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Language Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2014. Vol. 19, no. 5
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- Versatility of nasolabial flaps in oral cavity reconstructions(2014) Alonso Rodríguez, Estefanía; Cebrián Carretero, José Luis; Morán Soto, M.J.; Burgueño García, MiguelObjectives: Describe the techniques involved and the results obtained witn nasolabial flaps in small and medium- sized defects of the oral cavity. The procedure is an easy resconstructive option with a high success rate and with very good aesthetic and functional outcomes. Study Design: A retrospective analysis of 16 nasolabial flap reconstructions in 15 oncological patients with oral cavity defects undergoing single-stage surgical interventions. We evaluate the tumor type, its location, size, the resective and reconstructive techniques involved, as well as any complications. Results: Out of 15 patients, 9 were male and 6 female, with ages ranging from 60-85 years. The primary tumor was located in the mandibular or maxillary gingiva in 7 patients, the lateral margin of the tongue in 5, the floor of the mouth in 3 and the mandibular symphysis in a single patient. The tumors were of a small to medium size. All patients underwent intraoral resections. In most cases, a cervical dissection was performed. All flaps were completed as single-stage surgical interventions, with 14 unilateral and 2 bilateral procedures. Five patients had received radiotherapy treatment for previous tumors. During the follow up period, which ranged from 4 months to 8 years, only one patient required their flap to be thinned, there were two incidents of surgical wound dehiscence, two hematomas and one orocutaneous fistula, none of which affected the survival of the flap. Conclusions: The nasolabial flap proves highly versatile in oral cavity reconstructions, coupled with a minimal morbidity of the donor region and good aesthetic and functional results. Its high vascularity allows for cervical dissections to be carried out or even for radiotherapy to be administered prior to it. It is straightforward, safe, and carrying it out as a single-stage intervention makes it the ideal surgical option for small to medium intraoral defects in edentulous patients with other comorbidities.
- Immediate loading with fixed full-arch prostheses in the maxilla: review of the literature(2014) Peñarrocha Oltra, David; Covani, Ugo; Peñarrocha Diago, Miguel; Peñarrocha Diago, MaríaObjectives: To critically review the evidence-based literature on immediate loading of implants with fixed full- arch prostheses in the maxilla to determine 1) currently recommended performance criteria and 2) the outcomes that can be expected with this procedure. Study Desing: Studies from 2001 to 2011 on immediate loading with fixed full-arch maxillary prostheses were reviewed. Clinical series with at least 5 patients and 12 months of follow-up were included. Case reports, studies with missing data and repeatedly published studies were excluded. In each study the following was assessed: type of study, implant type, number of patients, number of implants, number of implants per patient, use of post-extrac - tion implants, minimum implant length and diameter, type of prosthesis, time until loading, implant survival rate, prosthesis survival rate, marginal bone loss, complications andmean follow-up time. Criteria for patient selection, implant primary stability and bone regeneration were also studied. Results: Thirteen studies were included, reporting a total of 2484 immediately loaded implants in 365 patients. Currently accepted performance criteria regarding patient and implant selection, and surgical and prosthetic pro - cedures were deduced from the reviewed articles. Implant survival rates went from 87.5% to 100%, prosthesis survival rates from 93.8% to 100% and radiographic marginal bone loss from 0.8 mm to 1.6 mm.No intraoperative complications and only minor prosthetic complications were reported. Conclusions: The literature on immediate loading with fixed full-arch prostheses in the maxilla shows that a successful outcome can be expected if adequate criteria are used to evaluate the patient, choose the implant and perform the surgical and prosthetic treatment. Lack of homogeneity within studies limits the relevance of the con - clusions that can be drawn, and more controlled randomized studies are necessary to enable comparison between the immediate and the conventional loading procedures.
