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The purpose of this article is to identify the types of complications that have been reported in conjunction with endosseous root form implants and associated implant prostheses. A Medline and an extensive hand search were performed on English-language publications beginning in 1981. The searches focused on publications that contained clinical data regarding success/failure/complications. The complications were divided into the following 6 categories: surgical, implant loss, bone loss, peri-implant soft tissue, mechanical, and esthetic/phonetic. The raw data were combined from multiple studies and means calculated to identify trends noted in the incidences of complications. The most common implant complications (those with a greater than a 15% incidence) were loosening of the overdenture retentive mechanism (33%), implant loss in irradiated maxillae (25%), hemorrhage-related complications (24%), resin veneer fracture with fixed partial dentures (22%), implant loss with maxillary overdentures (21%), overdentures needing to be relined (19%), implant loss in type IV bone (16%), and overdenture clip/attachment fracture (16%). It was not possible to calculate an overall complications incidence for implant prostheses because there were not multiple clinical studies that simultaneously evaluated all or most of the categories of complications. Although the implant data had to be obtained from different studies, they do indicate a trend toward a greater incidence of complications with implant prostheses than single crowns, fixed partial dentures, all-ceramic crowns, resin-bonded prostheses, and posts and cores.

A retrospective analysis of complications and side effects associated with surgery for 1000 mandibular and 500 maxillary impacted third molars was performed. The analysis included 614 patients with impacted mandibular third molars and 274 with impacted maxillary third molars who were treated in a 5-year timeframe from 1987 to 1992. The incidence of intraoperative complications and side effects of mandibular third molar surgery was 1.1% and 4% for maxillary third molar surgery whereas postoperative complications were 4.3% and 1.2%, respectively.

Post tooth extraction infective complications have occasionally been described in HIV-infected persons. However, there is little objective data as to the frequency of this and the need for antibiotic prophylaxis. Similarly the frequency of postextraction bleeding in patients infected with HIV, who may have thrombocytopenia, is unknown. In the present study the frequency of postextraction complications has been investigated in a group of 38 persons at stages 2 to 4 of HIV infection and 26 matched subjects from patients groups commonly at risk of HIV infection but not seropositive. During 40 clinical procedures in HIV-infected patients, 100 (range 1 to 23, median 1) teeth were extracted. Three episodes of delayed postextraction healing were recorded. During 30 procedures in the non-HIV-infected persons, 68 (range 1 to 5, median, 2) teeth were extracted, and two episodes of delayed postextraction healing were recorded. These differences were not significant. Only one HIV-infected patient had an episode of severe postextraction bleeding: this was a hemophiliac who bled despite receiving factor VIII prophylaxis. The bleeding occurred 7 days after the extraction and ceased with tranexamic acid and additional factor VIII. No control subject had severe postextraction hemorrhage. It is concluded that postextraction complications are uncommon in HIV-infected patients and that routine antibiotic prophylaxis is not indicated.

Two cases of oral caliber-persistent artery are reported. Both cases were different from the five previously reported oral examples of this unusual entity. One case is the first reported instance of a caliber-persistent artery not associated with spontaneous hemorrhage, inflammation, or ulceration. The clinical importance of this entity to the patient and the treating practitioner is stressed.

To investigate how the use of T-cell-depleted marrow or a combination of cyclosporine and methotrexate to prevent graft-versus-host disease affect oral health and the ability to maintain adequate nutrition during the neutropenic phase after allogeneic bone marrow transplantation, 48 allogeneic bone marrow recipients were studied. From a group of adult leukemic marrow recipients of HLA identical sibling marrow, 23 patients were randomly chosen to receive T-cell-depleted marrow and 25 were selected to receive cyclosporine and four doses of methotrexate to prevent graft-versus-host disease. Before the transplantation, all patients were given all necessary dental treatment as well as oral hygiene and nutrition instructions. The oral mucosal and nutritional status in all patients (except one who died) were followed from 5 days before the procedure, during the neutropenic period after transplantation, and until discharge from the hospital. The number of oral lesions was similar in both groups. The subjective experience of orally related problems, such as pain from the oral cavity and number of days with total parenteral nutrition, was less in the T-cell-depleted recipients compared with those who received a graft-versus-host disease prophylaxis with cyclosporine and methotrexate (p less than 0.005). The oral cavity was considered to be the port of entry in four of six patients in the cyclosporine and methotrexate group who developed septicemia, compared with only one of six patients in the T-cell-depleted group with septicemia. The difference in the frequency of septicemia derived from the oral cavity did not, however, reach the significant level.(ABSTRACT TRUNCATED AT 250 WORDS)

