Repair of oroantral communications in the third molar region by random palatal flap

Various palatal flap procedures based on the greater palatine vessels have been advocated for the repair of oroantral communications (OACs). However, when the defect is located in the third molar region, difficulty is encountered in using the palatal flap because rotation is hindered by the vascular pedicle. In this study, we used random palatal flaps to repair OACs in the third molar area in 21 patients. The vascular pedicles were ligated and severed in all cases in order to evaluate whether it was necessary to preserve the greater palatine vessels when using the palatal rotation flap (PRF). The repair was successful in 16 cases (76.2%). The length/width ratio of the flap was the most important factor determining the outcome. The ratios were 2.23 +/- 0.12 and 2.40 +/- 0.14 in the success and failure groups, respectively and their difference was statistically significant (P<0.05). Other clinical parameters such as age, gender, antral infection, tooth displacement into the sinus and duration of the communication had no influence on the outcome (P>0.05). The study showed that the PRF with the appropriate length/width ratio can safely be used in a random fashion. This provided another option in the repair of oroantral communications of difficult locations such as in the tuberosity area.     

Clinical Outcomes after Apical Surgery on the Palatal Root of the Maxillary First Molar Using a Palatal Approach

IntroductionClinicians are often reluctant to use the palatal approach in apical surgery for the maxillary first molar. This study aimed to investigate the outcomes and complications associated with apical surgery on the palatal root of the maxillary first molar by using a palatal approach.MethodsWe searched for patients who underwent apical surgery with a palatal approach on the palatal root of the maxillary first molar between March 2010 and September 2017 by a single operator. A total of 46 teeth from 46 subjects were included, and they were examined at 6 and 12 months after surgery and annually thereafter. To evaluate whether there was nerve damage on the surgical side, a pinprick test and cotton swab test were used with a 0–10 numerical rating scale, and the results were statistically compared by using the Wilcoxon signed-rank test.ResultsOf the total 35 recall cases (recall rate, 76%; average follow-up time, 3.5 years), success was considered achieved in 32; 30 cases showed complete healing, and 2 had incomplete healing. Three cases resulted in failure, all occurring within 1 year after surgery. The pinprick test results showed that all the numerical rating scale scores were higher than 7, and the responses on the surgical site were not statistically different from those on the contralateral site (P = .109). All subjects showed normosensitivity to the cotton swab test.ConclusionsApical surgery on the palatal root of the maxillary first molar using a palatal approach was predictable and successful, and the number of complications resulting from artery and nerve damage was small.     

Maxillary nerve block anaesthesia via the greater palatine canal: A modified technique and case reports

A modification of the technique of maxillary nerve block (via the greater palatine canal) is discussed. This technique has been employed in the Exodontia and Oral Surgery Clinics of the United Dental Hospital of Sydney for more than 40 years. Clinical experience in that time has shown that once the greater palatine canal has been negotiated successfully, the palatal canal approach to the maxillary nerve is safe and reliable. The value of being able to anaesthetize the maxillary nerve and its branches is illustrated by the presentation of two clinical cases where local anaesthesia was achieved and the extractions performed in patients who would otherwise have required a general anaesthetic for the procedures.     

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随着牙周临床不断发展,每一位从事牙周疾病治疗的医生都面临着临床技能和专业知识方面的巨大挑战.本文就开展牙周手术治疗所需的基本知识和条件做一简单论述,希望对致力于开展和正在开展牙周临床治疗的青年医生实施牙周手术有所裨益.     

