Tooth Extraction

AIM: To present a case that emphasizes the importance of the use of intentional replantation as a technique to successfully treat a periapical lesion and an odontogenic maxillary sinusitis through the alveolus at the same time. SUMMARY: This case report presents a patient with odontogenic maxillary sinusitis secondary to periapical disease of a maxillary molar that had previously received root canal treatment. The molar was extracted, with drainage and rinsing of the maxillary sinus. The apices were resected extra-orally, the retrograde cavities prepared with ultrasound and retrograde fillings of silver amalgam placed. The tooth was then replanted. After 2 years, the patient was asymptomatic, periapical radiography showed no evidence of root resorption and computed tomography scanning demonstrated the resolution of maxillary sinusitis. Key learning points: *When root canal treatment or periapical surgery cannot be undertaken or has failed, intentional replantation may be considered....

Osteonecrosis of the jaw (ONJ) is a serious complication associated with bisphosphonate therapy, but its epidemiology in the setting of oral bisphosphonate therapy is poorly understood. The present study examined the prevalence of ONJ in patients receiving chronic oral bisphosphonate therapy.We mailed a survey to 13,946 members who had received chronic oral bisphosphonate therapy as of 2006 within a large integrated health care delivery system in Northern California. Respondents who reported ONJ, exposed bone or gingival sores, moderate periodontal disease, persistent symptoms, or complications after dental procedures were invited for examination or to have their dental records reviewed. ONJ was defined as exposed bone (of >8 weeks' duration) in the maxillofacial region in the absence of previous radiotherapy.Of the 8,572 survey respondents (71 ± 9 years, 93% women), 2,159 (25%) reported pertinent dental symptoms. Of these 2,159 patients, 1,005 were examined and an additional 536 provided dental records. Nine ONJ cases were identified, representing a prevalence of 0.10% (95% confidence interval 0.05% to 0.20%) among the survey respondents. Of the 9 cases, 5 had occurred spontaneously (3 in palatal tori) and 4 occurred in previous extraction sites. An additional 3 patients had mandibular osteomyelitis (2 after extraction and 1 with implant failure) but without exposed bone. Finally, 7 other patients had bone exposure that did not fulfill the criteria for ONJ.ONJ occurred in 1 of 952 survey respondents with oral bisphosphonate exposure (minimum prevalence of 1 in 1,537 of the entire mailed cohort). A similar number had select features concerning for ONJ that did not meet the criteria. The results of the present study provide important data on the spectrum of jaw complications among patients with oral bisphosphonate exposure.

Objectives. The aim of the study was to investigate the effectiveness of an educational program on the reduction of the incidence of wrong-site tooth extraction at the outpatient department of a university hospital in Taiwan. Study design. Data collected from cases of wrong-site tooth extraction during 1996 to 1998 were used to develop a specific educational intervention that was implemented from 1999 to 2001. The annual incidence of erroneous extraction was compared between the preintervention and intervention periods. The factors contributing to wrong tooth extraction were also analyzed. Results. The annual incidence rates of erroneous extraction from 1996 to 1998 were 0.026%, 0.025%, and 0.046%, respectively. During the intervention period from 1999 to 2001, wrong-site tooth extraction did not occur at the department. There was a significant difference in the incidence of erroneous extraction between the preintervention and intervention periods (P\.01). Cognitive failure was the most frequent form of active failure responsible for wrong-site tooth extraction, whereas communication and training were found to be major latent factors contributing to these errors. Conclusions. Our results suggest the effectiveness of an educational program comprising case-based materials, information feedback, and clinical guidelines in reducing the incidence of wrong-site tooth extraction.

Immediate implant placement and provisionalization has been considered as a preservative procedure when replacing failing teeth, especially in the esthetic zone. Nevertheless, an average facial gingival tissue recession of 1 mm is still common after one year of function. Furthermore, facial gingival recession of thin periodontal biotype seems to be more pronounced than that of thick biotype. Biotype conversion around both natural teeth and implants with subepithelial connective tissue graft has been advocated, and the resulting tissues appear to be more resistant to recession. A technique combining subepithelial connective tissue graft and immediate implant placement and provisionalization is devised to achieve a more stable peri-implant tissue in thin biotype situations. This article describes the surgical and prosthodontic approach of this procedure as well as its clinical rationale.

