Biomedical subjects

Devorah Schwartz-Arad

Publications and source records attributed to Devorah Schwartz-Arad.

27 records · Page 2Linked to original sources

PubMed2004

Maxillary nerve block--a new approach using a computer-controlled anesthetic delivery system for maxillary sinus elevation procedure. A prospective study.

OBJECTIVE: The maxillary (or second division) nerve block is an effective method of achieving profound anesthesia of a hemimaxilla. This block can be used for procedures involving the maxillary sinus, including the maxillary sinus elevation procedure. The purpose of this study was to evaluate a computer-controlled anesthetic delivery system (Wand) for maxillary nerve block injection to attain maxillary sinus anesthesia for sinus floor elevation procedure. METHOD AND MATERIALS: The study population consisted of 61 healthy adult patients, ranging in age from 40 to 72 years (mean 45 years), who received 76 maxillary nerve blocks (17 having both right and left maxillary blocks) by means of the Wand system via the greater palatine nerve approach, for sinus floor elevation procedure. Two patients (3%) were excluded from the study due to the inability to negotiate the greater palatine foramen. For each block, two cartridges of 2% lidocaine hydrochloride with adrenaline (1:100,000) were administered, using a 27-gauge--long needle. After ensuring the anesthetized areas (waiting time 2.5 minutes), the sinus elevation procedure was performed. Parameters recorded were the success or failure of anesthesia, positive (blood) aspiration, bony obstructions in the greater palatine canal, and complications. RESULTS: The use of this technique increased the ability to more easily locate the greater palatine foramen. A local infiltration (at the incisor region) was needed in 13 (17%) of the blocks, and seven (9.2%) sites required an extra infraorbital block injection in addition to the maxillary nerve block. One block had a positive aspiration. There were no bony obstructions demonstrated in the canal interfering with the injection, and no complications were recorded. CONCLUSION: The Wand appears to offer a number of advantages over the hand-held syringe when the greater palatine block technique for the maxillary nerve block is used. It is suggested that, when indicated, and with the required knowledge and respect for the associated anatomy, this technique should be considered with greater ease and more confidence.

Adult↗

PubMed2003

A retrospective radiographic study of root-end surgery with amalgam and intermediate restorative material.

OBJECTIVE: We sought to compare amalgam with intermediate restorative material in terms of their effectiveness as root-end filling materials during root-end surgeries. STUDY DESIGN: A root-end operation was performed on 228 patients with 262 endodontically treated teeth with periapical lesions. Of these teeth, 122 from 101 patients were available for follow-up. Radiographs were taken immediately postoperatively and again at a mean of 11.25 months (range, 6-45 months) postoperatively. The radiographs were digitized, and the diameter of the periapical lesion was measured by means of a computerized system. The mesiodistal distance at the cementoenamel junction served as an internal standard. Radiographic findings were classified into 1 of 3 groups: complete healing, incomplete healing, or unsatisfactory (no) healing. RESULTS: Complete healing was observed in 44.3% of the teeth, incomplete healing in 21.3%, and unsatisfactory healing in 34.4%. No statistical significance was found for amalgam versus intermediate restorative material, but teeth that underwent additional operations had a significantly worse success rate than those that underwent only first-time operations. No correlation was found between the subjective prognosis by the surgeons and the long-term outcome. CONCLUSION: As root-end filling materials, amalgam and intermediate restorative material had the same clinical effectiveness. The classic root-end operation is unpredictable. Reoperations should be reconsidered and avoided if possible.

Adolescent↗

PubMed2003

Effect of anxiety on the experience of pain in implant insertion.

Pain is a complex experience affected by such factors as stress, anxiety and cognitions. The purpose of this study was to examine the inter-relationship between anxiety and acute pain perception under an oral surgery procedure of implant insertion. The study population consisted of 60 dental patients (58% female, mean age 42 year), who were scheduled for implant insertion in a private clinic specializing in oral surgery. Patients were evaluated on three consecutive occasions: immediately preoperatively (T1), immediately post-operatively (T2), and at 4 weeks post-operative follow-up (T3). Patients were requested to complete questionnaires concerning their anxiety on each occasion and to indicate their subjective evaluations concerning pain (on visual analogue scales). Patient anxiety and pain evaluation were highest immediately before the surgical procedure (T1) with a significant decrease immediately afterwards (T2). The best predictor of the patient's pain evaluation at each time point was their state of anxiety at that time (T1: mean square = 7844.36, F = 16.26, P < 0.001; T2: mean square = 7652.74, F = 15.86, P < 0.001; T3: mean square = 5433.04, F = 8.99, P < 0.005). Pain experienced by patients in oral surgery is best predicted by their anxiety at each time point. Proper understanding of the variables that affect pain is important as they may produce emotional responses that could influence compliance.

Acute Disease↗

PubMed2003

Peripheral giant cell granuloma associated with dental implants.

