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Language Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2008. Vol. 13, no. 3
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- Flap repositioning versus conventional suturing in third molar surgery(2008) Sanchís Bielsa, José María; Hernández Bazán, Sergio; Peñarrocha Diago, MiguelObjectives: A comparative study is made of two types of flaps in semi-impacted third molar surgery and their relation to the postoperative period (pain, swelling and trismus). Material and methods: Twenty-five healthy patients were subjected to surgical extraction of both semi-impacted lower third molars, located in a similar clinical and radiographic position. In 25 cases the wound was sutured using a reflection flap (healing by first intention), while in the 25 contralateral cases the conventional technique was used (simple approximation of the wound margins). Pain, swelling and trismus were evaluated, during the first week of the postoperative period. Results: There was lesser pain, swelling and trismus after extraction of a semi-impacted third molar when healing took place by second intention (simple approximation of the margins), than in the case of healing by first intention (flap repositioning and margin-to-margin suturing). Conclusions: The postoperative course proved worse when using a reflection flap for healing by first intention than on suturing by simple approximation of the wound margins.
- Evaluation of healing criteria for success after periapical surgery(2008) Peñarrocha Diago, Miguel; Ortega Sánchez, Bárbara; García Mira, Berta; Martí Bowen, Eva; Arx, Thomas von; Gay Escoda, CosmeIntroduction: In periapical surgery, the absence of standardization between different studies makes it difficult to compare the outcomes. Objective: To compare the healing classification of different authors and evaluate the prognostic criteria of periapical surgery at 12 months. Material and methods: 278 patients (101 men and 177 women) with a mean age of 38.1 years (range 11 to 77) treated with periapical surgery using the ultrasound technique and a 2.6x magnifying glass, and silver amalgam as root-end filling material were included in the study. Evolution was analyzed using the clinical criteria of Mikkonen et al., 1983; radiographic criteria of Rud et al., 1972; the overall combined clinical and radiographic criteria of von Arx and Kurt, 1999; and the Friedman (2005) concept of functional tooth at 12 months of surgery. Results: After 12 months, 87.2% clinical success was obtained according to the Mikkonen et al., 1983 criteria; 73.9% complete radiographic healing using Rud et al. criteria; 62.1% overall success, following the clinical and radiographic parameters of von Arx and Kurt, and 91.9% of teeth were functional. The von Arx and Kurt criteria was found to be the most reliable. Conclusion: Overall evolution according to von Arx and Kurt agreed most closely with the other scales.
- Malignant fibrohistiocytoma of the parotid region : report of a case(2008) Alba García, José Ramón; Armengot Carceller, Miguel; Zapater Latorre, Enrique; Pérez Valles, Ana Isabel; Basterra Alegría, JorgeMost salivary gland tumors are benign, malignant lesions accounting for 15-30% of the total. The most frequent site of salivary gland neoplasms is the parotid gland (80% of all cases). We present a case of malignant fibrohistiocytoma with atypical features due to its location (in the parotid region), size and rapid growth. Generally, this type of tumor arises in the lower limbs and in the abdomen. When located in the parotid gland, these lesions appear as a firm, slow growing and painless mass. Due to the low frequency of such lesions and their clinical behavior, the imaging study and fine-needle aspiration biopsy findings tend to diagnose them as pleomorphic adenoma. The definitive diagnosis requires microscopic study of the resection piece using immunohistochemical techniques. The treatment of choice is surgery, occasionally associated to radiotherapy. The success of treatment is dependent upon complete resection of the tumor - long term follow-up being necessary due to the risk of recurrence or distant metastasis.
- A comparative study of silver amalgam and compomer as retrograde filling materials in periapical surgery(2008) Gargallo Albiol, Jordi; Aguirre Urízar, José Manuel; Gay Escoda, CosmeObjective: A comparative study is made of the histological effects of silver amalgam versus compomer (Dyract®) 90 days after placement as retrograde filling materials in experimental animals. Method: Six Beagle dogs were used, with total pulpectomy and orthograde material filling followed by periapical surgery of the 6 upper and 6 lower incisors (for a total of 72 teeth). Thirty-six teeth corresponded to the right side and were filled with the control material (silver amalgam), while the 36 teeth on the left side were filled with the compomer study material (Dyract®). After three months the animals were sacrificed and the histological study was carried out, with evaluation of bone formation, inflammation, and the tissue in contact with the filler material. The results obtained were subjected to a descriptive and comparative statistical analysis (chi-square test). Results: The samples retrogradely filled with compomer showed significantly greater percentage inflammation (76.19% versus 26.66% in the control group). On the other hand, a large proportion of samples with root cement growth were found in the compomer group. Filler material expulsion was also significantly more common when compomer was used. Conclusions: the comparative study of the histological findings showed greater inflammation but also greater root cement growth in the compomer group versus the controls.