A representative case in which a polymicrobial infection involving Fusobacterium nucleatum, Actinomyces israelii and Aggregatibacter (formerly Actinobacillus) actinomycetemcomitans was initially diagnosed as malignancy in an edentulous patient. Additional history obtained after the nature of the syndrome was elucidated revealed that he had had his two remaining teeth extracted four months prior to this episode.

Background: Mucogingival interceptive therapy in patients with buccally erupting teeth is performed to prevent the ectopic permanent tooth from developing periodontal lesions. The keratinized tissue entrapped between the erupting tooth and the deciduous tooth is retained to maintain a satisfactory width of the gingiva for the permanent tooth. The aim of the present study on buccally-erupted premolars scheduled for orthodontics was to evaluate the keratinized tissue width 3 months, 2 years, and 7 years subsequent to mucogingival interceptive therapy and orthodontic treatment. Methods: Twenty-nine patients participated. Three different surgical techniques were used according to specific indications. Eight patients were treated with double pedicle flaps (DPF), 10 patients with apically positioned flaps (APF), and 11 with free gingival grafts (FGG). Results: The amount of keratinized tissue on the treated (test) sites was not significantly less than on the control (untreated) sites showing normally erupting premolars at all observation periods. All 3 surgical procedures appeared to be effective in saving the keratinized tissue for the permanent tooth. Preoperative periodontal parameters such as gingival width, probing depth, and bleeding on probing significantly influenced the outcome 3 months after surgery (P <0.01). Conclusions: Mucogingival interceptive surgery is an effective approach to conserve the keratinized buccal gingiva of ectopically erupting premolars.

Brain abscesses are rare but potentially deadly complications of odontogenic infections. This phenomenon has been described mainly in the form of case reports, as large-scale studies are difficult to perform. We compiled a total of 60 previously published cases of such a complication to investigate the predisposing factors, microbiology, and clinical outcomes of intracranial abscesses of odontogenic origin. A systematic review of the literature using the PubMed database was performed. Men accounted for 82.1% of cases, and the mean age was 42.1years. Caries with periapical involvement and periodontitis were the two most common intra-oral sources, and wisdom tooth extraction was the most common preceding dental procedure. In 56.4% of cases, there were obvious signs of dental disease prior to development of intracranial infection. Commonly implicated microorganisms included Streptococcus viridans (especially the anginosus group), Actinomyces, Peptostreptococcus, Prevotella, Fusobacteri...

This study compared the difference in decision making regarding retreatment of endodontically treated teeth by general dental practitioners and endodontists. Thirty radiographs of endodontically treated teeth taken from undergraduate records with their respective case descriptions were submitted to fifteen endodontists and fifteen general dental practitioners. Seven treatment alternatives were given as choices; reasons for retreatment, if chosen, were also requested and presented as choices. The results showed statistically different decisions among these two groups regarding retreatment cases. More endodontists opted for retreatment of cases, while higher percentages of general dentists decided to observe, not treat or extract. To prevent misdiagnosis and eventually mistreatment, endodontic decision making should be taught. Currently, there are no specific guidelines for management of failed root canal retreatment. It is suggested that guidelines generated by evidence-based dentistry may produce less variation in clinical decision making.

Mandibular infiltration has been routinely avoided in treating mandibular molars because of its questionable adequacy. The purpose of our investigation was to determine the effectiveness of mandibular infiltration compared with mandibular block in treating primary molars in children, and to relate the effectiveness to age and type of treatment performed. The study population consisted of 89 cooperative children, 3 to 9 years old, requiring the same type of treatment on contralateral mandibular molars. The half-mouth study design was used. Dental procedures included class I and II amalgam restorations, stainless steel crowns, formocresol pulpotomies, and extractions. Evaluations of pain and behavior for each anesthesia technique and type of treatment were made using sounds, motor, and ocular changes indicating pain and the Frankl Behavior Rating Scale. Evaluations were made upon probing, rubber dam placement, and during tooth preparation and extraction. No statistically significant d...

provides the superior access needed for removal of large lesions in the posterior maxilla. The Le Fort I down-fracture is a routine procedure in oral and maxillofacial surgery. Its postoperative morbidity is low, and the results are predictable, without changes to the occlusion after surgery. The Le Fort I down-fracture approach also gives an excellent view of the entire maxillary sinus, allowing well-visualized, safe, and thorough removal of the tumor.