- Correlation between permanent tooth eruption pattern and the predominance of the motor function laterality(2014) Veloso Durán, Ana; Vazquez Salceda, Mª Carmen; López Jiménez, Julián; Veloso Durán, Margarita; Puigdollers Pérez, AndreuObjectives: To asses whether dental eruption order can play a role in the early diagnosis of crossed laterality. Study Design: Dental eruption pattern along with eye, ear, hand and foot lateralism were examined on 131 chil - dren between 6 to 8 years old from public schools from a multietnic population area of Barcelona city. Statistic methods (Statgraphics Plus 5.1 program) were used to evaluate data recollected. Results: Only foot and dentition lateralities behave as independent variables regarding hand laterality. So dental eruption laterality (along with the foot one) would be one of the parameters more related to hand laterality given that dentition variable relationship is greater that the foot one. This suggests that tooth eruption could be more clinically relevant. Crossed laterality hand-foot is significantly more predominant in men (13%) than in women (1,6%). Meanwhile, the relationship between hand and dentition didn't show any influence of sex. Conclusions: Dental eruption order, can be used as a good parameter in the determination of the patient's laterality.
- Dental treatment under general anesthesia in a group of patients with cerebral palsy and a group of healthy pediatric patients(2014) Escanilla Casal, Alejandro; Aznar Gómez, Mirella; Viaño, José Mª; López Giménez, Ana; Rivera Baró, AlejandroThis is a comparative study between two groups, one of healthy children and the other of children with cerebral palsy, which underwent dental treatment under general anesthesia at Hospital Sant Joan de Déu Barcelona. The purpose of the study was to compare and determine oral pathology, frequency, severity and postoperative complications in pediatric patients with and without an underlying disease which undergo a dental treatment un - der general anesthesia.
- Influence of bruxism on survival of porcelain laminate veneers(2014) Granell Ruiz, María; Agustín Panadero, Rubén; Fons Font, Antonio; Román Rodríguez, Juan Luis; Solá Ruiz, María FernandaObjectives: This study aims to determine whether bruxism and the use of occlusal splints affect the survival of porcelain laminate veneers in patients treated with this technique. Material and Methods: Restorations were made in 70 patients, including 30 patients with some type of parafunc - tional habit. A total of 323 veneers were placed, 170 in patients with bruxism activity, and the remaining 153 in patients without it. A clinical examination determined the presence or absence of ceramic failure (cracks, frac - tures and debonding) of the restorations; these incidents were analyzed for association with bruxism and the use of splints. Results: Analysis of the ceramic failures showed that of the 13 fractures and 29 debonding that were present in our study, 8 fractures and 22 debonding were related to the presence of bruxism. Conclusions: Porcelain laminate veneers are a predictable treatment option that provides excellent results, rec - ognizing a higher risk of failure in patients with bruxism activity. The use of occlusal splints reduces the risk of fractures.
- Implants in disabled patients: a review and update(2014) Romero Perez, María Jesús; Mang de la Rosa, María Rocío; López Jiménez, Julián; Fernández Feijoo, Javier; Cutando Soriano, AntonioThe range of indications for dental implants has broadened enormously owing to their predictability and the im - provement of patient satisfaction in terms of stability, comfort, aesthetics and functionality. The aim of this article is to review those indications in patients with mental or physical disabilities as the difficulty to cope with oral hygiene often leads to teeth extraction, adding edentulousness to the impairments already present. Following that goal, available literature in Pubmed database, Scopus, Web of Knowledge and The Cochrane Library database about dental implants placement in these patients has been reviewed, assessing the variables of each study: number of patients, sex, average age, oral hygiene, parafunctional habits, impairment, bone quality, protocol of implant surgery, necessity of deep intravenous sedation or general anesthesia, follow-up period and number of failures. The comparison with studies involving other patient populations without mental or physical impediments did not show statistically significant differences in terms of the failure rate recorded. Although there is not much literature available, the results of this review seem to suggest that osseointegrated oral implants could be a therapeutic option in patients who suffer from any physical or psychological impairment. The success of an oral rehabilitation depends mainly on an adequate selection of the patients.
- Proposal for a new staging system for osteoradionecrosis of the mandible(2014) Karagozoglu, Kemal H.; Dekker, Hannah A.; Rietveld, Derek; Bree, Remco de; Schulten, Engelbert A.J.M.; Kantola, Saara; Forouzanfar, Tymour; Waal, Isaäc Van derA new staging system for osteoradionecrosis of the mandible has been retrospectively applied to a group of 31 patients. In this system clinicoradiographic signs and symptoms are incorporated in a simplified manner. For im - aging purposes the use of plain radiographs such as periapical films and panoramic radiographs is recommended, mainly because of their readily availability. The presented staging system seems well reproducible, facilitating the comparison of study groups dealing with the various issues of osteoradionecrosis of the mandible. It is yet to be evaluated whether the presently proposed staging system is useful for management purposes.
