Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2011. Vol. 16, no. 6

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    Oral health-related quality of life of a consecutive sample of Spanish dental patients
    (2011) Montero Martín, Javier; Yarte, José María; Bravo Pérez, Manuel; López-Valverde Centeno, Antonio
    Objectives: Assessment of the oral health-related quality of life and the modulating factors of patients deman-- ding dental treatment in the city of Salamanca, through the use of two validated instruments: the OIDP-sp (Oral Impacts on Daily Performance) and OHIP-14 (Oral Health Impact Profile). Study design: the study was conducted on a consecutive sample of 200 patients aged 18-65 years visiting an Integral Dental Centre in the city of Salamanca. Two validated instruments (OIDP-sp and OHIP-14) were used to measure the oral health-related quality of life. An analogue visual scale was used to register oral satisfaction. Data on sociodemographic background, behavioural and clinical factors were also gathered. ANOVA, T Student Test, and both Pearson and Spearman correlations coefficients were used for the statistical analysis. Results: according to the OIDP, 68.5% suffered from some kind of impact in their oral quality of life, while impact prevalence with the OHIP was 85%. Some other factors influencing the quality of life and degree of satisfaction were revealed. Conclusions: patients over 45 years, regardless of their gender, from high social class, living in rural areas and with poor hygiene, showed higher impact and lower satisfaction. The study also revealed some clinical conditions closely related to the level of satisfaction. © Medicina Oral S. L.
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    No association between periodontal disease and GHQ-12 in a Brazilian Police population
    (2011) Godinho, Eliane Lopes; Farias, Lucyana Conceição; Aguiar, João Carlos Andrade; Martelli Júnior, Hercílio; Bonan, Paulo Rogério Ferreti; Ferreira, Raquel Conceição; De Paula, Alfredo Maurício Batista; Martins, Andréa Maria Eleutério de Barros Lima; Guimaraes, Andre Luiz Sena
    Objectives: We attempt to investigate a possible association between periodontal disease (PD) and mental disorders (MD) in a population of Brazilian Police. Study Method: From a total study population consisting of 803 policemen, 345 police officers were obtained by a sample calculation using the finite population correction who were randomly selected in Montes Claros, Minas Gerais, Brazil. Patients who had been prescribed steroids or those diagnosed with diabetes and cardiovascular diseases were excluded from this study. The General Health Questionnaire (GHQ-12) was used to assess mental disorders. Odds ratios (ORs) for periodontal diseases severity and their respective 95% confidence intervals (CIs) were estimated. The risk of advanced scores in Clinical Attachment Level (CAL) and Community Periodontal Index (CPI) were estimated using Poisson Regression analyses. Results: Only smoking and age were associated with severity in CAL and CPI index. No relation between MD and PD was observed even in different positions within the police department. Conclusions: It was not observed relation between GHQ 12 and the incidence of Periodontal Disease in a Brazi-lian Police population. Classical factors like age and smoking, however, were associated with CAL and CPI index higher scores in this population. © Medicina Oral S. L.
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    Effects of Chamomilla recutita(L.) on oral wound healing in rats
    (2011) Duarte, Carina Magalhães Esteves; Quirino, Maria Rozelide Souza; Patrocínio, Mônica César; Anbinder, Ana Lia
    Objectives. The purpose of this study was to evaluate the effect of Chamomilla recutita on the healing of ulcers in rats. Study Design. A 5-mm wound was inflicted on the tongue of 36 rats. Treatment group animals were treated topically with 0.04 mL/day of chamomile ointment, whereas control group animals were not treated. Animals were sacrificed after 3, 7 or 10 days. Semi-quantitative analysis of the degree of inflammation, fibroblast count and wound size was performed, as well as histometric analysis of re-epithelialization and percentage of collagen fibers of the lesion. Results. Animals treated with chamomile showed the best results regarding epithelialization and percentage of collagen fibers after 10 days. As expected, time had a statistically significant effect(p< 0.05) on fibroblast count, epithelialization, inflammation and wound size; animals sacrificed at 3 days showed the worst results. Conclusions. Chamomile stimulated re-epithelialization and the formation of collagen fibers after 10 days of treatment; it did not, however, influence inflammation or fibroblast count. © Medicina Oral S. L.
