Faculty Bibliography

Clinicians often perform dental procedures and dentoalveolar surgery on patients who take prescribed anticoagulant medications. Such medications can present clinical challenges with regard to modifying or temporarily discontinuing a patient's anticoagulant regimen, which may not be medically indicated. In many instances discontinuation or altering of anticoagulation can be avoided through use of local hemostatic factors while patients are therapeutically continued on their prescribed warfarin doses. This article discusses a useful adjunct to dental treatment for the warfarin-anticoagulated patient- tranexamic acid (TA). The purpose of TA in these dental patients is to promote safe surgical site hemostasis for improved intraoperative visibility and postoperative hemostasis.

Data sourcesCochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline via Ovid, Embase via Ovid, US National Institutes of Health Trials Registry and the World Health Organisation (WHO) International Clinical Trials Registry Platform were searched until July 2015 followed by hand searching of relevant references.Study selectionUsing no language restrictions, two authors independently assessed for inclusion of randomised controlled trials (RCTs) evaluating any intervention for treating oro-antral communications (OAC) and oro-antral fistulae (OAF) due to dental procedures. Quasi-RCTs and crossover trials were excluded.Data extraction and synthesisTwo authors independently assessed for inclusion, resolved disagreement by discussion and a third reviewer was consulted if necessary.Qualitywas determined independently by using GRADE 2004.For the dichotomous outcome complete closure, they expressed the estimate effect as risk ratio (RR) with 95% confidence interval (CI).ResultsA single study that started with 22 participants was included in the review where the overall risk of bias was judged as unclear. The main outcome was complete closure. The study compared pedicled buccal fat pad flap (PBFPF) with buccal flap (BF) and showed no difference in the closure of OAC, with a calculated RR of 1.00, 95% CI 0.83 to 1.20.ConclusionsVery low quality evidence from a small single study provided insufficient proof to judge if there is a difference in the effectiveness of the interventions.

Purpose: The use of non-steroidal anti-inflammatory drugs (NSAIDs) after third molar surgery has been shown to be superior to the use of combination opioid narcotics (1). However, most oral surgeons frequently prescribe these narcotics to their patients. Unlike NSAIDs, opioids have significant addiction potential and prescription drug abuse has reached epidemic proportions (2). Prescribing patterns are often based on providers' preferences without clear scientific evidence as to which modality of postoperative pain management is best. A better understanding of the prescribing patterns after third molar surgery may help focus provider behavior and alter the management of acute odontalgia. Hypothesis: Patient, provider, and surgical factors are related to the prescribing of opioids analgesics by oral surgeons. Materials and Methods: Using a historical cohort study design, 300 charts were reviewed from patients who underwent mandibular third molar extractions in the New York University College of Dentistry's Oral and Maxillofacial Surgery Clinic in 2011. Ultimately, 260 charts were included in the study. The presence or absence of specific patient predictor risk factors and outcomes were identified and recorded. Patient predictors included: age, gender, ethnicity, and American Dental Association (ADA) procedure code. ADA code is related to the difficulty of extraction. Outcomes included: positive or negative combination opioid narcotic prescription, type of opioid prescribed, dosage of opioid prescribed, number of subsequent visits to the clinic for postoperative pain, number of additional combination opioid prescriptions given, type of additional opioid prescribed, and dosage of additional opioid prescribed. Provider experience was also recorded. 20 charts were reviewed by two independent examiners to calculate inter- examiner reliability. Results: Overall, 78.8% of the sample was prescribed a combination opioid narcotic. Risk ratios were calculated for the relationship between individual risk fa!

Statement of the Problem: Repair of bone lost to trauma, disease, or birth defect requires regeneration of large volumes of structurally complex bone. Current bone repair methods, like bone grafts or particulate materials, are imperfect for repair of complex craniofacial defects which require formation of large amounts of natural, mechanically strong bone. 3D-printed, Direct Write (DW), scaffolds composed of tricalcium phosphate (TCP) with temporary calcium sulfate filler can serve as a better option to repair large complex bone defects. Such scaffolds are mechanically stable and can be custom printed to match the exact defect shape and size. Current literature debates scaffold pore sizes for optimal bone repair, stating scaffold pore size should be from 100-400mm. The objective of this study is to determine how pore size dictates the quality of ingrowing bone. Thiswill allow the design of scaffolds that can regenerate the natural architecture and mechanical properties of bone in complex craniofacial defects. Methods: Scaffold pores (spaces defined by struts) varied in all dimensions. Two 11mm diameter disk scaffold designs were DW printed of 15:85 HAP/b-TCP ink and filled with temporary calcium sulfate(CS) cement. These two designs allowed the study of pores from ~0-940 mm. The two scaffolds were placed symmetrically in bilateral trephine defects in the calvarias of 8 New Zealand white rabbits. Animals were sacrificed after 8 weeks (n=7) and 16 weeks (n=1). Bone ingrowth and remodeling rates of resected implants were quantified by microCT and hard tissue histology. Results: Contrary to previous literature findings, significant bone ingrowth occurred in pores ranging from 20mm to 940mm. Larger pore sizes allowed more bone ingrowth than smaller pore sizes. As pore size decreased, bone as a fraction of available space increased from 55%-85% and scaffold remodeling decreased from 32%-5%. Conclusions: This study demonstrated precision scaffold production where variable porosity scaffolds were used !

Implants are becoming the standard of care for the replacement of missing teeth; therefore, an in-depth understanding of bone grafting and bone healing is essential for the modern practitioner. We provide an overview of basic bone biology and graft classifications that are frequently used in these procedures. In it, we present the three different properties of bone grafting materials, including osteoinduction, osteogenesis and osteoconduction. And we describe different types of bone grafting materials, including natural and artificial bone sources