- Epidermal growth factor receptor expression in different subtypes of oral lichenoid disease(2014) Cortés Ramírez, Dionisio Alejandro; Rodríguez Tojo, María José; Coca Meneses, Juan Carlos; Marichalar Mendia, Xabier; Aguirre Urízar, José ManuelThe oral lichenoid disease (OLD) includes different chronic inflammatory processes such as oral lichen planus (OLP) and oral lichenoid lesions (OLL), both entities with controversial diagnosis and malignant potential. Epidermal growth factor receptor (EFGR) is an important oral carcinogenesis biomarker and overexpressed in several oral potentially malignant disorders. Objectives: To analyze the EGFR expression in the OLD to find differences between OLP and OLL, and to correlate it with the main clinical and pathological features. Material and Methods: Forty-four OLD cases were studied and classified according to their clinical (Group C1: only papular lesions / Group C2: papular and other lesions) and histopathological features (Group HT: OLP-typical / Group HC: OLP-compatible) based in previous published criteria. Standard immunohistochemical identification of EGFR protein was performed. Comparative and descriptive statistical analyses were performed. Results: Thirty-five cases (79.5%) showed EGFR overexpression without significant differences between clinical and histopathological groups (p<0.05). Histological groups showed significant differences in the EGFR expression pattern (p=0.016). Conlusions: All OLD samples showed high EGFR expression. The type of clinical lesion was not related with EGFR expression; however, there are diff erences in the EGFR expression pattern between histological groups that may be related with a different biological profile and malignant risk.
- Verrucous carcinoma of the oral mucosa: an epidemiological and follow-up study of patients treated with surgery in 5 last years(2014) Candau Álvarez, Alberto; Dean Ferrer, Alicia; Alamillos Granados, Francisco; Heredero Jung, Susana; García García, Blas; Ruiz Masera, J.J.; Arévalo Arévalo, Rafael; Zafra Camacho, F.; Valenzuela Salas, B.Introduction: Oral Verrucous Carcinoma (OVC) is described apart of the Squamous Cell Carcinoma (SCC) due to its specific properties. The objective of our study is to show our series of cases of OVC and to compare with the SCC in terms of clinical manifestations, epidemiology, histopathology, treatment and follow-up. Material and Methods: This is a retrospective study of all the OVC treated in our department between January- 2007 and December-2011. The analyzed variables were sex, age, localization in the oral cavity, histopathology, number of biopsies needed to diagnose OVC, TNM classification, treatment and recurrences during follow-up. Results: Our sample was composed by n=14 patients, 57% female, with a mean age of 69.14 years. The most com - mon localization was buccal mucosa (n=5). Seven patients were diagnosed of OVC with the first biopsy. TNM classification was: pT1: 7 patients, pT2: 3 patients, pT3: 3 patients, pT4: 1 patient. No cervical metastases were observed either in cervical neck dissection or during the follow-up of the patients. The treatment was surgery with clinical resection margins up to 1 cm in all cases, followed by radiotherapy in selected cases. Only n=1 patient (7.69%) presented a recurrence after 34 months of follow-up. The overall survival rate was 92.85%. Conclusions: In our population, OVC represents the 6.16% of all oral cavity and oropharynx cancer, and is more frequent in female patients above 70 years old. It uses to rise over a previous lesion, and usually affects the buccal mucosa. In patients with high suspicious lesions, more than one biopsy may be needed to diagnose OVC. No pa - tient showed cervical dissemination. In our experience, treatment based on local resection, without cervical neck dissection, could be a good option for these patients.
