Comparative analysis of an innovative app versus conventional techniques to improve patient compliance after minor oral surgical procedures (Preprint)

BACKGROUND Certain factors such as compliance, comprehension, retention of instructions, and other unaccounted elements impact the objectives of post-operative care. It is imperative that patients follow the instructions and prescribed regimen diligently for a smooth and placid healing. Keeping the same principles in view, ExoDont was designed by our team, an android-based mHealth app which ensures a smooth post-operative period for the patients after a dental extraction. Besides providing post-operative instructions at defined intervals, the app also sends out drug reminders as an added advantage over other available conventional modes. OBJECTIVE To compare the compliance rate of individuals with respect to the prescribed regimen, postoperative instructions, and additionally, assess any significant changes in post-operative complications rate under the three categories namely Verbal, Verbal plus Written, and ExoDont group. METHODS The patients after tooth extraction were randomly assigned to the aforementioned groups and a one week follow-up through a phone call was planned to obtain the responses from study participants. The result obtained from the three groups was then statistically analyzed. RESULTS The compliance rate in patients for post-operative instructions and prescribed drug adherence was statistically significant in the group using ExoDont app than in Verbal or Verbal plus Written group. However, the difference in the incidence of postoperative complication rate was not significant among the three groups. CONCLUSIONS As evident from the result, it is anticipated that the ExoDont app will be revolutionary in not only circumventing the unaccounted possibilities of missing the prescribed dose and post-operative instructions but also ensure a smooth post-operative phase and easy recovery for the patients.

Conduta Clínica Frente a Comunicação Oro-Antral: Uma Revisão de Literatura / Clinical Conduct Facing Oroantral Communication: A Literature Review

Resumo: Inúmeras complicações podem ocorrer durante procedimentos cirúrgicos odontológicos, sendo a comunicação oro-antral uma das mais abordadas na literatura. Esta condição é resultante, principalmente, em exodontias de elementos dentários superiores posteriores, visto sua proximidade com o seio maxilar. O seu diagnóstico é feito basicamente por meio da manobra de Valsalva e análise do fragmento, contudo exames complementares podem evidenciar essa condição. A literatura considera, também, que a conduta de tratamento pode ser bastante diversificada. Objetivo: Apresentar por meio de uma revisão narrativa da literatura, as possibilidades técnicas de condutas clínicas para casos de comunicação oro-antral. Metodologia: A pesquisa bibliográfica foi online, com inclusão de artigos em português, inglês e espanhol, publicados nos últimos 10 anos, exceto àqueles fundamentais a respeito do tema, com tempo maior de publicação. Foram excluídos, também, cartas ao editor e editoriais. Foi, então, confeccionada uma análise descritiva dos artigos e os dados foram organizados de forma a subsidiar os profissionais da odontologia a intervir de forma segura diante desta complicação. Considerações finais: A comunicação oro-antral é uma realidade que pode ocorrer no consultório odontológico. Suas consequências são bastante variadas, cabendo ao Cirurgião-Dentista, além de evitar e diagnosticar, saber intervir quando necessário de forma eficaz. Haja vista que suas complicações podem limitar a qualidade de vida do paciente. Palavras-chave: Seio maxilar; Cirurgia bucal; Procedimentos Cirúrgicos Bucais. Abstract: Numerous complications can occur during dental surgical procedures, and oroantral communication is one of the most discussed in literature. That condition results mainly from extractions of posterior superior dental elements, given its proximity to the maxillary sinus. Its diagnosis is basically made through the Valsalva maneuver and analysis of fragment, however complementary exams can demonstrate that condition. The literature also considers the treatment approach can be quite diversified. Objective: Topresent, through a narrative review of literature, technical possibilities of clinical approaches for cases of oroantral communication. Methodology: The bibliographic research was online, including articles in Portuguese, English and Spanish, published in the last 10 years, except for those fundamental on the topic, with longer publication time. Letters to editor and editorials were also excluded. A descriptive analysis of articles was then carried out and the data were organized in order to support dentistry professionals to intervene safely in face of that complication. Final Considerations: Oroantral communication is a reality that can occur in the dental office. Its consequences are quite varied, and it is up to the dental surgeon, in addition to avoiding and diagnosing, to know how to intervene effectively when necessary, given that its complications may limit the patient's quality of life. Keywords: Maxillary sinus; Oral surgery; Oral Surgical Procedures.

