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Language Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2006. Vol. 11, no. 6
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- Mandibular odontogenic myxoma : reconstructive considerations by means of the vascularized fibular free flap(2006) González García, R.; Rodríguez Campo, Francisco José; Naval Gias, Luis; Muñoz Guerra, Mario F.; Sastre Pérez, Jesús; Díaz González, F.J.The odontogenic myxoma is a rare entity located in mandible and upper maxilla. Due to its local aggressiveness, wide surgical excision is mandatory. Several surgical techniques have been described for the reconstruction of segmental mandibular defects. In comparison with other free flaps, the vascularized free fibular flap (VFFF) supports the longest amount of bone and, due to the nature of the vascular supply a complete freedom in location of the osteotomy is present. A precise mandibular arc can be performed following bone resection. We suggest the performance of the ?in situ? VFFF technique in order to recreate mandibular contour by means of several osteotomies, while the pedicle is still attached to the leg. Substantial decrease in surgical time is obtained. With the ?double-barrel? technique and subsequent osseointegrated implants, good results are obtained in the reconstruction of dentate patients without maxillary atrophy. We present two new cases of large odontogenic mandibular myxoma. Wide surgical excision by means of hemimandibulectomies and subsequent reconstruction with VFFF were performed.
- Frontal sinus mucocele with intracranial and intraorbital extension(2006) Peral Cagigal, B.; Barrientos Lezcano, F.J.; Floriano Blanco, Raúl; García Cantera, J. M.; Sánchez Cuéllar, L.A.; Verrier Hernández, AlbertoABSTRACT Introduction: Frontal sinus mucoceles can present with a multitude of different symptoms including ophthalmic disturbances. Even benign, they have a tendency to expand by eroding the surrounding bony walls that displaces and destroys structures by pressure and bony resorption. Case report: A 32-year-old man with diplopia, proptosis of the right eye and headache was presented. The diagnosis was frontal sinus mucocele with intracranial and intraorbital extension. Possible clinical manifestations of mucoceles, diagnostic imaging techniques and treatment used are discussed. Conclusion: Frontal mucoceles are benign and curable, early recognition and management of them is of paramount importance, because they can cause local, orbital or intracranial complications.
- Variations of interleukin-6 after surgical removal of lower third molars(2006) López Carriches, Carmen; Martínez González, José María; Donado Rodríguez, ManuelObjectives: To determine if there is a release of IL-6 after surgical removal of lower third molars and to compare the amount of IL-6 in patients treated with NSAID and in those treated with glucocorticoids. Study Design: Prospective study on 73 patients who attended the Oral Surgery Unit (Department of Medicine and Oral Surgery) in the Faculty of Odontology of the Universidad Complutense de Madrid for the surgical removal of their lower third molars. These patients were separated into two groups: the diclofenac group and the methylprednisolone group. A record card was completed with preoperative and postoperative epidemiological and clinic data. Samples of gingival crevicular fluid were collected in order to assess the release of interleukin-6 after surgery. In order to make a broad study of data, the BMDP program was used for statistical analysis. Results: Levels of IL-6 were higher after surgical extraction of lower third molars and remained high until the seventh day after. Levels were higher in the diclofenac group 24 hours after surgery, the difference was significant (0.008). Conclusions: IL-6 is higher after surgical extraction of lower third molars, behaving differently in each of the groups.
- Influence of cavity type and size of composite restorations on cuspal flexure(2006) Gonzalez Lopez, Santiago; Sanz Chinesta, Maria Victoria; Ceballos García, Laura; Haro Gasquet, F. de; González Rodríguez, Mª PalomaObjectives: The present study examines the influence of cavity type, and size of composite restorations on cuspal flexure due to polymerization shrinkage. Methods: Thirty healthy premolars were selected and divided into two experimental groups. Group 1: Mesial, mesiodistal, and MOD cavities were successively prepared in each tooth by means of the SONICSYS approx system (KaVo ®) using a nº 2 (small) diamond tip. Group 2: The same cavity preparation sequence was followed but a nº 3 (medium) tip was used. Cavity preparations were performed and afterwards restored using the same adhesive system and resin composite. Cuspal displacement was measured 15 min after completion of each type of restoration. Results: Under the experimental conditions used, polymerization shrinkage of composite restorations resulted in an inward deflection of the cusps in all the situations evaluated. The Friedman global test found significant differences according to the cavity type and size (p<0.05). The Wilcoxon test revealed that deflection was significantly affected by the amount of dental tissue lost, since practically no movement was observed in the case of mesial cavities but extensive displacements were recorded for MOD restorations (p<0.05). However, no influence of bucco-lingual width on cuspal flexure was detected by the Student?s t test (p>0.05). Conclusions: The present study demonstrates that significantly higher cuspal deflection is observed in MOD restorations, showing that the degree of dental removal influences the cuspal flexure from polymerization shrinkage of composite restorations.