Purpose: The purpose of this study was to analyze the incidence of various complications following routine exodontia performed using fixed protocols. Materials and Methods: A total of 22,330 extractions carried out in 14,975 patients, aged between 14 and 82 years, who reported to the Department of Oral and Maxillofacial Surgery at Padmashree Dr. D. Y. Patil Dental College and Hospital, Nerul, Navi Mumbai, were evaluated for various complications. Results: The most common complications encountered were tooth fracture, trismus, fracture of cortical plates and dry socket. Wound dehiscence, postoperative pain and hemorrhage were encountered less frequently. Luxation of adjacent teeth, fracture of maxillary tuberosity, and displacement of tooth into adjacent tissue spaces were rare complications. Conclusion: The practice of exodontia inevitably results in complications from time to time. It is imperative for the clinician to recognize impending complications and manage them accordingly.

For most warfarin indications, the target maintenance international normalised ratio (INR) is 2-3. Risk factors for bleeding complications with warfarin use include age, history of past bleeding and specific comorbid conditions. To reverse the effects of warfarin, vitamin K(1) can be given. Immediate reversal is achieved with a prothrombin complex concentrate (PCC) and fresh frozen plasma (FFP). Vitamin K(1) is essential for sustaining the reversal achieved by PCC and FFP. When oral vitamin K(1) is used for warfarin reversal, the injectable formulation of vitamin K(1) is preferable to tablets because of its flexible dosing; this formulation can be given orally or injected. To temporarily reverse the effect of warfarin when there is a need to continue warfarin therapy, vitamin K(1) should be given in a dose that will quickly lower the INR to a safe, but not subtherapeutic, range and will not cause resistance once warfarin is reinstated. Prothrombinex-HT is the only PCC approved in Au...

The purpose of the present study was to investigate if diclofenac administration interferes with the time course of alveolar wound healing in rats. Forty-two Wistar rats were used, 21 rats received 10 mg/kg/day of diclofenac one day before and 4 days after extraction of the right maxillary incisors and 21 rats received saline. The animals were sacrificed 7, 14 and 21 days after tooth extraction. Progressive new bone formation and a decrease in the volume fraction of blood clot and connective tissue from 1 to 3 weeks after tooth extraction was quantified using the histometric point-counting method. Diclofenac treatment caused a significant delay in new bone formation in association with an impairment of blood clot remission/organization.

The aim of this retrospective study is to report on the prevalence of post-extraction complications among patients attending the Oral Surgery outpatient clinic of the Faculty of Dentistry, University of Malaya over a 12-month period from January to December, 1992. The prevalence of post-extraction complications which required further treatment was only 3.4% (n = 100), out of a total of 2968 patients who had extraction of one or more permanent teeth. Analysis based on complete clinical reports (n = 79) showed that dry socket accounted for nine out of ten cases of post-extraction complications. However the aetiology was largely unknown. No obvious association with medical history could be made. Lower teeth were more likely to have complications. The most common teeth associated with dry socket were the molars (76%) and premolars (19%). The most common molars to be affected are the first, followed by the third and lastly the second molars. A brief review of current aetiological factors of dry socket was discussed.

Background: As a complement to the earlier reported 3-year results from a prospective multicenter study of immediate and delayed placement of implants into fresh extraction sockets, the 5-year results are reported.Purpose: The purpose of this 5-year report was to evaluate the immediate and long-term success of implants placed into fresh extraction sockets, with respect to implant size and type, bone quality and quantity, implant position, initial socket depth, and reason for tooth extraction.Materials and Methods: This paper presents the 5-year results of the original 12 centers that participated with 143 consecutively included patients. A total of 264 implants were placed either immediately after tooth extraction or after a short soft-tissue healing time (3–5 weeks). The patients were divided into five subgroups, depending on the type of insertion method used.Results: The outcome demonstrated that the cumulative implant survival rate after 5 years of loading has not changed and remains 92.4% in the maxilla and 94.7% in the mandible. No difference in failure rates can be seen between the groups when relating the failures to insertion method.Conclusion: This prospective study demonstrated that placing Brånemark implants into fresh extraction sites can be successful over a period of 5 years of loading. One of the outcomes of the study shows that there is a clinical correlation between implant failure and periodontitis as a reason for tooth extraction, even if it is difficult to give it a casual association. It can be hypothesized that periodontitis affected tissues might have a negative local influence because of the presence of infrabony defects that could possibly increase the gap between bone and implant or jeopardize achievement of primary stability.

