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[ Oral/Maxillofacial Surgery ]
Success and failure in periradicular surgery A longitudinal retrospective analysis
Tiziano Testori, MD, DDSa
Matteo Capelli, DDSb
Silvano Milani, PhDc Roberto L. Weinsteind
The objective of the present study was to compare the success rates of 2 different periapical surgical techniques, the traditional technique with rotary instruments and the ultrasonic technique, which uses ultrasonic retrotips. A longitudinal retrospective study was carried out on 302 apices (181 teeth) that had undergone periapical surgery. Surgical outcome was evaluated by 2 independent operators using standardized periapical radiographs. Each radiographic finding was classified into 1 of 4 groups: complete healing, incomplete healing, uncertain healing, and unsatisfactory outcome (failure). An SAS statistical analysis system was used for data management and analysis. Prognostic factors were determined by means of the Fisher exact test. Complete healing after 4.6 years (the average follow-up period) was observed in 68% of the teeth treated through the use of the standard technique and 85% of those treated through the use of the ultrasonic technique. The success rate increased as the follow-up period lengthened (68.4% at 2 years vs 80% at 6 years). The success rate was higher in maxillary (77.9%) than in mandibular (66.1%) teeth. A comparison between the retrofilling materials was not feasible because all teeth in the standard technique group were retrofilled with amalgam and all teeth in the ultrasonic group were retrofilled with Super-EBA.
Primary leiomyosarcoma of the mandible in a 7-year-old girlReport of a case and review of the literature
Laurie C. Carter, DDS, MA, PhDa
Alfredo Aguirre, DDS, MSb
Barry Boyd, DMD,
Mark D. DeLacure, MDd Buffalo, NY
Leiomyosarcoma is a malignant neoplasm of smooth muscle origin that manifests itself uncommonly in the oral cavity because of the paucity of smooth muscle in that location. To the best of our knowledge, only 10 cases of leiomyosarcoma primary to the jawbones have been reported in the English language literature. We report the first pediatric case of leiomyosarcoma arising from the mandible. Facial asymmetry and swelling were accompanied by a rapidly growing exophytic soft tissue mass that caused buccal displacement of the mandibular left permanent first molar. The lesion, observed radiographically as an extensive ill-defined area of osteolytic alveolar destruction, perforated the lingual cortex, displaced the inferior alveolar nerve canal inferiorly, and produced a "floating-in-air" appearance of the first molar. Diagnosis of leiomyosarcoma was made after initial incisional biopsy of the lesion. A 5-cm segmental mandibulectomy and supraomohyoid neck dissection were followed by reconstruction with a dynamic mandibular reconstruction plate and placement of a multidimensional mandibular distraction device in a transport rectangle of bone to promote bifocal distraction osteogenesis. Forty millimeters of distraction (the technical limit of the device) were performed; this was followed by terminal iliac crest bone grafting. Seventeen months after the definitive surgical procedure, the patient remains free of disease.
Considerations in the selection of a root-end filling material
Surgical root canal treatment often includes the placement of a root-end filling material. New materials have recently emerged to challenge the long-standing position of amalgam as the root-end filling material of choice. This review discusses several of the commonly used root-end filling materials, with emphasis on indications and contraindications for the use of each.
Treatment of Peri-implant Defects with Guided BoneRegeneration: A Comparative Clinical Study with Various Membranes and Bone Grafts
Intl journal of aral and maxillo facial implants
Vol. 13, No. 5 1998 Page: 639
Abstract: In this clinical study, a bioabsorbable membrane (Biofix) and two augmentation membranes made of exapnded polytetrafluoroethylene (Gore-Tex) were tested for their osteopromotive potential. Forty-six implants were augmented with Gore-Tex membranes, 45 implants with titanium-reinforced Gore-Tex membranes, and 38 peri-implant defects with a resorbable polyglycoid membrane (Biofix). Autogenous bone (n= 85) and bovine bone matrix (Bio-Oss, n = 16) were used as filling materials beneath membranes. The results showed that bone repair is significantly improved by the use of membrane techniques. The average rate of bone regeneration with non-resorbable memb ranes was 84% (GTAM) and 81% (TR-GTAM). The use of Biofix membranes resulted in an average bone gain of 60%. The differences in efficacy established for the three types of membranes were found to be statistically significant (P < .001). Barrier membranes represent a valid technique for the treatment of peri-implant defects. Clinical and histologic results showed that Bio-Oss is an osteoconductive scaffold that promotes new bone formation.
Clinical and Histologic Evaluation of an Active Implant Periapical Lesion : A Case Report Intl journal of aral and maxillo facial implants
Vol. 13, No. 5 1998 Page: 713
Abstract: A new entity called implant periapical lesion has recently been described. This lesion could be the result of, for example, bone overheating, implant overloading, persence of a preexisting infection or residual root fragments and foreign bodies in the bone, contamination of the implant, or implant placement in an infected maxillaary sinus. This case report describes a titanium implant that was placed in the maxillary premolar region. A fenestration involving the middle portion of the implant was present. After 7 months, the apical portion of the implant showed radiolucency. This lesion rapidly increased in size and a vestibular fistula appeared. A systemic course of antibiotics was not successful, and the implant was then removed. The histologic examination showed the presence of necrotic bone inside the antirotational hole of the implant. The etiology of the implant failure in this instance could possibly be related to bone overheating associated with an excessive tightening of the implant and compression of the bone chips inside the apical hole, producing subsequent necrosis.
Removal Torque Values of Titanium Implants in the Maxilla of Miniature Pigs -Intl journal of aral and maxillo facial implants
Vol. 13, No. 5 1998 Page: 611
Abstract: The purpose of this study was to compare side-by-side two different titanium screw-type implants in the maxillae of miniature pigs. The test implants had a machined and acid-etched surface (Osseotite) whereas the control implants were sandblasted and acid-etched (SLA). After 4, 8, and 12 weeks of healing, removal torque testing was performed to evaluate the shear strength of the bone-implant interface for both implant types. The results demonstrated significant differences between both implant types (P < .01). Osseotite implants revealed mean removal torque values (RTV) of 62.5 Ncm at 4 weeks, 87.6 Ncm at 8 weeks, and 95.7 Ncm at 12 weeks of healing. In contrast, the SLA implants demonstrated mean RTV of 109.6 Ncm, 196.7 Ncm, and 186.8 Ncm at corresponding healing periods. The mean RTV for SLA implants was 75% to 125% higher than for Osseotite implants up to 3 months of healing.
Topical Vaccine Eliminates Streptococcus Mutans for up to 4 months
A clinical trial conducted by researchers from guys Hospital Dental School in London utilized a vaccine applied to teeth and Streptococcus mutants was unable to recognize the teeth.The vaccine was used as mouth wash twice a week for three weeks. Control subjects had Streptococcus mutants back in their mouths at two months while the vaccine group had no return of Streptococcus mutants for 4 months.
Searching for MB2|
Implants #18, #19
Molars with lesions
Lower incisor retreatment
Peri radicular healing
2 upper molars
2 Anterior teeth
File broken in tooth
2 year trauma
Squirt on mesials|
Palatal root exits
Color map 3