SBP (mmHg)
DBP (mmHg)
PR (bpm)
RPP (bpm × mmHg)
Normotensive patients (N = 410)
On arrival at the office
133.0 ± 18.4
76.4 ± 12.5
79.2 ± 13...
SBP (>160 mmHg)
RPP (>12,000 bpm × mmHg)
Normotensive group (N = 410)
On arrival at the office
41 (10.0%)
111 (27.1%)
Prior to sedation
...
Normotensive group
Hypertensive group
p
value
Number (male: female)
410 (127: 283)
106 (37: 69)
0.170
Age (year mean ± SD)
...
Kimura, M., Takasugi, Y., Hanano, S. et al. Efficacy of intravenous sedation and oral nifedipine in dental implant patients with preoperative hypertension - a retrospective study of 516 cases. Int J Implant Dent 1, 6 (2015). https://doi.org/10.1186/s40729-015-0004-4
Download citation
Received: 08 October 2014
Accepted: 14 January 2015
Published: 18 March 2015
DOI: https://doi.org/10.1186/s407...
Motoshi Kimura, Yoshihiro Takasugi, Shigeyoshi Hanano, Katsuyuki Terabe and Yuko Kimura declare that they have no competing interests.
YT and MK designed the study; MK, SH, and KT performed the surgeries; YT performed the intravenous sedation. YT, MK, and YK collected and analyzed the data; MK wrote the manuscript. YT revised the manuscript. All authors read and approved the final manuscript.
Hanano Dental Clinic, 4-2-3 Yamanoue, Hirakata, Osaka, 573-0047, Japan
Motoshi Kimura & Shigeyoshi Hanano
Department of Anesthesiology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
Yoshihiro Takasugi
Terabe Dental Clinic, 4-249 Sakae-cho, Tsu, Mie, 514-0004, Japan
Katsuyuki Terabe
First Department of Internal Medicine, Osaka Medical College...
Abraham-Inpijn L, Borgmeijer-Hoelen A, Gortzak RAT. Changes in blood pressure, heart rate, and electrocardiogram during dental treatment with use of local anesthesia. J Am Dent Assoc. 1988;116:531–6.
Brand HS, Gortzak RA, Palmer-Bouva CC, Abraham RE, Abraham-Inpijn L. Cardiovascular and neuroendocrine responses during acute stress induced by different types of dental treatment. Int Dent J. 1995...
Little JW. The impact on dentistry of recent advances in the management of hypertension. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90:591–9.
Aubertin MA. The hypertensive patient in dental practice: updated recommendations for classification, prevention, monitoring, and dental management. Gen Dent. 2004;52:544–52.
Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet. 2000;356...
Systolic blood pressure
Diastolic blood pressure
Pulse rate
Rate pressure product
Electrocardiogram
Percutaneous oxygen saturation
Analysis of variance
Immediate-release
In this study, we showed that the stable hemodynamic was obtained by performing intravenous sedation and oral administration of nifedipine for patients with hypertension. It is important not only to understand the systemic management of the patient but also to obtain stabled hemodynamic by performing intravenous sedation and oral administration of nifedipine for patients with hypertension in order...
Implant surgery is performed in patients with a wide age range, including elderly patients with hypertension. Dentists or oral surgeons often encounter hypertensive patients who are undiagnosed or noncompliant. Among Japanese over the age of 30, 60% of men and 44.6% of women suffer from high blood pressure, and 33.8% of men and 25.6% of women with a history of hypertension have not been managed me...
For patients with stage 2 hypertension before operation, it is difficult to maintain the recommended blood pressure during surgery using only intravenous sedation, and it is necessary to decrease blood pressure by antihypertensive drugs. In this study, the blood pressure of patients with sustained hypertension was reduced to stage I hypertension about 30 min after administration of oral nifedipin...
In 44 (8.5%) of the 516 implant surgery cases, oral nifedipine had to be administered, since preoperative SBP was higher than 160 mmHg in these patients. Within 30 min of administration of nifedipine, SBP of hypertensive patients decreased to a similar range as that of hypertensive patients who did not need administration of oral nifedipine. Intravenous sedation after nifedipine administration t...