- Graft-versus-host disease : an eight case report and literature review(2006) de la Rosa García, Estela; Bologna Molina, Ronell; Vega González, María Teresa de JesúsGraft versus host disease (GVHD) is a common complication in bone marrow transplant (BMT) patients. It is characterized by systemic and oral cavity alterations. Depending on the timing of lesions, GVHD is classified as acute or chronic. Alterations in the oral cavity are lichenoid reticular lesions, erythema, ulcerations, and xerostomia. Sporadically, mucocele and pyogenic granulomas can be present. Aim: To describe GVHD oral manifestations in eight allogenic BMT patients, and discuss GVHD and drug-immunosuppresion associated lesions diagnosis and treatment. Study design: For a year, we examined the oral mucosa of eight consecutive allogenic BMT patients attending the Dermatology outpatient clinic at the Instituto Nacional de Cancerología (National Institute of Oncology) in Mexico City, looking for oral mucosa lesions. Results: Patients were five men and three women, ages 24.8 ± 9.7 years. Four had a BMT because of chronic granulocytic-, two for acute myeloblastic-, one for acute lymphoblastic- leukemia, and one for aplastic anemia. Three patients developed acute GVHD, with reticular oral mucosa lesions, erythema and mucositis; and all eight developed chronic GVHD, with reticular oral lesions, erythema, and ulcerations. A Patient had tongue and cheek pyogenic granulomas. Six reported xerostomía. Other oral lesions, associated to drug-immunosuppression, were candidiasis and herpes simplex. Conclusions: Patients with GVHD frequently develop oral lesions, some of which interfere with normal feeding; timely diagnosis and treatment are therefore essential to improve the quality of life of affected patients. We propose an alternative treatment for pyogenic granulomas.
- Prosthetic assessment in cleft lip and palate patients : a case report with oronasal communication(2006) Sala Martí, Silvia; Merino Tessore, Mª Dolores; Escuin Henar, TomásThe cleft lip and palate patient is mainly characterized by the presence of an oronasal communication, malformation or agenesis of the teeth close to the cleft, and deficient sagittal and transverse growth of the maxilla. These patients require various treatments involving a multidisciplinary team, which may include a maxillofacial surgeon, an orthodontist, a speech therapist, a paediatrician, a general dentist, a prosthodontist, an ENT specialist, a psychologist and all those professionals who can help provide functional, aesthetic and psychological improvement. This report describes a case of prosthetic rehabilitation in a patient with cleft lip and palate and an oronasal fistula (communication) following surgery. Different prosthetic treatments are described, with emphasis being placed on the approach chosen after to discuss the various limitations which arose.
- An update in periapical surgery(2006) Martí Bowen, Eva; Peñarrocha Diago, MiguelPeriapical surgery has largely improved at all levels due to new technologies provided by researchers throughout the last years. The aim of this article is to carry out a bibliographic revision of the last seven years. For this reason, we will analyse the studies published in Medline and the most important spanish dental magazines. The subjects to investigate are mainly based on the incorporation of ultrasonic root-end, which allow the performance of small and adjusted retrograde cavities; as well as the new filling materials. We also include magnifying glasses or surgical microscope to the work material, plus surgical laser and the application of guided tissue regeneration.