BACKGROUND: Peripheral giant cell granuloma (PGCG) is a well-circumscribed lesion confined to the alveolar and gingival mucosa. PGCG is considered a reactive lesion caused by local irritation or trauma. The objectives of the present study were to evaluate the incidence of PGCG in peri-implant lesions submitted for histologic examination, to establish its correlation with implant failure, and to discuss its pathogenesis. METHODS: The study was conducted on 25 periimplant biopsy specimens submitted for histological examination between 1999 and 2001. Sections (5 microm) of paraffin embedded tissues were cut and stained with hematoxylin and eosin. RESULTS: From the 25 specimens, three (two males and one female, ranging in age from 31 to 69 years) were identified as peripheral giant cell granuloma. The posterior mandible was affected in two cases and the anterior maxilla in one. The clinical appearance was an exophytic mass with a bleeding surface. The time interval between implantation and lesion development was from several months to 6 years. Recurrence following curettage was found in all cases. The implants were stable; however, two were removed either because of bone loss around the implant or because of several recurrences. In all cases healing was uneventful. CONCLUSIONS: Peripheral giant cell granuloma can develop in association with dental implants. Clinically, the lesions are similar to the classical PGCG. In the present study, the precise incidence could not be concluded because of the small number of selected cases. Due to the aggressive nature of the lesion and the high recurrence rate, implants can fail unless the lesion is detected early and proper surgical removal is performed. Tissue removed from the peri-implant area should always be submitted for histologic examination for accurate diagnosis.

Adult↗

PubMed2002

Smoking and complications of endosseous dental implants.

BACKGROUND: The purpose of this study was to compare the incidence of the complications and survival rate related to dental implants among smokers and non-smokers, and to evaluate the influence of smoking by analyzing data of 959 implants placed in 261 patients during the years 1995 to 1998. METHODS: Patients were divided into 3 groups: non-smokers, mild smokers (up to 10 cigarettes per day) and heavy smokers (more than 10 cigarettes per day); smokers were divided into 2 subgroups according to duration of smoking (less or more than 10 years). Complications included minor (spontaneous implant exposure), major (spontaneous implant exposure requiring surgical intervention), and implant failure. The influence of smoking was analyzed for the type of implant cover screw and immediate versus late implantation. RESULTS: The overall failure rate was 2% for non-smokers and 4% for all smokers. Minor and major complications were found in higher percentages (46%) in the smoking groups than in the non-smoking group (31%). A significantly higher incidence of complications was found among smokers who received dental implants with high cover screws (63%) compared to those who received dental implants with flat cover screws (27%). CONCLUSIONS: This study establishes a relationship between implant complications and smoking, implant type (external or internal hex), and time of implantation as significant factors. A higher incidence of complications was found in the smoking group, especially in implants that had a high cover screw. Most complications will not lead to failures. Immediate implants failed less frequently than non-immediate implants. Limiting or reducing smoking habits will decrease complications of endosseous dental implants.

Adolescent↗

PubMedDate not supplied

Smoking and complications of onlay bone grafts and sinus lift operations.

PURPOSE: To compare the incidence of complications related to onlay bone grafts (OBGs) and sinus lift operations (SLOs) among smokers and nonsmokers. MATERIALS AND METHODS: Data from 143 operations performed during the years 1995 to 2003 were analyzed. There were 64 OBGs and 79 SLOs. Patients were divided into 3 groups: nonsmokers, mild smokers (up to 10 cigarettes per day), and heavy smokers (more than 10 cigarettes per day). Duration of smoking (less or more than 10 years) was recorded. OBG complications were classified as minor (hematoma, swelling, inflammation, or temporary paresthesia) or major (graft exposure or mobility). For the SLO, perforations of the schneiderian membrane were the main intraoperative complication; postoperative complications mostly consisted of swelling, acute or chronic sinus infection, or bleeding. RESULTS: Of smokers having OBG, 50% experienced complications, compared to 23.1% of nonsmokers. Major complications were observed in one third of the smokers, compared to only 7.7% in nonsmokers. There was also a tendency toward complications in former smokers, although this relationship was not statistically significant. There was no relationship between SLO complications and smoking or a past smoking habit. DISCUSSION: In the present study, smokers demonstrated significantly higher postoperative complications following OBG operations. Smoking did not influence the results in the SLO group. There was no statistically significant difference between complications and past smoking. This finding indicates that the risk of complications can be reduced up to the normal nonsmoker complication rate when smoking ceases. CONCLUSIONS: This study established a relationship between OBG complications and smoking in this patient population. A higher incidence of complications was found in the smoking group. There was no significant influence of smoking on SLO complications.

Analysis of Variance↗

PubMedDate not supplied

Marginal bone loss pattern around hydroxyapatite-coated versus commercially pure titanium implants after up to 12 years of follow-up.