In patients with oral nifedipine in the hypertensive group, the PR value slightly increased prior to initiation of intravenous sedation (p = 0.224) and then significantly decreased until completion of the operation (p 160 mmHg during and at completion of operation showed maximum SBP of 180 mmHg in the normotensive group, 190 mmHg on the hypertensive group without preoperative oral nifedip...
Patient demographics and clinical characteristics are summarized in Table 1. There were significant differences in age (p
This study protocol was approved by the ethics committee of Japanese Dental Society of Anesthesiology (No. 2015–4).
Following confirmation of a sufficient anesthetic effect, intravenous sedation with continuous infusion of propofol 1 to 2 mg/kg/h and midazolam 20 to 40 μg/kg bolus together with inhalation of oxygen 3 L/min via nasal cannula was initiated. After confirming Verrill sign, implant surgery was initiated. During operation, the propofol dose was adjusted to maintain the optimum conscious sedative ...
A retrospective review of the clinical records was conducted for 336 patients who received dental implant-related surgeries combined with intravenous sedation between January 2008 and February 2012 at our outpatient dental offices. Among the patients, 125 patients received multiple surgeries during the observation period: 4 patients underwent surgery five times, 7 patients four times, 29 patients ...
Osseointegrated dental implants were introduced in Japan in 1983, and the procedures are now performed very frequently. Dental implants are placed in a wide age range of patients, including elderly patients with hypertension. Patients with very high blood pressure are at great risk for acute medical problems when undergoing stressful dental procedures, such as oral surgery, periodontal surgery, an...
To examine the effects of intravenous sedation and oral nifedipine on blood pressure and pulse rate in patients with perioperative high blood pressure undergoing implant surgery, the clinical records of dental implant patients managed by intravenous sedation at our outpatient dental offices were retrospectively evaluated.
A total of 516 clinical charts were evaluated. The subjects were divided in...
Fig. 1. Treatment strategies for OAF closure
Fig. 1. Treatment strategies for OAF closure
Author year
No. of participants
Method
Autogenous soft tissue flaps
Lin et al. 1991
16
...
Parvini, P., Obreja, K., Sader, R. et al. Surgical options in oroantral fistula management: a narrative review.
Int J Implant Dent 4, 40 (2018). https://doi.org/10.1186/s40729-018-0152-4
Download citation
Received: 14 August 2018
Accepted: 02 November 2018
Published: 27 December 2018
DOI: https://doi.org/10.1186/s40729-018-0152-4
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Not applicable.
Not applicable.
Puria Parvini, Karina Obreja, Robert Sader, Jürgen Becker, Frank Schwarz, and Loutfi Salti declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Correspondence to
Karina Obreja.
Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University, Frankfurt, Germany
Puria Parvini, Karina Obreja, Frank Schwarz & Loutfi Salti
Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
Robert Sader
Department of Oral Surgery, Universitätsklinikum Düsseldorf,...
Not applicable
No funding to declare.
All data generated or analyzed during this study are included in this published article.
Waldrop TC, Semba SE. Closure of oroantral communication using guided tissue regeneration and an absorbable gelatin membrane. J Periodontol. 1993;64:1061–6.
Götzfried HF, Kaduk B. Okklusion der Mund-Antrum-Verbindung durch eine: alkoholische Prolaminelösung; Tierexperimentelle Studie und erste klinische Erfahrungen. Dtsch Z Mund Kiefer Gesichts Chir. 1985;9:390.
Grzesiak-Janas G, Janas A. Co...
Shaker MA, Hindy AM, Mounir RM, Geaisa KM. Competent closure of chronic oroantral fistula with Zenoderm. Egypt Dent J. 1995;41:1237–42.
Ogunsalu C. A new surgical management for oro-antral communication: the resorbable guided tissue regeneration membrane—bone substitute sandwich technique. West Indian Med J. 2005;54:261–3.