- Assessment of PFA-100 system for the measurement of bleeding time in oral surgery(2006) Arrieta Blanco, J.J.; Bartolomé Villar, Begoña; Juzgado, Antonio; Mourelle Martínez, Mª RosaLos métodos diagnósticos habituales para conocer la hemostasia primaria han sido calificados como cruentos, dependientes del operador, de difícil reproducción y en ocasiones no muy fiables. Es por ello que se han propuesto diferentes sistemas para valorar el tiempo de hemorragia, siendo uno de ellos el dispositivo PFA-100, el cual presentamos en este trabajo. Objetivo: Comparar la especificidad entre el método tradicional Ivy con el sistema PFA-100 para la determinación del tiempo de hemorragia. Material y método: Obtuvimos una muestra de 33 pacientes de entre 24-80 años en tratamiento antiplaquetario a los cuales se debía realizar una cirugía oral. Se les realizó un tiempo de hemorragia mediante el método Ivy , un INR mediante una analítica realizada el mismo día y un Coagucheck una hora antes de la cirugía así como la determinación del tiempo de sangrado mediante el dispositivo PFA-100. Resultados: El valor medio del tiempo de hemorragia mediante el método Ivy fue de 406.36 sg. El tiempo de hemorragia medio con el sistema PFA-100 para el cartucho de colágeno/epinefrina fue de 226.91 sg. y para el cartucho de colágeno/ ADP fue de 110.27 sg. Todos estos valores se encuentran dentro de la normalidad. Observamos desviaciones típicas muy altas con el método Ivy y más regulares para el sistema PFA-100 indicando una mayor especificidad del mismo. Obtuvimos también una gran correlación entre el cartucho colágeno/epinefrina y el ácido acetil salicílico. Conclusiones: Encontramos una mayor especificidad del analizador de función plaquetaria PFA-100 para la medición del tiempo de hemorragia en relación con el método tradicional Ivy.
- Failure of locoregional anesthesia in dental practice : review of the literature(2006) Boronat López, Araceli; Peñarrocha Diago, MiguelCorrect identification of the causes of dental anesthetic failure is essential in order to adopt the required measures for successful anesthesia. A review is made of the factors implicated in locoregional anesthesia failure, such as a bifid inferior alveolar nerve, retromolar foramen associated to accessory innervation, double or accessory mental foramen, the relation between the infiltration technique and bone density, accessory innervation in the case of the mylohyoid nerve and first cervical branches, cross innervation of the incisors, inactivity in the presence of tissue inflammation, inactive anesthetic solutions, an incorrect technique, and subjective perception on the part of particularly anxious patients. The therapeutic options available in the event such problems are encountered in routine clinical practice are commented.
- Buccodental health and oral mucositis : clinical study in patients with hematological diseases(2006) Sabater Recolons, M.M.; López López, José; Rodríguez de Rivera Campillo, M. E.; Chimenos Küstner, Eduardo; Conde Vidal, José MaríaEl objetivo del presente trabajo fue valorar si un buen estado buco-dental (valorado mediante índices dento-gingivales), se asociaba a una menor incidencia y gravedad de mucositis oral en pacientes con enfermedades hematológicas que iban a recibir tratamiento con quimioterapia o un trasplante de médula ósea. Diseño del estudio: El estudio se llevó a cabo en 97 pacientes ingresados en el Servicio de Hematología del Hospital Duran y Reynals en Barcelona en los años 2002-2003. Estos pacientes recibían tratamiento con quimioterapia o bien el acondicionamiento previo a un trasplante de médula ósea. Se realizó un estudio descriptivo analizando un índice dental, dos índices gingivales y la higiene oral y su relación con la aparición de mucositis. Resultados: Los pacientes que durante la quimioterapia mostraron valores elevados del índice de placa (IP) y gingival (IG) presentaron un mayor porcentaje de mucositis (77.4% y 65.7% respectivamente) frente a los que tenían poca placa o ésta no era visible. En el caso del IP las diferentas fueron estadísticamente significativas (p=0.015). Asimismo los pacientes que cepillaban los dientes 3veces/día sólo presentaron mucositis en un 26.7% de los casos, frente a los que no cepillaban o lo hacían una vez al día (65.9% y 68.4%), siendo estas diferencias también estadísticamente significativas (p=0.013). El ICAO mostró resultados similares en los pacientes con o sin mucositis (7.59 y 7.03 respectivamente). Conclusiones: En nuestro trabajo, un buen estado gingival así como una buena higiene oral durante la quimiorradioterapia, se asocian a una menor incidencia y gravedad de mucositis.