Efficacy of Anaesthesia Techniques in Periapical Diseased Tooth

Almost all minor oral surgical procedures can be performed effectively if patient is relaxed and comfortable. One of the contributing factor for patient comfort is effective pain control. This can be achieved pre and per-operatively by various local anaesthetic techniques. Infiltration techniques are commonly employed in all maxillary and mandibular teeth whereas mandibular posterior teeth requires a nerve block. In certain cases, these techniques fails or provide inadequate anaesthesia, for example, teeth associated with periapical pathology. Therefore, we conducted a study to determine effectiveness of infiltration and block techniques as well as when supplemented by intra-ligament injection for anaesthesia in periapical infected teeth. Keywords: anaesthesia, infiltration technique, block technique, intraligamental technique, periapical pathology.

Antibiotics to Prevent Surgical Site Infection (SSI) in Oral Surgery: Survey among Italian Dentists

The benefit of an antibiotic prophylaxis for most oral surgical procedures is controversial. The aim of this study was to collect information on the prescribing habits of a sample of Italian dentists with respect to the role of antibiotic prophylaxis in preventing surgical site infections (SSI). An anonymous questionnaire was prepared and made accessible online by sharing a Google Forms link. General anagraphic data and educational background information were collected to obtain a profile of the participants. Different clinical scenarios were then proposed, with the participants asked to choose whether they would prescribe an antibiotic prophylaxis and with which dosage regimens. In total, 169 dentists participated in the questionnaire and the obtained data were assessed through a percentage report. The results showed a substantial agreement in antibiotics prescription, but only in a limited number of clinical scenarios, such as deciduous teeth extraction or simple extractions in healthy adult patients. Discordant responses were found for several clinical cases, particularly for cases of comorbidities, surgical or multiple extractions, implant placement and abscess drainage. The answers obtained from the survey sample were notably heterogeneous, indicating that the choice to prescribe an antibiotic prophylaxis to prevent SSIs is often discretionary. Moreover, the dosage regimen of prophylaxis is also controversial. The results of this study demonstrate the need for specific guidelines on antibiotics in dentistry and, specifically, on antibiotic prophylaxis in oral surgery. Such guidelines would help to avoid unnecessary prescriptions.

Three dimensional technique of imaging in orthodontics: A review

The process of deploying the two dimensional data in to the three dimensional format is three dimensional imaging. Now a days three dimensional imaging is developing as an emerging factor in the field of dentistry. Three dimensional imaging is useful in the field of orthodontics, to view the anatomy along with the morphology of the bone for desired tooth movement, it is useful in the field of prosthodontics to check or verify the bone morphology, exact height and width of the bone for the process placing implant, three dimensional imaging is quite useful in the field of endodontics along with oral surgery to view the anatomy of the root curvature, to confirm the presence of accessory canals to confirm the bony architectural defect in oral surgical procedures. So in present days three dimensional imaging plays an important role in diagnosis as well as treatment planning in the field of dentistry.

Interaction between Different Implant Surfaces and Liquid Fibrinogen: A Pilot In Vitro Experiment

Background. Platelet concentrates like leucocyte- and platelet-rich fibrin (L-PRF) have been widely evaluated in different oral surgical procedures to promote the healing process. However, liquid L-PRF products such as liquid fibrinogen have been poorly explored, especially in the biomimetic functionalization of dental implants. The aim of this in vitro study is to evaluate the interaction between 5 different dental implant surfaces and liquid fibrinogen. Methods. Five commercially available dental implants with different surfaces (Osseospeed™, TiUnite™, SLActive®, Ossean®, and Plenum®) were immersed for 60 minutes in liquid fibrinogen obtained from healthy donors. After this period, the implants were removed and fixed for scanning electron microscopy (SEM). Results. All dental implants were covered by a fibrin mesh. However, noticeable noncontact areas were observed for the Osseospeed™, TiUnite™, and SLActive® surfaces. On the other hand, Ossean® and Plenum® surfaces showed a dense and uniform layer of fibrin covering almost the entire implant surface. The Osseospeed™, TiUnite™, and SLActive® surfaces presented with lower blood cell numbers inside the fibrin mesh compared with the others. Moreover, at higher magnification, thicker fibrin fibers were observed in contact with Ossean® and Plenum® surfaces. The Plenum ®surface showed the thickest fibers which also inserted and interconnect to the microroughness. Conclusion. The initial contact between an implant surface and the fibrin network differs significantly among different implant brands. Further studies are necessary to explore the clinical impact of these observations in the osseointegration process of dental implants.