Use of the greater palatine pedicled flap for the surgical management of trismus in oral submucous fibrosis

The aim of this paper was to clinically evaluate the efficacy of the greater palatine pedicled flap (GPPF) for the correction of trismus in oral submucous fibrosis (OSMF). This retrospective study was designed from the patients diagnosed with OSMF who underwent transection of fibrous bands and coverage of the defect in the retromolar trigone (RMT) region using GPPF from 2008-2019. Cases were analysed for preoperative (MO_pre-op), and postoperative mouth opening (MO_post-op), secondary healing of the palate, and complications of the procedure. A total of 29 diagnosed cases of OSMF were divided into two groups: group I/stage III (n=13) and group II/stage IV (n=16). The mean (SD) follow up was 29.6 (2.92) months for Group I and 32.4 (3.54) months for Group II. Increase in MO_post-op in group I from 20.0 to 32.92 mm (p=0.0001) and in group II from 6.81 to 26.31 (p=0.0001) was statistically significant. The mean difference of 6.57 mm in MO_pre-op and MO_post-op among the groups was also statistically significant (p=0.0001). The mean (SD) duration for secondary healing of the palate was 5 (1) week(s) and flap necrosis was encountered in two cases of group II/stage IV OSMF. We conclude that GPPF is reliable for the treatment of trismus in advanced stages of OSMF.     

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牙周手术治疗主要是为了消除牙周袋,建立生理性的软、硬组织形态,促进牙周组织修复和再生,建立新的牙周附着关系,恢复美观和功能需要.现代牙周手术往往包含软、硬组织的再生手术,而手术的成功,必须依赖实施规范的牙周外科操作,才能提高手术成功率.随着各种新技术和新材料用于牙周手术治疗,牙周手术的结果才会实现组织再生.     

Evaluation of the healing response following placement of Coe-pak and an experimental pack after periodontal flap surgery

Abstract 2 periodontal dressings. Coe-pak* and RD8 (a product under development). were assessed following periodontal surgery, using a double-blind study of randomised split-mouth design, with each patient acting as their own control. Matched sites were selected for periodontal flap surgery under local analgesia. Sites were randomly allocated to each group. The dressings were applied by a single operator and both patients and clinical assessors were blind as to the dressing employed. The dressings were assessed as to their handling properties, m addition to a 7-day post-operative assessment of the surgical sites and a subjective patient report. Maximum pain levels were relatively low (4 in a scale 0–10); subjects reported more pain and analgesics required with RD8 than with Coe-pak, This was reflected in the results of the patient assessment which indicated that 5O% preferred Coe-pak, compared to 25%. who preferred the RD8 dressing. The results showed RD8 to be an acceptable periodontal dressing when compared to Coe-pak, There were no statistically significant differences between treated sites in both groups with regard to post-operative plaque scores, bleeding scores or tissue healing.     

米诺环素作为牙周手术根面处理剂的临床研究

目的:探讨牙周翻瓣术后用米诺环素作为根面处理剂的临床效果。方法:将23名有中到重度牙周炎需做牙周翻瓣术的患者随机分成两组:对照组仅进行牙周翻瓣术,不做根面处理。实验组在牙周翻瓣术后,用米诺环素处理根面。观察两组术后3d和7d的术区反应及基线时、术后8周及12周的菌斑指数、牙龈指数、探诊出血、探诊深度的动态变化。结果:术后3d,实验组的术后反应显著轻于对照组(P<0.01)。与基线检查时相比,两组菌斑指数,牙龈指数,探诊出血及探诊深度均有显著改善。除8周时,实验组的探诊出血率显著低于对照组(P<0.05)外,两组之间的牙周指数并无显著性差异(P>0.05)。结论:米诺环素作为根面处理剂,能迅速减轻术后牙周组织的炎症反应,促进创口愈合。     

On the inability of root debridement and periodontal surgery to eliminate Actinobacillus actinomycetemcomitans from periodontal pockets

In a previous study, we observed that root debridement was inefficient in eliminating Actinobacillus actinomycetemcomitans from adult periodontitis lesions. The present report describes the effects on A. actinomycetemcomitans of subsequent treatments of 6 patients that had at least 2 separate sites still harboring A. actinomycetemcomitans 6 months following debridement. 1 site or more in each individual was treated with renewed root debridement and at least 1 other site was treated by surgical excision of the gingival tissue. The results indicated that retreatment with either repeated root debridement or with surgical excision of the gingival tissue was not more effective in eliminating A. actinomycetemcomitans than initial debridement. The possible reasons for this limited therapeutic effect on the subgingival presence of A. actinomycetemcomitans are discussed.     

