discontinued based on the initial results: two implants did not meet the 35-Ncm insertion test, and one implant failed within 1 month after implant placement. The 1-year implant survival rates were 86% (n = 12/14), 95% (n = 19/20), and 100% (n = 16/16) for G2, G3, and G4, respectively. Differences in survival rates between the groups were not statistically significant (P < .05). CONCLUSION Implant survival is affected by the timing of sinus augmentation and implant placement in relation to the timing of crown placement. Implants that were restored immediately regardless of the timing of bone augmentation showed greater failure rates than implants in augmented bone with delayed restoration protocols or those that were restored immediately in sites without bone augmentation. Neither the timing of loading nor timing of implant placement in relation to bone augmentation surgery affected mean bone loss.

Well-Circumscribed Recurring Facial Mass

In May 1992, a 24-year-old man was referred to the Oral and Maxillofacial Surgery Clinic for evaluation and treatment of a painful, soft swelling in the left facial and submandibular region. The patient reported that similar masses had occurred occasionally over the previous 2 years. However, these occurrences were followed by complete spontaneous resolution in 1 to 2 weeks. No precipitating or exacerbating event could be elicited by history. The patient was in excellent health and his family history was noncontributory. He was not taking any medication and denied a history of drug allergies or reactions. Clinical examination revealed a robust, young man in no apparent distress. He was afebrile and his vital signs were stable. The head and neck examination was significant for a soft, discrete swelling of the left facial and submandibular region adjacent to the antegonial notch of the mandible (Fig 1). No pulsation, thrill, or bruit could be detected. The mass measured 7.0 cm in cranial-caudal dimension by 3.0 cm in anterior-posterior dimension. The overlying skin and oral mucosa appeared normal, and the den&ion was in good repair. The panoramic radiograph confirmed no dental abnormalities or osseous involvement. Fine needle aspiration (FNA) of the mass produced blood and a few benign stromal cells. This was considered nondiagnostic, but a repeated FNA demonstrated similar findings. Axial T,-weighted, proton density and T,-weighted magnetic resonance imaging (MRI) was performed. Following intravenous gadolinium diethylene triamine penta-acetic acid administration (Gd-DTPA), T, imaging was repeated. MRI showed a lobulated mass adjacent to the left horizontal ramus of the mandible displacing the masseter muscle posteriorly (Fig 2). No osseous or parotid involvement was noted. Signal intensity characteristics showed some magnetic susceptibility effect within the central portion ofthe mass, suggesting blood accumulation. The remainder of the mass showed nonspecific signal intensity characteristics and predominantly prolonged T, and T2 relaxation. No significant contrast enhancement was observed.

Split-thickness skin grafts from surgically removed autogenous skin

In oral and maxillofacial surgery, autogenous split-thickness skin grafts (STSG) are generally used when keratinized tissue is needed. A common indication is in preprosthetic surgery in conjunction with a vestibuloplasty. ExcelIent results have been achieved with this technique. Disadvantages concerning the donor site, however, must always be considered. The patient commonly complains more about the donor site (usually the thigh), than the oral recipient site and associated surgery. In addition to postoperative pain, possible complications include infection, delayed healing, and scar formation. Infrequently, skin grafts have been obtained from avulsed or surgicalIy removed skin that was deemed otherwise useless using drum dermatomes. 1-3 An alternative we present is intentional surgical removal of a fulI-thickness skin portion including the sub cutaneous fat. A split-thickness or full-thickness skin graft can then be removed using the Reese dermatome on the back table away from the patient. Primary closure of the donor site can be achieved, which eliminates many complications. We have used abdominal skin in nearly alI cases. It accommodates primary closure even in thin patients. In the more obese patient, the donor site can be treated as a limited abdominoplasty.