Surgical Dental Treatment Research Articles

Analyzing the Educational Needs of Dental Hygiene Students Using the Borich Needs Assessment and Locus for Focus Models

Objective: This study aimed to develop a standard for a practice-based curriculum that reflects the needs of dental hygiene students’ clinical practice education and to provide basic data that can contribute to improving dental hygienists’ competence in clinical practice. Methods: A survey of 132 dental hygiene students from selected universities was conducted. The Borich Needs Assessment model and The Locus for Focus models were used to evaluate the students’ educational needs for clinical practice content. Results: The highest level of present educational needs was for ‘fluoride application,’ while the greatest requirement was for ‘preparing surgical dental treatment’. Using The Locus for Focus model, 33 items in the first quadrant were identified as common to the Borich Needs Assessment priorities. These items include ‘dental insurance claims’, ‘patient reception’, ‘dental materials counseling’, ‘making a temporary crown’, ‘setting a temporary crown’, ‘document management’ and ‘prepare of dental emergencies’. Conclusions: The analysis of the clinical practice needs of dental hygiene students identified the needs for practice-oriented education. These findings suggest that future curriculum revisions should reflect not only the needs of students, but also the perspectives of educators and clinical dental hygienists.

Possible vascular complications due to anatomical variations in dental surgical treatments

The facial artery undergoes multiple anatomic variations that condition the territory that vascularizes to the facial level. During the dissection of several pieces, we find a curious anatomic alteration in which the transverse facial artery is the one that replaces the facial artery because it disappears at the level of the submandibular gland. This anatomic variance can help to improve the knowledge of the vascularization of this area and be helpful in the different surgical or aesthetic processes in the facial region, and doing so minimizes the damages that can be caused in the anatomical surfaces treated. This is why in the planning of the treatment it would be always useful to know the path of the main vessels and nerves to avoid their possible injury and, in this case, we recommend the use of means such as ultrasound.

One-stage combined ENT and dental surgical treatment of odontogenic sinusitis: a prospective study

PurposeThe study analyses outcomes of the surgical treatment of odontogenic sinusitis that concurrently address sinusitis and its dental source.MethodsA total of 364 adult patients were included, representing 13% of all patients we have operated on for any rhinosinusitis over the past 18 years. The diagnosis was based on both ENT and dental examinations including CT imaging. Patients were divided into three groups: (1) FESS with dental surgery without antrotomy, (2) FESS with intraoral antrotomy, and (3) intraoral surgery without FESS. The mean postoperative follow-up was 15 months.ResultsFirst group involved 64%, second group 31%, and third group 6% of the cases. The one-stage combined ENT and dental approach was used in 94% of cases (group 1 and 2) with a success rate of 97%. Concerning FESS, maxillary sinus surgery with middle meatal antrostomy only was performed in 54% of patients. Oroantral communication flap closure was performed in 56% of patients (success rate 98%). Healing was achieved within 3 months. The majority (87%) of patients were operated on unilaterally for unilateral findings. Over the past 18 years, a 6% increase of implant-related odontogenic sinusitis was observed.ConclusionOdontogenic sinusitis is common, tending to be unilateral and chronic. Its dental source needs to be uncovered and treated and should not be underestimated. Close cooperation between ENT and dental specialists has a crucial role in achieving optimal outcomes. The one-stage combined surgical approach proves to be a reliable, safe, fast and effective treatment.

Chronic antiplatelet therapy in prevetion of cardiovascular diseases (in population of elderly) from the perspective of oral health: Cardiologic safety versus complications risk. Influence of oral diseases on global health risk in elderly

Introduction and purpose: Oral cavity diseases are a common problem in everyday clinical practice, particularly important in the context of elderly people affected by numerous chronic diseases, on the verge of frailty. These patients are often characterized by an increased risk of cardiovascular events, but also an increased risk of bleeding, which is the reason for dentists' doubts regarding the maintenance or suspension of chronic antiplatelet therapy in the periprocedural period. The aim of our work is to present the risks of untreated oral diseases and to summarize the current knowledge and recommendations on the use of antiplatelet drugs during surgical dental treatment.
 Description of the state of knowledge: It has been proven that the ongoing disease processes in the oral cavity exacerbate the course of chronic diseases by several different mechanisms, the best known of which are: opening the gates to the bloodstream, blood circulation of inflammatory mediators and direct colonization of the respiratory tract by microorganisms from the focal point in the oral cavity. According to current research, standard dental surgeries can be safely performed in patients taking antiplatelet drug(s) chronically without the need to discontinue therapy in the periprocedural period. The risk of prolonged or excessive bleeding in such patients is not significantly increased, and bleeding complications that occur can be managed with local haemostasis measures. 
 Conclusions: Prevention and early treatment of oral diseases can protect against their negative global impact on health. There is no indication to interrupt chronic antiplatelet therapy with one or two drugs prior to standard dental procedures.

