Canal diameter enlargement was greater anteriorly to the ridge and posteriorly to the palatal bone, mainly because of tooth extraction. The atrophy of disuse may influence surrounding structures, similar to the maxillary sinus tendency to expand into surrounding bone mainly after tooth loss.

A waiting period of 12 months or longer to allow total socket healing used to be accepted protocol for placing dental implants. More than 15 years of research and clinical practice were needed for the concept of immediate endossceous implantation into fresh extraction sites to be accepted. Today the dilemma is no longer when, but which, protocol to follow. The diverse recommendations found in the literature leave the practitioner confused as to the methodology of choice. The conclusions drawn after reviewing the relevant literature on immediate dental implantation are: 1) implants placed into fresh extraction sockets have a high rate of survival, ranging between 93.9% to 100%; 2) implants must be placed 3 to 5 mm beyond the apex in order to gain a maximal degree of stability; 3) implants should be placed as close as possible to the alveolar crest level (0 to 3 mm); 4) there is no consensus regarding the need for gap filling and the best grafting material; 5) the use of membrane does not imply better results-on the contrary, membrane exposure may carry complications in its wake; and 6) the absolute need for primary closure remains to be established.

Parotidectomy is performed for benign or malignant tumors and for selected benign inflammatory and autoimmune conditions. Possible associated complications include facial nerve paralysis, pain, loss of sensation, gustatory sweating, and facial scarring. Global quality of life in patients undergoing parotidectomy has not been reported. The implications of facial surgery with the catastrophic potential of facial nerve paralysis may severely affect quality of life. A quality-of-life study was conducted in patients undergoing parotidectomy for benign and malignant diseases to define the significance of associated morbidity and its impact on quality of life. A quality-of-life instrument was specifically created, based on the principles of the University of Washington Quality of Life questionnaire, and mailed to the patients. Questions addressed recognized complications of parotidectomy. Patient group results were compared for age above and below 45 years, sex, benign versus malignant disease, presence or absence of Frey syndrome, and presence or absence of benign pleomorphic adenoma. Forty-six percent of 125 patients meeting the study criteria fully replied to the questionnaire. The global health score was 3.5, corresponding with "good" to "very good." Except for local sensation, which had a score of 50, all other domains scored above 76. Change in appearance, gustatory sweating, and pain were reported by 70 percent, 57 percent, and 30 percent, respectively. Importance attributed to all domains except facial function was low. Pain was encountered significantly less in patients younger than 45 years of age, and scores for appearance were also highly significant in this age group. Postoperative sequelae were noted in the majority of patients. The dominant sequelae were altered sensation, change in appearance, Frey syndrome, and pain. A degree of permanent postoperative facial nerve impairment was reported by 10 patients. Nevertheless, overall, parotidectomy does not seem to severely affect quality of life.

No abstract

A 7-year follow-up of implants placed immediately after tooth extraction into fresh extraction sites is reported. Small autogenous bone chips (from bone adjacent to implant sites) were grafted into the defect between the implant and the socket walls when needed. Closure of the wound was obtained by coronal repositioning of the flap, and no membranes were used. Care was taken to minimize hematoma formation under the flap during healing by part-time use of removable prosthesis with thick soft linings after implant surgery. At second stage surgery, mucoperiosteal flaps were apically repositioned for maximum attached gingival width and to reconstruct the vestibule. Minor complications such as exposure occurred in 16% of cases. Implant mean 5-year cumulative survival rate was 95%. There was no implant loss after loading. The results indicated that implants placed into fresh extraction sites grafted with autogenous bone chips will heal predictably.

The generation of higher cholesterol blood levels is proposed as a possible link between chronic periodontal inflammation and atherosclerosis.

Dental implant placement associated with augmentation of the sinus floor in the severely atrophic maxilla can be performed in 1- or 2-surgical stages, depending on the height of the residual alveolar bone. A minimum of 4 to 5 mm of residual alveolar bone height is recommended for a 1-stage surgical procedure. The present study describes a 1-stage procedure in cases where the residual alveolar bone height in the posterior maxilla was 1 to 2 mm. A total of 55 hydroxyapatite-coated dental implants were inserted in 20 grafted sinuses of 20 patients. No case presented any difficulty in achieving initial stabilization and parallelism. No perforation of the sinus membrane or clinical complications of the sinuses were evident. Prior to exposure, radiographic evaluation revealed bone consolidation and a close bone-implant relation. At second-stage surgery, there was no clinical evidence of crestal bone loss around the implants. All implants were clinically osseointegrated. All patients received fixed implant-supported prosthesis. The mean follow-up was 26.4 months (range 15 to 39 months). There was no implant loss after loading. The following surgical modifications are essential: a wide lateral window opening, the use of a bone mill to homogenize the bone graft, meticulous condensation, and clinical measurements to ensure implant parallelism.

It is stressed that short implants (14 mm or less) should be used in the mandibular canine region and that effective treatment of this complication is essential.