Infiltrated lidocaine 2% with epinephrine 1:80,000 causes more postoperative pain than lidocaine 2% after oral soft tissue surgery.
(1/23)
A controlled, randomized, double-blind, within-patient, crossover study was made with 50 patients (28 women and 22 men) of mean age 47 years (range, 32-69 years) who were subjected to identical bilateral gingivectomies. On one occasion, lidocaine 2% was infiltrated as the local anesthetic. On the other occasion, lidocaine 2% with epinephrine 1:80,000 was given. Postoperative pain intensity was recorded by the patients on a 100-mm visual analogue scale every hour during an 11-hour observation period. The mean pain intensity was numerically higher after lidocaine 2% at 0 hours and 1 hour postoperatively. Then the mean pain intensity after lidocaine 2% was lower than that after lidocaine 2% with epinephrine 1:80,000 throughout the remaining observation period. The difference in pain intensity was statistically significant (P < .05) at 2, 4, 5, 6, and 7 hours after surgery. Mean sum (SEM) pain intensity over the 11-hour observation period was lower (P = .03) after lidocaine 2%, 66.5 (13.4) mm than after lidocaine 2% with epinephrine 1:80,000, 92.6 (15.4) mm. The study shows that high epinephrine concentration (1:80,000) increases the postoperative pain after dental soft tissue surgery with mild pain. (+info)
A dose-response study of adrenaline combined with lignocaine 2%: effect on acute postoperative pain after oral soft tissue surgery.
(2/23)
AIMS: The combination of lignocaine and adrenaline may cause more postoperative pain than other types of local anaesthetic agents with comparable clinical efficacy. This study investigates the dose-response effect of adrenaline added to lignocaine on postoperative pain, when used as local anaesthetic for oral soft tissue surgery. METHODS: A controlled, randomized, double-blind, parallel group study included 195 patients (108 females/87 males) with mean age 49 years (range 26-75 years). The patients were allocated to one of three treatment groups receiving lignocaine 2% (n = 66), lignocaine 2% with adrenaline 1 : 160 000 (n = 63) or lignocaine 2% with adrenaline 1 : 80 000 (n = 66). RESULTS: Lignocaine 2% with adrenaline 1 : 80 000 gave significantly more pain intensity than lignocaine 2% or lignocaine 2% with adrenaline 1 : 160 000. The postoperative pain intensity courses after lignocaine 2% and lignocaine 2% with adrenaline 1 : 160 000 showed a similar pattern except for the time period just after completion of surgery when lignocaine 2% with adrenaline 1 : 80 000 caused less pain. CONCLUSIONS: High adrenaline concentrations (1 : 80 000) combined with lignocaine local anaesthetic solution offers no advantage with respect to pain alleviation during the immediate postoperative pain period. High exogenous adrenaline concentrations may play a significant role in enhancing acute postoperative intensity. (+info)
Treatment and long-term follow-up of a patient with hereditary gingival fibromatosis: a case report.
(3/23)
This report addresses the complex nature of oral diagnosis, treatment and long-term case management in the hereditary form of recurrent gingival fibromatosis. Case management is discussed in relation to a 13-year-old girl who presented with recurrent, progressive gingival enlargement requiring consecutive periodontal and orthodontic treatment. The initial course of treatment included 4-quadrant gingivectomy with reverse bevel incisions, followed by orthodontics. Microscopic examination of the gingivectomy specimens supported the clinical diagnosis. Three years later, recurrence of the condition was observed in all quadrants. To facilitate orthodontic tooth movement and to achieve optimal esthetics, another full-mouth gingivectomy was performed. There was no recurrence of the condition a year later. It is recommended that patients with this condition be monitored closely after gingivectomy, so that the treatment requirements of localized areas can be addressed as needed. (+info)
Gingival prostheses--a review.
(4/23)
Gingival replacement is often a component of comprehensive prosthodontics. Gingival prostheses may be fixed or removable and may be made from acrylics, composite resins, silicones or porcelain-based materials. Undercuts or dental attachments are used to secure removable prostheses, which are esthetically pleasing and easy to maintain. This paper describes several clinical situations in which gingival prostheses were used effectively. (+info)
Idiopathic gingival hyperplasia and orthodontic treatment: a case report.
(5/23)
There are many reasons for gingival hyperplasia. Mostly, proper oral hygiene is sufficient to achieve normal healthy gingiva. In some situations, however, gingival hyperplasia is drug-induced or can be a manifestation of a genetic disorder. In the latter, it may exist as an isolated abnormality or as part of a syndrome. If orthodontic treatment is needed in patients with gingival hyperplasia, both orthodontic and periodontal aspects need to be considered. Extreme hereditary gingival fibromatosis was periodontally treated, by removal of all gingival excess using flaps and gingivectomies. After a follow-up period, the orthodontic treatment started with fixed appliances. Monthly periodontal check-ups (scaling and polishing) were scheduled to control the gingival inflammation. After the orthodontic treatment, permanent retention was applied, once more followed by a complete gingivectomy in both maxilla and mandible. One of the most important keys to successful treatment of hyperplasia patients is the cooperation between the periodontist and the orthodontist. (+info)
Removal of hyperplastic lesions of the oral cavity. A retrospective study of 128 cases.