Ibuprofen is a safe and effective analgesic, but some formulations have a slow onset of action. Ibuprofen arginate is a rapidly absorbed salt designed to promote more rapid onset of analgesia. A clinical trial was conducted in 226 patients with postoperative dental pain to assess the analgesic efficacy and speed of onset of the arginine salt of ibuprofen compared with one of the commercially available forms of ibuprofen. Patients were administered a single dose of either ibuprofen arginate (200 mg or 400 mg), ibuprofen (200 mg or 400 mg), or placebo in this double-blind, randomized trial. To determine the onset of action of the study medication patients were required to note time to ''any'' pain relief and then time to ''meaningful'' pain relief, using the two-stopwatch method. Pain intensity and relief were assessed using traditional categorical scales over a 6-h period. Meaningful pain relief was achieved in 42 min and 24 min for ibuprofen arginate 200 mg and 400 mg, respectively, compared with 50 min and 48 min for ibuprofen 200 mg and 400 mg, respectively (P<0.05). The results for the measurements of analgesic effectiveness [sum of pain intensity difference, total pain relief (TOTPAR), peak pain relief and overall evaluation of treatment] all showed that both doses of ibuprofen arginate and both doses of ibuprofen were significantly better than placebo and both 200-mg and 400-mg ibuprofen arginate doses were significantly better than ibuprofen 200 mg for peak pain relief. Mean plasma ibuprofen concentrations at 30 min and 60 min, respectively, were: ibuprofen arginine 200 mg, 13.9 lg/ml and 15.7 lg/ml; ibuprofen arginine 400 mg, 29.5 lg/ml and 29.3 lg/ml; ibuprofen 200 mg 2.5 lg/ml and 5 lg/ ml; ibuprofen 400 mg, 2.3 lg/ml and 7.4 lg/ml. (P<0.05). Adverse event profiles were similar across treatment groups. These results overall suggest that ibuprofen arginate when taken at doses equivalent to commercially available ibuprofen formulations produces analgesia that is faster in onset.

The purpose of this study was to compare the success rates of Class II subdivision malocclusion patients treated with either symmetric or asymmetric extractions. The sample consisted of 51 patients with Class II subdivision malocclusion. The patients were divided into 2 groups. Group 1 included 28 patients who were treated with 4 premolar extractions. The 23 patients in group 2 were treated with 3 premolar extractions (2 maxillary premolars and 1 mandibular premolar on the Class I side). The initial and final study models were evaluated by means of Grainger's treatment priority index (TPI). Individual evaluations of improvements in maxillary-to-mandibular dental midline deviation, overjet, and overbite were also made. The final mean TPI and the mean improvement in TPI and in the other variables of each group were compared with independent t tests. The results showed a statistically significant difference only for the improvement in maxillary-tomandibular dental midline deviation of the groups. The 3-premolar-extraction group had a greater improvement of the initial interdental midline deviation. There is a tendency for a slightly better treatment success rate when Class II subdivision patients are treated with asymmetric extraction of 3 premolars, compared with extraction of 4 premolars. (Am J Orthod Dentofacial Orthop 2003;124:257-64)

Introduction: The purpose of this prospective study was to analyze the factors related to extraction of endodontically treated teeth. Methods: One hundred nineteen cases of extraction of endodontically treated teeth were consecutively reviewed, and the following items were recorded: type of tooth; presence and type of coronal restoration; motive of consultation; reasons for extraction; patient's age, gender, level of education; smoking status. Association between factors was investigated with c 2 analysis. Results: Dental pain was the main motive for consultation (68.9%). The teeth most extracted were mandibular molars (51.3%), followed by maxillary molars (16.1%). First molars were the most frequently extracted (29.4%). Ninety-one teeth (76.5%) were restored coronally with or without post, and crowned teeth represented 5.9% of the sample. The reasons for extraction were periodontal disease (40.3%), endodontic failure (19.3%), vertical root fracture (13.4%), nonrestorable cuspid and crown fracture (15.1%), nonrestorable caries (5.2%), iatrogenic perforations and stripping (4.2%), and prosthetic (0.8%). Analysis between gender, smoking status, and education level showed no significant difference for reasons of extraction (P = .33 and .34). Conclusions: The mandibular first molar without crown was the most frequently extracted tooth. The main reasons for extractions were periodontal disease, endodontic failure, and nonrestorable tooth damage caused by fracture or caries. (J Endod 2011;37:1512-1515