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    Extractions without eliminating anticoagulant treatment : a literature review.
    (2011) Rodríguez Cabrera, Manuel Alejandro; Barona Dorado, Cristina; Leco Berrocal, María Isabel; Gómez Moreno, Gerardo; Martínez González, José María
    To establish whether there is a high enough risk of bleeding in patients who take oral anticoagulants, such that it would justify not using oral anticoagulants when performing a dental extraction, as well as if the reason for and anatomical location of the extraction increases such risk. Study We performed a bibliographic search in order to carry out a meta-analytic study using descriptive statistics. We compiled a sample of 1194 patients from the articles selected. Of these patients, a total of 2392 simple, serial surgical extractions were performed; none of the patients interrupted their anticoagulant treatment with warfarin sodium. Of the sample, 83 patients presented a certain degree of bleeding; in 77 of such cases, the bleeding was controlled with local hemostasis, whereas 6 patients required their dose of oral anticoagulants to be adjusted. There was a higher incidence of bleeding in patients presenting a periodontal pathology, compared to deep caries and pericoronitis. Patients being treated with oral anticoagulants represent a risk that we should be aware of, but local hemostasis has proven to be effective when performing extractions, provided that the INR value is less than 4. There is an increased incidence of bleeding in patients with periodontal problems, due to the greater presence of inflammation in the soft tissues. If the extraction is performed in the maxilla, the incidence of hemorrhagic complications is slightly higher than in the mandible, although this difference is considered to be insignificant.
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    Denture-related oral mucosal lesions among farmers in a semi-arid Northeastern region of Brazil
    (2011) da Silva, Heitor Fontes; Martins Filho, Paulo R.; Piva, Marta R.
    Objectives: The purpose of this study was to evaluate the prevalence of denture-related oral mucosal lesions (DML) in São Francisco sertão microregion, in Sergipe State, Northeastern Brazil. Study Design: Data related to gender, age, type of denture, length of denture use, hygiene care, nocturnal denture wear, symptoms, and presence of DML were obtained. Statistical analysis included the Pearson's chi-square and multivariate logistic regression. Results: The global prevalence of DML was 50%, with a significant association between the DML and female gender, age ? 40 years, and length of use ? 5 years. By using the interaction model of logistic regression it was observed that females over 40 years have 4.5 greater odds of developing DML compared to males of the same age group. The DML more common was the type 2 denture stomatitis, followed by type 1 denture stomatitis and inflammatory fibrous hyperplasia. Conclusions: This study shows that the DML are more common in female over 40 years of age, suggesting that hormonal chances and age-related factors may favor the development of lesions. In addition, there is a significant association between length of denture use and prevalence of DML. © Medicina Oral S. L.
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    Preemptive analgesic effectiveness of oral ketorolac plus local tramadol after impacted mandibular third molar surgery
    (2011) Isiordia Espinoza, Mario; Pozos Guillén, Amaury de Jesús; Martínez Rider, Ricardo; Herrera Abarca, Jorge E.; Pérez Urizar, José Trinidad
    Objective: The aim of this study was to compare preemptive analgesia of oral ketorolac plus submucous local placebo with oral ketorolac plus submucous local tramadol after impacted mandibular third molar surgery. Study design: A double-blind, randomized, placebo-controlled clinical trial was conducted. Patients were randomized into two treatment groups (n = 15 per group): group A, oral ketorolac 10 mg, 30 minutes before surgery plus submucous local placebo (1 mL saline solution); group B, oral ketorolac 10 mg, 30 minutes before surgery plus submucous local tramadol (50 mg diluted in 1 mL saline solution). We evaluated the intensity of pain, time for the first analgesic rescue medication, and total analgesic consumption. Results: Pain intensity, number of patients requiring analgesic rescue medication, number of patients in each group not requiring analgesic rescue medication, and total analgesic consumption showed statistical significance. Conclusions: Preemptive use of oral ketorolac plus submucous local tramadol is an alternative treatment for acute pain after surgical removal of an impacted mandibular third molar. © Medicina Oral S. L.