Goldman EH, Stratigos GT, Arthur AL. Treatment of oroantral fistula...
Joshi A, Kostakis GC. An investigation of post-operative morbidity following iliac crest graft harvesting. Br Dent J. 2004;196:167–71.
Misch CM. Harvesting of ramus bone in conjunction with third molar removal for onlay grafting before placement of dental implants. J Oral Maxillofac Surg. 1999;57:1376–9.
Nkenke E, Radespiel-Tröger M, Wiltfang J, Schultze-Mosgau S, Winkler G, Neukam FW. Morb...
El-Hakim IE, El-Fakharany AM. The use of the pedicled buccal fat pad (BFP) and palatal rotating flaps in closure of oroantral communication and palatal defects. J Laryngol Otol. 1999;113:834–8.
Singh J, Prasad K, Lalitha RM, Ranganath K. Buccal pad of fat and its applications in oral and maxillofacial surgery: a review of published literature (February) 2004 to (July) 2009. Oral Surg Oral Med O...
Awang MN. Closure of oroantral fistula. Int J Oral Maxillofac Surg. 1988;17:110–5.
Hynes W. Fistula in the hard palate following cleft surgery. Br J Plast Surg. 1957:377–84.
Genden EM, Lee BB, Urken ML. The palatal island flap for reconstruction of palatal and retromolar trigone defects revisited. Arch Otolaryngol Head Neck Surg. 2001;127(7):837–41.
Salins PC, Kishore SK. Anteriorly based...
Yilmaz T, Suslu AE, Gursel B. Treatment of oroantral fistula: experience with 27 cases. Am J Otolaryngol. 2003;24:221–3.
Borgonovo AE, Berardinelli FV, Favale M, Maiorana C. Surgical options in oroantral fistula treatment. Open Dent J. 2012;6:94–8.
Güven O. A clinical study on oroantral fistulae. J Craniomaxillofac Surg. 1998;26:267–71.
Amaratunga NADES. Oro-antral fistulae- a study of c...
Buccal fat pad
Bone graft transplantation
Connective tissue grafts
Free mucosal graft
Guided tissue regeneration
Oroantral fistula
Platelet-rich fibrin
By reviewing the literature, we can conclude that in selecting the surgical approach to close an oroantral fistula, different parameters have to be taken into account, including location and size of fistula as well as its relationship to the adjacent teeth, height of the alveolar ridge, persistence, sinus inflammation and the general health of the patient.
A small oroantral fistula of less than 5...
Logan and Coates described a procedure that provided closure of OAF in immunocompromised patients [74].
The oroantral fistula was de-epithelialized under local anesthesia, and the patient wore an acrylic surgical splint continuously for an 8-week period. The acrylic surgical splint covered the fistula and the edentulous area including the hard palate. The investigators reported complete healing o...
Use of guided tissue regeneration has been documented by Waldrop and Semba [71]. This method uses an absorbable gelatin membrane, allogenic bone graft material, and a nonresorbable expanded polytetrafluoroethylene (ePTFE) membrane. After flap reflection, an absorbable gelatin membrane is placed over the OAF with its edges on the bony margins of the perforation, which serve as a barrier for the bon...
The use of a bioabsorbable root analog made of β-tricalcium phosphate for closure of oroantral fistulas was proposed by Thoma et al. [68]. The root replicas were fabricated chair side, using a mold of the extracted tooth [10]. The investigators reported that the healing was uneventful. However, fragmentary roots or overly large defects prevent replica fabrication or accurate fitting of the analog...
Polymethylmethacrylate has been introduced as an alternative technique for closing OAFs [64]. After 24 h of immersion in a sterilizing solution, the polymethylmethacrylate plate is placed over the defect. Mucoperiosteal flaps are then replaced without attempting to cover the acrylic plate. The polymethylmethacrylate plate is removed as soon as the edges become exposed. One of the common disadvant...
