Zvi Laster

Horizontal Alveolar Ridge Distraction in an Edentulous Patient

PURPOSEnFull fixed dental rehabilitation, including attachment based over denture (to dental implants) is the optimal solution for edentulous patients, although the insertion of implants will be impossible when the alveolar ridge has been horizontally and severely absorbed. A full arch narrow (knife-edge) alveolar crest creates a borderline condition. Dental implants cannot be inserted into a narrow ridge, which is also at risk of rapid absorption, especially under the pressure of a full denture. Current clinical solutions have been limited. In bone augmentation, the bone absorption rate has been approximately 50%, requiring 6-month therapy prolongation for the grafted bone to consolidate.nnnMATERIALS AND METHODSnWe have described an edentulous patient whose knife-edge maxillary alveolar crest was widened with crest expanders (horizontal distractors).nnnRESULTSnOnly 6 weeks after initiation of the distraction, a wide enough ridge had been created, allowing bilateral insertion of implants, followed by attachment-based full dental rehabilitation. Bone augmentation was avoided, and the implants were placed in the correct lateral position, with sufficient attached gingiva obtained.nnnCONCLUSIONSnHorizontal crest expanding in narrow-alveolar edentulous patients can significantly reduce both morbidity and the therapeutic period and substantially increase the therapeutic success rate, based on both soft tissue and bone distraction. With this technique, our patient was without the denture for only 6 weeks.

The Use of the Superficial Cervical Plexus Block in the Drainage of Submandibular and Submental Abscesses : An Alternative for General Anesthesia

h n adequate level of anesthesia has been a critical omponent of surgery since ancient times. The Peruian natives, the Incas, were the first to use cocaine to chieve local anesthesia. Contemporary, state-of-the rt techniques in medicine relate to general anestheia as a rather safe, useful, and simple way to achieve urgical anesthesia. Nevertheless, general anesthesia has its down sides: igh economic cost, a number of highly trained peronnel required, morbidity and mortality, and highost equipment. On the other hand, regional anesthesia has a numer of advantages:

New-design dental implants: a 1-year prospective clinical study of 344 consecutively placed implants comparing immediate loading versus delayed loading and flapless versus full-thickness flap.

PURPOSEnThis study compared the 1-year success rates of immediately loaded dental implants to delayed loaded implants, regardless of the surgical technique (flapless or conventional full-thickness flap) and regardless of extraction time. It also examined whether the surgical technique had an influence on the success rate of the immediately loaded implants.nnnMATERIALS AND METHODSnA total of 344 dental implants, some with a new expanded winged-thread design, were placed in 155 patients; 53% of the implants were immediately loaded. Of the immediately loaded implants, 68.9% were placed with a flapless surgical technique and 88% were placed in extraction sites. Pocket depth, mobility, bleeding on probing, presence of erythema, pain, or radiolucency around the implants, as well as clinical findings, were recorded. Implants were followed from placement through definitive restoration. Descriptive, univariate, and multivariate analyses using clustered marginal approach of the Cox proportional hazards model were applied.nnnRESULTSnOf the 344 implants in the study, 10 (2.9%) failures were recorded, 7 of which were immediately loaded; however, there was no significant difference in failure rates between the immediate and delayed loading groups. Seven of the implants that failed were placed with a flapless (extraction site) technique; however, there was no significant difference in the failure rates between the flapless versus full-thickness flap technique in immediately loaded implants.nnnCONCLUSIONSnThe clinical success of immediately loaded implants after 1 year showed no difference from the success rate of delayed loaded implants. The implantation procedure (flapless versus conventional flap) or extraction time also had no influence on the success rate of the immediately loaded implants.

Innovations in Dental Implant Design for Current Therapy

The use of osseointegrated dental implants has gained momentum, mainly in the last 20 years. Research and development in the field of implantology are constantly focusing on implant redesign to continue to try and improve implant success. The current aim of implant design is to address situations prone to failure, such as cases of low bone quality or cases of concomitant systemic diseases that compromise healing.

