Systemic management and periodontal treatment of hiv-necrotizing periodontitis: A case report

BACKGROUND

Necrotizing periodontitis (NP) is a rare form of periodontal disease. It can manifest in immunocompromised patients and present as painful and rapidly progressing destruction with necrotic and ulcerated periodontal tissues. This case report describes a rare case of severe NP in human immunodeficiency virus (HIV)-positive patient including medical management and periodontal treatment.

METHODS

A 28-year-old male presented to the Periodontal clinic with chief complaint of severe oral pain leading to loss of chewing ability, spontaneous gingival bleeding, generalized gingival recession, tooth mobility, and dentinal hypersensitivity. Clinical and radiographic examination revealed generalized tissue necrosis with severe periodontal destruction, extensive bleeding, spontaneous suppuration, and heavy biofilm.

RESULTS

Medical history was positive for perinatal HIV infection, which was treated and patient was asymptomatic until he discontinued antiviral medications nine years ago. Following initial examination, patient was referred to the Infectious Disease Clinic and multidisciplinary management was initiated with comprehensive management of primary disease including systemic antiviral, antibiotic, and antifungal therapy to establish immunocompetence compatible with providing mechanical non-surgical periodontal treatment.

CONCLUSIONS

This case report highlights a severe and generalized form of NP in an HIV- patient due to the cessation of antiviral therapy. Favorable course of interdisciplinary medical and periodontal therapy resulted in significant improvement in patient's systemic, oral and periodontal health. This article is protected by copyright. All rights reserved.

Influence of Metal Guide Sleeves on the Accuracy and Precision of Dental Implant Placement Using Guided Implant Surgery: An In Vitro Study

PURPOSE

Metal sleeves are commonly used in implant guides for guided surgery. Cost and sleeve specification limit the applications. This in vitro study examined the differences in the implant position deviations produced by a digitally designed surgical guide with no metal sleeve in comparison to a conventional one with a metal sleeve.

MATERIALS AND METHODS

The experiment was conducted in two steps for each step: n = 20 casts total, 10 casts each group; Step 1 to examine one guide from each group with ten implant placements in a dental cast, and Step 2 to examine one guide to one cast. Implant placement was performed using a guided surgical protocol. Postoperative cone-beam computed tomography images were made and were superimposed onto the treatment-planning images. The implant horizontal and angulation deviations from the planned position were measured and analyzed using t-test and F-test (p = 0.05).

RESULTS

For Step 1 and 2, respectively, implant deviations for the surgical guide with sleeve were -0.3 ±0.17 mm and 0.15 ±0.23 mm mesially, 0.60 ±1.69 mm, and -1.50 ±0.99 mm buccolingual at the apex, 0.20 ±0.47 mm and -0.60 ±0.27 mm buccolingual at the cervical, and 2.73° ±4.80° and -1.49° ±2.91° in the buccolingual angulation. For Step 1 and 2, respectively, the implant deviations for the surgical guide without sleeve were -0.17 ±0.14 mm and -0.06 ±0.07 mm mesially, 0.35 ±1.04 mm and -1.619 ±1.03 mm buccolingual at the apex, 0.10 ±0.27 mm and -0.62 ±0.27 mm buccolingual at the cervical, and 1.73° ±3.66° and -1.64° ±2.26° in the buccolingual angulation. No statistically significant differences were found in any group except for mesial deviation of the Step 2 group (F-test, p < 0.001).

CONCLUSIONS

A digitally designed surgical guide with no metal sleeve demonstrates similar accuracy but higher precision compared to a surgical guide with a metal sleeve. Metal sleeves may not be required for guided surgery.

Odontogenic Keratocyst is frequently misdiagnosed for a Lateral Periodontal Cyst in premolar and anterior tooth-bearing areas

INTRODUCTION

Radiolucent lesions with gingival swelling found in the premolar and intercanine region can elicit a different clinical diagnosis than one confirmed by histologic findings. The purpose of the study is to identify and present the frequency of the unexpected microscopic diagnosis of Odontogenic Keratocyst (OKC) in a location preoperatively favoring a Lateral Periodontal Cyst (LPC) with similar clinical and radiographic appearance.

