Deutsche zahnarztliche Zeitschrift最新文献

In a prospective study 506 patients with nerve blocks in the pterygomandibular space were examined before and 3-7 days after local anaesthesia. Clinical neurosensory testing including two-point discrimination revealed no differences between the neurological status before and after injection. Between December 1987 and April 1991 8 patients with 9 nerve injuries (lingual nerve n = 8, inferior alveolar nerve n = 1) after nerve blocks in the pterygomandibular space were treated. In addition to hypaesthesia or anaesthesia 5 out of 8 patients with injection damages of the lingual nerve suffered from a loss of taste sensations. Only 2 of the total of 9 nerve lesions showed a complete recovery of the neurological deficit. One patient with a persistent pain syndrome of the lingual nerve after an injection damage underwent partial nerve resection and microsurgical reconstruction after intraoperative monitoring of somatosensitive-evoced-potentials. The operation was successful for only a few weeks, afterwards a relapse of the pain syndrome took place.

For certain groups of patients, e.g. handicapped people, children or extremely anxious adults, dental surgery with local anesthesia is not possible and hospitalisation is not desirable. In order to provide outpatient treatment using endotracheal anesthesia, a successful practice-oriented concept is presented, involving cooperation between the dental surgeon and an anesthetist in private practices. In the past 10 years, 4205 patients have received outpatient treatment according to this concept.

The possibility of profound preoperative examination by an experienced anesthesiologist, the cooperation of dentists, oral and maxillo-facial surgeons, anesthesiologists, pediatricians, internal specialists and family doctors, careful planning, conduction and supervision of anesthesia and postoperative treatment in a recovery room are essential in safe outpatient treatment under general anesthesia in the field of oral and maxillo-facial surgery. In case of unexpected postoperative complications patients have to be hospitalized. All the aforementioned requirements in respect of staff, apparatus and rooms must be fulfilled.

In a dental office 592 direct and indirect pulp cappings were followed up to 24 years. 404 of these pulps remained vital. The success of this treatment seemed to be related to age, type of tooth, and the extent of pulp exposure. In some advanced cases the clinical outcome was better than expected.

In the hospital for Oral and Maxillofacial Surgery at the Medical University Hannover 105 tracheostomies were performed between 1980 and 1990. We see a limited indication for a general prophylactic tracheotomy in patients with ablative surgery and microvascular reconstructive procedures. The indication for tracheotomy must be considered in each individual case.

Cardiovaskular and pulmonary diseases, terminal renal failure, hepatitis B and C as well as the acquired immune deficiency syndrome, hemorrhagic diatheses, diabetes mellitus and hyperthyreosis are the major systemic diseases related to the practice of dentistry and require a modified treatment plan. Dental treatment during pregnancy may involve a risk for the woman and the fetus. The article outlines the most important aspects of interdisciplinary care for medial high-risk patients in the dental practice, refers to further readings and emphasizes the necessity of active continued education in the field of general medicine and specific emergency care.

In most cases the surgical management of craniofacial fractures involves a correction of the occlusion. This requires nasal intubation. In a frontobasal fracture with simultaneous CSF fistula, nasal intubation is thought to increase the risk of meningitis. An analysis of the records of 160 patients with frontobasal fractures and CSF fistulae revealed that the route of intubation had no influence on the post-operative complication rate. Nasal intubation is therefore not contraindicated in frontobasal fractures with CSF fistulae.

The case of a 67-year-old woman, who had been wearing an upper partial removable denture with a cast metal framework made of CoCrMo alloy for years without any problems, is described. After the extraction of a molar tooth a nickel alloy retention was soldered to the framework. Following reinsertion allergic reactions appeared. The soldered joint showed considerable corrosion. After removing the retention and the soldered joint, the allergic reactions disappeared, although an epicutanceous test had revealed a positive reaction to cobalt. This case supports the high corrosion resistance and biocompatibility reported for CoCrMo alloys in the literature and the loss of these properties due to inadequate processing. Furthermore, the case illustrates a true allergic reaction. In contrast to the rather indiscriminate use of the term allergy to describe various vague disorders, this diagnosis should be restricted to clearly identified clinical situations.

A clinical prospective study of 231 patients was conducted to examine the influence of Ornipressin (POR 8) on the cardiovascular system. The standard concentration of the vasoconstrictor was 0.2 i.u./ml. A control group of 34 patients received 0.9% NaCl solution. In less than 10% of all cases blood pressure or pulse frequency changed up to 30 mmHg or 30 bp. m. Cardiac arrhythmias without clinical relevance could be observed sporadically. There were significant differences to the control group only in terms of pulse rate under volatile anaesthetics, and changes in blood pressure during the first 10 minutes under neurolept analgesia and under combined anaesthesia.

In a randomized double blind study effects and tolerability of the local anesthetics Prilocaine 3% with Felypressin, Articaine 4% with Epinephrine 1/200,000 and 1/100,000, and Lidocaine 2% with Epinephrine 1/100,000 were tested. There was no significant difference between the four agents as far as effect on blood pressure, pulse, and tissue rehabilitation are concerned. Prilocaine can be used for extractions and surgical tooth removal. It can not be recommended for apicoectomy or implantation. The better results of Articaine 4% compared to Lidocaine 2% were statistically not significant.