Aim: The aim of the present study was to evaluate an early loading protocol for surface modified implants placed in the posterior mandible.Material and Methods: A total of 134 implants with a TiO2 blasted, fluoride modified surface were inserted into the posterior mandibles of 44 patients. The implants were functionally loaded after 7 weeks of healing. Implant stability quotient (ISQ) values (during the first year), bleeding on probing (BOP), plaque accumulation and marginal bone level (MBL) were assessed until the end of the observation period of 5 years. A total of 41 patients with 123 implants completed the study.Results: No implants were lost. ISQ values decreased significantly from the time of insertion to 2 weeks and increased significantly until the 1-year follow up. BOP varied until the end of the observation period between 7.9% and 13.0%. Plaque accumulation decreased from the time of early loading to the end of the study. MBL changed from 0.59 mm at the time of implant placement to 0.80 mm at the time of early loading. Thereafter, only slight variations in MBL occurred until the end of the observation period.Conclusions: The results confirm that early loading is a promising option also in posterior edentulism of the mandible.

Purpose Results from our oral cavity chemoprevention trial demonstrated appreciable interpatient variations regarding chemopreventive efficacy of a freeze dried black raspberry (FBR) gel. We speculated these data reflected individual patient-related differences in absorption, target tissue uptake and local compound metabolism of key FBR compounds (anthocyanins). Accordingly, this study assessed the distribution of anthocyanins from the 10% ( w / w ) FBR gel in saliva, oral tissues and plasma. Methods Human subject participation entailed collection of: (1) saliva, tissue and plasma (5 min following gel application, keratinized tissues), (2) saliva and plasma (5 min after sublingual gel application), (3) saliva and plasma at 1, 2, and 4 h post gel application (keratinized tissues), and (4) saliva (cyanidin 3-rutinoside incubations). Levels of FBR anthocyanins in the respective samples were analyzed by LC/MS/MS. Results Our data show: significantly higher anthocyanin levels in saliva and oral tissues relative to matched plasma samples, marked donor-specific variations in anthocyanin uptake, sustainability of anthocyanins at the target site, pH affects anthocyanin penetration and intraoral anthocyanin decomposition and/or metabolism. Conclusions No previous oral cavity chemoprevention trials evaluated compound distribution at the treatment site. Our data, which demonstrate a local delivery-derived pharmacologic advantage, provide insights which could advance oral cavity chemoprevention strategies.

A 50-year-old woman noticed a swelling of approximately 18 months' duration involving her left soft palate. She initially visited her family physician, who suggested that it might represent a ruptured blood vessel. When the lesion did not resolve in subsequent months, the family physician referred her to an otolaryngologist. Although unsure of the diagnosis, the otolaryngologist wanted to perform a biopsy. The patient then sought a second opinion from another otolaryngologist, and he referred her to an oral and maxillofacial pathologist (C.A.) for evaluation.

Maxillary edentulous patients have been successfully treated with implant-supported fixed and removable dental prostheses. The fixed implant-supported dental prosthesis has been used for >20 years. It has lost popularity because the design of this restoration requires special access for oral hygiene around the abutment cylinders creating an esthetic quandary in the maxilla. The use of the mid-sagital palatal suture to osseointegrate anchorage devices for orthodontic purposes has shown satisfactory results. This clinical case documents the successful use of mid-palatal implants as an extension of orthodontic anchorage to gain accessory support and retention for a maxillary complete removable dental prosthesis.

Patients with nonrestorable or missing anterior teeth are typically seen by their general or pediatric dentist who directs the course of consultation, referral, and treatment. In the mixed dentition stage, loss of permanent maxillary incisors is usually treated by various forms of removable/fixed prosthetic appliances. Because premolars are developing during this time period, transplantation of an available premolar to an incisor position is a viable alternative, that may provide a better biological substitute for a missing incisor than other choices. The purpose of this case report was to describe the treatment of the loss of a permanent maxillary central incisor by transplantation of a maxillary first premolar to the incisor position. Autotransplantation allowed normal alveolar bone development and a future option of permanent restoration without implants or partial dentures. Autotransplantation should be given consideration as a reasonable option for the treatment of missing incisors in mixed dentition.

The number of obese patients in the general population has increased dramatically over the past 20 years. This increase has highlighted concerns in treating these patients surgically in the office setting due to the increased likelihood of concomitant co-morbid conditions. With more and more surgical procedures being performed on an outpatient basis using deep sedation and general anesthesia techniques, it is critical for the oral and maxillofacial surgeon to be familiar with the physical condition of the surgical candidate. Thorough review of the patient’s health history and obtaining appropriate consultations can minimize associated risks and potential complications. Considerations concerning airway management and pharmacological issues need to be determined prior to the procedure to ensure both patient safety and operator efficiency. The oral and maxillofacial surgeon will increasingly be called upon to treat the obese patient. By reviewing the complexities of the obese patient from a physiological and pharmacological standpoint, considerations involved in the surgical and anesthetic management of these patients can be appreciated. Initiating appropriate protocols for the surgical and anesthetic management of these patients can improve patient outcome and safety.