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    Dental implants in patients with oral mucosal alterations : an update
    (2011) Candel Martí, Eugenia; Ata-Ali Mahmud, Francisco Javier; Peñarrocha Oltra, David; Peñarrocha Diago, María; Bagán Sebastián, José Vicente
    Objective: To determine whether a series of diseases of the oral mucosa - Sjögren syndrome, ectodermal dysplasia, epidermolysis bullosa and lichen planus - reduce the survival rate of dental implants. Material and Method: A Medline search was carried out using the key words: "Sjögren syndrome", "ectodermal dysplasia", "epidermolysis bullosa", "lichen planus" and "dental implants", including those publications involving clinical series comprising more than one patient with the mentioned disorders and treated with dental implants, in the last 10 years. Results: The study included three articles involving patients with Sjögren syndrome subjected to dental implant treatment, representing a total of 12 patients and 86 implants, with a mean pondered success rate of 86.33%. As regards ectodermal dysplasia, we included 14 articles, of which 11 corresponded to clinical series, two were reviews and one constituted a survey of dental professionals. The percentage success rate of the implants varied between 35.7-100%. In relation to epidermolysis bullosa, we included 6 articles corresponding to clinical series, with a total of 16 patients and 92 implants, and a success rate between 75-100%. In the case of oral lichen planus we found only two articles corresponding to clinical case series, with a total of 5 patients and 14 implants, and an implant survival rate of 100%. Conclusions: Based on our review of the literature, dental implant rehabilitation in patients of this kind is seen to be a valid treatment option, with a high percentage success rate. Long-term patient follow-up is essential in order to periodically monitor the condition of the disease and of the implants. © Medicina Oral S. L.
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    The expression of heat shock proteins 27 and 105 in squamous cell carcinoma of the tongue and relationship with clinicopathological index
    (2011) Mohtasham, Nooshin; Babakoohi, Shahab; Montaser Kouhsari, Laleh; Memar, Bahram; Salehinejad, Jahanshah; Rahpeyma, Amin; Khageh Ahmady, Saeedeh; Marouzi, Parviz; Firooz, Alireza; Pazoki Toroudi, Hamidreza; Anvari, Kazem
    Introduction: In oral cavity, the tongue is the most common site prone to development of squamous cell carcinoma (SCC). Considering malignant transformation as a cellular stress, the expression of heat shock proteins (HSPs) may be affected in this process. In this study we assessed the expression of HSP105 and HSP27 as two of the most interested stress proteins and investigated their relationship with grade and stage of the tongue SCC. Material and Methods: Fifty-six specimens including 31 early and 25 advanced tongue SCC were gathered. All specimens were graded histologically from I to III. Sixteen sections of normal oral mucosa were used as control group. The cellularity and intensity of HSP105 and HSP27 expression were studied immunohistochemically in both case and control groups. Results were expressed by histochemical score (HSCORE). Results: Significant differences were observed between expression of HSPs and stage of the disease. From early to advanced stage, the expression of HSP105 and HSP27 increased and decreased, respectively. There was no relationship between histological grade of lesion and HSCORE of HSP105 expression (P=0.5), although, HSP27 expression had reverse relationship with the SCC histological grade. Conclusion: HSP27 and HSP105 may be indicated for prognostic purposes in evaluation of tongue SCC. HSP 27 may be used for more accurate microscopic grading of tongue SCC. Increased expression of HSP105 in advanced stage may lead to using this protein for immunotherapy of tongue SCC. © Medicina Oral S. L.