Induced acute hereditary angioedema: a life-threatening condition.

A 19-year-old man presented to the emergency room complaining of dysphagia, as well as swelling of the right side of his face that had spread to his right lower eyelid. The patient had been referred by his general dental practitioner who suspected a dental abscess when the patient returned to him several hours following extirpation of the upper right first premolar nerve. The patient’s medical history was unremarkable. His vital signs were: blood pressure 130/55, pulse 84, oral temperature 36.5°C. The patient was tachypnoeaic and spoke with a “hot potato” speech. He had an oxygen saturation of 92%. Examination revealed edematous swelling on the right side of his face, especially in the periorbital area and lips. The swelling was not sensitive to palpation, was not warm to the touch, and there was no evidence of rubor. Laboratory tests showed: white blood cell count 8.95 10/L; eosinophils 4.5%; lymphocytes 28.8%; neutrophils 56.4%; red blood cells 26 10/mm; hemoglobin 17.8g/dL. Mouth opening was unrestricted and there was no evidence of submandibular lymphadenopathy. Intraorally, the maxillary right first premolar was temporarily filled, was not sensitive to percussion, with no buccal swelling or sensitivity to palpation. No sign of inflammation was present. The uvula, however, was swollen and edematous. X-ray examination (orthopantomogram) showed a deep carious lesion in the lower left second molar, but no signs of dentoalveolar abscess were present anywhere in the maxilla or mandible. Computerized tomography scan, performed to try to determine the cause of the dysphagia and respiratory distress, showed massive edema of the oropharynx and hypopharynx, resulting in almost complete closure of the airway (Fig 1). On further questioning, the patient’s father informed us that he himself suffered from C1 esterase deficiency (C1 INH) and was treated on a regular basis with danazol (Danocrine; Sanofi Winthrop, Bridgewater, NJ). A tentative diagnosis of C1 INH was made. Because of decreasing oxygen saturation, the patient was administered 2 doses of 0.5 mL adrenaline 1:1000 intravenously 15 minutes apart and 125 mg methylprednisolone sodium succinate (Solu-Medrol; Pharmacia and Upjohn, Allegan, MI) intravenously. This treatment yielded no signs of improvement. The patient was then given 2 units of fresh frozen plasma (FFP), and an almost immediate improvement was noted. The patient’s condition improved significantly approximately 40 minutes following the start of treatment, expressed by decreased swelling and improved swallowing and speech. The patient was released from the hospital 24 hours after arrival, in good health and without any of the symptoms that had been present on admission. He was released with a recommendation to undergo further tests, under the care of his general medical practitioner. Approximately 1 week after his release from hospital the patient returned to our department for results of laboratory tests, which revealed a quantitative defect of C1 INH. Received from the Department of Oral and Maxillofacial Surgery,

Innovations in dental implant design for current therapy.

The use of osseointegrated dental implants has gained momentum, mainly in the last 20 years. Research and development in the field of implantology are constantly focusing on implant redesign to continue to try and improve implant success. The current aim of implant design is to address situations prone to failure, such as cases of low bone quality or cases of concomitant systemic diseases that compromise healing.

Salivary biomarker analysis complementing regular clinical examination

AIMnTools for the diagnosis and evaluation of the severity and prognosis of periodontitis are currently insufficient. The aim of the current study was to find an array of salivary biomarkers that would be both sensitive and specific enough to be used as a complement to regular clinical examination. Furthermore, we investigated salivary markers of successful periodontal treatment to elucidate the underlying mechanism of disease.nnnPATIENTS & METHODSnSaliva was collected from periodontitis patients during illness and following successful disease termination. Parameters measured included sodium, potassium, chloride, calcium, phosphate, magnesium, total protein, Alb, LDH, amylase, IL-1α, uric acid and carbonyls.nnnRESULTSnSeven of the parameters analyzed were significantly altered when the disease is active and may be considered biomarkers.nnnCONCLUSIONnSalivary composition reflects disease severity and response to therapy, suggesting the efficacy of saliva monitoring for periodontal disease status and care.

