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Compendium
January 2015
Volume 36, Issue 1
Peer-Reviewed

Persistent pain and neurosensory disturbance after dental implant surgery: prevention and treatment

Al-Sabbagh M, Okeson JP, Bertoli E, et al. Dent Clin North Am. 2015;59(1):143-156. doi: 10.1016/j.cden.2014.08.005. Epub2014 Sep 22.

Abstract: Nerve trauma caused by dental implant placement is associated with altered sensation and chronic pain. Complete or partial loss of sensation is often reported by patients who have experienced nerve trauma during implant surgery. Some patients report persistent pain and neurosurgery disturbance long after the normal healing time has passed. In addition, neuropathic pain is reported after implant surgery. Practitioners who place 160;dental implants must be familiar with the differential diagnosis, prevention, and management of neuropathic pain. This article provides insights into the prevention and management of neurosensory deficits and chronic persistent neuropathic pain and considerations for patient referral. Keywords include: implant; management; nerve injury; neuropathic pain; neurosensory; and prevention.

A prospective randomized controlled trial of two different sedation sequences for third molar removal in adults

Khader R, Oreadi D, Finkelman M, et al. J Oral Maxillofac Surg.2014 Sep 16. doi: 10.1016/j.joms.2014.08.033. [Epub ahead of print]

Abstract: Fentanyl and midazolam are commonly used sedatives with different mechanisms of action and specific analgesic or amnestic properties. This study examined whether the order of their administration would affect a patient’s pain perception or procedural vital signs. A prospective, randomized, parallel-group clinical trial was conducted in patients who planned to undergo removal of at least 2 third molars under intravenous moderate sedation. Patients were randomly assigned to one of two groups. The fentanyl-first group received fentanyl and then midazolam; the midazolam-first group received midazolam and then fentanyl. Median scores on the Wong-Baker FACES pain scale for the two groups were 2.0 (interquartile range, 3.1) for the fentanyl-first group and 1.5 (interquartile range, 2.5) for the midazolam-first group (P = 0.333). CONCLUSIONS: In this study, selective sequencing of midazolam or fentanyl during an intravenous moderate-sedation procedure did not result in a measurable difference of recollected procedural pain scores at 24 hours after third molar extraction. The choice of the sedation agents and the order of their administration should be tailored to the patient’s needs, type of surgical procedure, and surgeon preference.

A comparison of sedation-related events for two multiagent oral sedation regimens in pediatric dental patients

McCormack L, Chen JW, Trapp L, Job A. Pediatr Dent.2014;36(4):302-308.

Abstract: This study compared the incidence of adverse sedation-related events occurring with two different multiagent oral sedation regimens in pediatric dental patients. Forty healthy patients (three to six years old) received either a sedation regimen of chloral hydrate, meperidine, and hydroxyzine with nitrous oxide (CH/M/H/N2O; N = 19) or a regimen of midazolam, meperidine, and hydroxyzine with nitrous oxide (MZ/M/H/N2O; N = 21). The two treating dentists answered a questionnaire regarding the perioperative period. Parents received two phone interviews at 8 and 24 hours after sedation. Statistical analysis included chi-square, Pearson correlation coefficient, and t-test (P < 0.05). Children sedated with MZ/M/H/N2O showed a significant increase in hyperactivity during dental treatment, slurring/difficulty speaking, and difficulty walking postoperatively within 8 hours after discharge. Children sedated with CH/M/H/N2O showed a significant increase in frequency of sleeping, talking less than normal after arriving home, and an increased need for postoperative pain medication. CONCLUSIONS: The provider of pediatric oral sedation should select a sedative regimen with an adverse sedation-related profile that he/she believes is optimal for the patient being treated. Parents should be counseled as to possible post-sedation effects anticipated based on the sedative regimen administered.

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