METHODS

A retrospective analysis of biopsies received from 2011 and 2019 was performed and the number of LPC and OKC cases were assessed. The alignment of clinical and radiographic diagnosis to histologic findings and anatomic location was analyzed and the number of OKC cases preoperatively misdiagnosed as LPCs was identified.

RESULTS

A total of 79257 biopsies were received. Of those, 184 were diagnosed as LPCs and 742 as OKCs. For all preoperatively diagnosed LPCs, the clinical and histological diagnosis aligned; however, 182 of 742 OKCs were submitted with a clinical misdiagnosis of LPCs. The location of these lesions with the unanticipated diagnosis overlapped with those for LPCs, specifically the maxillary and mandibular anterior and premolar regions.

CONCLUSION

Radiolucent lesions with gingival swelling in the premolar and intercanine region are frequently clinically and radiographically misdiagnosed. A biopsy should be considered in all cases to establish the correct pathologic diagnosis and treatment course.

In Vitro Comparison of Time and Accuracy of Implant Placement Using Trephine and Conventional Drilling Techniques Under Dynamic Navigation

The aim of this randomized in vitro study was to compare the time and accuracy of implant-site preparation and implant placement using a trephine drill versus a conventional drilling technique under dynamic navigation. In total, 42 implants were placed in simulation jaw models with the 2 drilling techniques by 2 operators who had previous experience with dynamic navigation. The timing of each implant placement was recorded, and horizontal, vertical, and angulation discrepancies between the planned and placed implants were compared. There was no significant difference in time or accuracy between the trephine and conventional drilling techniques. Implant-site preparation with a single trephine drill using dynamic navigation was as accurate under in vitro experimental conditions as a conventional drilling sequence.

Implant site preparation application of injectable platelet-rich fibrin for vertical and horizontal bone regeneration: A clinical report

Guided bone regeneration (GBR) using a combined injectable platelet-rich fibrin (i-PRF), leukocyte- and platelet-rich fibrin (L-PRF) and biocompatible bone substitute materials, is a convenient and effective method to augment a combined vertical and horizontal bone defect. This approach can create sufficient bone quality and quantity for implant surgical sites. A 55-year-old Asian woman presented with a severe bone defect in posterior mandible. The edentulous mandibular alveolar ridge was severely resorbed vertically and horizontally.  A GBR procedure using i-PRF and L-PRF combined with particulate bone graft was performed. Postoperative cone beam computed tomography scans, 8 months after the augmentation, revealed a large regeneration of the alveolar bone sufficient for implant placement. A combination i-PRF/L-PRF and particulate bone graft may provide biologically active molecules as well as a scaffold for osteogenesis. This treatment protocol may be a viable option for a large bone defect required augmentation prior to implant placement.

Effect of biologic materials on the outcomes of horizontal alveolar ridge augmentation: A retrospective study

PURPOSE

The purpose of this study was to investigate if the addition of biologic agents to a particulate bone graft enhances horizontal ridge augmentation outcomes in terms of bone dimensions, bone density, and successful implant placement.

MATERIALS AND METHODS

A retrospective chart review was done to assess the clinical and radiographic outcomes in 52 horizontal ridge augmentation sites in 43 patients. Information was gathered regarding surgical technique, type of graft material, biologic agents used (PRP or rhPDGF-BB), method of space maintenance, and achieved alveolar ridge width and bone density changes as quantified on CBCT scans.

RESULTS

The use of tenting screws, a resorbable membrane, and a combination of particulate allogenic and xenogenic bone graft material provided an average horizontal bone gain of 3.6 mm in the 52 augmented sites. There was no statistically significant difference observed in the amount of horizontal bone gain between sites treated with the addition of biologic agents (n = 21), or with a particulate bone graft alone (n = 31). A marginally statistically significant difference was found in the density of the grafted bone with the addition of biologics (p value = .0653).