- Clinical comparative study of the effectiveness of two dosages of Dexamethasone to control postoperative swelling, trismus and pain after the surgical extraction of mandibular impacted third molars(2008) Filho, José Rodrigues Laureano; Maurette, Paul E.; de Maurette, Marvis Allais; Cotinho, Milane; Fernandes, CaioPurpose: The aim of this study was to evaluate the effect of two different concentrations (4 and 8 mg) of dexamethasone to decrease the swelling and trismus after the surgical extraction of mandibular impacted third molars. Methods: This randomized clinical trial comprised thirty (30) adult patients of both genders with no local or systemic problems, with bilateral impacted lower third molars in similar position, where surgical extraction had been indicated. They were given 4 mg and 8 mg of dexamethasone 1 hour before the surgical procedure at the first or second surgery. The choice of which side to operate first and the amount of concentration of medication to use was made randomly and double-blindly. Postoperative pain was evaluated using a visual analog scale (VAS) and the degree of swelling was evaluated through facial reference points? variation. The presence of trismus was analyzed through measurement of the interincisal distance (IID). These assessments were obtained before the operation and 24h and 48h after the surgery. Results: Based on statistic analysis (pared t-student and Wilcoxon tests), the results showed a significant difference in the measurements of the degree of swelling and trismus of the treated sample. 8 mg of dexamethasone promoted a greater reduction of symptoms than 4mg of dexamethasone Conclusions: The administration of 8 mg of the dexamethasone was more effective than 4mg of the dexamethasone to reduce the degree of swelling and trismus. However, it had no effect on pain control.
- Endosseous dental implant fractures an analysis of 21 cases(2008) Gargallo Albiol, Jordi; Satorres Nieto, Marta; Puyuelo Capablo, José Luis; Sánchez Garcés, María Angeles; Pi Urgell, Joan; Gay Escoda, CosmeImplant fracture is an infrequent cause of implant failure. The present study evaluates 21 fractured implants, with an analysis of patient age and sex, the type, length and diameter of the implant, positioning in the dental arch, the type of prosthetic rehabilitation involved, the number of abutments and pontics, the presence or absence of distal extensions or cantilevers, and loading time to fracture. Implant fracture was more common in males than in females (15:4), and the mean patient age was 56.9 years. Most cases (n = 19) corresponded to implant-supported fixed prostheses - 16 with cantilevers of different lengths ? while only two fractured implants were supporting overdentures instead of fixed prostheses. The great majority of fractured implants (80.9%) were located in the molar and premolar regions, and most fractured within 3-4 years after loading. It is important to know and apply the measures required to prevent implant fracture, and to seek the best individualized solution for each case - though complete implant removal is usually the treatment of choice.
- Oral complaints in progressive systemic sclerosis : two cases report(2008) Cazal, Cláudia; Veras Sobral, Ana Paula; Neves, Ridel Frota Sá Nogueira; Freire Filho, Francisco Wagner Vasconcelos; Cardoso, Álvaro Bezerra; Da Silveira, Márcia María FonsecaProgressive systemic sclerosis is a chronic sclerotic disease which causes diffuse, increased deposition of extracellular matrix in connective tissue with vascular abnormalities, resulting in tissue hypoxia. Aesthetic and facial dysfunction are followed by important oral and facial manifestation of disturbances such as xerostomia, the lack of saliva in the mouth, and its associated complications. Most clinical manifestations begin with tongue rigidity. The facial skin changes and bone resorption of mandible angle are often reported. Other systemic changes include the involvement of internal organs which leads to serious complications as well as disorders in the cardiac muscle and Raynaud´s phenomenon. The objective of the this paper is to report two cases of systemic sclerosis in patients with oral and facial manifestations of the disease. A brief review of the literature, focusing on deontological alterations is also presented.
- Treatment with removable prosthesis in hypohidrotic ectodermal dysplasia : a clinical case(2008) Pipa Vallejo, Adolfo; López-Arranz Monje, E.; González García, Manuel; Martínez Fernández, Miguel; Blanco-Moreno Alvarez-Buylla, FernandoEctodermal dysplasias form part of a wide range of syndromes presenting abnormal development of two or more tissues derived from the ectoderm. Hypohidrotic ectodermal dysplasia is a congenital syndrome, characterized by hypotrichosis (hair is sparse, fine and weak; anomalies in the skin and nails), hypohidrosis (due to the paucity of sweat glands which in turn gives rise to sweat disorders) and hypodontia (partial, and occasionally total, absence of primary and/or permanent dentition). A case of a child with hypohidrotic ectodermal dysplasia with oligodontia and marked resorption of the maxillary and mandibular alveolar ridges is presented. A prosthetic rehabilitation in the form of a removable acrylic prosthesis was made, achieving excellent esthetics, functionality and adaptation, thanks to which a considerable improvement in self-esteem has been obtained.