To determine the impact of secondary versus primary closure techniques on the frequency and severity of pain, facial swelling, trismus, infectious complications, and postoperative bleeding after impacted mandibular third molar extraction. Materials and Methods: Randomized controlled trials were identified through MEDLINE, EMBASE, and CENTRAL, ongoing trial registers, meeting abstracts, doctoral and masters theses, and manual searching of the reference lists of eligible studies. Study selection, data extraction, risk of bias, and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) rating of confidence in effect estimates were undertaken independently in duplicate. Results: Of 1,721 identified citations, 14 studies proved eligible. Pain and facial swelling at postoperative days 3 and 7 and infectious complications at day 7 did not differ between techniques. Patients receiving secondary closure had less trismus (in millimeters) at postoperative days 3 (mean difference, 3.72; 95% confidence interval, 1.42 to 6.03, P ϭ .002) and 7 (mean difference, 2.35; 95% confidence interval, 0.37 to 4.33; P ϭ .02). Four randomized controlled trials reported bleeding: in 2, there was no bleeding in either group; the numbers of bleeding events with primary and secondary closures were 22 and 16 and 5 and 15, respectively, in the other 2. Because of the risk of bias and inconsistency in results, the evidence warranted, at best, low confidence in the estimates of effect across all outcomes. Conclusions: Although differences between primary and secondary closure techniques after impacted mandibular third molar extraction are likely to be small, available evidence provides only low confidence in the effect estimates. The results do not support a preference for either approach.

The purpose of this study was to identify risk factors for mandibular third-molar impaction in adolescent orthodontic patients. Methods: Radiographs made before (T1) and after (T2) treatment and at least 10 years postretention (T3) of 134 patients that allowed accurate diagnosis of impaction vs eruption of at least 1 mandibular third molar were evaluated. Results: Univariate logistic regression analyses at T1 showed that the decision to extract premolars (P Ͻ.05), an increase of 1 mm in mesial molar movement (P Ͻ.05), and an increase of 1 mm in eruption space measured from second molar to Xi point (centroid of the ramus) (P Ͻ.01) reduced the risk of impaction by 63%, 22%, and 30%, respectively. An increase of 1°in mandibular third-molar angulation relative to the occlusal plane increased the risk of impaction by 11% (P Ͻ.01). Multivariate logistic regression analyses at T1 showed that reduced eruption space (P Ͻ.01), signs of forward mandibular growth rotation (P Ͻ.01), and female sex (P Ͻ.05) increased the risk of impaction. However, association tests documented increased frequencies of extractions and more mesial molar movement in female patients with erupted third molars. Univariate logistic regression analyses at T2 showed that every millimeter of increase in eruption space measured from the second molar to the anterior border of the ramus and to Xi point reduced the risk of impaction by 29% and 22%, respectively (P Ͻ.01), whereas every degree of increase in the angle between the occlusal surface and the occlusal plane increased the risk of impaction by 11% (P Ͻ.01). Multivariate logistic regression analyses at T2 showed that increased eruption space reduced the risk of impaction (P Ͻ.05), whereas increased mesial angulation of the third-molar bud (P Ͻ.01) and signs of forward growth rotation (P Ͻ.05) increased the risk of impaction. (Am J Orthod Dentofacial Orthop 2006;130:47-55) Behbehani, Årtun, and Thalib 49 1.11 (0.98-1.25) Gonial angle -0.05 (0.03) P Ͻ .10 0.95 (0.99-1.00) American Journal of Orthodontics and Dentofacial Orthopedics Volume 130, Number 1 Behbehani, Årtun, and Thalib 51 Fig 4. Patient with distal impaction of both mandibular third molars despite extraction treatment, large eruption space at T2, favorable third-molar angulation at T2, and 3.2 mm mesial molar movement from T1 to T2.