CONCLUSION

The addition of biologic agents to the graft materials did not have a significant effect on the amount of horizontal bone gain or successful implant placement; however, it marginally enhanced the bone density of the grafted area.

Oral Soft Tissue Grafting

The presence of healthy soft tissue at the tooth and implant interface correlates to long-term success and stability in function and esthetics. Grafting procedures utilizing various techniques can be performed during any stage of the implant or restorative therapy. Materials of autogenous, allogeneic, and xenogeneic sources are available for oral soft tissue grafting. This article describes the classifications of soft tissue defects, treatment modalities, and materials used to enhance soft tissue quality and quantity and to achieve optimal esthetics and function around teeth and implants.

Effects of two Postprocessing Methods onto Surface Dimension of in-Office Fabricated Stereolithographic Implant Surgical Guides

PURPOSE

To evaluate the effects of two postprocessing methods in terms of the overall, intaglio, and cameo surface dimensions of in-office stereolithographic fabricated implant surgical guides.

MATERIALS AND METHODS

Twenty identical implant surgical guides were fabricated using a stereolithographic printer. Ten guides were postprocessed using an automated method. The other ten guides were postprocessed using a series of hand washing in combination with ultrasonics. Each guide was then scanned using cone-beam computed tomography to produce a set of digital imaging and communications in medicine (DICOM) files which were converted into standard tessellation language (STL) files. The STL file was then superimposed onto the original STL design file using the best fit alignment. The average positive and negative surface discrepancy differences in terms of means and variances were analyzed using t-test (α = 0.05).

RESULTS

For the alternative group, the average positive and negative overall, intaglio, and cameo surface discrepancies were 77.38 ± 10.68 µm and -67.74 ± 6.55 µm; 78.83 ± 8.65 µm and -68.16 ± 5.26 µm; and 70.5 ± 8.48 µm -64.84 ± 5.55 µm, respectively. For the automated group, the average positive and negative overall, intaglio, and cameo surface discrepancies were 51.88 ± 4.38 µm and -170.7 ± 11.49 µm; 64.3 ± 4.44 µm and -89.45 ± 6.25 µm; and 83.59 ± 4.81 µm and -144.26 ± 13.19 µm, respectively. There was a statistical difference between the means of the two methods for the overall, intaglio, and cameo positive and negative discrepancies (p < 0.001).

CONCLUSIONS

For a single implant tooth-supported implant guide, using hand washing with ultrasonics appeared to be consistently better than the automated method. The manual method presented with more positive discrepancies, while the automated method presented with more negative discrepancies.

Intaglio Surface Dimension and Guide Tube Deviations of Implant Surgical Guides Influenced by Printing Layer Thickness and Angulation Setting

PURPOSE

To measure overall intaglio dimensional and tube deviations of implant guides printed at 50 and 100 µm layer thickness at 0°, 45°, and 90° angulation using a stereolithographic (SLA) printer.

MATERIALS AND METHODS

A surgical implant guide design from a subject missing a maxillary right central incisor, used as the original standard tessellation language (STL) were stereolithographically fabricated at each thickness and angulation, 50 and 100 µm layer thickness at 0°, 45°, and 90° angulation (n = 10 each group). The guide was then scanned using cone beam computed tomography. The digital imaging and communications in medicine (DICOM) scanned files were then converted to an STL format. The overall dimensional deviations of the intaglio surface and the positioning of the implant guide tube were then superimposed onto the original designed STL file using best-fitting alignment. A t-test and an F-test as well as ANOVA followed by a post hoc t-test were used to determine statistical significant differences (α = 0.05) for the intaglio surface and guide tube deviation, respectively.

