Objectives: The initial aim of this study was to evaluate the influence of the use of the local anaesthetic articaine before and after dental extractions, on intraoperative pain during general anesthesia, and the subsequent consumption of intraoperative analgesics (Remifentanil) by children receiving oral rehabilitation at the Unit of Ambulatory Surgery and Anaesthesia of the University Hospital of Montpellier, France. Methods: The clinical study protocol evaluated the intraoperative pain of 62 ASA (American Society of Anaesthesiologists) I or II children, during dental extractions under general anesthesia. The children were divided into two groups by randomised simple blind draw. Group 1 received local anaesthetic before extraction. Group 2 received local anaesthetic after extraction. Their pain was objectified through its physiological manifestations: heart rate and arterial blood pressure. Results: The mean age of the boys was 6.55 years and for girls was 5.29 years. Those who received peri-apical local anaesthetic after extraction experienced a significantly higher increase in systolic blood pressure and heart rate (p ≤ 0.05) compared to those who received it before extractions. The mean increase in heart rate was +10.4% for the patients receiving the anaesthetic after extraction. For the group receiving it before, there was a mean decrease in heart rate of –0.7%. The mean increase in systolic blood pressure the anaesthetic-after group was 11.4%, but was only 1.4% in the anaesthetic-before group. These variations were significant (p Conclusion: This study illustrates the advantage of using local anaesthetic before dental surgery during general anesthesia, which limits the rise in systolic blood pressure and heart rate during tooth extraction. The logical consequent decrease of the consumption of intraoperative analgesics is to be evaluated by further studies.

Objectives: Immediate-load protocols for edentulous patients are well-documented treatment options, however it is expensive to fabricate a provisional prosthesis that is capable of loading, which must be followed after osteointegration and soft tissue healing by placement of a definitive restoration that fills gaps that appear between the gingiva and prosthesis. The aim of this study was to carry out the OSP technique using a single prosthesis with a metal framework that permits immediate loading, which could be transformed after complete healing to a definitive prosthesis. Methods: Three patients were treated by the OSP technique. Impressions were taken before surgery, with diagnostic set-up for the final restoration. After surgery, further impressions were made of the implants in position and gingival levels, and the master cast was prepared. Titanium cylinders were screwed onto the abutment replicas, and sections of 3.5-mm diameter titanium rods were laser-welded to them. Passive fit of the framework was checked. The prosthesis was intended to achieve optimum aesthetics and occlusion control. Contacts with the cantilever were avoided to prevent implant stress during osteointegration. After validation, the dentures were placed 24 hours after surgery. Master cast models were preserved on the articulator. After osteointegration, gaps between gingiva and prosthesis were recorded by taking mucostatic RIs of the edentulous areas between implants, with injection of silicone directly under the screwed prostheses. Master models were modified by eliminating the stone between the implants, and transitional silicone prostheses were screwed into place. New plaster was poured into the space to modify the crest profile according to the new anatomy, and resin was applied to improve occlusion of the teeth with the entire prosthesis, including the cantilever. The new prostheses were delivered five hours after making impressions. Results: During the observation period of 12–84 months, implant survival rates were 100%. None of the three prostheses were lost, thus the prosthetic survival rate was also 100%. In all three cases, soft tissue levels and the spaces between the prostheses and tissues were stable. Conclusion: The cost of implant treatment is important to patients. The OSP technique with RIs allows a single prosthesis to be used as temporary prosthesis suitable for immediate loading, that can be transformed, after a short time, to a definitive prosthesis that is adapted to the tissue after complete healing. This leads to cost reductions and increased access of patients. The use of RIs decreases chair time and laboratory time, and re-use of the master cast decreases material costs. Further studies are now required with larger sample sizes to better evaluate this promising low-cost option.

Female patient *1968, by Jung, Antonini, Triacca (2007-2009). This patient with hypodontia and multiple persistent deciduous teeth is looking for a long-lasting solution to improve her esthetic and masticatory performance.