PURPOSE: The purpose of this study was to compare the marginal bone loss (MBL), complications, and 12-year survival rates of commercially pure titanium (cpTi) and hydroxyapatite (HA)-coated implants placed in the maxilla. MATERIALS AND METHODS: The study group consisted of 120 patients (77 women, 43 men) treated from 1988 to 1997. A total of 388 implants (156 cpTi and 232 HA-coated) were placed in the maxilla. There were 126 immediate (32.5%) and 262 (67.5%) nonimmediate implants. Patients were evaluated annually. Mean follow-up was 60 +/- 32.3 months. MBL was measured on radiographs using the implant threads as the dimensional reference. MBL, complications, and 12-year survival and success rates were correlated with implant coating, time of implantation, implant dimensions, and position in arch. RESULTS: Total mean MBL was 1.07 +/- 2.16 mm. MBL was significantly lower with cpTi implants (0.55 +/- 1.04 mm) compared to HA-coated implants (1.51 +/- 2.71 mm) (P < .001). No statistical difference in regard to MBL was found between immediate and nonimmediate implants (0.86 +/- 1.8 mm vs 1.16 +/- 2.3 mm). The total 12-year survival rate was 91.4%. HA-coated implants had a significantly higher 12-year survival rate than cpTi implants (93.2% vs 89%; P < .03). Nonimmediate implants had a significantly higher failure rate (8.2%) than the immediate implants (1.3%) (P < .009). No correlation was found between type of implant coating and late implant failure. DISCUSSION: Immediate implants can serve as a predictable option, providing higher survival and success rates. HA-coated implants tended to fail less during the surgical phase, but had higher mean MBL compared to cpTi implants. CONCLUSIONS: HA-coated implants had greater MBL than cpTi implants but a higher 12-year survival rate. Immediate implants had a lower failure rate than the nonimmediate implants in this study population.

Adolescent↗

PubMedDate not supplied

Impact of smoking on marginal bone loss.

PURPOSE: To compare marginal implant bone loss (MBL), survival, and radiographic evidence of success of dental implants among smokers and nonsmokers. MATERIALS AND METHODS: Consecutive records of 161 patients (aged 23 to 89 years, mean 57 years) treated with a total of 646 implants between the years 1995 and 1998 were examined. Patients were divided into 3 groups: nonsmokers, moderate smokers, and heavy smokers. Tobacco exposure was calculated by cigarettes per day and by pack-years. Follow-up ranged from 1 to 7 years (mean 3.8 years). Postoperative panoramic radiographs obtained before implant exposure and annually thereafter were analyzed for MBL changes. The influence of smoking and other variables on MBL was analyzed at all implant sites. RESULTS: Generally, smokers had more MBL than nonsmokers (0.153 +/- 0.092 mm and 0.047 +/- 0.048 mm, respectively; P < .001). When each jaw was examined separately, smoking had a greater effect on MBL in the maxilla than in the mandible (0.158 +/- 0.171 mm versus 0.146 +/- 0.158 mm, respectively; P < .001). Furthermore, in the maxilla, heavy smokers had the greatest amount of MBL (0.1897 +/- 0.1825 mm), followed by moderate smokers (0.123 +/- 0.156 mm) and nonsmokers (0.0460 +/- 0.070 mm) (P < .001). In the mandible, there was no distinction between heavy and moderate smokers, and both had greater MBL than nonsmokers (P < .001). Only 3 of the 646 implants failed; the cumulative survival rate was 99.5%. Overall radiographic success rate was 93.2%. Nonsmokers had a higher radiographic success rate (97.1%) than smokers (87.8%) (P < .001). CONCLUSIONS: This study demonstrated a relationship between MBL and smoking habits. A higher incidence of MBL was found in the smoking group, and this was more pronounced in the maxilla.

Adult↗

PubMedDate not supplied

Implant marginal bone loss in maxillary sinus grafts.

PURPOSE: The marginal bone loss (MBL) around implants placed in maxillary sinus grafts was evaluated. MATERIALS AND METHODS: The study consisted of 70 patients who had undergone 81 sinus-graft procedures (total 212 screw-type implants). Complete radiographic records were available for 160 implants, which were used to calculate MBL (follow-up 6 to 56.5 months). Habits (smoking, bruxism), surgical phase parameters (preoperative residual bone, grafting material, implant characteristics, and complications), and prosthetic parameters (crown-implant ratio, marginal fit, and opposite-arch restoration) were recorded for each patient and statistically analyzed regarding MBL. RESULTS: Cumulative survival and overall radiographic success rates were 95.5% and 83.7% for 4.5 years, respectively. Smoking, small implant surface area, and a delayed implantation approach were related to enhanced MBL, with mean MBL values of 0.24 mm/y (P < .011), 0.21 mm/y (P < .031), and 0.31 mm/y (P = .052), respectively. In residual bone of < or =4 mm, the relation to enhanced MBL was stronger (P < .018) for delayed implantation. DISCUSSION: Survival and radiographic success rates compare well with other reports. However, most studies modify success criteria regarding MBL. Smoking may be a primary risk factor regarding implant success. Implants with greater surface area values could compensate for problematic bone characteristics (e.g., in grafted maxillary sinuses). The effect of delayed implantation on MBL was surprising and may prompt simultaneous implantation whenever primary stability can be achieved. CONCLUSIONS: Smoking and implant surface area affected MBL in this patient population. Criteria for long-term implant success should be revised to a standard.

Adult↗