RESULTS

The overall intaglio surface discrepancies (µm) printed at 0°, 45°, and 90° were 55.07 ± 1.36, 52.39 ± 2.09, and 61.02 ± 15.96 for 50 µm layer; and 98.38 ± 10.55, 84.47 ± 10.61, and 90.26 ± 5 for 100 µm layer with statistically significant differences for both t-test and F-test, p < 0.001. The maximal guide tube linear deviations (µm) printed at 0°, 45°, and 90° were 10.78 ± 3.84, 8.16 ± 3.68, and 12.57 ± 5.39 for 50 µm layer (ANOVA, p = 0.096); and 10.95 ± 5.23, 16.79 ± 4.97, and 22.63 ± 2.81 for 100 µm layer (ANOVA, p < 0.001). The maximal guide tube angular deviations (°) printed at 0°, 45°, and 90° were 1.29 ± 0.30, 0.64 ± 0.13, and 0.56 ± 0.21 for 50 µm layer (ANOVA, p < 0.001); and 1.57 ± 0.29, 0.86 ± 0.14, and 1.02 ± 0.31 for 100 µm layer (ANOVA, p = 0.034). There was a statistical difference in the deviations between 50 and 100 µm layer printing in all printed angulations except at 0° (t-test, p = 0.05, p = 0.03, and p = 0.001 for 0°, 45°, and 90°) and linear deviations (t-test, p < 0.001, p = 0.009, and p = 0.001 for 0°, 45°, and 90°).

CONCLUSION

Printing at 50 µm layer reduces dimensional intaglio deviations in general and reduces tube angular deviations with different angulations of printing. However, the deviations were only ∼60 to 100 µm for the intaglio dimension deviations; and ∼0.04 to 0.26 mm and ∼0.25° to ∼2° for tube deviations.

Discontinuation of Denosumab as a Potential Cause of Generalized External Cervical Root Resorption: A Case Report

Generalized occurrence of external root resorption in an adult patient is a rare finding. This case report describes external cervical root resorption extensively affecting the dentition that may be associated with the use and subsequent cessation of denosumab for the treatment of osteoporosis.

Effect of postoperative steroids on clinical outcomes and radiographic findings of horizontal alveolar ridge augmentation: A retrospective study

BACKGROUND

The purpose of the study was to investigate if the prescription of oral postoperative steroids has an effect on clinical outcomes of horizontal ridge augmentation including implant placement and characteristics of the grafted bone.

METHODS

A retrospective chart review of 73 horizontal ridge augmentation cases was completed to assess the clinical outcomes, 53 of those cases were further assessed radiographically. Information was gathered regarding surgical technique, grafting materials, postoperative healing, medications used postoperatively, bone growth, and density changes as quantified on a cone-beam computed tomography (CBCT) scan. Statistical analysis was completed to identify whether the use of postoperative oral steroids altered outcomes.

RESULTS

Steroids were used postoperatively following various horizontal ridge augmentation procedures. The use of tenting screws and resorbable membranes with a combination of osseous allograft and xenograft was used in 73 cases, 53 of which had preoperative and postoperative CBCT scans. Graft exposure occurred in five of the cases (9%), with the majority (n = 4) among those with postoperative steroids, but this was not statistically significant (P-value = 0.6510). Use of steroids was also not significantly associated with the number of courses of antibiotics (P-value > 0.05), but it was significantly associated with increased number of postoperative visits (P-value < 0.05). Among the subset for radiographic analysis (n = 53), there were significant clinical and radiographic dimensional changes in alveolar ridge width with an average horizontal bone gain of 3.6 mm. There were no statistically significant differences found in radiographic linear bone gain or clinical outcomes with the addition of steroids. A marginally statistically significant in the density of grafted bone was found with the addition of steroids (P-value > 0.05).

CONCLUSION

The prescription of postoperative steroids did not make a significant difference in clinical outcomes, success of implant placement or on radiographic assessment of grafted sites following horizontal alveolar ridge augmentation.