- Mucositis and salivary antioxidants in patients undergoing bone marrow transplantation (BMT)(2014) Bachmeier, Evelin; Mazzeo, Marcelo-Adrián; López, María-Marcela; Linares, Jorge-Alberto; Jarchum, Gustavo; Wietz, Fernando-Martín; Finkelberg, Ana-BeatrizObjectives: High doses of chemotherapy generate DNA damage in patients undergoing bone marrow transplantation (BMT), due to the production of reactive oxygen species (ROS). In order to evaluate the local defensive eff ectiveness of the patient undergoing BMT, the concentrations of the antioxidants superoxide dismutase (SOD) and uric acid (UA) were measured in saliva. Study Design: Basal saliva samples were collected from 20 patients undergoing BMT at the Oncology Department, Sanatorio Allende (Córdoba), in the stages: initial, prior to conditioning therapy (I); middle: 7 to 10 days after BMT (M) and final stage, 30 days after discharge from isolation (F). SOD levels were determined using a RANDOX kit (RANSOD superoxide dismutase manual), and for uric acid enzymatic UOD / PAP spectrophotometric method, ( Trinder Color Kit , Wiener Lab) was used. Results: 85% of the patients developed oral mucositis. SOD concentration in the M stage was significantly higher (p<0.01) compared with stage I, and it reversed in stage F. UA concentration was significantly lower (p<0.001) in stage M compared with stage I, and in stage F it recovered the initial values. Conclusions: SOD increase in stage M coincided with the appearance of mucositis, which could be interpreted as a defensive mechanism of saliva against oxidative stress produced by chemotherapy. UA decrease in stage M would favour the development of high er degrees of mucositis.
- Effect of Erythrina mulungu on anxiety during extraction of third molars(2014) Souto, Maria Luisa Silveira; São-Mateus, Carla-Rocha; Almeida-Souza, Liane-Maciel de; Groppo, Francisco CarlosObjectives: The aim of the present study was to evaluate the effect of Erythrina mulungu on the control of dental anxiety in patients who had under gone bilateral extraction of asymptomatic, impacted mandibular third molars. Material and Methods: In a randomized, double-blind, crossover study, 30 healthy volunteers (5 men and 25 wom - en, over 18 years of age), received either 500mg of E.mulungu (Mulungu Matusa®) or 500 mg of placebo, p.o., one hour before surgical procedure. The level ofanxiety was assessed through questionnaire sand physical parameters, such as blood pressure, heart rate andoxygen saturation. Data were analyzed by Chi-square test, ANOVA (Tukey test) and Friedman with significance level of 5%. Results: A higher preference (Chi-square, p = 0.0062) for E. mulungu was observed for both genders. Volunteers with higher anxiety levels tended to to prefer E. mulungu . No statistically significant differences were verified in blood pressure (one-way ANOVA, p = 0.1259), heart rate (Friedman, p > 0.05) and oxygen saturation (Friedman, p = 0.7664) among periods and types of treatments. Conclusions: E. mulungu showed an anxiolytic effect without significant changes in physiological parameters. It could be considered as an alternative to control the anxiety in adult patients undergoing mandibular thirdmolars su rger y
- Consensus Report of the XI Congress of the Spanish Society of Odontology for the Handicapped and Special Patients(2014) Machuca Portillo, Guillermo; Cabrerizo Merino, María del Carmen; Cutando Soriano, Antonio; Giménez Prats, Mª José; Silvestre Donat, Francisco Javier; Tomás Carmona, InmaculadaThis article summarizes the findings of consensus of the XI congress of the SEOEME. All of these conclusions are referring to the review articles responsible to the general rapporteurs in order to bringing up to date knowledge with regard to the use of implants in patients medically compromised and with special needs and, in the dental management of autism and cerebral palsy, in the dental treatment of patients with genetic and adquired haemato - logical disorders, the dental implications of cardiovascular disease and hospital dentistry.
