Full Dentition Periodontal Surgery Using Intravenous Conscious‐Sedation: A Report of 10,000 Cases

Abstract

In 1980 Ceravolo, et al, reported the results of 5200 cases of periodontal surgery performed in dental offices on patients while under conscious sedation. In no instance was a major complication noted. Successful case management coupled with a high degree of patient acceptance prompted the authors to continue to perform full dentition periodontal surgery with the aid of conscious sedation plus local anesthesia. To date, 10,000 cases have been completed in this manner. As yet no major complications have been noted.

Intravenous Moderate Sedation as an Adjunct for Periodontal Surgery: A Retrospective Analysis of 964 Cases

“…In the 964 periodontal procedures reviewed in this article, 18 complications, all minor, were noted, for a rate of 1.87%, similar to that reported by Rodgers 14 . Although this article and others have documented the safety of intravenous dental sedation, 1‐3,12‐14 clinicians must remain diligent in the safe application of this procedure because the risk of death is always present when medications are introduced to patients intravenously. According to the American Dental Association (ADA) Guidelines for the Use of Sedation and General Anesthesia by Dentists 17 as adopted by the 2007 ADA House of Delegates, “Patients considered for minimal, moderate, or deep sedation must be suitably evaluated prior to the start of any sedative procedure.…”

“…In healthy or medically stable individuals (ASA I, II) this may consist of a review of their current medical history and medication use. However, patients with significant medical considerations (ASA III, IV) may require consultation with their primary care physician or consulting medical specialist.” The careful presurgical evaluation and selection of patients for intravenous sedation may be one of the reasons for the minimal complication rate noted in this and other articles evaluating the use of intravenous sedation in the dental office 1‐2,12‐14 …”

“…Over the past three decades, multiple articles involving thousands of patients have documented the safety of intravenous conscious sedation when used as an adjunct for dental procedures 1‐3,12‐14 . These articles consistently report minimal adverse events.…”

“…These articles consistently report minimal adverse events. In consecutive reviews of 5,200 and 10,000 cases, Ceravolo et al 12,13 reported no major complications when intravenous sedation was used for periodontal surgery. Concerning oral surgery procedures, Rodgers 14 reported a complication rate of 2.66% during the first 7 years of practice, with most being minor complications, such as presyncope/syncope, restlessness/combativeness, and nausea/vomiting.…”

Clinical policy: Procedural sedation and analgesia in the emergency department

“…When the patient's level of consciousness or respiratory efforts can be adequately assessed, procedural sedation and analgesia has an extremely low risk of morbidity and mortality. 6,9,13,18,19,45,48,50,56,57 However, the rarity of adverse events results in low statistical power for detecting decreases in the adverse event rate. Without devaluing its utility as a monitoring adjunct, pulse oximetry should not substitute for clinical assessment during procedural sedation and analgesia, but rather be utilized as a reliable adjunct.…”