Von Willebrand's disease has been established as the most common hereditary hemorrhagic disease. Endodontic treatment, when possible, rather than extraction is the treatment of choice in patients suffering from such a disease. A case is presented in which, during regular endodontic treatment, uncontrollable bleeding occurred, suggestive of a generalized bleeding disorder. A thorough hematologic examination revealed von Willebrand's disease, which the patient was not aware of. The dental surgeon can play an important role in the diagnosis and treatment of such patients.

Presented is a case in which severe, prolonged hemorrhage, subsequent to simple dental extractions in an 85-year-old Negro man, was due to disseminated intravascular coagulation, with secondary fibrinolysis resulting from metastatic adenocarcinoma of the prostate gland. The difficulty and delay in diagnosis, selection of proper therapeutic regimen, and complications encountered during treatment are discussed.

A case of a 13-year-old boy with prolonged bleeding after tooth extraction is reported. This was the first manifestation of systemic lupus erythematosus found to be associated with circulating anticoagulants, including the "lupus anticoagulant," and possible hypoprothrombinemia.

Dental treatment for patients with hepatocellular disease constitutes a very complex problem because of their severe bleeding tendency. It seems that bleeding from the oral structures follows organ-specific patterns. The use of systemically administered antifibrinolytic agents, together with the local use of Gelfoam, cyanoacrylate spray, and intraligamentary anesthesia make possible bleeding-inducing procedures without exaggerated hemorrhage. This approach avoids the need for transfusion and hospitalization for dental treatment, making such treatment cheaper and more accessible.

A 25-year-old white woman was evaluated for "spots" on the roof of her mouth of 2 days' duration. The initial history, physical examination, and laboratory data all failed to indicate any cause for the bleeding diathesis. Therefore, a more intensive history was initiated which disclosed a probable case for fellatio as the cause of the spots. The intraoral examination showed the spots to be petechial hemorrhages located on the soft palate in the area of the insertion of the tendons of the tensor veli palatini and levator veli palatini muscles. The mechanism of injury producing these petechiae was postulated to be the combined muscular actions initiated reflexively through tactile stimulation and the negative pressure created through irrumation, both acting simultaneously on the mucosa of the soft palate. This case is presented to illustrate an addition that should be made to the differential etiologic factors of intraoral petechiae.

Oral complications were detected during 89% of hospital admissions for treatment of acute leukemia in adults. Changes that reflected the underlying myelosuppression and general immunosuppression predominated. Hemorrhagic phenomena (77%), neutropenic ulceration (49%), and herpes simplex virus infections (39%) were the most common.

The roles of hemodialysis and 1-deamino-8-D-arginine vasopressin (DDAVP) in the control of hemorrhage following oral surgery in a severely uremic patient are described.

Polycythemia vera is a stem cell disorder that results in an increase in the production of red blood cells. Although numerous mechanisms have been suggested, the cause of the disease is unknown. Diagnosis is based on clinical and laboratory presentation. This article reviews the history of polycythemia vera and illustrates a representative case report of the disease process. Postoperative morbidity in the surgical patient is discussed with respect to preoperative therapeutic control. Recommendations are made for preoperative therapy in patients undergoing oral and maxillofacial surgery.