- Benign cementoblastoma : a case report(2006) Sumer, Mahmut; Gündüz, Kaan; Sümer, Pinar; Gunhan, OmerIn the past the benign cementoblastoma was recognized in the World Health Organization?s classification of odontogenic tumours as one of the cementoma neoplasias. Recently the benign cementoblastoma is included into ?Mesenchyme and/or odontogenic ectomesenchyme, with or without odontogenic epithelium? odontogenic tumours. Benign cementoblastoma has characteristic radiologic and microscopic features and it appears to be fused to the tooth roots. Symptoms may be totally absent, and when they do occur, pain and swelling are frequent findings. The final diagnosis is usually made histopathologically, but the clinical diagnosis is comparatively easy if it is examined radiographically. The tumour has unlimited growth potential. Most frequently tends to be associated with an erupted permanent tooth, most often the first molar: rarely has an association with an impacted or partial impacted tooth been reported. This case represents a case of benign cementoblastoma associated with a partially impacted mandibular third molar.
- Amlodipine-induced gingival hyperplasia(2006) Lafzi, Ardeshir; Farahani, Ramin Mostofi Zadeh; Shoja, Mohammadali MohajelDrug-induced gingival hyperplasia is a serious concern both for the patient and the clinician. A 45 year-old Caucasian male patient with hypertension, who received amlodipine (10 mg/day, single dose orally) for two months, sought medical attention because of the new-onset gingival enlargement. On clinical examination a generalized and firm overgrowth of the gingival throughout the maxilla and the mandible were evident. The lack of gingival inflammation and purulent discharge were other features of the clinical scenario. Histological assessment of the biopsy specimen revealed the hyperplasia of connective tissue, epithelial acanthosis, and elongated rete ridges along with few inflammatory cells. The histological and the clinical evidences were consistent with amlodipine-induced gingival hyperplasia. We believe that the present report indicates the most rapidly developed case of amlodipine-induced gingival hyperplasia reported to date. The related literature is reviewed and the underlying pathogenic mechanisms of this rare side-effect are discussed here.
- Lepromatous leprosy : a review and case report(2006) Chimenos Küstner, Eduardo; Pascual Cruz, Montserrat; Piñol Dansis, Cristina; Viñals Iglesias, Helena; Rodríguez de Rivera Campillo, M. E.; López López, JoséLa lepra es una enfermedad granulomatosa sistémica crónica y contagiosa, producida por Mycobacterium leprae (bacilo de Hansen). Se transmite de persona a persona y tiene un largo período de incubación (entre 2 y 6 años). Existen dos formas clínicas polares: lepra lepromatosa (multibacilar) y lepra tuberculoide (paucibacilar), con otras formas intermedias de características híbridas. Las manifestaciones orales suelen aparecer en la lepra lepromatosa y se producen en el 20 al 60% de los casos. Pueden tratarse de nódulos múltiples (lepromas), que progresan a necrosis y ulceración. Las úlceras curan con lentitud; forman cicatrices atróficas o pueden causar la destrucción del tejido. Las lesiones suelen localizarse en el paladar duro y blando, en la úvula, en el dorso de la lengua, en los labios y en las encías. También puede producirse destrucción de la parte frontal del maxilar y pérdida de dientes. El diagnóstico, basado en la presunción clínica, se completa con el examen bacteriológico e histopatológico, así como mediante la prueba de la lepromina (intradermorreacción que suele ser negativa en la forma lepromatosa y positiva en la tuberculoide). El diagnóstico diferencial incluye lupus eritematoso sistémico, sarcoidosis, leishmaniasis cutánea y otras enfermedades de la piel, sífilis terciaria, linfomas, micosis sistémicas, lesiones traumáticas y neoplasias malignas, entre otras. El tratamiento es difícil, ya que ha de prolongarse durante mucho tiempo, requiere varios fármacos con efectos adversos y resulta muy caro, sobre todo para los países menos desarrollados. Los de empleo más frecuente son la dapsona, la rifampicina y la clofazimina. También son eficaces las quinolonas, como ofloxacino y pefloxacino, así como algunos macrólidos, como la claritromicina y la minociclina. En el presente trabajo se expone el caso clínico de un paciente afecto de lepra lepromatosa, adquirida en un ambiente familiar de contagio durante la infancia y adolescencia.
