Oral Surgery, Oral Medicine, Oral Pathology最新文献

Propofol is a relatively new intravenous anesthetic with qualities that make it useful in the practice of oral and maxillofacial surgery. In a preliminary study to examine the safety of the drug, 100 patients ASA class I patients were treated in an outpatient environment with standardized doses of fentanyl and midazolam in combination with propofol. An induction dose of propofol of 1 mg/kg was followed by a constant bolus given at the rate of 10 mg/minute. The overall quality of induction and maintenance of anesthesia was good to excellent in 91% of cases. The main complications experienced were excessive movements during administration of local anesthesia, movement to stimulation during the operative period, and modest decreases in blood pressure. The results indicate that propofol is an effective means for the provision of general anesthesia in the outpatient oral surgery setting.

Forty-eight extracted human teeth were prepared for study to compare ketac Endo cement with Grossman's cement in preventing leakage of a dye. Four groups were formed: (1) Grossman's sealer with a single gutta percha cone; (2) Grossman's sealer with lateral condensation of gutta percha; (3) Ketac Endo sealer with a single cone of gutta percha; and (4) Ketac Endo sealer with lateral condensation of gutta percha. The teeth were immersed in the dye for 10 days, after which they were rinsed in running tap water and cleared for observation. In the groups of teeth evaluated by three individual evaluators, the results consistently showed less leakage with glass ionomer sealers (groups 3 and 4) than with the Grossman's sealers (groups 1 and 2). The best results were noted when Ketac Endo sealers were used with lateral condensation.

The objective of this study was to retrospectively evaluate stability of mandibular advancement after bilateral sagittal split osteotomies were performed. Three different fixation and immobilization protocols were examined. Thirty-three patients were evaluated with preoperative, immediate postoperative, and long-term (mean, 13 months) lateral cephalometric radiographs. The patients were divided into three groups: group 1 (n = 10) had nonrigid internal fixation and 6 weeks of maxillomandibular fixation, group 2 (n = 12) had rigid internal fixation and immediate postoperative function, and group 3 (n = 11) had rigid internal fixation with maxillomandibular fixation for a mean of 14 days. Group 3 had the least amount of sagittal and vertical relapse. Differences in sagittal relapse were statistically significant between groups 1 and 3. Group 2 demonstrated greater sagittal relapse than did group 3, although the result was not statistically significant. This study suggests that the use of rigid internal fixation with a period of maxillomandibular fixation appears to be more stable than nonrigid internal fixation with maxillomandibular fixation or rigid internal fixation without maxillomandibular fixation.

Cases of pyogenic granuloma in pregnant women, nonpregnant women, and men were evaluated for the detection of estrogen and progesterone receptor proteins by immunoperoxidase staining. Immunostaining for estrogen receptors revealed a marked immunoreactivity of the endothelium within lesional tissue and in the overlying mucosal epithelium in many cases. Progesterone receptor immunoreactivity was only present within the epithelium, where it was much less than that of estrogen receptor immunoreactivity in both quantity (proportion of positive cells) and intensity. No characteristic staining pattern or significant quantitative difference among the three study groups could be discerned. These findings suggest that the quantity of estrogen or progesterone receptors in pyogenic granuloma is not the determining factor in the pathogenesis of this lesion. Rather, such a role may be attributed to the levels of circulating hormones. The levels of estrogen and progesterone are markedly increased in pregnancy and could therefore exert a greater effect on the endothelium of the pyogenic granuloma.

A study of radiographic practices of general dentists was conducted by mail survey. Eighty percent of 963 dentists returned completed questionnaires. All participants resided in the province of Ontario, Canada, and were graduates of either of the two provincial dental schools. Fewer than one third of radiographs were taken by the dentist with only 10% of dentists taking three fourths or more of the radiographs in their practices. There was infrequent use of E speed film (11%) and rectangular collimation (8%). Automatic processing was used by 93% of dentists. Although the overwhelming majority of dentists used a film holder, 2% still have the patient hold the film. The type of film holder used was affected by dental school experience, whereas the use of E speed film was not.

The outcomes of surgical reconstruction for patients who have undergone extensive tumor resection of the mandible and associated soft tissue have been less than desirable for many reasons: lack of cancer cure, radiation problems, as well as inadequate functional reconstructive results. These patients traditionally have undergone multiple surgical procedures for restoration of the surgical deformity. With the advent of new donor sites and successful transfer of microvascular hard and soft tissue, one can restore the largest defects created during cancer excision. Combining these techniques with biocompatible dental implants and reconstructive bone plates, technology has advanced to the point of predictable outcomes. The restoration of appearance, mandibular function, and mastication is mandated by patients. Dental implants are now placed in vascularized bone reconstruction of the mandible immediately at the time of ablative surgery. This obviates the need for additional surgical reconstructive procedures, adjunctive hyperbaric oxygen therapy, and problems associated with the placement of dental implants in irradiated tissue.

Serum levels of soluble intercellular adhesion molecule-1, soluble interleukin-2 receptor, and cytokines such as interleukin-3, interleukin-4, interleukin-6, tumor necrosis factor-α, and granulocyte-macrophage colony-stimulating factor were examined in patients with oral disorders with 20 healthy persons used as control subjects. Patients studied included 30 with squamous cell carcinoma, 26 with oral lichen planus, 20 with recurrent aphthous ulcer, 19 with acute odontogenic bacterial infection, 16 with pseudomembranous candidiasis, and 16 with herpetic gingivostomatitis. Compared with levels in control subjects, detectable serum levels of interleukin-3 (≧ 10 pg/ml) existed more frequently in pseudomembranous candidiasis ($\text{13}\text{16}$), acute odontogenic bacterial infection ($\text{14}\text{19}$), and squamous cell carcinoma ($\text{24}\text{30}$) and of granulocyte-macrophage colony-stimulating factor (≧ 4 pg/ml) more frequently in recurrent aphthous ulcer ($\text{15}\text{20}$) and squamous cell carcinoma ($\text{21}\text{30}$). These cytokine levels were increased with T stage of squamous cell carcinoma. About 20 pg/ml of interleukin-4 was detected in serum from one third to one fourth of patients with oral lichen planus, recurrent aphthous ulcer, and squamous cell carcinoma. Tumor necrosis factor-α was hardly detected in most patients except those with oral lichen planus and squamous cell carcinoma in which about one third of the patients had more than 40 pg/ml of tumor necrosis factor-α in serum. More than 10 pg/ml of interleukin-6 was frequently detected in all disorders, especially recurrent aphthous ulcer ($\text{18}\text{20}$), pseudomembranous candidiasis ($\text{12}\text{16}$), and acute odontogenic bacterial infection ($\text{17}\text{19}$). After treatment, the serum interleukin-6 level increased in pseudomembranous candidiasis, acute odontogenic bacterial infection, herpetic gingivostomatitis, and squamous cell carcinoma, but decreased in oral lichen planus and recurrent aphthous ulcer. As compared with levels in the control subjects, significantly higher levels of soluble intercellular adhesion molecule-1 were observed in recurrent aphthous ulcer, herpetic gingivostomatitis, and pseudomembranous candidiasis and levels of soluble interleukin-2 receptor were significantly increased in oral lichen planus, recurrent aphthous ulcer, and pseudomembranous candidiasis. These results seem to indicate the immunologic characteristics of the individual oral disorder.