Aim: To use multilevel, multivariate models to analyze factors that may affect bone alterations during healing after an implant immediately placed into an extraction socket. Material and methods: Data included in the current analysis were obtained from a clinical trial in which a series of measurements were performed to characterize the extraction site immediately after implant installation and at re-entry 4 months later. A regression multilevel, multivariate model was built to analyze factors affecting the following variables: (i) the distance between the implant surface and the outer bony crest (S-OC), (ii) the horizontal residual gap (S-IC), (iii) the vertical residual gap (R-D) and (iv) the vertical position of the bone crest opposite the implant (R-C). Results: It was demonstrated that (i) the S-OC change was significantly affected by the thickness of the bone crest; (ii) the size of the residual gap was dependent of the size of the initial gap and the thickness of the bone crest; and (iii) the reduction of the buccal vertical gap was dependent on the age of the subject. Moreover, the position of the implant opposite the alveolar crest of the buccal ridge and its bucco-lingual implant position influenced the amount of buccal crest resorption. Conclusions: Clinicians must consider the thickness of the buccal bony wall in the extraction site and the vertical as well as the horizontal positioning of the implant in the socket, because these factors will influence hard tissue changes during healing.

Background: Patients experiencing acute pain after surgery, including dental surgery, often require analgesia. Ideally, the chosen analgesic should have a rapid onset and sustained effect. Etoricoxib is a new cyclooxygenase-2selective inhibitor that has demonstrated analgesic efficacy in the treatment of acute pain with a rapid onset and long-lasting pain relief.

The aim of this study was to analyze through clinical and histomorphometric parameters the use of acellular dermal matrix (ADM) with or without mineralized bone allograft (AB) on bone formation in human alveoli after a 6- to 8-month healing period. A total of 19 patients in need of extraction of the maxillary anterior teeth were selected and randomly assigned to the test group (ADM plus AB) or to the control group (ADM only). Clinical and histomorphometric measurements and histologic analysis were recorded 6 to 8 months after ridge preservation procedures. Clinical parameters and amount of mineralized and nonmineralized tissue were measured and analyzed. In the clinical measurements, the test group showed reduced bone loss in the buccopalatal dimension after 6 to 8 months (intragroup analysis P &lt; .01). Histologic findings showed higher percentages of mineralized tissue and lower percentages of nonmineralized tissue in the test group when compared with the control group (P &lt; .0...

The aim of this study was to investigate the nature of the template structure on which trabecular bone formation occurs during healing of the rodent tooth extraction socket, a well studied bone healing system. The presence of collagen type II mRNA has previously been described in the healing socket, although the formation of the protein or cartilage has not been observed. However, recent evidence from developmental and other bone healing studies indicates that collagen type III may be important in forming the preliminary scaffold on which bone trabeculae are formed. The maxillary right molar teeth were removed from rats under general anaesthesia and the animals killed at various times afterward. The tissues were examined using histological, in situ hybridization, and immunohistochemical staining techniques. It was concluded that collagen type IIA mRNA was produced by osteoblast cells of the socket, but that collagen type II, if present, would account for less than 0.01% of the total proteins extracted. During bone formation, Sharpey's fibers were seen radiating from the peripheral bone toward the center of the socket. These optically active collagen fibers were inserted into the forming bone trabeculae and were recognized by antibodies raised against collagen type III. The arrangement and composition of these fibers therefore suggest that they form a preliminary framework on which deposition of woven bone trabeculae occurs. (J Bone Miner Res

The orthodontic treatment of an adult patient with a skeletal Class III malocclusion, increased anterior facial height, negative overjet, and bilateral posterior crossbite is presented. Treatment options included mandibular first premolar or third molar extractions with dentoalveolar compensation or combined surgicalorthodontic treatment. Mandibular third molar extraction with dentoalveolar compensation was the treatment choice. Biofunctional brackets, with accentuated lingual crown torque on the maxillary incisors and accentuated buccal crown torque on the mandibular incisors, were used. The anterior crossbite was corrected with intermaxillary elastics from the palatal aspect of the maxillary incisors to the labial aspect of the mandibular incisors. Class III elastics moved the maxillary teeth mesially and assisted in retruding the mandibular teeth. Patient compliance with the elastics was excellent, and satisfactory dentofacial esthetics were achieved. This treatment protocol has rigorous indications, and it is not a routine plan. The mechanotherapy and the pros and cons of this approach are discussed. (Am J Orthod Dentofacial Orthop 2005;128:787-94)

