Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2008. Vol. 13, no. 4

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    Cement system and surface treatment selection for fiber post luting
    (2008) Monticelli, Francesca; Ferrari, Marco; Toledano Pérez, Manuel
    This literature review summarizes the recent research on fiber posts and provides information regarding their bonding to resinous cement or composites, based on the results of original scientific full-papers from peer-reviewed journals listed in Pub Med. The search was conducted evaluating the different materials available for luting fiber posts to radicular dentin. A consistent number of in vitro studies investigating different combinations of adhesive systems and luting agents for improving bond strength have been published so far. Their results have been summarized in the following categories: conventional resinous cements and self-adhesive cements. Low bond strength values and the lack of long-term clinical data limit the application of recently marketed self-adhesive cements. The choice of the total-etch technique using dual-curing adhesive systems and cements represents the most predictable methodology for luting fiber posts. Particular attention has been deserved also to the post surface treatment for improving their adhesiveness: the methodology may include chemical and/or micro-mechanical treatments. The majority of available literature data is based on studies that investigated different ?chair-side? post superficial treatments. According to the in vitro results, surface conditioning improves fiber post bonding properties and bond strength of pre-treated fiber posts to restorative materials is satisfactory. Long-term clinical studies are needed prior to making a general recommendation for their use.
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    Electromyographic comparisons between clenching, swallowing and chewing in jaw muscles with varying occlusal parameters
    (2008) Moreno Hay, Isabel; Sánchez Sánchez, Teresa; Ardizone García, Ignacio; Aneiros, Fernando; Celemín Viñuela, Alicia
    The aim of this study is to determine the influence of Angle molar class, presence of a posterior crossbite, anterior guidance, as well as gender in the muscular activity of the masticatory system in a population of healthy dental students. Study design: Surface electromyography recordings are made for the masseter, anterior and posterior temporalis and digastric muscles; in three different tests: clenching at maximum intercuspation, swallowing and chewing. Results: The results obtained show that: men achieve a higher masseter activity at maximum effort than women. Women achieve higher values than men, for the digastric muscles in deglution. Angle class II show higher activity than other classes for the temporalis muscle in deglution, while class III show higher activity than other classes for all muscles in maximum effort. The anterior guidance does not cause significant differences. The presence of a posterior crossbite affects the behaviour of anterior temporalis and masseter muscles. Conclusion: The results of this study show the influence of the occlusal parameters on the muscular activity of the stomatognatic system.
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    Dentinal sensitivity : concept and methodology for its objective evaluation
    (2008) Martínez Ricarte, José; Faus Matoses, Vicente; Faus Llácer, Vicente; Flichy Fernández, Antonio; Mateos Moreno, B.
    Dentinal sensitivity is a clinical condition of some importance, particularly in periodontal patients. Symptoms appear on applying a triggering stimulus to the exposed dentine - the particularity being that the pain is similar to that of other dental disorders of different etiology and treatment. Hence the importance of a correct differential diagnosis. The main problem not only in clinical practice when treating the disorder, but also in designing studies for the objective evaluation of dentinal sensitivity, is the difficulty of standardizing, evaluating and interpreting the clinical condition in its different degrees. Thus, consensus in designing and evaluating studies of dentinal sensitivity would facilitate our understanding of its etiology, and the assessment of possible treatments. Such studies may center their methodology on individual patient response or on the nature of the triggering stimulus. The present study provides an updated and global view of the disorder, and reviews the basic protocol for the objective assessment of dentinal sensitivity.
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    The impact of low power laser in the treatment of conditioning-induced oral mucositis : a report of 11 clinical cases and their review
    (2008) Antunes, Héliton Spíndola; Ferreira, Elza Maria de Sá; Matos, Valkiria D Aiuto de; Pinheiro, Claudia Tereza; Ferreira, Carlos Gil
    We have investigated the clinical effects of low power laser therapy (LPLT) on the treatment of conditioning-induced oral mucositis (OM) in patients submitted to hematopoietic stem cell transplantation (HSCT). The evaluation of OM was done using the Oral Mucositis Assessment Scale (OMAS) and World Health Organization (WHO) scale. In the context of a randomized placebo-controlled trial with 38 patients for the evaluation of preventive LPLT, eleven individuals were submitted to allogeneic (AL) HSCT and developed oral mucositis grade 4 (WHO) or a total area of OM of 12 cm (OMAS) and due to that were treated with LPLT with the purpose of symptom relief. The irradiation used was a diode InGaAlP, emitting light at 660 nm, 50 mW and 8 J/cm² measured at the end of fiber optic with 0.196cm² of section area during the treatment. The tip of the laser device touched the oral mucosa and patients recovered on average 6 days (3-12 days) from the beginning of the laser application. Our results have indicated that the use of LPLT in HSCT patients is a powerful instrument in the treatment of overt OM and is now a standard procedure in this group of patients in our hospital.