Pain management following dental trauma and surgical procedures.

Surgical procedures and post-traumatic management of dental patients require effective pain management during treatment, but being considerably more invasive than conservative treatments, pain management is required into the postoperative period. Clinical trials on pain intensity following dental surgical procedures (e.g., 3rd molar extraction, implant placement, periodontal, and endodontic surgery) have shown that pain is most intense approximately 5-6 h after completion of the procedure, reaching its peak levels during the first postoperative day. Greatest consumption of analgesics occurs during the first 48-72 h after 3rd molar extraction. For the management of perioperative pain associated with either conservative or surgical dental treatment, the local anesthetics articaine, lidocaine, mepivacaine, and prilocaine are preferred. These drugs, with a vasoconstrictor, provide a rapid onset and a duration of pulpal anesthesia adequate to complete most dental and surgical procedures painlessly. For management of post-traumatic and postsurgical pain, bupivacaine-administered by an appropriate nerve block-near the conclusion of a surgical procedure, can provide the patient with a pain-free period of up to 12 h. Nonsteroidal anti-inflammatory drugs represent the most effective drugs for the management of dental postsurgical pain. NSAIDs, as a group in therapeutic doses, have numbers needed to treat (NNTs) ranging from 2 to 3, while opioid analgesics do not approach those for NSAIDs. A protocol for management of pain following surgical procedures and traumatic injuries is discussed in this paper and includes preemptive NSAID; perioperative pain management; postoperative pain management-local anesthesia; postoperative pain management-analgesics; postoperative telephone call.

Perioperative Management of Antithrombotic Therapy in Patients Who Undergo Dental Procedures: A Systematic Review of the Literature and Network Meta-Analysis

The surgical dental treatment of subjects admitted for anticoagulants therapy represents a consistent risk for peri-operative bleeding. The aim of the present study was to investigate the clinical findings of dental surgery operative management of the patients under anticoagulants drugs protocol. The literature screening was performed using Pubmed/Medline, EMBASE and Cochrane library, considering only randomized clinical trials (RCTs) papers. No limitations about the publication's period, follow-up time or clinical parameters were considered. A total of eight RCTs were included for the qualitative synthesis. No thromboembolic complications were reported in any studies. Several bleeding episodes associated with anticoagulant drugs in dental surgery were mild and generally happened on the first day after the treatment. The use of local haemostatic measures is generally effective for bleeding control with no further pharmacological drug management or suspension.

Comparative analysis of the effectiveness of SF-MPQ-2 and VAS for assessing the severity of pain syndrome in dental patients in the postoperative period

Conducting a comparative analysis of the effectiveness of the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2) and the Visual Analogue Scale (VAS) for assessing the severity of pain syndrome in dental patients in the postoperative period in dynamics. The study included 51 patients who received dental surgical treatment. Two groups of patients were formed, depending on the type of surgery and the degree of trauma of the operation. Group 1 - low degree of injury - 28 patients; group 2 - high degree of injury - 23 patients. Patients independently filled out questionnaires at four stages of the study: before surgery, on the 1st, 3rd, and 5th days after surgery as part of scheduled visits. In patients of group 2, the severity of pain symptoms was higher than in patients of group 1 in terms of pain symptoms on SF-MPQ-2 at all stages of the study, except the day before surgery. At the same time, there were no differences with the indicators of the VAS scale at any of the stages of the study. The most informative indicators of SF-MPQ-2 are the total indicator MPQ-Sum and the constant pain indicator MPQ-Const, which were significantly higher in group 2 on the 1st day after surgery, taking into account the correction for gender and age. The highest level of coincidence of indicators on VAS and the total score on MPQ-Sum was revealed on the 5th day of the operation, regardless of the degree of trauma of the operation. The use of SF-MPQ-2 with a detailed description of pain sensations is the most acceptable way to assess the degree of pain syndrome in operative surgery, especially during the period when the severity of pain symptoms is maximum (in the first days of the postoperative period).

