Fortschritte der Kiefer- und Gesichts-Chirurgie最新文献

Follow-up examinations were made retrospectively on 799 apicoectomized teeth from a group of patients with a total of 3,524 apicectomies, the mean postoperative interval of observation being 4.2 years. An intraoperatively orthograde root-canal filling was performed in 51.3%, an intraoperatively retrograde in 23.7% and a preoperative filling in 25.0% of the patients. Apart from 126 teeth that had already been extracted, a further 160 teeth had been clinically and/or radiologically conspicuous, so that a total of 286 failures was to be recorded. The dentally related success graphs computed according to Kaplan and Meier (1958) showed a significantly worse success probability for the preoperative filling compared to the two other techniques. With regard to the different materials employed in orthograde application, the silver filling had a higher and the guttapercha filling a less favourable success quota compared to a titanium filling. Moreover, in the retrograde method, amalgam resulted in a significantly higher success probability than glass ionomer cement. With an attendant cyst there was a significantly improved success quota over apical parodontitis or a renewed operation. With regard to the localization of apicectomies, maxillary front teeth attained the highest success rate. The present results point unequivocally to an unfavourable outcome after preoperative endodontics and underscore the good prognosis of an intraoperatively orthograde filling. Due to the fact that biocompatibility is in the forefront today, time-tested materials, such as silver and amalgam, are clearly being used less.

This investigation compared the results of 2 types of wound closure - primary closure technique with and without Penrose drains (Naturallatex) - after mandibular third Molar removal. In both the test group (n = 27) and control group (n = 25), the molar were removed using a buccal mucoperiosteal flap. The test group received a drain partially submerged into the socket to secure more drainage of woundsecrete. Examination were performed 1 day, 3 days and 7 days after surgery, and swelling, trismus, pain and analgetic consommation were recorded. Analysis of Variance indicated that there was significant difference between the 2 methods. The drain method appears to minimize postoperative edema, trismus, pain and analgetic consommation, and thus contributes to enhanced patient comfort.

In a one-armed prospective study including 60 patients (27 male, 33 female; age 17-75 years), 109 teeth were treated by means of a screw system made of Syntacoben and Niob according to Wirz. 103 teeth were transfixed successfully: 48% of them were provided with a partial removable denture; 34% were used as a bridge pier; 11% underwent conservative treatment; in 7% prosthetic treatment is planned. The use of the Wirz-System for primary transfixation combines in an ideal way the advantages of endodontic conservation and the ready-made post with the improved stability of the prosthetic pier.

The prospective randomised study on the root apex resections with orthograde root filling comparing Guttapercha with Titan pins encompasses 500 patients with 633 operations on all front teeth and premolars. The patients were divided into three preoperative stages so that for this broadly defined diagnoses comparable collectives could be built. After an average postoperative interval of 21 months, 258 patients with 298 resected teeth could be evaluated. From these, 188 root apex resections had been treated with Guttapercha and 110 with Titan pins. 73.5% of the root apex resections were successful, whereby the group treated with Guttapercha was more successful by 7%. The comparatively high failure rate of 26.5% is attributable to the broadly defined diagnosis and the long follow-up period.

The outcome of 81 of 99 patients being treated from 1980 to 1993 by transplantation of autologous teeth was investigated. The overall transplant survival rate was 91% after 1 year, 81% after 5 years and 70% after 9 years. The early loss of transplanted teeth was due to healing disorders. The long-term losses were due to caries and replacement resorption. Caries in tooth transplants has to be treated very early, because deep caries or deep drilling leads to an infection of the nutrient canals of the osteodentine. If the pulp chamber of a transplant is once obliterated by osteodentine, endodontic treatment can no longer be performed in many cases. The periodontal condition of the transplants did not differ from that of normal teeth. In 23% there was a decreased tooth mobility, caused by ankylosis of the transplant. 51% of the transplants showed occlusal disturbances but none of the patients had signs of occlusal traumatization of the teeth or of the temporomandibular joint. In comparison to success rates taken from the literature it is pointed out that tooth transplantation has a better long-term prognosis than endodontic treatment. Therefore, in young patients requiring root canal treatment, tooth transplantations should be considered.

Closure and dressing techniques in wound treatment after surgical removal of the mandibular third molars were compared. Large abscesses were found after third molar removal in 8 percent. An extraoral incision was made in 58 percent of these cases. On the other side, in a group of 1189 third molar removals treated by a gauze strip no abscess was observed. In a further investigation the subjective disturbance of patients treated with a dressed gauze were the slightest. Also, the dressing technique in the treatment after third molar removal could decrease the number of postoperative infections.

This paper describes the application of a new material, Biocem, for retrograde root-canal filling. The series included 222 teeth, including 234 roots treated during the period 1987-1992. This material consists of two components and once mixed, the autopolymerisation results in a three-dimensional structure. The biomechanical, histological and clinical longterm follow-up confirms the optimal qualities of this material, fulfilling the requirements in regard to biocompatibility, watertight sealing and application. The material proved to be superior in comparison to conventional materials and ceramics. The significant reduction of complications and the new apposition, as well as the evaluation of the results are most encouraging.