A prospective, randomized, triple-blind comparison of articaine and bupivacaine for maxillary infiltrations

Objectives: To compare the clinical anesthetic efficacy of 0.5% bupivacaine and 4% articaine (both with 1:200.000 adrenaline) for anterior maxillary infiltration in healthy volunteers. Material and methods: A triple-blind split-mouth randomized clinical trial was carried out in 20 volunteers. A supraperiosteal buccal injection of 0.9 ml of either solution at the apex of the lateral incisor was done in 2 appointments separated 2 weeks apart. The following outcome variables were measured: latency time, anesthetic efficacy (dental pulp, keratinized gingiva, alveolar mucosa and upper lip mucosa and tissue) and the duration of anesthetic effect. Hemodynamic parameters were monitored during the procedure. Results: Latency time recorded was similar for both anesthetic solutions (p>0.05). No statistically significant differences were found in terms of anesthetic efficacy for dental pulp, keratinized gingiva or alveolar mucosa. Articaine had a significant higher proportion of successful anesthesia at 10 minutes after infiltration in lip mucosa and lip skin (p=0.039). The duration of anesthesia was 336 minutes for bupivacaine and 167 minutes for articaine. (p<0.001). No significant hemodynamic alterations were noted during the procedure. Conclusions: Articaine and bupivacaine exhibited similar anesthetic efficacy for maxillary infiltrations. The duration of anesthesia was longer with the bupivacaine solution, but lip anesthesia was better with articain

Bupivacaine 0.5 % versus articaine 4 % for the removal of lower third molars. A crossover randomized controlled trial

Objective: To compare the anesthetic action of 0.5% bupivacaine in relation to 4% articaine, both with 1:200,000 epinephrine, in the surgical removal of lower third molars. As a secondary objective hemodynamic changes using both anesthetics were analyzed. Study Design: Triple-blind crossover randomized clinical trial. Eighteen patients underwent bilateral removal of impacted lower third molars using 0.5% bupivacaine or 4% articaine in two different appointments. Preoperative, intraoperative and postoperative variables were recorded. Differences were assessed with McNemar tests and repeated measures ANOVA tests. Results: Both solutions exhibited similar latency times and intraoperative efficacy. Statistical significant lower pain levels were observed with bupivacaine between the fifth (p=0.011) and the ninth (p=0.007) postoperative hours. Bupivacaine provided significantly longer lasting soft tissue anesthesia (p<0.05). Systolic blood pressure and heart rate values were significantly higher with articaine. Conclusions: Bupivacaine could be a valid alternative to articaine especially due to its early postoperative pain prevention ability

Efficiency of conventional and computer-assisted implant planning and placement in partially edentulous patients using single splints

La colocación de implantes dentales para rehabilitar pacientes con edentulismos parciales o totales se considera un procedimiento rutinario con excelentes porcentajes de éxito a largo plazo. La alta predictibilidad de estos resultados se basa en una secuencia de tratamiento protocolizada, que comprende una fase de diagnóstico y planificación, una fase quirúrgica y una fase restauradora. La fase de diagnóstico preoperatorio implica un detallado análisis protésico, clínico y radiográfico. En este momento, se realiza un set-up protésico que permite predecir el contorno de la futura reconstrucción protésica con el fin de determinar la posición ideal del implante. Este set-up se transforma en una férula radiológica que el paciente porta durante el examen radiográfico. La imagen resultante incorpora la referencia protésica a la imagen radiográfica y permite, conjuntamente con la información obtenida de la exploración clínica, el estudio de la disponibilidad ósea, la identificación de estructuras anatómicas relevantes, y la determinación de la posición y dimensiones del implante a colocar. Posteriormente, el clínico intenta transferir la posición planeada al escenario clínico con la ayuda de una férula quirúrgica convencional, que transfiere la información protésica al campo operatorio.The present investigation has tried to analyze and compare two implant planning and placement treatment concepts from a holistic approach. Conventional and, more frequently, computer-assisted implant planning and placement protocols have been repeatedly investigated in terms of implant placement accuracy. However, the implant placement precision is only one of the relevant aspects when evaluating an implant planning and placement procedure. Other aspects such as treatment’s predictability, complications or unexpected events derived, treatment outcomes, patients’ perception, influence on the patient’s quality of life, or time and economic costs derived, are identically relevant when assessing the treatment’s value. Therefore, the aim of this study was to investigate all of these parameters in order to quantify the treatments’ efficiency