- Oral mucosa symptoms, signs and lesions, in end stage renal disease and non-end stage renal disease diabetic patients(2006) de la Rosa García, Estela; Mondragón Padilla, A.; Aranda Romo, Saray; Bustamante Ramírez, Martha AliciaAim: To assess oral signs, symptoms and oral lesions (OL) type and prevalence, in diabetic patients with end stage renal disease (ESRD DM), and compare them with analogous findings in a non-ESRD DM group; analyze the possible association between oral manifestations, as well as with relevant laboratory findings. Research design. Two adult groups were studied: Group A: ESRD DM on dialysis, and group B: non-ESRD DM (serum creatinine <2.0 mg/dl). Known DM evolution time, dialysis treatment type and duration, and laboratory results were recorded. An oral exam was performed, searching for signs, symptoms and ESRD-associated OL. Associations were analyzed using Chi square, Fisher?s exact test, and odds ratios (OR) with 95% confidence intervals. Ages, time on dialysis, and laboratory results were compared with Student?s t test. Results: 229 individuals were examined, group A 99, and group B 130 pts. Signs and symptoms prevalence was higher in group A: 77.8% vs. 57.6%, (P<0.001), uremic breath (48.5%), unpleasant taste (45.5%) and xerostomia (44.4%) being the most frequent ones. OL were also more prevalent in group A; 65.6% vs. 36.9% (P<0.001). The most frequent OL were dry, fissured lips (28.3%), saburral tongue (18.2%) and candidiasis (17.2%). No difference was found in candidiasis prevalence between groups. Candidiasis was found associated to xerostomia (P<0.05) and smooth tongue (P<0.05) only in group A. Conclusions. ESRD DM patients had a significantly higher prevalence of signs, symptoms and OLs, as compared to non-ESRD DM pts. The high prevalence of uremic fetor, xerostomia, saburral tongue and candidiasis in group A, could be tried as warning signs on the possibility of non diagnosed advanced renal disease in other diabetic patients.
- Topic tacrolimus, alternative treatment for oral erosive lichen planus resistant to steroids : a case report(2006) Riaño Argüelles, A.; Martino Gorbea, Raúl; Iglesias Zamora, María Eugenia; Garatea Crelgo, J.The lichen planus is a mucocutaneous disease with unknown etiology and auto-immune pathogenia. There have been three variants of lichen planus: the reticular, the plaque-like and the atrophic-erosive lesions. It?s a chronic disease with acute relapses that generally affects more frecuently to women from the fourties. The diagnostic is based on the clinic identification of the lesions joined with the histopathologic study (basal cells hidropic degeneration, linfoplasmocitic infiltration and absence of displasy signs). The great number of therapeutic options are explained for its high prevalency (0.5-2%), its recurrence and its risk for malignant transformation. We present a case of oral erosive lichen planus, refractory to numerous treatments, mainly corticosteroids. During 15 days the lesion responded to the administration of a 0.1% tacrolimus in topic application. This article tries to show the new indication of tacrolimus, a calcineurin inhibitor immunosuppressor, that it is effective in the erosive lesions treatment.
- Bisphosphonates and Oral Pathology II. Osteonecrosis of the jaws : Review of the literature before 2005(2006) Estefanía Fresco, Ruth; Ponte Fernández, N.; Aguirre Urízar, José ManuelBisphosphonates are bone-turnover modulating drugs which are used in the management of a number of bone diseases ranging from osteoporosis to neoplasic pathology-associated osteolysis. In the last years a number of cases of osteonecrosis of the jaws associated with these drugs have been reported. In this review we analyze the cases published in the literature indexed from 2003 to December 2005. During this period 246 cases were reported, being more frequently associated with women in the sixth decade of life. More frequently associated bisphosphonates were the nitrogenated bisphosphonates (pamidronate, zolendronic acid) and the most common oral antecedent was a dental extraction. Nevertheless more than 25% of the cases were spontaneous. The most frequent site was the mandible and most of the cases presented clinical evidence of bone exposure and pain. Different treatments have been proposed with different antibiotic therapies with or without surgery, showing in general terms an uncertain prognosis with low healing rates.