The salivary tip of the p53 mutagenesis iceberg: Novel insights

Salivary malignancies are rare, heterogeneous, unpredictable in their clinical behavior and seldom studied. This study focused on examining the expression of mutated p53, the most prevalent mutated gene related to human cancer, in a rather large cohort of salivary malignancies (n = 70) and for a prolonged period (20 years). P53 was found to be a most powerful predictor for poor survival and more so when the tumor concurrently expressed TUNEL and heparanase markers, dramatically dropping the survival probability of the patients to 0! Survival probability at 6 years for patients with tumors stained negatively vs. positively for p53, TUNEL and heparanase was 100% vs. 49% while at 18 years this probability dropped to 67% vs. 0%, respectively (p = 0.023). Significant correlation rates were found between age and poor survival, age and p53, and p53 and other co-existing malignancies. These findings support mutated p53 as a prognostic predictor and a pivotal player in salivary carcinogenesis. Significantly more extensive therapy applied to salivary p53-positive patients did not improve mortality rate, questioning the justification for such extensive therapy and emphasizing the need to understand p53, TUNEL and heparanase biological pathways and develop additional therapeutic tools for fighting salivary cancer.

The use of free fat tissue transfer from the buccal fat pad to obtain and maintain primary closure and to improve soft tissue thickness at bone-augmented sites: technique presentation and report of case series.

PURPOSEnAtrophic ridges usually have both hard and soft tissue shortages, and bone augmentation can make soft tissue closure difficult. The aim of this case series is to present a new method utilizing transfer of free fat tissue grafts (FFG) from the buccal fat bad (BFP) during bone augmentation to enhance immediate primary soft tissue closure and improve long-term soft tissue thickness and quality at the recipient site.nnnMATERIALS AND METHODSnPatients with moderate to severe ridge atrophy in different regions of the jaws were treated over a 4-year period with bone augmentation and FFG. The BFP was the donor site for the FFG. Patients were examined clinically and radiographically (periapical) every 2 weeks. At 4 months, computed tomography was performed to evaluate the bone gain. Reentry was performed after 4 to 5 months to evaluate the soft tissue, obtain specimens for histologic examination, and insert implants.nnnRESULTSnTwenty patients (18 women, 2 men; mean age 43 years) were followed for 4 to 42 months and received 92 implants in the augmented sites. The healing process was uneventful, with minimal morbidity. Bone volume increased by 4 to 8 mm horizontally and 3 to 6 mm vertically. Thick soft tissue was obtained at the recipient sites and around the dental implants, and histologic specimens showed that the FFG was replaced by fibrous tissue.nnnCONCLUSIONSnHarvesting of the FFG from the BFP is a simple procedure with minor complications, and manipulation and handling of the graft are easy. The FFG enhances primary soft tissue closure of augmented bone, prevents dehiscences, improves long-term soft tissue thickness, and mimics the attached gingiva in its fibrous healing.

A Novel Technique for Vertical Bone Augmentation in the Premaxillary Region

A severely absorbed alveolar ridge in an edentulous premaxillary region is often augmented vertically with various methods to allow for dental implant insertion. Such a severely absorbed ridge most often results from loss of bone due to periodontitis or trauma or after dental extraction; and if socket preservation is not performed immediately after extraction, the alveolus narrows and its vertical dimension may often be reduced by 4 to 5 mm. We introduce a new technique for bone augmentation in the premaxillary region, in which vertical bone augmentation can be performed simultaneously with the insertion of dental implants. The dental implants fix the bone transferred to the maxilla, and particulate bovine bone is placed in the gap between the 2 segments. This method involves a single operation only, requires minimal chair time, and reduces postoperative pain and swelling and involved gingival trauma. In addition, the period required before prosthodontic rehabilitation is shortened.