Quality of life following third molar removal under conscious sedation

Aim: The aim of this study was to assess quality of life (QoL) and degree of satisfaction among outpatients subjected to surgical extraction of all four third molars under conscious sedation. A second objective was to describe the evolution of self-reported pain measured in a visual analogue scale (VAS) in the 7 days after extraction. Study design: Fifty patients received a questionnaire assessing social isolation, working isolation, eating and speaking ability, diet modifications, sleep impairment, changes in physical appearance, discomfort at suture removal and overall satisfaction at days 4 and 7 after surgery. Pain was recorded by patients on a 100-mm pain visual analogue scale (VAS) every day after extraction until day 7. Results: Thirty-nine patients fulfilled correctly the questionnaire. Postoperative pain values suffered small fluctuations until day 5 (range: 23 to 33 mm in a 100-mm VAS), when dicreased significantly. A positive association was observed between difficult ranked surgeries and higher postoperative pain levels. The average number of days for which the patient stopped working was 4.9. Conclusion: The removal of all third molars in a single appointment causes an important deterioration of the patient"s QoL during the first postoperative week, especially due to local pain and eating discomfort

Advanced smile diagnostics using CAD/CAM mock-ups

Diagnostics are essential for predictable restorative dentistry. Both patient and clinician must agree on a treatment goal before the final restorations are delivered to avoid future disappointments. However, fully understanding the patient's desires is difficult. A useful tool to overcome this problem is the diagnostic wax-up and mock-up. A potential treatment outcome is modeled in wax prior to treatment and transferred into the patient's mouth using silicon indexes and autopolymerizing resin to obtain the patient's approval. Yet, this time-consuming procedure only produces a single version of the possible treatment outcome, which can be unsatisfactory for both the patient and the restorative team. Contemporary digital technologies may provide advantageous features to aid in this diagnostic treatment step. This article reviews opportunities digital technologies offer in the diagnostic phase, and presents clinical cases to illustrate the procedures

Accuracy of computer-assisted, template-guided implant placement compared with conventional implant placement by hand-An in vitro study

OBJECTIVES To compare free-hand to computer-assisted implant planning and placement (CAIPP) regarding planned to achieved implant position. MATERIAL AND METHODS Forty-eight cast/bone models were mounted in mannequin heads. On each side, a tooth gap of different sizes was created. In the test group (T), study implants were placed using a CAD-CAM guide based on virtual planning. In the control (C), free-hand implant placement was performed. After CBCT scanning, the implant position was compared with the planned position. Descriptive statistics were applied, and ANOVA was used to identify differences between groups and gaps. (p < .05). RESULTS In C, mean lateral deviations at the implant base amounted to 0.7 mm (max. 1.8) (large gap) and 0.49 mm (1.22) (small gap). In T, 0.18 mm (0.49) and 0.24 mm (0.52) were recorded. At the apex, 0.77 mm (2.04) (large gap) and 0.51 mm (1.24) (small gap) were measured in C, and 0.31 mm (0.83)/0.34 mm (0.93) in T. Mean vertical deviations in C measured 0.46 mm (1.26) (large gap) and 0.45 mm (1.7) (small gap). In T, 0.14 mm (0.44) and 0.28 mm (0.78) were recorded. Mean angular deviations of 1.7° (3.2°) were observed in C (large gap) and 1.36° (2.1°) (small gap). In T, mean values were 1.57° (3.3°) and 1.32° (3.4°). Lateral and vertical deviations were significantly different between groups (not gaps), angular between gaps (not groups). CONCLUSIONS CAIPP protocols showed smaller deviations irrespective of the size of the tooth gap. In C, the gap size had an influence on the error in angulation only

Analysis of the antibiotic prophylaxis prescribed by Spanish oral surgeons

Aim: To identify prophylactic antibiotic prescription practices among Spanish dentists with preferential dedication to Oral Surgery in different types of tooth extraction surgeries. Method: Members of the Spanish Oral Surgery Society were surveyed on antibiotic prophylaxis use in 4 different tooth extraction modalities scaled according to their surgical invasiveness. Results: Sixty-nine of the 105 distributed questionnaires were returned completed. Thirteen percent of the surveyed surgeons would prescribe antibiotics to prevent postoperative wound infection when confronted with conventional tooth extraction lasting less than 5 minutes. In the case of surgery lasting more than 5 minutes, the percentage of participants that would prescribe antibiotics increased to 39%. When a mucoperiosteal flap was elevated or an ostectomy was performed, 87% and 100%, respectively, would prescribe antibiotic prophylaxis. Amoxicillin and its combination with clavulanic acid were the most commonly prescribed antibiotics. All participants would prescribe the antibiotic orally, starting after surgery and with a duration that ranged from 2-8 days. Conclusions: The results obtained suggest that antibiotic prophylaxis for preventing local odontogenic infection is not being correctly implemented in Spain. This can generate new bacterial resistances, facilitate adverse drug reactions and favor opportunistic infections. Better designed studies are needed in order to clarify the role of antibiotics in the prevention of postsurgical wound infectio