Oral health of patients suffering from end-stage solid organ insufficiency prior to solid organ re-transplantation: a retrospective case series study

BackgroundThe oral health of organ transplanted patients before organ re-transplantation is largely unknown. This retrospective clinical study evaluates the necessity for intraoral surgical intervention and/or conservative treatment in candidates awaiting organ re-transplantation, both for graft failure and for reasons of another upcoming solid organ transplantation (renal or non-renal).MethodsFrom January 2015 to March 2020 n = 19 transplant recipients in evaluation on the waiting list for solid organ re-transplantation could be included in the retrospective case series study. Using clinical and radiological examinations, necessity for oral surgical or conservative dental treatment was evaluated. On the basis of anamnesis data, current kidney function, renal replacement treatment (RRT), and medication, a risk profile for several patient subgroups was created.ResultsThe clinical and radiological examinations showed a conservative and/or surgical treatment need in n = 13 cases (68.42%). In n = 7 cases (36.84%) surgical intervention was recommended due to residual root remnants (n = 5), unclear mucosal changes (n = 1), and periimplantitis (n = 1). In n = 16 recipients (84.2%) RRT (n = 15 hemodialysis; n = 1 peritoneal dialysis) had been performed. N = 14 recipients (73.68%) received immunosuppressants. In n = 1 patient (5.3%) displayed intraoral and n = 4 patients (21.1%) extraoral neoplasms due to drug-induced immunosuppression.ConclusionsSolid organ transplant recipients with renal failure present a complex treatment profile due to a double burden of uremia plus immunosuppressants. In cases of surgical treatment need a hospitalized setting is recommended, where potentially necessary follow-up care and close cooperation with disciplines of internal medicine is possible in order to avoid surgical and/or internal complications.

Combining Ergonomic Risk Assessment (RULA) with Inertial Motion Capture Technology in Dentistry-Using the Benefits from Two Worlds.

Traditional ergonomic risk assessment tools such as the Rapid Upper Limb Assessment (RULA) are often not sensitive enough to evaluate well-optimized work routines. An implementation of kinematic data captured by inertial sensors is applied to compare two work routines in dentistry. The surgical dental treatment was performed in two different conditions, which were recorded by means of inertial sensors (Xsens MVN Link). For this purpose, 15 (12 males/3 females) oral and maxillofacial surgeons took part in the study. Data were post processed with costume written MATLAB® routines, including a full implementation of RULA (slightly adjusted to dentistry). For an in-depth comparison, five newly introduced levels of complexity of the RULA analysis were applied, i.e., from lowest complexity to highest: (1) RULA score, (2) relative RULA score distribution, (3) RULA steps score, (4) relative RULA steps score occurrence, and (5) relative angle distribution. With increasing complexity, the number of variables times (the number of resolvable units per variable) increased. In our example, only significant differences between the treatment concepts were observed at levels that are more complex: the relative RULA step score occurrence and the relative angle distribution (level 4 + 5). With the presented approach, an objective and detailed ergonomic analysis is possible. The data-driven approach adds significant additional context to the RULA score evaluation. The presented method captures data, evaluates the full task cycle, and allows different levels of analysis. These points are a clear benefit to a standard, manual assessment of one main body position during a working task.

Patients with hypertension – influence of hypertension therapy on the impending dental surgical treatment

Hypertension affects a large part of the world's population. Late diagnostics of the disease, asymptomatic course and its wide distribution are the reasons why dentists are among the first to face the disease and its consequences. It is very important to take into account the specific drugs used during dental treatment, and the effects of therapy applied so far on the patients, in order to increase the success rate of the dental treatment. The aim of the article is to reveal specific guidelines for dental treatment of patients with hypertension.