Penicillin control of swelling and pain after periodontal osseous surgery

Abstract Comparable flap operations incorporating curettage and osteoplasties were performed in 17 patients on opposite sides of the same jaw on separate occasions. For one side a cover of phenoxymethyl penicillin 250 mg q.d.s. for 5 days commencing at the time of operation was given and for the other side a placebo was used. Healing was more advanced at 1 week after operation and there was less post-operative discomfort during the first week when the penicillin cover was used. There was a tendency towards less facial swelling when penicillin was administered but the difference was not significant.     

Influence of smoking on the outcome of periodontal surgery

Abstract. The 5-year outcome following periodontal surgery was evaluated in 57 patients that had received regular maintenance care throughout the follow-up period. The study population included 20 smokers, 20 former smokers and 17 non-smokers in the age range 37–77 years. The clinical characteristics evaluated were supragingival plaque, gingival bleeding and pocket probing depth. The region assigned for surgery was, in addition, radiographically evaluated in terms of periodontal bone height. Furthermore, the occurrence of the periopathogens Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) and Prevotella intermedia (Pi) and the gingival crevicular fluid (GCF) levels of tumor necrosis factor alpha (TNF-α) were assessed at follow-up. Plaque index was 28.5% at baseline and 32.9% at follow-up, indicating a good standard of oral hygiene, and gingival bleeding 31.7% and 24.9%, respectively, suggesting a low to moderate level of gingival inflammation. In regions assigned for surgery, pocket probing depth decreased significantly from on average 5.6 mm to 4.3 mm ( p <0.0001) and periodontal bone height increased significantly from on average 62.5% to 67.5% ( p <0.0001). In terms of bone height, the outcome was less favorable among smokers compared with non-smokers. There was a predominance of smokers among patients exhibiting loss of bone height after the 5 years of maintenance. No significant associations were found between the therapeutical outcome and supragingival plaque or subgingival occurrence of periopathogens. The associations between GCF levels of TNF-α and probing depth and bone height were unclear, whereas the level of TNF-α was significantly elevated in smokers.     

Effect of Tisseel on healing after periodontal flap surgery.

The purpose of this investigation was to evaluate the effect on healing of fast and slow absorbable Tisseel in combination with periodontal flap surgery. Mucoperiosteal flaps were raised on the buccal aspect of maxillary premolars and mandibular premolars and first molars in 4 beagle dogs. The underlying buccal, interproximal and inter-radicular bone was then removed to a level of approximately 5 mm apically to the original bone crest and half way into the interdental spaces and bifurcations. The exposed root surfaces were curetted in order to remove the periodontal ligament tissue, and a notch was made in the root surface at the base of the defects. On the control teeth, the flaps were sutured immediately after creation of the defects, while on the test teeth, a layer of fast (group I) or slow (group II) absorbable Tisseel was applied between the curetted roots and the subsurface of the flaps prior to suturing. Postoperatively, the teeth were brushed 2 x weekly. The dogs were sacrificed after 4 months. Histological analysis revealed that the amounts of new attachment and bone regrowth were similar in the test and control groups, although the results tended to be most favorable for the group of teeth treated with fast absorbable Tisseel (Group I).     