Exploring training dental implant placement using computer-guided implant navigation system for predoctoral students: A pilot study

INTRODUCTION

Recent computer-guided dynamic navigation systems promise a novel training approach for implant surgery. This study aimed to examine learning progress in placement of dental implants among dental students using dynamic navigation on a simulation model.

MATERIALS AND METHODS

Senior students with no implant placement experience were randomly assigned five implant placement attempts involving either three maxillary or four mandibular implants distributed in the anterior/posterior, and left/right segments. Implant placement was planned using a Navident Dynamic Guidance system. Surgical time was recorded. Horizontal, vertical and angulation discrepancies between the planned and placed implant positions were measured using superimposed CBCT scans. Data were analysed with repeated measures regression with Tukey's adjusted pairwise comparisons (α = 0.05).

RESULTS

Fourteen students participated, with a mean age of 26.1 years and equal males and females. Mean time for implant placement was associated with attempt number (P < 0.001), implant site (P = 0.010) and marginally related to gender (P = 0.061). Students had a significant reduction in time from their first attempt to their second (10.6 vs 7.6 minutes; adjusted P < 0.001) then plateaued. Overall 3D angulation (P < 0.001) and 2D vertical apex deviation (P = 0.014) improved with each attempt, but changes in lateral 2D (P = 0.513) and overall 3D apex deviations (P = 0.784) were not statistically significant. Implant sites were associated with lateral 2D, 2D vertical and overall 3D apex deviation (P < 0.001).

DISCUSSION

Males were marginally faster than females, had slightly lower overall 3D angulation, and reported higher proficiency with video games. Novice operators improved significantly in speed and angulation deviation within the first three attempts of placing implants using dynamic navigation.

CONCLUSION

Computer-aided dynamic implant navigation systems can improve implant surgical training in novice population.

Accuracy and precision of 3D-printed implant surgical guides with different implant systems: An in vitro study

STATEMENT OF PROBLEM

Implant guided surgery systems promise implant placement accuracy and precision beyond straightforward nonguided surgery. Recently introduced in-office stereolithography systems allow clinicians to produce implant surgical guides themselves. However, different implant designs and osteotomy preparation protocols may produce accuracy and precision differences among the different implant systems.

PURPOSE

The purpose of this in vitro study was to measure the accuracy and precision of 3 implant systems, Tapered Internal implant system (BioHorizons) (BH), NobelReplace Conical (Nobel Biocare) (NB), and Tapered Screw-Vent (Zimmer Biomet) (ZB) when in-office fabricated surgical guides were used.

MATERIAL AND METHODS

A cone beam computed tomography (CBCT) data set of an unidentified patient missing a maxillary right central incisor and intraoral scans of the same patient were used as a model. A software program (3Shape Implant Studio) was used to plan the implant treatment with the 3 implant systems. Three implant surgical guides were fabricated by using a 3D printer (Form 2), and 30 casts were printed. A total of 10 implants for each system were placed in the dental casts by using the manufacturer's recommended guided surgery protocols. After implant placement, postoperative CBCT images were made. The CBCT cast and implant images were superimposed onto the treatment-planning image. The implant positions, mesiodistal, labiopalatal, and vertical, as well as implant angulations were measured in the labiolingual and mesiodistal planes. The displacements from the planning in each dimension were recorded. ANOVA with the Tukey adjusted post hoc pairwise comparisons were used to examine the accuracy and precision of the 3 implant systems (α=.05).

RESULTS

The overall implant displacements were -0.02 ±0.13 mm mesially (M), 0.07 ±0.14 mm distally (D), 0.43 ±0.57 mm labially (L), and 1.26 ±0.80 mm palatally (P); 1.20 ±3.01 mm vertically in the mesiodistal dimension (VMD); 0.69 ±2.03 mm vertically in the labiopalatal dimension (VLP); 1.69 ±1.02 degrees in mesiodistal angulation (AMD); and 1.56 ±0.92 degrees in labiopalatal angulation (ALP). Statistically significant differences (ANOVA) were found in M (P=.026), P (P=.001), VMD (P=.009), AMD (P=.001), and ALP (P=.001). ZB showed the most displacements in the M and vertical dimensions and the least displacements in the P angulation (P<.05), suggesting statistically significant differences among the M, VMD, VLP, AMD, and ALP. NB had the most M variation. ZB had the least P deviation. NB had the fewest vertical dimension variations but the most angulation variations.