Genetic disorders of bone constitute a large number of alterations approaching almost 300 types. This article focuses on the most common disorders in this group, which at the same time are the most clinically significant because of their incidence and degree of involvement of the craniofacial skeleton.

Purpose: The goal was to measure heat generated in bone by 3 implant drill systems after repeated drilling and sterilization.Materials and Methods: Temperature was measured with thermocouple technology in vitro using the bovine femoral cortical bone model. Intermittent drilling was accomplished at a constant 2.4-kg load and drill speed of 2,500 rpm. External irrigation at 40 mL/min with normal saline was used. Three implant drill systems-system A (triple twist drills with a relief angle), system B (triple twist drills without a relief angle), and system C (double twist drills with a relief angle)-were evaluated and heat was measured at the final drill in the drilling sequence (4.0 turn or 4.2 mm) at a depth of 15 mm. Thermocouples were placed 0.5 mm from the osteotomy at a depth of 15 ram. Heat measurements were recorded out to 25 uses.Results: Results showed temperature increased with multiple uses. System A and C drills had temperature measurements that were below 47 degrees C, even after 25 uses. System B drills had temperatures that exceeded 47 degrees C from the initial use. Light microscopy showed little drill wear even after 25 uses.Conclusions: Drill geometry plays a major role in heat production and may explain the increased temperature readings seen in System B. These drills lack relief angles and have the smallest clearance angles of the 3 systems. It also has fewer drills in its drilling sequence compared with systems A and C. This study shows that temperatures increase when drills are used multiple times. Systems A and C had acceptable temperature measurements out to 25 uses. System B drills showed significantly higher heat production with little visual signs of wear, (c) 2006 American Association of Oral and Maxillofacial Surgeons.

Purpose: Alendronate sodium (Fosamax; Merck, Whitehouse Station, NJ) is a second-generation bisphosphonate used widely in osteopenic individuals for decreasing bone resorption and increasing bone density. The ability of alendronate to affect systemic bone remodeling raises natural questions about the drug's influence on dental implant osseointegration. Current knowledge regarding the effect of systemic bisphosphonates, specifically alendronate, on all 3 phrases of osseointegration is incomplete and only a few studies have started to investigate peri-implant bone responses to alendronate-coated implants. The purpose of this study was to determine the effect of systemic alendronate therapy on osseointegration of dental implants based on torque-removal values in rabbits.Materials and Methods: Identical titanium dental implants were placed using a standardized surgical protocol in the bilateral distal femur and proximal tibia of 20 New Zealand white rabbits (79 implants total). One week before implant placement, 10 rabbits were given doses of alendronate and continued on weekly dosing for 5 weeks until euthanized. The other 10 rabbits were untreated controls. Torque-removal values were determined using a Tohinichi 15-BTG torque wrench (Tohinichi Mfg Co, Ltd, Tokyo, Japan) for all implants.Results: Analysis of torque data showed no statistical differences between the atendronate and control groups in both femur and tibia sites. A statistically significant difference, however, was noted in torque removal values between femur and tibia sites regardless of drug or non-drug groups.Conclusions: In summary, orally dosed alendronate administration in rabbits had no significant effect on dental implant torque-removal values 6 weeks after endosseous placement in femur and tibia. (C) 2006 American Association of Oral and Maxillofacial Surgeons.

Bleeding at the time of surgery has the potential to become a serious complication. Careful patient assessment and review of history are of the utmost importance if this situation is to be avoided on the operating table. Unfortunately, many patients, particularly younger individuals with little to no previous exposure to surgery, are unaware of underlying bleeding disorders that they may have. Understanding the basic pathophysiology and management of these conditions becomes critical for the treating surgeon. For patients who have known conditions, close interconsultation with the treating hematologists and careful observation of preoperative, intraoperative, and postoperative established protocols reduces the risk of complications for patients and makes the possibility of success a reality for these individuals.