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    Metaanalysis of filler materials in periapical surgery
    (2008) Fernández-Yáñez Sánchez, Ángela; Leco Berrocal, María Isabel; Martínez González, José María
    Objective: To evaluate the success and failure, apical sealing and biocompatibility of silver amalgam, IRM®, SuperEBA® and MTA as retrograde filler materials. Study design: A metaanalysis is made of filler materials in periapical surgery, evaluating a total of 30 articles published in recent years. Results: Percentage success with silver amalgam was 76.5% and slightly inferior to that afforded by IRM®. Performance in turn increased considerably when the materials used were SuperEBA® or MTA. As regards marginal leakage, MTA with a mean leakage time of 65.5 days afforded the best results, followed by SuperEBA®, IRM® and silver amalgam. MTA was the most biocompatible of the materials studied, with practically no inflammatory response, while inflammation proved mild or moderate with SuperEBA®, mild with IRM®, and moderate to severe in the case of silver amalgam. Tissue regeneration was only observed with MTA, in the same way as cement appositioning. Bone neoformation was observed with all four filler materials. Conclusions: MTA appears to be an ideal material, though the results obtained require confirmation by in vivo studies.
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    Submental intubation in oral maxillofacial surgery : review of the literature and analysis of 13 cases
    (2008) Caubi, Antonio Figueiredo; Vasconcelos, Belmiro Cavalcanti; Vasconcellos, Ricardo José de Holanda; Morais, Hecio Henrique Araújo de; Rocha, Nelson Studart
    Objectives: Various different methods of intubation are suitable for facial trauma cases. A choice often has to be made between orotracheal and nasotracheal when surgical access to the nasal or oral cavity is necessary. This work presents our current experience using submental intubation in the airway management of facial trauma patients. Study design: From July 2003 to February 2005, 13 sufferers from facial trauma benefited from submental intubation. All the patients were males and the ages ranged from 19 to 35 years (mean, 27 years). Results: In all the patients, the submental intubation permitted simultaneous reduction and fixation of all fractures and intraoperative control of the dental occlusion without interference from the tube during the operation. There was only one intra-operative complication, when the tracheal pressure increased as a result of deviation and compression of the tube. No post-operative complications were reported. Conclusion: Submental intubation is a simple, secure and effective procedure for operative airway control in major maxillofacial traumas.
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    Metastatic benign pleomorphic adenoma : report of a case and review of the literature
    (2008) Rodríguez Fernández, Javier; Mateos Micas, Mario; Martínez Tello, Francisco J.; Berjón, Jennifer; Montalvo Moreno, J.J.; Forteza González, Gabriel; Galán Hernández, Ramón
    Pleomorphic adenoma (PA), originally called mixed tumour, is the most common neoplasm of the salivary glands and is generally accepted as benign biologically. Occasionally PA may give rise to metastasis. The metastasis may develop in a PA in which a malignant transformation occurs, either arising a carcinoma in the PA (carcinoma ex-mixed tumour) or as a carcinosarcoma (so?called true malignant mixed tumour). However, very rare benign PA eventually metastasise, usually after having a previous recurrence, displaying benign histological features as well in the primary tumour as in the metastasis. These tumours have been termed metastatic PA or metastatic mixed tumours. The aim of this paper is to report one case of metastatic histological benign pleomorphic adenoma, and to consider the clinical, pathological and therapeutic consequences of these rare tumours as well as its possible causes and mechanisms for its behaviour.