(6/23)
AIMS: Based on our accumulated experience, the present study evaluates and discusses the indications, advantages and inconveniences of oral cavity epulis resection using the carbon dioxide laser (CO2) versus the Erbium:YAG laser (Er:YAG), diode laser and surgical scalpel. MATERIAL AND METHODS: A retrospective study has been made of 120 patients involving the removal of 128 epulis lesions with the CO2 laser, Er:YAG laser, diode laser and surgical scalpel. Postoperative controls were carried out after 7, 15 and 30 days to evaluate healing and wound evolution, and after 3, 6 and 12 months to assess possible relapse. RESULTS: Two groups were defined, based on the clinical and etiopathogenic characteristics of the excised lesions: gingival hyperplastic lesions (77 cases) and fibromatous hyperplasia (51 cases). The lower jaw was the most frequent location of gingival hyperplasia (51.9%). Fibrous hyperplasia was the most common histological diagnosis (49 cases; 63.6%). Percentage relapse following removal was 9.1%, of which 5 cases corresponded to fibrous hyperplasia. Only one malignancy was identified, corresponding to infiltrating squamous cell carcinoma. On the other hand, of the 51 treated cases of fibromatous hyperplasia, 58.8% were located in the upper jaw. These were histologically confirmed to be fibrous hyperplasia, with relapse in 19.6% of the cases. CONCLUSIONS: Although the different surgical techniques used for removal of epulis of the oral cavity are appropriate, we consider the CO2 laser to be the treatment of choice, since it offers a number of both intra- and postoperative advantages. On the other hand, all oral lesions require histological study to establish a firm diagnosis. (+info)
Analysis of proliferative activity in oral gingival epithelium in immunosuppressive medication induced gingival overgrowth.
(7/23)
BACKGROUND: Drug-induced gingival overgrowth is a frequent adverse effect associated principally with administration of the immunosuppressive drug cyclosporin A and also certain antiepileptic and antihypertensive drugs. It is characterized by a marked increase in the thickness of the epithelial layer and accumulation of excessive amounts of connective tissue. The mechanism by which the drugs cause gingival overgrowth is not yet understood. The purpose of this study was to compare proliferative activity of normal human gingiva and in cyclosporine A-induced gingival overgrowth. METHODS: Gingival samples were collected from 12 generally healthy individuals and 22 Cyclosporin A-medicated renal transplant recipients. Expression of proliferating cell nuclear antigen was evaluated in formalin-fixed, paraffin-embedded gingival samples using an immunoperoxidase technique and a monoclonal antibody for this antigen. RESULTS: There were differences between the Cyclosporin A group and control group in regard to proliferating cell nuclear antigen and epithelial thickness. In addition, the degree of stromal inflammation was higher in the Cyclosporin A group when compared with the control group. CONCLUSION: The results suggest that the increased epithelial thickness observed in Cyclosporin A-induced gingival overgrowth is associated with increased proliferative activity in keratinocytes. (+info)
Anesthetic management of a patient with Sturge-Weber syndrome undergoing oral surgery.
(8/23)
This case involves a possible complication of excessive bleeding or rupture of hemangiomas. Problems and anesthetic management of the patient are discussed. A 35-year-old man with Sturge-Weber syndrome was to undergo teeth extraction and gingivectomy. Hemangiomas covered his face and the inside of the oral cavity. We used intravenous conscious sedation with propofol and N2O-O2 to reduce the patient's emotional stress. It was previously determined that stress caused marked expansion of this patient's hemangiomas. Periodontal ligament injection was chosen as the local anesthesia technique. Teeth were extracted without excessive bleeding or rupture of hemangiomas, but the planned gingivectomies were cancelled. Deep sedation requiring airway manipulation should be avoided because there are possible difficulties in airway maintenance. Because this was an outpatient procedure, propofol was selected as the sedative agent primarily because of its rapid onset and equally rapid recovery. Periodontal ligament injection with 2% lidocaine containing 1: 80,000 epinephrine was chosen for local anesthesia. Gingivectomy was cancelled because hemostasis was challenging. As part of preoperative preparation, equipment for prompt intubation was available in case of rupture of the hemangiomas. The typically seen elevation of blood pressure was suppressed under propofol sedation so that expansion of the hemangiomas and significant intraoperative bleeding was prevented. Periodontal ligament injection as a local anesthetic also prevented bleeding from the injection site. (+info)