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    In vitro evaluation of the efficacy of two bleaching procedures
    (2011) Llambés Arenas, Gonzalo; Llena Puy, María Carmen; Amengual Lorenzo, José; Forner Navarro, Leopoldo
    Objective: In vitro comparison of the efficacy of two bleaching procedures, one based on carbamide peroxide (CP) and the other on hydrogen peroxide (HP), simulating clinical conditions. Study Design: Two groups of 20 teeth in each group were selected. Group A: 22% CP, one hour a day for 21 consecutive days. Group B: 37.5% HP, in 2 treatment sessions with an one week interval between each session. At each session the product was applied three successive times for eight minutes. Colour was recorded before treatment, when it was finished and one week after finishing it, with the Vita EasyShade spectrophotometer. CIEL*a*b* and ?E were established at each moment in the study. Intra-group data was compared using the paired t-test and inter-group data with the independent groups t-test. Scores from the Vita Classical guide provided with the device were recorded and the colour improvement percentage was calculated. Results: In both groups significant whitening was achieved by the end of treatment. Lightness remained significantly high when treatment was finished and one week after in both groups. The percentage of bleaching was significantly higher in group A. Conclusions: Both 22% CP and 37.5% HP were effective for bleaching teeth. Bleaching effect was greater in CP group. © Medicina Oral S. L.
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    Jacob's disease secondary to coronoid process osteochondroma. A case report
    (2011) Coll Anglada, Manel; Acero Sanz, Julio Jesús; Vila Masana, Irene; Navarro Cuéllar, C.; Ochandiano Caycoia, Santiago; López de Atalaya Gutiérrez, Javier; Navarro Vila, C.
    The formation of a new joint between a pathologically elongated coronoid process and the body of the malar homolateral bone is known as Jacob's disease. Coronoid process hyperplasia was first described in 1853 by Von Langenbeck, and it was not until 1899 when Oscar Jacob described the disease that it was named after him. Jacobs's disease is an uncommon entity with only a few documented cases in the literature. The condition first manifests with progressive limitation of mouth opening and facial asymmetry. Pain is uncommon and it mainly affects young patients. Different factors have been postulated as possible causes, including temporal muscle hyperactivity, previous trauma, chronic disc displacement of the ipsilateral temporomandibular joint, endocrine stimuli, and genetic alterations. Definitive diagnosis is by histopathology and it is necessary to confirm bone hyperplasia, the presence of cartilage and synovial capsule forming the new joint between the malar bone and the coronoid process. We report a 52-year-old woman patient with a history of childhood trauma in the right preauricular region. She came to our department with a 2-year history of progressive limitation of mouth opening. Computed tomography (CT) revealed a right coronoid process elongation, in contact with the homolateral malar bone, causing it to deform. Surgery with general anesthesia was performed using an intraoral vestibular approach. Histopathology confirmed the diagnoses of Jacob's disease. © Medicina Oral S. L.
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    The status of dental caries and related factors in a sample of Iranian adolescents
    (2011) Pakpour, Amir H; Hidarnia, Alireza; Hajizadeh, Ebrahim; Kumar, Santhosh; Harrison, Adrian Paul
    Objective: To describe the status of dental caries in a sample of Iranian adolescents aged 14 to 18 years in Qazvin, and to identify caries-related factors affecting this group. Study design: Qazvin was divided into three zones according to socio-economic status. The sampling procedure used was a stratified cluster sampling technique; incorporating 3 stratified zones, for each of which a cluster of school children were recruited from randomly selected high schools. The adolescents agreed to participate in the study and to complete a questionnaire. Dental caries status was assessed in terms of decayed teeth (DT), filled teeth (FT) and decayed, missing and filled teeth (DMFT). A multivariate regression analysis was used to determine statistically significant associations between DMFT and other variables. Results: The study sample comprised 380 adolescents, 188 (49.5%) being male. The mean age of the adolescents was 15.42 (SD= 1.1) years, and the mean DMFT was 2.61 (SD=1.89). Boys had significantly higher DMFT scores than girls (P<0.05). The multivariate regression analyses revealed a significant relation between high DMFT scores and such variables as increasing age, male gender, lower levels of parental education, higher family income, lower frequency of tooth brushing and dental flossing, having a history of no visits to the dentist, and bad perception of own oral health. Conclusions: The present study reveals that Iranian adolescents have a poor oral hygiene, as very few subjects brush and floss their teeth on a regular basis. Although the incidence of caries was found to be moderate, it was influenced by demographic factors such as age and gender in addition to socio-behavioral variables such as fami-ly income, the level of education attained by parents, the frequency of dental brushing and flossing, and both the frequency and type of visit to a dentist. © Medicina Oral S. L.
