BLOOD PRESSURE CHANGES OF ELDERLY HYPERTENSIVE PATIENTS DURING DENTAL EXTRACTION UNDER SEDATION WITH CONTINUOUS INTRAVENOUS INFUSION OF MIDAZOLAM

Objective To evaluate the changes in blood pressure (BP) of elderly hypertensive patients having dental extraction under sedation with continuous intravenous infusion of midazolam. Methods One hundred elderly hypertensive patients undergoing dental extraction were recruited for this single-blind, randomized, controlled study. Patients in intervention group (n=50) were given midazolam dissolved in glucose solution and patients in control group (n=50) were given glucose solution only with communication technique. Systolic BP (SBP) and diastolic BP (DBP) were recorded in five time points. Results Under basal conditions, intervention group did not show significant difference in BP compared with control group. Before sedation, mean values of SBP and DBP (especially SBP) significantly increased compared with basal conditions in both groups (P<0.05). During dental extraction sessions, mean values of BP in intervention group significantly decreased than control group (P<0.05), but coefficient of variation did show significant difference in both groups. Conclusion Continuous intravenous infusion of midazolam has been proved to be very successful in controlling BP of elderly patients having dental extraction.

Pneumomediastinum and subcutaneous emphysema secondary to dental extraction:Two case reports

BACKGROUND Dental extraction is a common operation in oral surgery and is usually accompanied by pain,swelling,and local infection.The application of high-speed air turbines increases the comfort of alveolar surgery and makes it more minimally-invasive.However,high-speed gas can enter the subcutaneous tissue of the face and neck or even the chest and mediastinum,which is a serious iatrogenic complication.CASE SUMMARY We describe two cases of severe subcutaneous and mediastinal emphysema caused by high-speed turbine splitting during dental extraction.The first case involved a 34-year-old man who complained of swelling of the face,mild chest tightness,and chest pain after dental extraction.Computed tomography(CT)scan showed a large amount of gas in the neck,chest wall,and mediastinum.The second case involved a 54-year-old woman who complained of swelling and pain of the neck after dental extraction.CT showed a large amount of gas collected in the neck and mediastinum.Both of them used high-speed turbine splitting during dental extraction.CONCLUSION High-speed turbine splitting during dental extraction may lead to severe subcutaneous and mediastinal emphysema.Dentists should carefully operate to avoid emphysema.If emphysema occurs,CT can be used to improve the diagnosis.The patient should be informed,and the complications dealt with carefully.

Evaluation of success rates of immediate and delayed implants after tooth extraction

Objective To evaluate the success rates of immediate and delayed placement of implants with respect to the causes of tooth extraction and implant positions.Methods A total of 310 dental implants (immediate implants∶delayed implants=76∶234) were inserted into 80 patients. The types,sizes and positions of the implants and the causes of tooth extraction were recorded. We then investigated the relationship of implant loss with the causes of tooth extraction and placement methods. Results A higher failure rate was found for the implants in the posterior region of the maxilla,and when periodontitis was cited as a reason for tooth extraction. The overall success rates were 93.4% and 95.7% in the immediate and delayed implant placement groups,respectively,after a 2-year follow-up. No obvious relationship of success rate was observed with the implant placement method,cause of tooth extaction,and implants’ position. Conclusion The immediate placement of implants into fresh extraction sockets could offer advantages over the delayed implant placement. It seems to be a safe and predictable method for patients.

Comparison of bone regeneration in alveolar bone of dogs on mineralized collagen grafts with two composition ratios of nanohydroxyapatite and collagen

To study the effect of two composition ratios of nano-hydroxyapatite and collagen(NHAC)composites on repairing alveolar bone defect of dogs.Eighteen healthy adult dogs were randomly divided into three groups.Two kinds of the NHAC composites were prepared according to the constituent ratios of 3:7 and 5:5;immediately after extraction of the mandibular second premolars,each kind of the NHAC composite was implanted into extraction socket,respectively:Group I,nHA/Col紏3:7;Group II,nHA/Col紏5:5 and Group III,blank control group.The bone-repairing ability of the two grafts was separately analyzed by morphometric measurement,X-ray tomography examination and biomechanical analysis at 1st,3rd and 6th month post-surgical,respectively.The NHAC composites were absorbed gradually after implanting into alveolar bone defect and were replaced by new bone.The ratios of new bone formation of Group I was significantly higher than that of Group II after 3 months(P<0.05).The structure and bioactive performance can be improved when the ratio between the collagen and the hydroxyapatite was reasonable,and the repairing ability and effect in extraction sockets are obviously better.

Osteonecrosis of the jaw in a patient with acute myeloid leukemia,who received azacitidine

The first case of osteonecrosis of the jaw(ONJ)related to azacitidine therapy was reported.A 64-year-old male with acute myeloid leukemia,who received 5-azacitidine,presented with pain and purulence of the right second premolar.An unsuccessful endodontic therapy resulted in dental extraction 6 months later.The post-extraction non-healing socket was managed with antibiotics and multiple surgical debridements without response.ONJ stage 2 was diagnosed 12 months after the initial symptoms of pain and purulence and was managed conservatively.Currently the patient is still receiving 5-azacitidine therapy,while ONJ remains asymptomatic.This case highlights the presence of alveolar bone disease prior to the appearance of ONJ.Osteonecrosis in chemotherapy,although rare,may increase as long-term survival of cancer patients,who receive those medications increases.Health care professionals need to be alert,while collaboration with an experienced oral/dental oncologist would be beneficial to the patient.