- The clinical characteristics of benign oral mucosal tumors(2014) Allon, Irit; Kaplan, Ilana; Gal, Gavriel; Chaushu, Gavriel; Allon, Dror M.Objectives: To investigate the clinical characteristics and pre-biopsy provisional diagnoses of benign oral mucosal tumors. Material and Methods: A 10- year retrospective analysis of all benign tumors of the oral mucosa, from a univer- Methods: A 10- year retrospective analysis of all benign tumors of the oral mucosa, from a univer - sity- affiliated oral and maxillofacial surgery department. Results: 146 benign tumors were included. The mean age was 49.6 years, with an approximately equal gender dis - tribution. The most prevalent tumor types were lipomatous tumors (27.4%), vascular (23.3%), and salivary gland tumors (16.5%). Tongue, labial and buccal mucosa were the most frequently involved sites. The vast majority (98.6%) presented as non-ulcerated masses. Only 2 (1.4%) presented as ulcerated masses. The clinical provisional diagnosis correctly classified lesions as non-malignant in 93.3%. In only 9 (6.7%) suspicion of malignancy was in - cluded in the provisional diagnosis. However, benign neoplasia was unsuspected in 42.1% of tumors. These cases were clinically classified as reactive. Conclusions: Benign tumors were most likely to be clinically correctly classified as non-malignant, but even in the setting of experienced oral surgeons, neoplasia was unsuspected in more than 40% of cases. This data strongly supports the need to biopsy every oral mucosal mass, since inaccurate clinical evaluation of the lesion's biological nature was a frequent event.
- Behavioural aspects of patients with Autism Spectrum Disorders (ASD) that affect their dental management(2014) Limeres, Jacobo; Castaño Novoa, Patricia; Abeleira Pazos, María Teresa; Ramos Barbosa, IsabelDental treatment in patients with Autism Spectrum Disorders (ASD) can be complicated due to the presence of behavioral alterations. In this group, there are no specific behavioral profiles that allow dentist to anticipate the attitude that a patient will show during a visit. Thus, behavioral attitudes have been described that vary from total permissiveness and collaboration during even bloody procedures, to the absolute impossibility in conducting a simple oral examination. There is no effective behavioral management technique for all ASD patients. Prior information, such as the type of ASD or the presence of certain concurrent pathologies can help predict the patient's likely behavior. Therefore, gathering all the information in a preliminary interview with the parents/guardians of the patient is recommended. Knowing these factors will allow individualized behavioral management strategies to be designed and facilitates the planning of dental treatment.
- Analysis of 415 adverse events in dental practice in Spain from 2000 to 2010(2014) Perea Pérez, Bernardo; Labajo González, Elena; Santiago Sáez, Andrés; Albarrán Juan, María Elena; Villa Vigil, Manuel AlfonsoIntroduction: The effort to increase patient safety has become one of the main focal points of all health care profes - sions, despite the fact that, in the field of dentistry, initiatives have come late and been less ambitious. The main objective of patient safety is to avoid preventable adverse events to the greatest extent possible and to limit the negative consequences of those which are unpreventable. Therefore, it is essential to ascertain what adverse events occur in each dental care activity in order to study them in-depth and propose measures for prevention. Objectives: To ascertain the characteristics of the adverse events which originate from dental care, to classify them in accordance with type and origin, to determine their causes and consequences, and to detect the factors which facilitated their occurrence. Material and Methods: This study includes the general data from the series of adverse dental vents of the Spanish Observatory for Dental Patient Safety (OESPO) after the study and analysis of 4,149 legal claims (both in and out of court) based on dental malpractice from the years of 2000 to 2010 in Spain. Results: Implant treatments, endodontics and oral surgery display the highest frequencies of adverse events in this series (25.5%, 20.7% and 20.4% respectively). Likewise, according to the results, up to 44.3% of the adverse events which took place were due to predictable and preventable errors and complications. Conclusions: A very significant percentage were due to foreseeable and preventable errors and complications that should not have occurred.