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    Clinical-therapeutic management of drooling : review and update
    (2011) Silvestre Rangil, Javier; Silvestre Donat, Francisco Javier; Puente Sandoval, A.; Requeni Bernal, Juan; Simo Ruiz, Juan Manuel
    Drooling is the uncontrolled leakage of saliva outside the mouth, generally as a result of difficulty in swallowing the saliva produced. Many factors contribute to drooling, though it is more commonly seen in children with brain paralysis - particularly those receiving anticonvulsivant medication. Drooling is also often seen in patients with lip sealing problems or malocclusions such as anterior open bite. Clinically, the affected patients can develop skin irritation or abrasions, problems of hygiene, unpleasant smell and - in the more severe presentations - the need to wear protectors or frequently change clothing. Treatment of this disorder is complex, and should be addressed from a multidisciplinary perspective, with planning on an individualized basis. Among the different existing managements, myofunctional therapy, behavioral change programs and drug treatments are the most widely used options, though there are also more invasive surgical techniques designed to reduce or cause submandibular saliva secretion to be rerouted towards posterior zones of the oral cavity. In any case, no scientific evidence-based management protocol has yet been established capable of affording favorable results in the majority of cases. The present study offers a review and update on the clinical and dental management aspects of drooling. © Medicina Oral S. L.
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    The correlation between the severity of radiotherapy-induced glossitis and endothelial cell injury in local tissues in a rat model
    (2011) Li, Chun-Yang; Hong, Yun; Tao, Xiao-An; Xia, Juan; Cheng, Bin
    Objectives: To explore the correlation between the severity of radiotherapy-induced glossitis (RTG) and endothelial cell injury in local tissues in a rat model. Study Design: The RTG animal model was designed and used by our team. The Oral mucositis index(OMI) was documented daily. Immunohistochemistry (IHC) Staining of CD34 was utilized to identify endothelial cells in the RTG tissues. Apoptosis of endothelial cells in local lesions due to RTG was detected by the TUNEL assay. The dynamic relationship between the OMI and apoptotic endothelial cells was statistically analyzed by time. Results and Conclusions: The injury and apoptosis of endothelial cells were observed 3 day post-irradiation. The vascular lumens of the post-irradiation tongue lesions were irregular; thrombosis formation in the center of the lumens, unsmooth lumen walls and vasodilated vessels were observed. Also, endothelial cells detached from the basal membrane and were found in the lumens. The percentages (%) of apoptotic endothelial cells were 78.3±0.31 (5 day); 89.3±0.83 (8 day); 83.5±0.41 (14 day); 69.3±0.57 (21 day); and 47.3±0.59 (28 day). The OMI was correlated with the percentage of apoptotic endothelial cells (R=0.67, P=0.034). Summary, endothelial cell injury was correlated with the pathogenic condition of RTG. © Medicina Oral S. L.
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    Periodontal disease and diabetes : review of the literature
    (2011) Bascones Martínez, Antonio; Matesanz Perez, Paula; Escribano-Bermejo, Marta; González Moles, M.A.; Bascones Ilundain, Jaime; Meurman, Jukka H.
    Aims: To provide updated knowledge on the relationship between periodontal disease and diabetes from an oral health perspective. Methods: A review of the English-language literature was performed, gathering articles on the two diseases published over the past 10 years. Results: Both diseases result from the confluence of various triggering and modifying factors, and there are inter-individual differences in the risk of their development. Recent research has shown that diabetes may increase the risk of periodontitis, and it has been proposed that chronic periodontal disease may influence the natural course of diabetes. There appears to be an association among oral infections, impaired sugar metabolism, and atherosclerosis, indicating a theoretical link between metabolic syndrome and periodontal disease. Clinical implications: Control of periodontal disease may enhance glycemic control in patients with type 2 diabetes. In turn, improved glycemic control may contribute to a better control of periodontal disease. © Medicina Oral S. L.