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    An update on the management of anticoagulated patients programmed for dental extractions and surgery
    (2008) Jiménez Soriano, Yolanda; Poveda Roda, Rafael; Gavaldá Esteve, Carmen; Margaix Muñoz, María; Sarrión Pérez, María Gracia
    Oral anticoagulants (OACs) antagonizing vitamin K - fundamentally sodium warfarin and acenocoumarol - are widely used for preventing arterial thromboembolism in patients with atrial fibrillation and/or heart valve prostheses, and for the treatment and prevention of deep venous thrombosis and pulmonary embolism. The handling of these drugs requires correct monitorization and dose adjustment to obtain the desired therapeutic effect while minimizing the adverse effects associated both with excessive anticoagulation (which leads to bleeding) and with insufficient antithrombotic action (which can produce thrombosis). This is particularly important when patients must be subjected to surgical procedures such as tooth extractions. In this context, a number of management recommendations are available. The present study offers an update on the recommendations for the management of anticoagulated patients programmed for tooth extractions. In recent years, most studies do not recommend reducing or interrupting anticoagulation, or replacing it with heparin, prior to tooth extraction - provided therapeutic international normalized ration (INR) levels are maintained, with emphasis on the application of local measures such as antifibrinolytic agents, for the control of hemostasia.
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    Traumatic neuroma of the inferior alveolar nerve : a case report
    (2008) Arribas-García, Ignacio; Alcalá-Galiano Rubio, Andrea; Gutiérrez, Ramón; Montalvo Moreno, J.J.
    Traumatic neuromas are rare entities which characteristically arise subsequently to surgery and are usually accompanied by pain, typically neuralgic. We present an unusual case of an intraosseous traumatic neuroma of the inferior alveolar nerve following tooth extraction. A 56-year-old man consulted for paresthesias and hyperesthesia in the left mandibular region following extraction of the left mandibular third molar (#38). The panoramic radiograph revealed a radiolucent lesion in the inferior alveolar nerve canal, and CT demonstrated the existence of a mass within the canal, producing widening of the same. Nerve-sparing excisional biopsy was performed. Histopathology and immunohistochemistry were consistent with traumatic neuroma of the left inferior alveolar nerve. After 3 years of follow-up, the patient is asymptomatic and there are no signs of recurrence.
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    Drug-induced burning mouth syndrome: a new etiological diagnosis
    (2008) Salort Llorca, Cesar; Mínguez Serra, María Paz; Silvestre Donat, Francisco Javier
    Burning mouth syndrome (BMS) is defined as a burning sensation of the oral mucosa, in the absence of specific oral lesions. The underlying etiology remains unclear. Peripheral alterations may be related to the density or reactive capacity of the oral mucosal membrane receptors - these being largely influenced by BMS-related risk factors such as stress, anxiety, the female gender, climacterium and advanced age. The present study compiles the cases of BMS induced by drugs reported in the literature, and attempts to draw a series of conclusions. A search was conducted in the PubMed® database using the following key words: burning mouth syndrome, drug-induced, antihypertensive and chemically-induced. The search was carried out in April 2007. The literature yielded clinical cases in which oral burning sensation is described after the administration of drugs belonging to different therapeutic groups: antiretrovirals, antiseizure drugs, hormones and particularly antihypertensive medication. Curiously, among the different types of antihypertensive drugs, BMS was only associated with those compounds that act upon the angiotensin-renin system.
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    A new cephalometric diagnostic method for Down?s Syndrome patients with open bite
    (2008) Alió Sanz, Juan José
    Vertical cephalometric analysis is a new cephalometric diagnostic method, created and studied by the author, which allows us to identify objectively the dental and skeletal components found in certain types of open bites. Down?s Syndrome patients frequently have this type of malocclusion which produces a significant dysfunction of the whole stomatognathic system. The primary complication of the treatment lies in the difficulty of identifying exactly how much of an open bite is dental and how much is skeletal; indeed, it is precisely this extremely important factor where this diagnostic method will be useful. Only two indexes are needed. The first, called SOBI (skeletal open bite index), measures the skeletal component, while the DOBI (dental open bite index) measures the dental component. The quantitative value of both components will establish a diagnosis-prognosis for the patient.