Dental rehabilitation in the complex treatment of children and adolescents with maxillofacial neoplasms

Of the study was to improve algorithms and methods of complex dental rehabilitation of children and adolescents with maxillofacial neoplasms. Sixty-seven patients aged from 2 to 17 years (average age 10.43±4.56; 30 boys, 37 girls) underwent complex rehabilitation as a part of neoplasm treatment (40 benign, 27 malignant). Patients were divided into 3 groups: group 1 aged 2 to 7 years; group 2 aged 8 to 12 years; group 3 aged 13 to 17 years. Structural integrity of upper and lower jaws was reconstructed using vascularized bone flaps (27 cases), non-vascularized bone flaps (5 cases), titanium reconstructive plates (11 cases) or individual titanium endoprostheses of the temporomandibular joint (2 cases). Orthodontic, orthopedic and surgical dental treatment was performed at all stages of rehabilitation of patients and had its own characteristics depending on the group affiliation. Algorithms for dental rehabilitation of children and adolescents with maxillofacial neoplasms have been improved on the base of performed treatment.

A case of dental surgery intervention for a hemophilia A patient

Hemophilia A is a genetic coagulation disorder associated with a deficiency of clotting factor VIII (FVIII). It can be inherited or acquired and have different levels of severity. The present case report describes a male patient with FVIII deficiency who underwent dental surgical treatment. The patient was a 70-year-old male with a prosthetic mechanical aortic valve who had undergone ascending aortic replacement surgery and coronary artery bypass surgery. He also had a history of cerebral infarction with right paraplegia. Therefore, he visited our hospital for surgical dental treatment. The patient underwent blood tests and imaging to assess the severity of hemophilia and the condition of the surgical area. The treatment plan for the day of surgery was to ensure that markers for bleeding tests would not be increased and prolongation of the partial thromboplastin time (PTT) would remain mild; accordingly, the patient was administered FVIII before the surgical treatment under local anesthesia. The blood examination revealed a mild prolonged PTT and slight changes in platelet count and FVIII level. There was no subsequent bleeding or complications at follow-up, and the wound had healed completely without abnormalities.

Comparison of mandibular cortical bone among obese, overweight, and normal weight adolescents using panoramic mandibular index and mental index.

The objective of this study is to evaluate the mental index (MI) and panoramic mandibular index (PMI) of a group of adolescent patients in different body mass index (BMI) percentile. Subjects were divided into three different groups in accordance to their BMI percentile status: normal weight (35 subjects; mean age, 14.81 ± 2.12 years), overweight (32 subjects; mean age, 14.77 ± 2.56 years), and obese (33 subjects; mean age, 14.06 ± 2.59 years) groups. Mental index (MI) and panoramic mandibular index (PMI) were assessed on panoramic radiographs. There were statistically significant differences in PMI and MI that were observed among groups (p < 0.0001 and p < 0.001, respectivel). MI and PMI are higher in overweight and obese individuals than in normal-weight. Mandibular cortex was found thicker in patients who are obese and overweight compared to normal weight patients. We can suggest that young obese individuals' bone structure can be take in consideration in orthodontic or dental surgical treatment planning. Dense cortical bone may cause some difficulties in orthodontic and surgical treatment. Clinicians should understand obesity and overweight-related jaw bone changes and consider these factors to treat their patients.

PREVALENCE OF PNEUMATIZATION OF THE CRISTA GALLI IN DENTAL PATIENTS

<h3>Background</h3> A large field of view (FOV) cone beam computed tomography (CBCT) scan can show an anatomic variant, such as pneumatization of the crista galli. The crista galli is a bony projection that extends superiorly from the cribriform plate of the ethmoid bone. It is located at the midline of the anterior cranial fossa and is where the falx cerebri attaches anteriorly. As there is no literature on this topic using CBCT imaging, we undertook this study to add to the research as well as to inform dentists and specialists about pneumatization of crista galli. <h3>Objective(s)</h3> The aim of this study was to report the prevalence of pneumatization of the crista galli using CBCT images and to compare the prevalence of pneumatization of crista galli in patients receiving nonsurgical versus surgical dental treatment. <h3>Study Design</h3> The study included 514 diagnostic CBCT scans from 2015 to 2016. Age, sex, treatment provided, and the size of pneumatized crista galli were recorded. The associations between age and sex versus pneumatization of the crista galli were evaluated using the Mann-Whitney U test. The associations between treatment and pneumatization of crista galli were assessed using Pearson's χ² and Fischer's exact tests. <h3>Results</h3> The average age of the patients was 15.69 years. Pneumatization of crista galli occurred in 20 out of 514 (3.8%) patients. The median cranial–caudal length of a pneumatized crista galli was 4.78 mm in females and 5.62 mm in males. The median width was 4.49 mm in females and 6.98 mm in males. Patients with pneumatization were statistically significantly older than the patients without pneumatization (U = 3041.5; <i>P</i> = .004). Among the nonsurgical categories, orthodontic treatment was classified as significant (<i>P</i> = .008). Among surgical categories, orthognathic surgery was found to be significant in the presentation of pneumatization of the crista galli (<i>P</i> = .001). Fischer's exact test showed there was a significantly higher percentage of surgical patients with pneumatization compared with nonsurgical patients (<i>P</i> = .003). <h3>Discussion/Conclusions</h3> Age, orthodontic treatment, and orthognathic surgery were significantly associated with pneumatization of the crista galli. Gender did not contribute substantially to pneumatization of the crista galli.