Various synthetic materials have been used for OAF closures. Use of gold foil and gold plate for the closure of OAFs was reported for the first time by Goldman and Salman, respectively [59, 60]. It is a simplified technique for the closure of oroantral fistulas. The technique consists of elevating the mucoperiosteum to expose the bony margins of the fistula. Then, the opening is covered with an ov...
Multiple techniques have been described for the closure of OAFs using lyophilized fibrin glue of human origin [53]. In this technique, the fibrin glue is prepared and injected into the socket, together with the collagen sheet. Stajčić et al. stressed the importance of inserting the syringe above the floor of the antrum to protect the clot from airflow [53]. The technique is simple with few posto...
An autogenous bone graft and platelet-rich fibrin (PRF) membrane as a treatment strategy for closure of OAF has also been proposed [50]. PRF is a product of centrifuged blood. The biochemical components of PRF are well-known as factors acting synergistically in the healing process. This includes platelet-derived growth factor (PDGF), whose components are the reason why PRF has anti-inflammatory pr...
Recently, auricular cartilage graft has been used for the closure of OAFs. A full-thickness flap is raised at the defect site [47]. A semicircular incision is then made posteriorly over the conchal cartilage. The conchal cartilage with overlying perichondrium is exposed with a blunt dissection. The harvested auricular graft is then adapted on the defect site and sutured with the surrounding tissue...
A retromolar bone graft is a viable procedure for OAF closure. However, harvesting of a retromolar bone can occasionally be combined with removal of the third molar, which may affect acceptance of the procedure by patients [44]. When compared to chin bone grafts, the significant disadvantage of the retromolar donor area is the confined amount of bone available [45]. The incision is made medial to ...
The tongue is an excellent donor site for soft tissue defects of the oral cavity, due to its pliability, position, and abundant vascularity. Tongue flaps can be created from the ventral, dorsal, or lateral part of the tongue [36]. The surgical design of the flap is dictated by the location of the defect. A lateral tongue flap has been described as a suitable method for the closure of large OAF [37...
Free mucosal grafts (FMG) or connective tissue grafts (CTG) are suitable for the closure of small to moderate size defects in the premolar area as well as small to medium size-persistent defects. In contrast to the techniques described so far, the harvested grafts are not directly vascularized. The flap initially receives its nutrients within the first three postoperative days by diffusion alone, ...
The palatal straight advancement flap is of limited use due to the inelastic nature of the palatal tissue, which reduces its lateral mobility. For the same reason, it is suitable for the closure of minor palatal or alveolar defects [17].
The palatal hinged flap has been used successfully to close small fistula of the hard palate, i.e., those less than 2 cm in diameter in a one-stage operation [1...
Môczáir [14] described closing alveolar fistulas by the buccal sliding flap, shifting the flap one tooth distally. This technique produces only a negligible change in the depth of the buccal vestibule. A drawback of this approach is that it requires a large amount of dentogingival detachment in order to facilitate the shift, which may result in gingival recession and periodontal disease.
The fi...
A narrative literature review of articles and case reports for oroantral fistula has been conducted in the PubMed databases of published English literature. Articles published until April 2018 were reviewed. In addition to 262 articles on the closure of oroantral, 4 articles on the closure of antrooral fistula in humans, and 5 articles in animals, citations were referenced to identify further rele...
Radiologically, in the computed tomography (CT) or cone beam computed tomography (CBCT), the oroantral fistula might show as sinus floor discontinuity, opacification of the sinus, or communication between the oral cavity and the sinus. In addition, focal alveolar atrophy and associated periodontal disease may be observed [6]. In chronic OAF, there is generalized mucosal thickening. Recent studies ...
An oroantral fistula (OAF) can be defined as an epithelialized pathological unnatural communication between the oral cavity and the maxillary sinus [1]. The term oroantral fistula is used to indicate a canal lined by epithelium that may be filled with granulation tissue or polyposis of the sinus membrane [2]. They can arise as late sequelae from perforation and last at least 48–72 h. An oroantr...