正畸扩弓治疗中疼痛与昼夜节律相关性的研究

目的：研究按照昼夜节律进行正畸加力控制,获得昼夜节律对正畸扩弓治疗中疼痛的影响和作用,为临床上更有效地进行正畸加力治疗后的疼痛控制。方法：34例连续正畸扩弓治疗病例,男18例,女16例,年龄10.8～12.8岁,腕骨片示均处于生长发育高峰期,采用相同固定快速扩弓装置,每日加力时间按照人体昼夜节律规律分为0点、3点、6点、9点、12点、15点、18点、21点8个时段组,每组加力方式相同,利用MPQ疼痛量表进行疼痛程度的观察,通过统计学软件进行余弦拟合及多样本t检验。结果：不同性别对于疼痛的耐受力有区别,女性对于正畸扩弓治疗疼痛的耐受力低于相同情况下男性。正畸加力后疼痛量化结果显示正畸加力后疼痛基本符合昼夜节律规律。峰值出现在0点,而谷值出现在12点的时间节点。结论：人体昼夜节律可以影响正畸扩弓治疗后的疼痛程度。按照昼夜节律进行正畸扩弓矫治可以获得更好的疼痛控制效果。提示正畸扩弓加力较合适在午间进行,这样有利于控制正畸患者的疼痛。     

Alterations of the position of the marginal soft tissue following periodontal surgery

The present study was performed to examine the alterations of the position of the marginal soft tissue ("gingival margin") on the buccal surface of teeth in patients who following periodontal surgery were enrolled in a supervised maintenance care program for 10--11 years. The material consisted of 43 patients with severe destruction of the periodontal tissues. Following initial treatment comprising scaling, root planing and instructions in plaque control measures, deepened periodontal pockets were eliminated by the use of an apically repositioned flap procedure including osseous surgery to eliminate bony defects. After treatment, the patients were recalled once every 3--6 months for maintenance care. In all patients, the distance between the cemento-enamel junction and the gingival margin on the buccal surfaces of all treated teeth was assessed (1) prior to surgery, (2) after initial healing, and (3) at a reexamination 10--11 years after treatment. In addition, the presence or absence of keratinized gingiva was determined. The results showed that (1) during active periodontal treatment the position of the gingival margin was shifted in an apical direction, (2) this displacement was to some extent compensated for by a coronal regrowth during the postoperative maintenance care period, (3) the alterations of the position of the gingival margin followed a similar pattern in areas with and without a zone of keratinized gingiva, (4) the number of gingival units devoid of keratinized gingiva decreased during the maintenance care period.     

Impact of anxiety on pain perception associated with periodontal and implant surgery in a private practice

Background: There are limited data on pain perception after periodontal or implant surgery or how pain perception is affected by presurgical anxiety. Methods: Presurgical anxiety and surgical pain perceptions were measured by visual analog scale (VAS) scores and by interview of patients (N = 102) undergoing periodontal or implant therapy in a private periodontal specialty practice in Norway. Results: Patients reported that bad taste, receiving the local anesthetic, and excessive fluid in the mouth were the most uncomfortable experiences associated with periodontal or implant surgery. Analysis of identical responses to these questions showed that there was low intrapatient agreement for uncomfortable experiences (κ = 0.18), but there was reasonably good agreement for comfortable experiences (κ = 0.76). There were no significant differences between repeated VAS scores for pain perception (P = 0.91) or anxiety (P = 0.75) from two consecutive surgeries. There were no significant differences of VAS scores for perception of discomfort for periodontal surgery (9.9 ± 17.0) compared to implant surgery (16.7 ± 24.2; P >0.2). Presurgical anxiety scores were higher for implant surgery (45.5 ± 33.4) than for periodontal surgery (19.5 ± 28.1; P <0.01). Patients with high pretreatment anxiety scores reported that periodontal and implant surgery were more uncomfortable than patients with low anxiety scores (20.5 ± 25.6 versus 0.45 ± 1; P <0.001). VAS perception and anxiety scores did not change on first‐time through fourth‐time surgeries, but retreatment surgery patients recorded higher perception and anxiety VAS scores than patients undergoing surgery for the third or fourth time (P <0.01). Females recorded significantly higher anxiety scores than males (P = 0.04). Conclusion: For periodontal surgery and implant treatments pain perception is affected by the level of presurgical anxiety.     