The efficacy of homeopathic Arnica montana 200 CH on dental surgical treatments: a double-blind, placebo-controlled study

Objectives: The aim of this placebo-controlled study was to assess the efficacy of single dose homeopathic Arnica montana 200 CH in dental surgeries. Methods: The study included 79 patients undergoing wisdom teeth extractions, implant placements, cystectomies, augmentation procedures, alveoloplasties, lefort-1 osteotomies at Istanbul Medipol University’s Department of Oral and Maxillofacial Surgery. The patients were randomly divided into two groups using a computer program. Three globulesof Arnica montana 200 CH were administered in the sublingual area in the patients group 1, and glucose globules were administered in the sublingual area in the patients into group 2. After each patient’s surgical operation, the surgeoncompleted a survey about operation time and scope. In addition,a self-assessment survey was completed by the patients the day after their operationsto evaluate their post-operational swelling and pain. Results: Arnica montana did not appear to significantly prevent post-operative swelling and pain when compared to the placebo (p &amp;lt; 0.05). Conclusions: This study showed that the use of Arnica montana before a physically traumatic procedure is not more effective than the use of a placebo. However, the results should be evaluated in other studies, including the administration of Arnica montana after a physically traumatic procedure to clearly demonstrate its homeopathic efficiency.

Pediatric Dental Surgery Under General Anesthesia: Uncooperative Children.

Dental treatment of young pediatric patients can be confounded by lack of cooperation for dental rehabilitation procedures and even examination and/or radiographs. With the recent US Food and Drug Administration warning applied to many anesthetic/sedative agents for children less than 3 years old, a retrospective review of general anesthesia (GA) cases from 1 private pediatric dental practice was studied for age, gender, body mass index, anesthetic duration, airway management used, extent of dental surgical treatment, recovery time, and cardiac/pulmonary complications. For the 2016 calendar year, 351 consecutive GA cases were identified with patients aged 2-13 years. Of these, 336 underwent nasal endotracheal intubation. Forty-six of 351 patients (13%) were younger than 3 years. Median anesthesia duration was approximately 1.7 hours for all age groups. Dental treatment consisting of 8-9 teeth including crowns, fillings, and extractions was most frequently encountered. One hundred sixty-eight patients (48%), however, required care for 10-18 teeth. There were no episodes of significant oxygen desaturation. The overall complication rate was 1.1%, with 2 cases of postextubation croup, 1 case of mild intraoperative bronchospasm, and 1 case of intraoperative bradycardia. Complications did not correlate with children being overweight or obese.

Перспективність надання гігієністом зубним профілактичної стоматологічної допомоги населенню м. Житомира