Fig. 3. Treatability refers to OPG/CBCT and to residents in oral surgery and orthodontics
Fig. 3. Treatability refers to OPG/CBCT and to residents in oral surgery and orthodontics
Fig. 2. Accuracy of diagnostic answers given by residents in orthodontics (R right, F false, NS not sufficient)
Fig. 2. Accuracy of diagnostic answers given by residents in orthodontics (R right, F false, NS not sufficient)
Fig. 1. Accuracy of diagnostic answers from residents in oral surgery (R right, F false, NS not sufficient)
Fig. 1. Accuracy of diagnostic answers from residents in oral surgery (R right, F false, NS not sufficient)
Variable
p value
Odds ratio (95% CI)
Specialisation: oral surgery vs orthodontics
4 year
0.045*
...
Question pertaining to
OPG (%)
CBCT (%)
p value
Odds ratio (95% CI)
Contact to nerve
...
Question pertaining to
OS (%)
ORTH (%)
p value
Odds ratio (95% CI)
Contact to nerve
...
Case
Age (years)
Sex
Pathology
Time between OPG and CBCT
1
...
Resident
Age (years)
Sex
Specialisation
Experience as a dentist (years)
1
...
Radic, J., Patcas, R., Stadlinger, B. et al. Do we need CBCTs for sufficient diagnostics?-dentist-related factors.
Int J Implant Dent 4, 37 (2018). https://doi.org/10.1186/s40729-018-0147-1
Download citation
Received: 06 July 2018
Accepted: 08 October 2018
Published: 16 November 2018
DOI: https://doi.org/10.1186/s40729-018-0147-1
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
The study was approved by the cantonal ethics committee of the canton of Zurich (KEK 2016-00070).
Not applicable
Josipa Radic, Raphael Patcas, Bernd Stadlinger, Daniel Wiedemeier, Martin Rücker and Barbara Giacomelli-Hiestand declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Correspondence to
Barbara Giacomelli-Hiestand.
Clinic of Cranio-Maxillofacial and Oral Surgery, Centre of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
Josipa Radic, Bernd Stadlinger, Martin Rücker & Barbara Giacomelli-Hiestand
Clinic for Orthodontics and Paediatric Dentistry, Centre of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
Raphael Patcas
Statistical S...
Ren H, Chen J, Deng F, Zheng L, Liu X, Dong Y. Comparison of cone-beam computed tomography and periapical radiography for detecting simulated apical root resorption. Angle Orthod. 2013;83(2):189–95. https://doi.org/10.2319/050512-372.1 published Online First: Epub Date]|.
Tantanapornkul W, Okouchi K, Fujiwara Y, Yamashiro M, Maruoka Y, Ohbayashi N, et al. A comparative study of cone-beam comput...
Hasani A, Ahmadi Moshtaghin F, Roohi P, Rakhshan V. Diagnostic value of cone beam computed tomography and panoramic radiography in predicting mandibular nerve exposure during third molar surgery. Int J Oral Maxillofac Surg. 2017;46(2):230–5. https://doi.org/10.1016/j.ijom.2016.10.003 published Online First: Epub Date]|.
Alqerban A, Jacobs R, Fieuws S, Willems G. Comparison of two cone beam comp...
Mason C, Papadakou P, Roberts GJ. The radiographic localization of impacted maxillary canines: a comparison of methods. Eur J Orthod. 2001;23(1):25–34.
Maverna R, Gracco A. Different diagnostic tools for the localization of impacted maxillary canines: clinical considerations. Prog Orthod. 2007;8(1):28–44.
Neves FS, Passos CP, Oliveira-Santos C, Cangussu MC, Campos PS, Nascimento RJ, et al. C...
Three-dimensional
Cone beam computed tomography
Digital Imaging and Communications in Medicine
Orthopantomography
Odds ratio
Resident in orthodontics
Resident in oral surgery
This study analysed (i) whether pathologies are accurately diagnosed in three different imaging modalities (OPG, CBCT, 3D model). Diagnostic accuracy was decent with OPG and was improved with CBCT. Next, the study assessed (ii) whether each case was classified as treatable on the basis of the present imaging modality. This result was influenced by the professional background, which influenced whet...