Gloves Perforations in Minor Oral Surgical Procedures: A Comparison of Latex and Nitrile Gloves

OBJECTIVE: This study was performed to compare incidence of perforations in Latex and Nitrile examination gloves during Minor Oral surgical procedures performed under local anesthesia. METHODOLOGY: 100 pairs of latex and 100 pairs of Nitrile examination gloves where used to perform 200 minor oral surgical procedures under local anesthesia. After completion of every minor oral surgical procedure each gloves was examined by Water Inflation method to observe presence or absence of Perforations. A data sheet was used to collect data including type of Gloves used (Latex or Nitrile) presence of perforations, sites of perforations and nature of minor oral surgical procedures. Data was entered and analyzed using SPSS version 20. Descriptive analysis was conducted to calculate frequency and percentages of Number and sites of perforations for both Nitrile and latex examination gloves. Chi Square test was used to find out statistical significance of difference of perforations rate between Nitrile and Latex gloves. P value of < 0.05 was considered significant. RESULTS: Out of 200 latex gloves 23 (11.5) had 29 perforations whereas out of total 200 Nitrile gloves 28 (14%) had 22 perforations. Nitrile gloves had a statistically significant higher rate of perforations as compared to Latex gloves. (P value 0.043). For both Nitrile and Latex gloves left non dominant hand had highest frequency of perforations Latex 18 (81.81%) perforations and Nitrile 18(62.06%). Index finger and thumb were most frequent sites of perforations in both Latex and Nitrile gloves. CONCLUSION: Gloves perforations were more common in Nitrile examination gloves however total number of perforations was more in Latex examination gloves.

Dental Pulp Stem Cells on Implant Surface: An In Vitro Study

In the field of biology and medicine, one hears often about stem cells and their potential. The dental implant new surfaces, subjected to specific treatments, perform better and allow for quicker healing times and better clinical performance. The purpose of this study is to evaluate from a biological point of view the interaction and cytotoxicity between stem cells derived from dental pulp (DPSCs) and titanium surfaces. Through the creation of complex cells/implant, this study is aimed at analyzing the cytotoxicity of dental implant surfaces (Myth (Maipek Manufacturer Industrial Care, Naples, Italy)) and the adhesion capacity of cells on them and at considering the essential factors for implant healing such as osteoinduction and vasculogenesis. These parameters are pointed out through histology (3D cell culture), immunofluorescence, proliferation assays, scanning electron microscopy, and PCR investigations. The results of the dental implant surface and its interaction with the DPSCs are encouraging, obtaining results increasing the mineralization of the tissues. The knowledge of this type of interaction, highlighting its chemical and biological features, is certainly also an excellent starting point for the development of even more performing surfaces for having better healing in the oral surgical procedures related to dental implant positioning.

Antiresorptive-Type and Discontinuation-Timing Affect ONJ Burden

Osteonecrosis of the jaws (ONJ), a severe side effect of antiresorptive medications, is characterized by exposed, nonhealing bone in the oral cavity. Treatment options for ONJ range from management of symptomology to surgical resection of the affected area. Antiresorptive discontinuation, often termed a “drug holiday,” has been used for managing ONJ patients. Antiresorptives can be discontinued prior to oral surgical procedures, such as tooth extraction, to prevent ONJ development or in patients with established ONJ to accelerate healing. Here, our objective was to test these clinical scenarios using the potent bisphosphonate, zoledronic acid (ZA), and the denosumab surrogate for rodents, OPG-Fc, in a rat model of ONJ. Animals were pretreated with antiresorptives or saline, after which we induced ONJ using periapical disease and tooth extraction. In our first experimental design, antiresorptives were discontinued 1 wk prior to tooth extraction, and animals were evaluated 4 wk later for clinical, radiographic, and histologic features of ONJ. In the second experiment, ONJ was established and antiresorptives were discontinued for 4 wk. Discontinuation of OPG-Fc, but not ZA, prior to tooth extraction ameliorated subsequent ONJ development. In contrast, discontinuation of either ZA or OPG-Fc in rats with established ONJ did not lead to ONJ resolution. In conclusion, our findings suggest that antiresorptive discontinuation is dependent on both the type of antiresorptive and the timing of discontinuation.