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    Merkel cell carcinoma : our experience in this rare pathology
    (2011) Rosado Rodríguez, Pablo; Junquera Gutiérrez, Luis Manuel; Vivanco Allende, B.; García Consuegra, Luis; Gallego, Lorena
    Merkel cell carcinoma (MCC) was first described in 1972 by Toker, who described five cases of the so-called "trabecular carcinoma of the skin". MCC is a rare, aggressive skin cancer that affects mainly the elderly. Sun exposed areas are mainly affected, specially the head and neck. Immunohistochemical analysis is essential to reach a correct diagnosis. According to the origin of MCC, the tumor expresses both epithelial and neuroendocrine markers. MCC has a propensity for recurrence, regional and distant metastases. Several treatment options are available, such as surgical excision or Moh's surgery, accompanied by neck dissection or radio and chemotherapy in advanced cases. The present study aims to evaluate the clinical behaviour and the evolution of five cases of this disease that were treated at our institution (reference to 1100000 inhabitants) in the last five years. It is stressed on the bad prognosis of this pathology, which presents high rates of locoregional recurrence, even though the recent advances in radio and chemotherapy. © Medicina Oral S. L.
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    Tooth size changes with age in a Spanish population : percentile tables
    (2011) Paulino, Vera Susana; Paredes Gallardo, Vanessa; Cibrián Ortiz de Anda, Rosa María; Gandía Franco, José Luis
    Objectives: The aims of this work were: firstly, to draw up tables of percentile tooth sizes similar to those of Sanin and Savara for three age groups of a Spanish population; secondly, to describe changes in tooth size between those groups over time, as well as observing any sexual dimorphism and, finally, to compare both the Spanish and Sanin and Savara's American population samples. Material and methods: The sample included 359 patients and was divided into three age groups: adolescents, young adults and adults, of both genders. After dental cast digitalization, mesiodistal tooth-size was measured on each dental cast using a digital method. Dental size tables organized by percentiles for each group of age and gender were drawn up. Percentiles under 30 were considered as small, between 30 and 70 as average, and above 70 as large. As symmetry was found between contralateral teeth, the mean between the teeth of the two semi-arches was considered. Results: The mesiodistal tooth sizes of adolescents did not present statistically significant differences between genders, in contrast to the two other age groups. Conclusions: Mesiodistal tooth diameters tended to diminish with age, especially in women, in the Spanish population. The values obtained for our dental tables, organized by percentiles, were slightly higher than those found by Sanin and Savara in an American population, especially for women. © Medicina Oral S. L.
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    Patient safety in dentistry : dental care risk management plan
    (2011) Perea Pérez, Bernardo; Santiago Sáez, Andrés; García Marín, Fernando; Labajo González, Elena; Villa Vigil, Manuel Alfonso
    Objectives: Although the safety of patients has been one of the inherent concerns of dental practice, but because the proposals made in the field of dentistry are few and improperly structured, this paper constitutes an attempt to present a proposal titled "Plan for Dental Health Care Risk Management," promoted by the General Council of Dentists of Spain, including a description of the proposed work methodology. Design: The "risk management plan" proposed in this paper is based on applying the basic concepts dealt with in patient safety to the field of dentistry, due to the fact that the available bibliography contains no specific "health care risk management plan" for dentistry specifically. Results and conclusions: In order to implement health care risk management in the field of dental care provided at any level throughout Spain, a seven-step plan which covers the main objectives in Patient Safety is provided. © Medicina Oral S. L.
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    Immediate temporary restoration of single-tooth implants : prospective clinical study
    (2011) Aguirre Zorzano, Luis Antonio; Rodríguez Andrés, Carlos; Estefanía Fresco, Ruth; Fernández Jiménez, Aitziber
    Purpose: The goal of this study is to assess the survival, marginal bone loss and complications around sing le-tooth implants on which immediate provisionalization was carried out. Patients and Methods: 78 implant were placed in 57 patients: 56 after extraction and 22 in healed sockets. Immediately after surgery provisional crowns were delivered without contacts in both centric and excursive jaw movements. The final crowns were inserted between 3 to 6 months later. During the study there were 3 x-rays taken per patient. The marginal bone loss was measured and complications were recorded. The statistical analys is of the data was carried out with the STATA 10® software. Results: The mean duration of the study was 92 weeks. Survival rate was 98.7% (1 failure out of 78 implants). The mean mesial bone loss was 0.2±0.4 mm and the mean distal bone loss was 0.2±0.4 mm. No statistically significant diff erences were found between immediate or delayed implants. 67 implants sh owed a bone loss less than 1 mm, and 36 did not sh ow any bone loss at all. The main complications were the uncementing of the crowns (11 crowns), the presence of cement remnants (10 crowns) and the development of apical lesions around implants (6 implants). Conclusion: With the limitations of this study, it can be concluded by saying that immediate restoration with sing le-tooth implants and provisional crowns may be cons idered as a predictable technique. © Medicina Oral S. L.