Certain limitations affect the generalizability of this study’s results. First, only nine cases were assessed with a limited range of pathologies (five retained teeth (canines and molars), two tooth resorptions, one odontoma and one supernumerary tooth). Moreover, the assessment was performed by a small amount of residents of the local university. The fact that all residents shared a similar aca...
In 81.6% of the cases, further imaging was requested after the OPG. Caution should be applied in the interpretation of this number, as the residents’ decision was theoretical and did not imply additional costs or radiation exposure. Nevertheless, it is striking that in the majority of the cases, further imaging was requested. One possible explanation might be the diagnostic difficulty of the cho...
Moreover, another valuable and novel observation is the divergence seen in the importance of printed 3D models. For residents in oral surgery, printed 3D models caused more uncertainties and led to a decrease of diagnostic accuracy (if assessed in sequential order after OPG and CBCT). In contrast, residents in orthodontics seemed to benefit of an additional assessment of printed 3D models, which r...
The aim of this study was twofold: (i) to analyse the diagnostic accuracy of pathologies in three different imaging modalities of the same case and (ii) to analyse the need for further imaging in order to enable treatment. Further, aspects like the impact of specialisation, gender and dental experience were analysed. In contrast to the plethora of scientific literature available dealing with CBCT ...
Overall, the majority of the questions were answered correctly, independently to the imaging modality. The percentages of correct answers given by OS were 66.3% for OPG, 83.4% for CBCT and 76.4% for 3D model; and differed slightly to those given by ORTH with 63.7% for OPG, 78.0% for CBCT and 78.7% for 3D model (Figs. 1 and 2). Both OS and ORTH alike answered to around 20% of the questions that th...
Statistical analysis and plots were performed using the statistical software R [12]. To evaluate the differences in the proportions of correct diagnostic answers between OS and ORTH and between different imaging modalities, Fisher’s exact tests were used and odds ratios (OR) including confidence intervals (CI) were computed for every question separately. Likewise, Fisher’s exact tests were app...
Each resident was shown the region of interest to which the questions related to
Allowed setup change of OPG: zoom
Allowed setup change of CBCT: brightness, contrast, zoom, scroll in all three levels (coronal, axial and sagittal
3D model: no restrictions
The OPGs of this study were taken either in-house (CRANEX D, Kw73, 10 mA) or extramural. All CBCTs were taken at the Centre of Dental Medici...
Fourteen residents were recruited for this survey [7 residents in oral surgery (OS) and 7 residents in orthodontics (ORTH), respectively; m = 6, f = 8]. Their characteristics are listed in Table 1. Every resident assessed individually nine separate patient cases, each containing a distinct dentoalveolar pathology, as defined in the study planning process (Table 2).
For each patient case...
Finally, the request for a CBCT should always be guided by the pursuit of improved diagnostic accuracy and the prospect of an enhanced treatment plan. Preferably, the indications for a CBCT should be based entirely on case-related factors. Yet, dentist-related factors might influence the request for a CBCT as well.
The aim of this study was therefore (i) to assess whether pathologies are accurate...
Along with the clinical examination, radiological imaging is essential for a complete diagnosis in dental medicine [1, 2]. Orthopantomography (OPG), a two-dimensional panoramic radiograph, is widely used across all dental disciplines including oral surgery and orthodontics [3,4,5] to address basic diagnostic queries. An OPG contains an abundance of information on the teeth, mandible, maxilla, incl...
The aim of this study was to assess the diagnostic accuracy of various dentoalveolar pathologies based on panoramic radiography (OPG), cone beam computed tomography (CBCT) and printed 3D models in consecutive order; and to evaluate the impact of specialisation of residents in oral surgery (OS) versus residents in orthodontics (ORTH).
Fourteen residents were recruited to evaluate nine selected cas...