CONCLUSIONS

Dimensional and angulation displacements of guided implant systems by in-office 3D-printed fabrication were within clinically acceptable limits: <0.1 mm in M-D, 0.5 to 1 mm in L-P, and 1 to 2 degrees in angulation. However, the vertical displacement can be as much as 2 to 3 mm. Different implant guided surgery systems have strengths and weaknesses as revealed in the dimensional and angulation implant displacements.

Trephination-based, guided surgical implant placement: A clinical study

STATEMENT OF PROBLEM

Conventional guided implant surgery promises clinical success through implant placement accuracy; however, it requires multiple drills along with surgical sleeves and sleeve adapters for the horizontal and vertical control of osteotomy drills. This results in cumbersome surgery, problems with patients having limited mouth opening, and restriction to specific drill or implant manufacturers. A protocol for using trephination drills to simplify guided surgery and accommodate multiple implant systems is introduced.

PURPOSE

The purpose of this clinical study was to evaluate the accuracy of implant placement using this novel guided trephine drill protocol with and without a surgical sleeve.

MATERIAL AND METHODS

Intraoral scanning and preoperative cone beam computed tomography (CBCT) scans were used for implant treatment planning. Surgical guides were fabricated using stereolithography. Implant surgery was performed using the guided trephination protocol with and without a surgical sleeve. Postoperative CBCT scans were used to measure the implant placement deviations rather than the implant planning position. Surgical placement time and patient satisfaction were also documented. One-tailed t test and F-test (P=.01) were used to determine statistical significance.

RESULTS

Thirty-five implants in 17 participants were included in this study. With a surgical sleeve, implant positional deviations were 0.51 ±0.13 mm vertically, 0.32 ±0.10 mm facially, 0.11 ±0.11 mm lingually, and 0.38 ±0.13 mm mesially. Without a surgical sleeve, implant positional deviations were 0.58 ±0.27 mm vertically, 0.3 ±0.14 mm facially, 0.39 ±0.16 mm lingually, and 0.41 ±0.12 mm mesially. No statistically significant difference was found between the 2 protocols (P>.01), except that the sleeve group had greater vertical control precision (F-test, P=.006), reduced placement time, and the time variation was reduced (t test, P=.003; F-test, P<.001).

CONCLUSIONS

This trephination-based, guided implant surgery protocol produces accurate surgical guides that permit guided surgery in limited vertical access and with the same guided surgery protocol for multiple implant systems. Guided sleeves, although not always necessary, improve depth control and reduce surgical time in implant placement.

Burnout, depression and suicidal ideation in dental and dental hygiene students

INTRODUCTION

The aim of this study was to assess the relationship between burnout, depressive symptoms and suicidal ideation in dental and dental hygiene students and to evaluate the influence of gender, programme type and year of study.

SUBJECTS AND METHODS

Third- and fourth-year dental (DS) and first- and second-year hygiene students (DHS) completed the Patient Health Questionnaire (PHQ-9) and an abbreviated Maslach Burnout Inventory online as measures of depressive symptoms/suicidality and burnout, respectively. The statistical analyses included summary statistics and tests for intergroup comparisons (chi-square) to evaluate the influence of gender, programme type (DHS or DS) and year of study. Correlations between depression, suicidality and burnout were also conducted.