OBJECTIVE:To develop a cephalometric determination of anteroposterior skeletal occlusion on the basis of a clinically rational "gold standard" and objectively determined cut points.MATERIALS AND METHODS:Pretreatment cephalograms from 10- to 18-year-old Caucasian patients with a normal vertical face dimension were digitized. Facial profile line drawings were judged by orthodontist raters as Class I, II, or III. Subjects who met all inclusion criteria were divided into Class I, Class II, and Class III on the basis of the matched skeletal (facial) and dental occlusion and comprised our gold standard for anteroposterior skeletal occlusions. Cephalometric variables included ANB angle, McNamara analysis, Harvold unit differential, anteroposterior dysplasia index (APDI), and Wits analysis. Half the sample was used to derive skeletal classification norms using receiver operator characteristic (ROC) curves, and half the sample was used to test for diagnostic ability and to compare the diagnoses based on traditional cephalometric norms with the new norms.RESULTS:Results of the study showed that ANB and McNamara analysis performed well with traditional and ROC-derived norms, whereas Wits, Harvold unit differential, and APDI showed fewer errors in diagnosis with ROC norms compared with traditional norms.CONCLUSIONS:The use of a single set of diagnostic norms for each analysis to distinguish between the skeletal classifications for the 10- to 18-year-age group proved to be highly successful for each of the analyses and performed as well or better than when using traditional norms based on age and sex.

Purpose: The purpose of this study is to test bioresorbable screws as an alternative to titanium screw graft fixation. When cortical onlay grafts are used, it is necessary to rigidly immobilize them with titanium screws into the recipient site. The screws must be removed before placing implants into this site. Bioresorbable screws may be an alternative to titanium fixation, eliminating the additional morbidity associated with this.Materials and Methods: Fifteen New Zealand White rabbits were divided into 3 groups. Bilateral tibial onlay bone grafts were placed in the mandible and secured using titanium fixation, bioresorbable fixation, or no fixation. After 6 weeks, all grafted sites were harvested. Hematoxylin-eosin and Giemsa staining were performed to evaluate inflammation, graft integration, and thickness.Results: The treatment groups showed evidence of consolidation under light microscopy. Smooth integration of the graft borders with the recipient bone was identified. No integration was seen in the control group. The average thickness of the grafted sites was: 1) bioresorbable, 2.28 mm; 2) titanium, 1.87 mm; and 3) control, 1.06 mm. The differences were statistically significant (P =.0004) between the titanium group and the control group, as well as between the bioresorbable and the control group (P.01). There was no statistically significant difference between the 2 treatment groups (P =.19).Conclusion. The overall thickness of the treatment specimens was greater than that of the control group. The bioresorbable group showed graft integration equal to that of the titanium group, making it an adequate alternative for graft fixation. (C) 2004 American Association of Oral and Maxillofacial Surgeons.

a m s t o m t o p besity is a condition in which excess body fat may ut a person at health risk.1 It is the most prevalent utrition-related disorder in the United States. Dened as total body weight 20% above the ideal body eight, obesity affects approximately 55% of the US opulation.2 It is a condition with a poorly established pecific etiology, due to the multifactorial nature of he disorder. Various components have been impliated in obesity, including genetic, metabolic, biohemical, cultural, and psychosocial factors. An inrease in age corresponds to an increased prevalence f obesity. Race also plays a role. For instance, 60% of lack women older than 45 years have obesity. Reults of the 1998 National Institutes of Health Obesity eport (NHANES III) show that Mexican American ales and females and women of low socioeconomic tatus more commonly have a higher-than-average inidence of obesity.3 It is clear, however, that a comination of poor dietary habits and lack of physical ctivity leads to excessive weight accumulation and etention. Males tend to accumulate the overabunance of adipose tissue initially around the abdomen, hereas women tend to demonstrate the excess round the hips and thighs, with progressive widepread deposition seen in both males and females as eight gain progresses.

Most major oral surgery procedures, such as orthognathic surgery, require the use of general anesthetic to achieve adequate patient comfort as well as manageable operating conditions for the surgeon. Recently, the increasing demand for ambulatory orthognathic surgery has been fueled by the changes in medical insurance coverage and the desire to avoid the cost of overnight hospital stay. This retrospective study is designed to evaluate the safety and efficacy of the clinic-based orthognathic surgery cases performed at the Ohio State University during the past twelve years and to explore the possibility of performing predictable outpatient orthog- nathic surgery with same-day discharge of the patient. Ambulatory orthognathic procedures including 23 bilateral sagittal split osteotomies (BSSO) and 17 LeFort I osteotomies from July 1993 to July 2005 were reviewed. Data consisting of age, sex, proce- dure, operative time, anesthesia time, amount of fluids administered, estimated blood loss, duration of time from extubation to dis- charge, total duration of stay in the clinic, and complications were collected and evaluated. The efficacy and safety of these outpa- tient surgeries were then assessed. Of the forty orthognathic procedures evaluated, none showed complications which resulted in overnight hospital admission. All patients were discharged on the day of surgery. Therefore, ambulatory orthognathic surgery is a safe and effective way to render treatment when the proper patient selection criteria are met. This method of treatment provides con- siderable cost reduction and convenience for the patients.