Preventive medicine is the basis for the development of health care systems in the European Union, and investment in prevention is recognized as the most effective investment in the industry of preserving and improving health. Prophylactic direction – one of the most important in modern dentistry.The aim of the study – analysis of treatment and prevention performance indicators of Municipal Institution Zhytomyr City Dental Hospital No.1 and defi nition of methods for improving the primary prevention.Materials and Methods. We analyzed the annual reports of internal medicine and surgical departments of Zhytomyr City Dental Hospital No. 1 for the period from 2015 till 2016; we held a poll of 115 patients of the establishment regarding the methods for teeth cleaning and using the accessories and means necessary for oral cavity care. The following methods were used: bibliosemantic, system analysis and logical concluding,interview, and mathematical processing of the collected data. Results and Discussion. Numeric materials refl ecting the work of Zhytomyr City Dental Hospital No.1 indicate that doctors employed in the establishment conduct numerous maneuvers related to oral cavity sanitation using modern fi lling materials and diagnostic methods. However (and predominantly), all the work is directed at secondary prevention. As a result, annually a lot of teeth are removed due to complex caries (23.370–23.898), and there are a lot of patients with signs of periodontal diseases (3.521–3.766). Dispensary for diseases includes 94 patients with pre-tumor pathology. Considering that public hygienic teaching and education is one of the main components of primary treatment, we held a poll involving 115 patients of Zhytomyr City Dental Hospital No. 1. Study results indicate that the patients of the dental care entity have insuffi cient knowledge on using the accessories and means necessary for hygienic procedures. All the respondents are more ready to invest into prevention care than internal medicine and surgical dental treatment. It is possible to reach an upward trend in dental health indicators only with primary caries and periodontal diseases prevention. Adding hygienist in the staffi ng list of dental care entities would allow not only for comprehensive primary prevention, but would also unload the high-class dentists enabling them to conduct more complex oral cavity operations.Conclusions. Zhytomyr City Dental Hospital No. 1 employs no hygienists, that is why its work is aimed at secondary treatment of oral cavity diseases. Low sanitary culture level of Zhytomyr residents is tightly connected with dental health indicators. Further development and reforming of dental care demands training of the new generation of highly qualifi ed junior medical staff (hygienists). Involving of hygienists in treatment care allows improving the quality of preventive dental services and decreasing dental diseases incidence rate.

Initial approach in cleidocranial dysplasia: the role of Pediatric Dentistry

Objetivo: enfatizar a importância da Odontopediatria no planejamento do tratamento odontológico como primeiro passo de reabilitação em um paciente pediátrico com diagnóstico de Displasia Cleidocraniana (CCD). Relato de Caso: este estudo apresenta o caso de uma menina de dez anos, com diagnóstico de DCC, que frequentou o Setor de Odontopediatria da Faculdade de Odontologia de São Leopoldo Mandic - Campinas / São Paulo encaminhada pelo ortopedista, cuja principal queixa foi o atraso irrupção dos dentes anteriores. Precisa de tratamento odontológico preventivo, curativo, reabilitador, ortodôntico e cirúrgico. Após um planejamento interdisciplinar, uma proposta de tratamento foi indicada e aceita pelos responsáveis do paciente.

Quality of oral surgery and patients' satisfaction in state and municipal clinics

The aim of the multicenter study was to assess quality of oral surgical procedures and patients' satisfaction in state and municipal clinics in different regions of Russian Federation. A questionnaire survey was conducted in 3 regions of Russian Federation: European (Moscow, Tula, Tambov, Kaluga, Volgograd), North (Saint-Petersburg, Novgorod, Tver) and South (Armavir, Derbent, Kaspiysk, Kislovodsk, Makhachkala, Pyatigorsk, Rostov, Sochi, Stavropol). Sixty-six males and 34 females undergoing surgical dental treatment in public and municipal dental clinics (total number - 100 patients) at the age of 20 to 70 years (an average age was 36,3 and 39.5, respectively) were included in the study. Comparative analysis of patients' satisfaction rates in relation with expert evaluated quality of oral surgery is presented.

Management of osteoporosis patients for prosthetic restoration

The average life expectancy has been increased, so the proportion of elderly patients that visit to the dental clinic for prosthetic restoration has increased. Elderly patients have various chronic diseases. Recent trends show an increase of osteoporosis in elderly patients, and thus, the number of osteoporosis patients is expected to escalate. Currently, the most widely used drug for osteoporosis is bisphosphonate. However, osteonecrosis of the jaw has been reported as a side effect derived from longterm oral administration or injection treatment of the drug. Surgical dental treatment was the main cause of medication related osteonecrosis of the jaw (MRONJ). As MRONJ is very difficult to cure, it is important to take preventive measures. Surgical operation may be needed for the mouth preparation before prosthetic restoration. For successful treatment, the dentist should have a full understanding of osteoporosis and show a continued interest toward this disease for careful management.