RESULTS

A total of 32 dental hygiene and 119 dental students participated. 40% of the dental and 38% of the hygiene students met criteria for burnout. No differences were found between years or between programmes. Nine per cent of both dental and hygiene students were above the cut-off for moderate depressive symptoms, but there were no statistical differences between the third- and fourth-year dental and the first- and second-year hygiene students. Six per cent of the dental and 9% of the dental hygiene students were above the cut-off for clinically significant suicidal ideation, but there were no statistical differences between dental and hygiene students. There were no differences noted in the dental students based on gender for any of the measures. Depression was significantly associated with all three subscales of burnout. Suicidal ideation was only significantly related to the lack of personal accomplishment subscale of burnout.

DISCUSSION

These findings suggest the need for introducing preventive measures for such affective states in dental and dental hygiene training programmes.

Helicopter Mountain Rescue in Slovenia from 2011 to 2015

INTRODUCTION

The popularity of adventure recreation in wilderness areas across the world continues to increase. Nevertheless, the risk of injury and illness remains significant. The purpose of this study is to analyze the mountain rescue operations performed in Slovenia between 2011 and 2015.

METHODS

This retrospective study reports mountain rescue operations documented by the Slovenian National Mountain Rescue Association. The annual number of ground-based and helicopter-based rescues were identified and compared. For 2015, the indication for rescue and the severity of injury were also analyzed, specifically for interventions requiring the use of a helicopter.

RESULTS

From 2011 through 2015, the number of rescues remained consistent with an annual average of 413 (SD ±15; range, 393-434) rescues. However, the percentage of ground-based rescues varied significantly year by year (P=0.016), with highest rate in 2014 (68%) and the lowest in 2015 (56%). In 2015, 434 mountain rescue operations were reported in Slovenia. Injury accounted for 44%, illness for 10%, and fatality for 9% of the rescues. In 37%, no illness or injury was reported. Helicopter rescue was used in 190 (44%) of all interventions. Among the 190 helicopter rescues, 49% of patients had nonfatal injuries, 29% required no medical treatment, 15% had illness, and 7% had fatal injuries.

CONCLUSIONS

A significant number of mountain rescue operations were conducted in Slovenia from 2011 through 2015. Most of these were needed for injured, ill, or deceased persons. A notable number of rescues in 2015 required a helicopter.

How Effective Is the Tent Screw Pole Technique Compared to Other Forms of Horizontal Ridge Augmentation?

PURPOSE

The tent screw pole technique is one of the methods available for practitioners to perform horizontal ridge augmentation to facilitate dental implant placement. The purpose of this study was to evaluate the efficacy of the tent screw pole technique for horizontal ridge augmentation and to compare the results with those of the tunnel technique and open ridge augmentation.

PATIENTS AND METHODS

In this retrospective cohort study, 35 patients underwent horizontal ridge augmentation with the tent screw pole technique, a 1:1 ratio of mineralized freeze-dried bone allograft and particulate bovine hydroxyapatite, and a resorbable collagen membrane. The incidence of early wound dehiscence and membrane exposure, the number of courses of antibiotics and postoperative visits required for their management, and the number of sites that subsequently had successful implant placement were recorded. These parameters were compared with those in 21 patients who had undergone horizontal ridge augmentation by the tunnel technique and 31 patients who had been treated using an open procedure and a resorbable polytetrafluoroethylene (PTFE) membrane in the authors' previous study (J Oral Maxillofac Surg 74:1752, 2016).

RESULTS

Implant placement rate was similar for all 3 methods (71 to 97%). However, there were significant differences among the 3 surgical techniques for membrane exposure and wound dehiscence (P = .0033), graft loss (P = .0256), courses of antibiotics (P = .0017), and postoperative visits (P = .0043). The PTFE method consistently had the highest rate of complications, whereas the tent screw and tunnel techniques were comparable.

CONCLUSIONS

All 3 techniques allowed a high rate of implant placement; however, the PTFE technique was consistently associated with increased postoperative complications compared with the other 2 methods. The tent screw technique might be more favorable than the tunnel technique in cases in which the bony deficiency is flat.