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    The influence of platform switching on the biomechanical aspects of the implant-abutment system. A three dimensional finite element study
    (2011) Canullo, Luigi; Pace, Francesco; Coelho, Paulo G.; Sciubba, Enrico; Vozza, Iole
    Objective: To evaluate the biomechanical scenario of platform switching geometric implant-abutment configuration relative to standard configurations by means of finite element analysis.Study Design: A 3D Finite Element Analysis (FEA) was performed on 3 different implant-abutment configurations: a 3.8 mm implant with a matching diameter abutment (Standard Control Design, SCD), a 5.5 mm implant with matching diameter abutment (Wider Control Design, WCD), and a 5.5mm implant with a 3.8 mm abutment (Experimental Design, ED). All the different experimental groups were discretized to over 60000 elements and 100000 nodes, and 130N vertical (axial) and 90N horizontal loads were applied on the coronal portion of the abutment. Von Mises stresses were evaluated and maximum and minimum values were acquired for each implantabutment configuration. Results: The load-induced Von Mises stress (maximum to minumum ranges) on the implant ranged from 150 MPa to 58 Pa (SCD); 45 MPa to 55 Pa (WCD); 190 MPa to 64 Pa (ED). The Von Mises stress on the abutment ranged from 150 MPa to 52 MPa (SCD); 70 MPa to 55 MPa (WCD), and 85 MPa to 42 MPa respectively (ED). The maximum stresses transmitted from the implant-abutment system to the cortical and trabecular bone were 67 Pa and 52 MPa (SCD); 54 Pa and 27 MPa (WCD); 64 Pa and 42 MPa (ED), respectively. When the implant body was evaluated for stresses, a substantial decrease in their levels were observed at the threaded implant region due to the diametral mismatch between implant and abutment for the ED configuration. Conclusion: The platform switching configuration led to not only to a relative decrease in stress levels compared to narrow and wide standard configurations, but also to a notable stress field shift from bone towards the implant system, potentially resulting in lower crestal bone overloading. © Medicina Oral S. L.
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    Multiple odontogenic abscesses. Thoracic and abdomino-perineal extensión in an immuno competent patient
    (2011) Arias Chamorro, Bartolomé; León Camacho, María De Los Ángeles; Acosta Moyano, A.; Ruiz Delgado, F.; Bermudo Añino, Lucas; Valiente Álvarez, Antonio
    Introduction: Odontogenic infection (OI) may lead to death if it extends beyond the buccal area. The virulence of pathogens and the local and systemic status of the patient influence the propagation of the pathogen, either by anatomical continuity or haemematogenous dissemination. Several severe complications derived from OI have been reported in the head, neck and chest. However, OI with an abdominal component, caused by bacteraemia with dental foci or the direct passage of pus from the thorax to the abdomen, are unusual. Case report: We present the case of a young immunocompetent woman who, after false cure of an odontogenic abscess, again reported gynaecological symptoms. A network of connected abdomino-perineal, thoracic and cervical abscesses was discovered. Discussion: The peculiarity and severity of this case is a reminder that treatment of an abscessed OI should include intravenous broad-spectrum antibiotics, together with surgical drainage of the purulent collections. Samples should be taken for culture and an antibiogram in order to use specific antibiotics if the initial empirical therapy shows resistance. The diagnosis and follow-up should be by CT, which in our patient showed anatomical continuity of the abscesses from the dental focus. The time sequence of the symptoms, in the absence of any other infectious cause, revealed the descending odontogenic nature of the process. © Medicina Oral S. L.