Deutsche zahnarztliche Zeitschrift最新文献

Infections caused by dental disease may result in severe swelling of the throat and whole neck. In an operation for opening an abscess, the initial phase of general anaesthesia is often critical due to obstructions of the airway and trismus. Therefore the wide use of a fibre-optic intubation is advocated in order to avoid an emergency tracheostomy or other complications.

For the conservative treatment of mandibular fractures with arch bars under local anaesthesia we used two forms of premedication in 140 patients: 1. an analgetic sedation with pethidine 1 mg/kg body weight and promethazine 0.5 mg/kg body weight i.m. (n = 70 cases) 2. an anxiolytic sedation with midazolam 0.05-0.1 mg/kg body weight i.v. (n = 70 cases). The effect of the premedication was measured retrospectively by the mean amount of local anaesthetics used during splinting. It could be noted that the mean consumption of local anaesthetics was significantly lower in the midazolam-group than in the pethidine/promethazine-group. The postoperative subjective assessment of the operation by the patients is better under anxiolytic than under analgetic sedation, too.

The aim of the present study was to evaluate the effect of one tablet of midazolam (Dormicum 7.5 mg) used as a premedicant for minor oral surgery and to assess the potential risk of hypoventilation. In all of the patients no significant drop in arterial oxygen saturation could be observed, but on the other hand, no real anxiolytic or amnestic effects either. With the little therapeutic use observed with the given premedication, a more widespread application of the substance in this dosage cannot be recommended, particularly when taking into account the possibility of complications and the loss of the patients's fitness to drive for the next twelve hours.

Self medication using anxiolytic and relaxing agents prior to surgery is a common phenomen in many patients. In our prospective study of 356 patients undergoing prolonged surgical procedures (greater than 3 h), we evaluated the preoperative ethanol level of the blood using gas-chromatography. In 39 (10.9%) of 307 tumor patients ethanol could be detected in high concentrations, indicating the ingestion of disinfectants. Among our 49 orthognathic cases blood alcohol was found in 4 cases (8.2%). Since the minimum effective dose for ethanol ist 0.1 to 0.2 g/l, the patients' legal capacity when giving informed consent for surgery and anesthesia is to be questioned and the risks of analgosedation in outpatient must be considered.

Alcohol-addicted patients have a high risk of intercurrent complications during the postoperative period. In addition to the predisposition for infection, alcohol withdrawal syndrome is potentially life-threatening in these patients. However, this concerns only addicts, and definite preoperative diagnosis of addiction therefore is a crucial parameter in assessing the postoperative risks. In our department, 40% of maxillofacial tumor patients with a history of alcohol abuse were assessed as alcohol-addicted according to a complex diagnosis scheme. In these patients, postoperative withdrawal syndrome prophylaxis with continuous, low-dose alcohol infusion is indicated after exclusion of contraindications. If prophylaxis is impossible and differential diagnosis has confirmed a withdrawal syndrome, therapy must take into account the patient's symptoms and the latest neurobiochemical findings on withdrawal-related imbalances in neuronal transmitter systems.

Since 1986 we have been using Clonidine in patients with alcoholic history as a prophylaxis to avoid postoperative delirious states. This therapy does not compromise microsurgical vascular anastomoses.

A randomised, prospective study was conducted to compare the efficiency and safety of methods for intravenous conscious sedation in patients undergoing oral surgery under local analgesia. 150 systemically healthy patients (ASA Class I and II) participated. Three groups were formed: group 1 received 0.05 mg/kg midazolam; group 2 0.05 mg/kg midazolam, 1.5 mg/kg tramadol, 50 mg alizaprid; group 3 0.05 mg/kg midazolam, 0.2 mg/kg nalbuphine, 50 mg alizaprid. Blood pressure, heart rate and oxygen saturation were measured throughout the procedure. The results confirmed that the use of nalbuphine (group 3) allows a reduction in the mean dosage of midazolam required to produce satisfactory sedation and effected a more rapid recovery time compared to group 12 and 2. With the combination nalbuphine and alizaprid nausea and vomiting could be reduced for the most part compared to group 2.

The removal of polymerized excess resin cement around adhesive inlays is very time consuming and often tooth-destructive. In this study we evaluated, if brushing away of the unset resin cement produced any marginal imperfections. It was found that this procedure caused underfilled margins especially in the occlusal portion of the inlay margins. For this reason the use of this method to remove excess resin cement is not recommended.

More than 10 years ago 400 mentally and physically handicapped children aged 3 to 18 years were included in a dental care program to improve their oral health status. Besides dental treatment a comprehensive preventive program (tooth brushing, application of fluorides, dietetic recommendations) was carried out. The results prove a significant caries reduction and an increase in caries free children. A reduction of dental plaque and marginal inflammations were also observed. To prevent the carious destruction of the dentition of the handicapped, these patients should receive regular prevention-oriented dental care from the age of 3 years.

Laboratory-manufactured gold, ceramic and composite inlays were compared with the CAD/CAM produced CEREC inlay experimentally and clinically. The following systems were examined: Dicor, Optec, Hi-Ceram, Du-Ceram, Cerec, Kulzer, Coltene, SR-Isosit composite inlays, and gold inlays (Degulor C) with adhesive fixation (group I) and with zinc oxide phosphate cement (group II). In the clinical trial inlays in 270 teeth were re-evaluated in a total of 73 patients after 2.3 to 5 years. After 3 years the results obtained with Optec, Hi-Ceram and the Coltene composite inlay were less favorable than those of other systems--statistically however, this difference was of rather low significance (p less than 0.05). Fractures of ceramic inlays occurred in 6 cases within 8 months. 10 failures of ceramic and composite inlays were due to secondary caries.