Aplastic anemia is a failure of all the cellular components of the bone marrow and, untreated, usually results in death from bleeding and/or infection within 4 months. Treatment by bone marrow transplantation offers the only means of survival. When a bone marrow graft fails, the patient is extremely susceptible to severe infection and/or hemorrhage. In this case, a bone marrow transplantation in a 34-year-old white man with aplastic anemia failed. Among the medical problems that subsequently developed were severe, prolonged and life-threatening oral bleeding and infection.

A retrospective chart review of 500 leukemia patients was carried out to analyze the role of oral pathoses in the presentation of leukemia and to determine those factors which affect the frequency of oral involvement during the initial clinical phases of the disease. The data indicate that oral pathoses were frequent signs or symptoms in patients with undiagnosed acute leukemia but were less prevalent in patients with undiagnosed chronic leukemia. Neither age nor sex appeared to be a significant factor affecting oral involvement. Oral signs of thrombocytopenia were the most prevalent complaint of patients seeking diagnosis for their leukemia because of an oral problem, and they were also most frequently responsible for oral problems found at initial physical examination. Head and neck lymphadenopathy was also a frequent presenting sign or symptom. Dentists were responsible for initiating the diagnosis of leukemia in a significant number of patients with acute nonlymphoblastic leukemia.

The periodontal conditions of two patients with hereditary hemorrhagic telangiectasia were successfully treated by a two-phase plan. The first phase of treatment eliminated inflammation from local etiologic factors by removing plaque and plaque-retaining factors. The second phase eliminated the residual anatomic defects of periodontal disease. Gingival bleeding has been indicated as a symptomatic factor of hereditary hemorrhagic telangiectasia, but such bleeding is more likely the result of periodontal inflammation.

Thrombocythemia is characterized by an increase in platelet numbers coupled with abnormal function. Three cases diagnosed after referral to an oral surgeon are presented. In each case the reason for referral concerned excessive dental hemorrhage. Thrombocythemia should be included in the differential diagnosis in cases of oral hemorrhage.

The present study demonstrates the feasibility of chronic anticoagulation in rabbits and of estimating the resulting increase in blood loss following extraction of four front teeth from labeled red cell disappearance curves. This setup proved useful for the evaluation of hemostatic techniques. Socket packing with oxidized cellulose soaked in thrombin solution or local application of cyanobutylacrylate reduced early blood loss; oral administration of tranexamic acid reduced both early and late bleeding; the combination of socket packing and oral tranexamic acid completely abolished the excessive blood loss that resulted from anticoagulation alone.

Two cases of thrombasthenia, a rare hereditary disorder of platelet function, are presented. The oral surgical and dental management of these cases is discussed in the light of the development of isoantibodies to transfused platelets in one of the cases and in another case encountered. The problems of obtaining donor platelets matched for platelet and HL-A antigens are discussed. Emphasis is placed on the use of local hemostatic measures and antifibrinolytic agents in the management of hemorrhage in this disorder and the avoidance of platelet transfusions as far as possible. Conservative dentistry and early preventive dental advice are considered desirable in order to avoid extractions.

Charts of 132 patients with proved classic hemophilia were reviewed. The diagnosis of hemophilia was most often made after 6 months of age but before 2 years. Persistent oral bleeding led to the diagnosis in 13.6 percent of the cases. The oral site most often involved was the frenum of the lip. In the patient with proven hemophilia, oral bleeding accounted for 9 percent of those bleeding episodes requiring infusion therapy.

The authors present three cases which created diagnostic problems. The etiology of these is, in the authors' experience, unique and not generally known. It is suggested that this etiology be considered whenever palatal erythema, ecchymoses, or petechiae are seen.

A prolonged epistaxis following routine dental extractions was observed in a 50-year-old woman with a history of chronic hemodialysis. Despite the clinical impression of a significant coagulopathy, extensive hematologic testing failed to reveal any abnormalities. Recent evidence suggests that a prostaglandin (prostacyclin) with platelet antiaggregatory properties may be responsible for episodes of prolonged bleeding reported in patients undergoing hemodialysis.