Clinical uses of botulinum toxin A in smile aesthetic modification

In this article we review the pharmacodynamics of commercially available preparations of botulinum toxin type A, and discuss the potential uses of the drug in smile modification. A major emphasis is placed on applications relevant to modern dental practice, and to the complications arising from its use. Botulinum toxin A, when applied correctly, is a safe and effective means of achieving aesthetic smile modification, with limited data on any demonstrable long-term adverse effects.

Complications of augmentation procedures for dental implants in private practice, Victoria, Australia

PURPOSE

This study audited complications associated with augmentation for dental implants, retrospectively over a 5-year period in a variety of private dental practices in Victoria (Australia).

METHODS

Complications were categorized as surgical or biological and compared to a group not requiring augmentation. Implant factors underwent univariate and multivariate analysis.

RESULTS

The study assessed 8486 implants with 26.9% undergoing augmentation. Augmentation had no effect on implant survival, however, a significant increase in complications for those implants requiring augmentation was found (P = <0.001). The hard tissue augmented group had significantly more cases of insufficient bone/dehiscences at implant placement (P < 0.001), and post-placement bone loss (P = 0.0014). These implants were grafted simultaneously (P < 0.05) with particulate autogenous bone and/or Bio-Oss (P < 0.05) with resorbable xenograft membrane (P < 0.001). There was significantly more bone loss in open sinus lifted cases than implants placed in native bone (1.90% v 0.30%; P = 0.009).

CONCLUSIONS

The study demonstrated no increase in graft complications that could be related to any specific augmentation technique, suggesting that routine grafting procedures used in private practice were safe and appropriate. Previously augmented sites were found to be more likely to require further augmentation at implant placement.

Brief alcohol intervention in alcohol involved facial fracture patients-a survey of patient attitudes to screening and intervention

PURPOSE

Alcohol intoxication is an important contributor to traumatic facial injuries. The period following injuries afford clinicians a useful window of opportunity to provide alcohol screening and brief intervention (SBI) which may affect changes in patients' future drinking behaviour. Although SBI has been reported to decrease at risk drinking and potentially trauma recurrence, it is not routinely utilised in most clinical settings in the world. This study aims to assess utilisation of, as well as patients' knowledge and attitude towards SBI in the management of patients presenting with alcohol-related facial fractures.

METHODS

Twenty consecutive patients who presented to Western Health with facial fractures who met selection criteria were offered an alcohol screening and survey questionnaire.

RESULTS

Ninety percent of patients were male and 50% were aged between 19 and 34. ASSIST score showed 65% were in the moderate risk category; 75% reported this was their first admission with alcohol related trauma. Although 75% acknowledged alcohol as a main cause of injury, only 40% agreed they drink too much. Forty-four percent felt that talking to a healthcare worker might help and 33% would consider accepting help. Forty-seven percent felt reading materials would be helpful in changing future drinking habits. Whilst 63% would like to know safe drinking limit, only 45% would like to have a discussion about alcohol-related harms.

CONCLUSIONS

Most patients presented in this survey were in moderate risk category who are amenable to behavioural change with provision of SBI. However, there is resistance to implementation of this intervention due to lack of knowledge, self-awareness and willingness to change. Nonetheless, patients are prepared to accept advice from clinicians and some formats of intervention. It is important to formulate a simple screening questionnaire and intervention strategy that are easy to administer to affect positive changes in patients with harmful drinking behaviours.

Analysis of commonly reported medical conditions amongst patients receiving dental implant therapy in private practice

BACKGROUND

The population seeking implants in private practice is a demographically and medically unique group. Understanding their medical needs can improve treatment planning and service delivery specifically for this population.

METHODS

Privately practising dental clinicians from Victoria, Australia, participated in a five-year retrospective study. Data were collected from the medical histories of 4116 patients who met the inclusion criterion of at least one implant placed within the study period of 1 January 2005 to 31 December 2009. Descriptive statistics were used to describe patient demographics and commonly reported medical conditions.

RESULTS

The most common age group to receive implant therapy was between 51 and 60 years (30.4% of patients). The patient population reported a broad range of co-morbidities including psychiatric disorders (83 patients), cardiovascular disorders (253 patients), gastrointestinal disorders (224 patients) and respiratory disorders (502 patients). Smoking was less prevalent amongst the study population compared to the general population.

CONCLUSIONS

The population assessed in this study was a medically diverse group. Clinicians must be familiar with their target demographic and understand how the common co-morbidities amongst this patient group can influence clinical decision making and outcomes.