How Effective is a Dental Workshop at Improving the Knowledge and Confidence of Medical Students in the Management of Dental Emergencies?

The purpose of this study was to evaluate the effect of a three-hour hands-on workshop for medical students and residents on their pre- and postcourse knowledge and confidence in managing dental emergencies. A 1-hour lecture followed by four 20-minute "hands-on" skill stations on dental mannequins was administered to a group of 30 medical students and residents. Pre- and postworkshop questionnaire surveys were conducted. There was a significant increase in the percent of attendees who responded correctly to three of the four knowledge questions following the workshop (P-value < 0.005). Confidence, as expressed in various statements, about treating dental emergencies was significantly improved after the lecture for eight of the nine statements. These findings indicate that dental knowledge is generally not provided during medical training. Our interactive workshop appeared to be effective in increasing this knowledge and self-reported confidence in handling dental emergencies. These findings clearly indicate the need for additional dental education during medical school. The use of a hands-on workshop may be one model for achieving this goal.

Antibiotic Prescribing Habits of Oral and Maxillofacial Surgeons in Conjunction With Routine Dental Implant Placement

PURPOSE

Although various prophylactic systemic antibiotic regimens have been suggested to minimize failure after dental implant placement, the role of antibiotics in implant dentistry is still controversial. The purpose of the present survey was to determine the current antibiotic prescribing habits of oral and maxillofacial surgeons in conjunction with routine dental implant placement to determine whether any consensus has been reached among such practitioners.

MATERIALS AND METHODS

An electronic survey was sent by electronic mail to all members of the American College of Oral and Maxillofacial Surgeons. The questions asked were related to whether antibiotics were routinely prescribed either pre- or postoperatively during routine dental implant placement, and, if so, what antibiotics, dosage, frequency, and duration were used. The survey participants were also asked to specify whether they were in solo private practice, group private practice, academia, military, or "other." The results were tabulated and analyzed using SAS software. Descriptive statistics and χ(2) analyses were used.

RESULTS

A total of 217 members responded to the survey. Overall, 112 of 217 (51.6%) prescribed antibiotics preoperatively (95% confidence interval [CI] 50.0 to 58.2%) and 152 of 213 (71.4%) prescribed antibiotics postoperatively (95% CI 65.0 to 77.0%) during routine dental implant placement. Also, 72 (34%) indicated that they prescribed antibiotics both pre- and postoperatively. The most common preoperative regimen used was amoxicillin 2 g given 1 hour before the procedure (32%, n = 36). The most common postoperative regimen used was amoxicillin 500 mg 3 times daily for 5 days (53%, n = 81).

CONCLUSIONS

We found no consensus among oral and maxillofacial surgeons regarding the use of antibiotics in association with routine dental implant placement, the type of regimen to use, or whether such use is even effective in preventing early implant loss. Furthermore, most of the antibiotic regimens being used are not in accordance with the recommendations current in the published data.

Sensory nerve conduction study of the mental nerve

We describe a technique for sensory nerve conduction study of the mental nerve. A monopolar recording needle is placed near the mandibular foramen using the same approach as that for routine inferior alveolar nerve block in dentistry, and a surface reference electrode is positioned over the ipsilateral mastoid process. Sensory nerve action potentials to stimulation of the mental nerve at the chin can be reliably recorded orthodromically in normal healthy subjects. The method is simple and well tolerated and provides a useful means to evaluate mental nerve function electrophysiologically.

Noma: report of a case resulting in bony ankylosis of the maxilla and mandible

Noma, or cancrum oris, has been described as a gangrenous infection of the soft and hard tissues of the oronasal region. Prior to the advent of antibiotics the disease was commonly fatal. Now many survive the acute phase of the disease and present the surgeon with formidable problems of repair. This is a report of a presumed case of noma that resulted in bony ankylosis of the maxilla and mandible. Three-dimensional shaded surface CT reconstruction images were especially useful in demonstrating the architecture of the abnormal bone.