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    Benign tumors of the oral mucosa: A study of 300 patients
    (2008) Torres Domingo, Santiago; Bagán Sebastián, José Vicente; Jiménez Soriano, Yolanda; Poveda Roda, Rafael; Murillo Cortés, Judith; Díaz Fernández, José María; Sanchís Bielsa, José María; Gavaldá Esteve, Carmen; Carbonell Pastor, Enrique
    Objectives: To analyze the frequency and type of the most common benign tumors of the oral mucosa found at the Hospital Stomatology Service, and to study the clinical characteristics and possible etiological factors. Material and Methods: This is a retrospective study of 300 patients with histologically diagnosed benign tumors of the oral mucosa. Data was compiled for each case, documenting information relating to age, gender, medication, habits (smoking, oral hygiene), anamnesis (reason for consultation, symptomatology, evolution), and the characteristics of the lesion (site, color, size, surface, consistency, and base). Results: Of all the tumors studied, 53% were histologically diagnosed as fibroma. In the study of prevalence of benign tumors of the oral mucosa, no differences were found for age; however there were differences according to gender, finding a greater prevalence of fibromas, pyogenic granulomas, and giant cell granulomas in women, at a ratio of 2:1. The group of tumors studied showed a significantly asymptomatic behaviour, and self-limiting and slow growth. With respect to the possible etiologic agents, we found no statistically significant differences between them. Conclusions: Following the study of 300 patients histologically diagnosed with benign tumor of the oral mucosa, we can state that with regard to prevalence, we found significant differences with respect to gender, being more frequent in women. The fibroma is the most frequent benign tumor of the oral cavity.
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    Metallothionein immunoexpression in oral leukoplakia
    (2008) Johann, Aline Cristina Batista Rodrigues; Silveira Júnior, João Batista; Souto, Giovanna Ribeiro; Horta, Martinho Campolina Rebello; Aguiar, Maria Cássia Ferreira; Mesquita, Ricardo Alves
    Objectives: to report the immunoexpression of metallothionein in oral leukoplakia and to correlate with histological grade and clinical localization. Leukoplakia is the most common potentially malignant lesion of the oral cavity. As the histological study of oral leukoplakia can not predict precisely the malignant transformation of this lesion, and metallothionein is a protein that has been associated with carcinogenesis, this study could be auxiliary in this histological assessment of this lesion. Study design: samples of oral leukoplakia (35 cases) and of normal oral mucosa (10 cases) were evaluated. Oral leukoplakia was graded in: hyperkeratosis without dysplasic change (9 cases), mild dysplasia (8 cases), moderated dysplasia (10 cases), and severe dysplasia (8 cases). Immunohistochemistry for the metallothionein was performed and the Mann-Whitney test was used in statistical analysis. Results: metallothionein was identified in squamous cells of the all samples. The metallothionein stain in all cases exhibit a mosaic pattern and was predominantly in compartments cytoplasmatic and nuclear simultaneously. The total stain was significantly higher in moderate dysplasia when compared with normal oral mucosa, hyperkeratosis, and mild dysplasia. Conclusion: it was suggested that the metallothionein may be a marker to moderate dysplasia and may play a role in oral carcinogenesis.
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    Oncocytic metaplasia in inflammatory fibrous hyperplasia : histopathological and immunohistochemical analysis
    (2008) Ayroza Rangel, Ana Lúcia Carrinho; León, Jorge Esquiche; Jorge, Jacks; Lopes, Márcio Ajudarte; Vargas, Pablo Agustín
    Oncocytic metaplasia (OM) is not a well-known feature in inflammatory fibrous hyperplasia (IFH) lesions, although it may be common, as proposed in our previous study about this lesion. In the present paper, we assessed the histopathological and immunohistochemical features of 18 cases of IFH containing OM areas. All the samples were examined on haematoxylin and eosin stained sections and cytokeratins (AE1/AE3, 34ßE12, CK5, CK7, CK8, CK13, CK14 and CK19), CD15, CD20, CD68, CD45Ro, and LCA primary antibodies were used. The vast majority of IFH occurred in women (n=14) and the most common site of presentation was the buccal vestibule. Oncocytic and salivary duct cells showed uniform immunoreactivity for AE1/AE3, CK7, CK8 and CK19. CD45Ro+ T-lymphocytes were the most common inflammatory cells surrounding the OM areas followed by CD20+ B-lymphocytes. These findings suggest that oncocytic cells present in IFH might develop from salivary duct epithelium, and T-lymphocytes might play an important role in its etiopathogenesis.