- Topical treatment of oral lichen planus with anthocyanins(2014) Rivarola de Gutierrez, Emilce; Di Fabio, Amanda; Salomón, Susana; Lanfranchi, HéctorBackground: Oxidative stress is involved in oral lichen planus (OLP) pathogenesis; meanwhile anthocyanins are natural antioxidants present in grapes skin. Objectives: The aim of this research was to verify the utility of anthocyanins, extracted from grapes skin, for the local treatment of oral lichen planus and to compare it with clobetasol propionate- neomycin -nystatin cream (CP-NN). Study Design: Prospective, non-randomized study, with control group. Fifty-two patients with OLP were includ - ed. We divided patients into two categories: erosive oral lichen planus (EOLP) and non erosive oral lichen planus (NEOLP). 38 had EOLP (17 cases and 21 controls) and 14 presented NEOLP types (9 cases and 5 controls).Cases received local treatment with anthocyanins from grapes and controls, were treated with CP-NN. The clinical evo - lution of patients was followed up during six months. Results: The patients had a therapeutic response with anthocyanins. This was better than CP-NN treatment for patients with EOLP, in improving the involvement score of the oral mucosa and in the morphometric study of the affected areas. In EOLP there were no statistically significant differences in: therapeutic response time, the evolution of pain, or the relapse rate between the two groups. With respect to the treatment of NEOLP there was improved pain relief in the group treated with anthocyanins. This was not observed with CP-NN. The resting analized variables showed no significant difference with both treatments. Conclusions: OLP has a favorable response to local treatment with anthocyanins from grapes. We found an equal to or better response than with CP-NN treatment. Many of our patients have systemic diseases, which may con - traindicate the use of steroids. With regard to this particular group, the use of this natural antioxidant present in the diet is considered advantageous.
- Alveolar graft in the cleft lip and palate patient: review of 104 cases(2014) Luque Martín, Estela; Tobella Camps, Lluïsa M.; Rivera Baró, AlejandroIntroduction: Alveolar bone grafting is a vital part of the rehabilitation of cleft patients. The factors that have been most frequently associated with the success of the graft are the age at grafting and the pre-grafting orthodontic treatment. Objectives: 1) Describe the cases of alveolar bone grafts performed at the Maxilofacial Unit of Hospital Sant Joan de Déu, Barcelona (HSJD); and 2) Analyze the success/failure of alveolar grafts and related variables. Material and Methods: Descriptive retrospective study using a sample of 104 patients who underwent a secondary alveolar graft at the Craniofacial Unit of HSJD between 1998 and 2012. The graft was done by the same surgeon in all patients using bone from the iliac crest. Results: 70% of the patients underwent the procedure before the age of 15 (median 14.45 years); 70% of the graft patients underwent pre-graft maxillary expansion. A total of 100 cases were recorded as successful (median age of 14.58 years, 68 underwent pre-graft expansion) and only 4 were recorded as failures (median age of 17.62 years, 3 underwent pre-graft expansion). We did not find statistically significant differences in age at the time of grafting or pre-surgical expansion when comparing the success and failure groups. We found the success rate of the graft to be 96.2%. Conclusions: The number of failures was too small to establish a statistically significant conclusion in our sample regarding the age at grafting and pre-grafting expansion. The use of alveolar bone grafting from the iliac crest has a very high success rate with a very low incidence of complications. Existing controversies regarding secondary bone grafting and the wide range of success rates found in the literature suggest that it is necessary to establish a specific treatment protocol that ensures the success of this procedure.
- Indications and contraindications of dental implants in medically compromised patients: update(2014) Gómez de Diego, Rafael; Mang de la Rosa, María Rocío; Romero Perez, María Jesús; Cutando Soriano, Antonio; López-Valverde Centeno, AntonioThe aim of this study was to review the current scientific literature in order to analyse the indications and contrain - dications of dental implants in medically compromised patients. A reference research was carried out on PubMed using the key words "implant" AND (oral OR dental) AND (systemic disease OR medically compromised), in articles published between 1993 and 2013. The inclusion criteria were the following: clinical studies in which, at least, 10 patients were treated, consensus articles, reviewed articles and meta-analysis performed in humans treated with dental implants, and which included the disease diagnosis. A total of 64 articles were found, from which 16 met the inclusion criteria. Cardiac systemic diseases, diabetic endocrine pathologies or controlled metabolic disorders do not seem to be a total or partial contraindication to the placement of dental implants. Tobacco addiction, and head and neck radiotherapy are correlated to a higher loss of dental implants. Patients suffering from osteoporosis undergoing biphosphonates therapy show an increased risk of developing bone necrosis after an oral surgery, especially if the drugs are administered intravenously or they are associated to certain concomitant medication.