牙周骨切除术和骨成形术教学训练模型的设计制作及初步应用

牙周基础性手术训练是牙周专业教学重点内容之一.本研究设计一种模拟临床病损拟实施牙周骨切除术和骨成形术的教学训练石膏模型,并制定相关的手术训练流程.该训练模型直观地模拟了临床中常见的典型牙槽骨缺损类型,研究生和进修医生在手术训练过程中可以深刻理解牙周炎导致牙槽骨骨破坏的特点,熟练掌握牙槽骨修整的过程,并学会如何通过修整形...     

意向性牙再植术治疗上颌侧切牙畸形舌侧沟1例

本病例为上颌侧切牙畸形舌侧沟致牙周牙髓联合病损病例,唇腭根面的凹陷、腭侧窄而深牙周袋、根管系统的峡部、破坏严重的唇腭骨板和迁延不愈的瘘道等,给控制根管内外感染保留该牙提出了严重挑战。本病例采用显微根管治疗技术、意向性牙再植术以及纳米生物活性材料,实现了对该患牙的感染控制、患牙保留以及牙周新附着的形成。     

美容牙周手术在前牙固定修复中的临床应用及评价

目的:探讨美容牙周手术与前牙固定修复的关系.方法:58例门诊患者依据病情不同,在修复前分别应用了龈成形术、滑行瓣术、游离组织移植术、牙槽骨手术及牙冠延长术等美容牙周手术.并在修复后立即以及修复后6个月时进行检查,从牙龈、牙周组织健康,患者满意度,医生满意度等方面进行评价.结果:无论采用何种美容牙周手术,只要手术适应证选择恰当,手术设计合理,均可获得良好的美容效果.结论:美容牙周手术是一种获取修复体牙周组织健康及美观性的外科措施,值得在临床上推广应用.     

Significance of frequency of professional tooth cleaning for healing following periodontal surgery

Abstract. The present investigation was undertaken to study the significance of frequently repeated professional tooth cleaning for healing results following periodontal surgery. 24 patients suffering from moderately advanced periodontal disease were selected for the study. Following a Baseline examination comprising assessment of oral hygiene status, gingival conditions, probing depths and attachment levels, all patients were given detailed instruction in proper oral hygiene measures. They were then subjected to periodontal surgery using the modified Widman flap procedure. During the initial 6 months after surgery all patients were enrolled in a maintenance care program which included measures such as scaling and professional tooth cleaning. The patients were randomly distributed into 3 different maintenance care groups. 8 patients (Group 1) received maintenance care once every 2 weeks, another 8 patients (Group 2) received a similar treatment once every 4 weeks while the remaining 8 patients (Group 3) were recalled once every 12 weeks. Following a reexamination at the termination of this 6month period the recall program was changed. Thus, during the subsequent 18 months of maintenance (the maintenance phase) all 24 patients were recalled for prophylaxis once every 3 months. A final reexamination was performed 24 months after completion of active therapy. The reexamination performed 6 months after surgery revealed that while patients who had been recalled for professional tooth cleaning once every 2 weeks had low numbers of inflamed gingival units and deep (>3 mm) periodontal pockets, test subjects recalled less frequently exhibited an increasing number of inflamed gingival units and deep pockets. In addition, the frequency of sites exhibiting attachment loss of > 1 mm was closely related to the frequency of maintenance care. Patients recalled once every 12 weeks for maintenance therapy had 3 times the number of sites with attachment loss (>1 mm) as compared to those who were recalled once every 2 weeks. With the use of regression analysis critical probing depth values were calculated. This analysis showed that while the critical probing depth value was Sow in patients frequently recalled during the healing phase, this parameter adopted gradually increasing values in patients recalled with less frequent intervals. Between the 6- and 24-month reexaminations there were no significant alterations of the oral hygiene status, the gingival condition or the probing depth and attachment level data in any of the 3 groups of patients.