Fortschritte der Kiefer- und Gesichts-Chirurgie最新文献

Clinical and radiological findings in two groups of patients in whom apicectomies were done are presented. In one group root canal filling was by means of phosphate cementum; in the other, Diaket and guttapercha points were used. Evaluation was according to the methods applied already by Lüders in 1990. Preoperative diagnoses most often had been chronic periapical periodontitis followed by traumatic injuries to frontal teeth and complications encountered during endodontic treatment. In those persons in whom phosphate cementum had been applied, treatment was successful in 210 teeth (77.2%) and a failure was noted in 62 teeth (22.8%). In the Diaket/guttapercha group the success rate was 167 teeth (80.7%), while treatment was without success in 40 teeth (19.3%).

In spite of preventive procedures before, during and after radiotherapy, profound caries and periodontal breakdown of healthy teeth occur. In the course of dentoalveolar surgery in the region of irradiated bone, the risk of development of an infected osteoradionecrosis can be reduced by prophylactic antibodies, prevention of extensive detaching of the periosteum careful osteotomy or extraction, complete smoothing of sharp alveolar ridges and epiperiosteal plastic coverage. When extensive dentoalveolar surgery is necessary, the application of prophylactic pre- and postoperative hyperbaric oxygen may reduce the rate of complications even more.

An infected osteoradionecrosis (IORN) is one of the most problematic sequelae of radiation in the course of cancer treatment in the head and neck. To prevent this, prophylactic dental extractions have been demanded before radiation, as well as specific measures (epiperiostalplastic cover, perioperative antibiotic treatment) if a tooth has to be extracted after the radiation treatment has been carried out. From 1980 until 1993, 812 Patients who had to be irradiated underwent a prophylactic dental extraction programme. Only in 0.5% of these cases an infected osteoradionecrosis developed later on. 167 patients were treated after the radiation had been applied, using perioperative antibiotic treatment and meticulous soft tissue cover following epiperiostal preparation of the gingiva. In spite of 25% of localised dehiscences no immediate infection of the bone was observed. At the same time 53 infected osteoradionecrosis were treated, 43% of which were of dental origin. Most of these were seen in the lower molar area. The results show the high value of prophylactic dental extractions before radiation as well as the benefit of careful extractions with epiperiostal gingival cover, after the radiation treatment, especially in the area of the posterior lower alveolus.

In 24 patients, 31 palatal impacted maxillary canines were brought in position using the same surgical and orthodontic concept. After temporal surgical exposure a little silver chain was attached at the crown of the canine, the mucoperiostal flap was repositioned, and the canine was moved into its position by innovative orthodontic treatment means. The combined method is described intensively. With respect to the applied technique the results indicate that according to the criteria of periodontal status, vitality, bone support, root resorption and occlusion no differences exist to free erupted canines despite a mean orthodontic correction of 36.7 degrees.

The RTOG score, which describes radiation-caused side effects in a reproducible way, was introduced as a guide for the treatment of irradiated patients. By means of a prospective study (27 patients; acute effects) and a retrospective study (81 patients; long-term effects) the score was evaluated. Special importance was placed on the recording of dental and maxillofacial findings as well as on the therapeutic outcome. It was shown that frequency of dental lesions increased with the score of radiation effects while dental treatment decreased inverse to the score of radiation effects. Evaluation of radiation reactions of the lower jaw showed better results concerning preventive treatment and osteoradionecrosis than have been described in the literature.