Objectives: The aim of this systematic review was to evaluate the best timing for placing implants after tooth extraction, by comparing early vs. delayed implant placement and evaluating the hard and/or soft tissue ridge dimensional changes and the outcomes related with implant survival and prosthesis success. Material and methods: An online search of the main databases including The National Library of Medicine (MEDLINE via Pubmed), Embase and The Cochrane Central Register of Controlled Trials was conducted up to February 2011. Randomized controlled clinical trials (RCTs), prospective cohort studies and case-control retrospective studies, with a follow-up of at least 1 month after loading of dental implants, comparing: (i) early vs. delayed implant placement, (ii) augmentation vs. no augmentation at implant placement in early placed implants and/or (iii) the comparison of various augmentation procedures at early implant placement, were conducted. A hand search of relevant journals was also performed. Screening of eligible studies, assessment of their methodological quality and data extraction were conducted in duplicate by two independent reviewers. Authors of studies were contacted for clarification or missing information.

Purpose: We sought to determine the incidence of dry socket in a Nigerian teaching hospital and to evaluate the patients' demographic pattern, predisposing factors, the treatment given, and treatment outcome. Patients and Methods: A retrospective review of records of dental extractions complicated by dry socket in Obafemi Awolowo University Teaching Hospital, Ile-Ife, between January 1996 and December 2000 was undertaken. Information retrieved included patient sociodemographic data, indications for extraction, tooth extracted, status of attending surgeon, onset of symptoms, relevant findings of the examining clinician, interval before presentation, treatment given, and its outcome. Results: Of the 3,319 dental extractions performed in 3,008 patients, 136 (4.1%) were complicated by dry socket. The patients' mean age was 33.4 (15.4) years and a peak age incidence of 21 to 30 years was found. A slight female preponderance (1.4:1) was observed. The majority of patients were in the low-income group, and presentation in the hospital was prompt in the high-income group. Mandibular teeth were affected 3 times more than maxillary teeth (P ϭ .00080). Most cases of dry socket resulted from extractions performed by undergraduates and house officers. Various underlying systemic conditions were found in 11.0% of cases, none of which included use of oral contraceptives. Treatment was usually the use of zinc oxide eugenol dressing in an irrigated socket, combined with antibiotic therapy in 45.3% of cases. No adverse reaction to zinc oxide eugenol was observed. Conclusion: The incidence of dry socket in our hospital is 4.1%. The mandible was involved 3 times more than the maxilla. With the use of zinc oxide eugenol dressing, 70.6% of patients completed treatment satisfactorily and 29.2% were lost to follow-up.

The correlation between blood levels of ibuprofen and clinical analgesic response A clinical trial comparing ibuprofen, 400, 600, and 800 mg, with aluminum ibuprofen, 400 mg, and placebo was conducted in patients with moderate or severe pain subsequent to third molar extraction. Pain intensity ratings and ibuprofen serum levels were obtained at baseline, 30 minutes, 1 hour, and hourly thereafter for 3 hours. Pain intensity ratings were also obtained at hours 4, 5, and 6. Serum levels at 1, 2, and 3 hours correlated significantly with the log dose of ibuprofen (r = 0.35, 0.49, and 0.48, respectively) and with global analgesic response as measured by the percentage of the sum of the pain intensity scores (r = 0.28,0.34, and 0.26, respectively). However, possibly because of differences in drug formulation, the percentage of the sum of the pain intensity scores did not correlate significantly with log dose. The highest correlations were found between contemporaneous serum levels and pain intensity difference values, particularly at hour 1 (r = 0.54). Our results support the proposition that increased ibuprofen serum levels lead to increased analgesia. (CLIN PHARMACOL THER 1986;40:1-7.) Our study was designed to investigate the relationship between clinical analgesic efficacy and serum ibuprofen concentrations resulting from the use of graded doses of ibuprofen, 400, 600, and 800 mg, and aluminum ibuprofen, 400 mg, in the treatment of severe postop-From the Nathan S.

The public myth of the discovery of penicillin is an archetypal "quest story" of the type common to every human culture. But the real story of the discovery, testing and refinement of penicillin is a complex tale of accident, serendipity, oversight, conflict, the pressure of war, idiosyncratic personalities and even -the invention of history.