- Clinicopathological analysis of oral mucous autoimmune disease : a 27-year study(2008) Arisawa, Emília Angela Loschiavo; Almeida, Janete Dias; Carvalho, Yasmin Rodarte; Cabral, L.A. GuimaraesObjectives: The aim of the present study was to analyze the main clinical and histopathological features of autoimmune diseases with oral manifestations such as oral lichen planus (OLP); mucous membrane pemphigoid (MMP); pemphigus vulgaris (PV) and erythema multiforme (EM). Study design: Retrospective review of 5770 files from the Oral Pathology Laboratory of São José dos Campos Dental School, São Paulo State University (UNESP) comprising a 27-year period from 1974 to 2000. Results: The cases accounted for 64 (1.10%) of 5770 anatomopathological examinations performed over the study period. Among the autoimmune diseases diagnosed, 49 (76.56%) were OLP, 6 (9.37%) were MMP, 5 (7.82%) were EM and 4 (6.25%) were PV. Descriptive statistical analysis was used. Conclusion: The initial manifestations of most autoimmune diseases occur in the oral mucosa. An earlier diagnosis and proper therapeutic protocol will delay the dissemination of the lesions, thus greatly contributing to a better prognosis and quality of life of the patient.
- Adverse side effects of statins in the oral cavity(2008) Pascual Cruz, Montserrat; Chimenos Küstner, Eduardo; García Vicente, José Antonio; Mezquiriz Ferrero, Xavier; Borrell Thio, Eulalia; López López, JoséIncreased plasma levels of cholesterol are high risk factors of cardiovascular disease. Statins are drugs that inhibit cholesterol synthesis at both pancreatic and extrahepathic levels, being the treatment of choice for hypercholesterolemia. Objective: To analyze the side effects of statins in the mouth cavity, and to analyze the symptoms after interruption of the treatment. Design: Observational study, preliminary. Material and methods: Patients aged 50-70, diagnosed with hypercholesterolemia and undergoing treatment with statins, referred from their primary care physician to the dentist?s office. Anamnesis over oral symptoms was performed in the first visit. Statin treatment was discontinued, followed by lab tests and control visits seven and fifteen days later. We monitored the improvement and/or remission of oral symptoms. Statin treatment was resumed, sending out a report of the patient evolution to the PCP. Symptoms were registered in sheet specially designed for the study. Exclusion criteria: patient refusal, use of drugs for dry mouth treatment, Sjögren?s syndrome. Results: n=26 patients. Dry mouth patients: improvement in 17 out of 23 patients (88.5%). Itchiness: 6 out of 15 cases improved (57.7%). Bitterness: improvement in 13 out of 14 patients (53.8%). Cough: improvement in 11 out of 12 patients (46.1%). Discussion: A high percentage of oral symptoms are associated to treatment with statins. There is a marked improvement after temporary interruption of the treatment. Little is known regarding the side effects of oral treatment with statins. This preliminary study includes a relatively small number of patients. The design of experimental treatments will be required to establish a true correlation between statin treatment and oral symptoms.
- Clinicopathological analysis of oral mucous autoimmune disease : a 27-year study(2008) Arisawa, Emília Angela Loschiavo; Almeida, Janete Dias; Carvalho, Yasmin Rodarte; Cabral, L.A. GuimaraesObjectives: The aim of the present study was to analyze the main clinical and histopathological features of autoimmune diseases with oral manifestations such as oral lichen planus (OLP); mucous membrane pemphigoid (MMP); pemphigus vulgaris (PV) and erythema multiforme (EM). Study design: Retrospective review of 5770 files from the Oral Pathology Laboratory of São José dos Campos Dental School, São Paulo State University (UNESP) comprising a 27-year period from 1974 to 2000. Results: The cases accounted for 64 (1.10%) of 5770 anatomopathological examinations performed over the study period. Among the autoimmune diseases diagnosed, 49 (76.56%) were OLP, 6 (9.37%) were MMP, 5 (7.82%) were EM and 4 (6.25%) were PV. Descriptive statistical analysis was used. Conclusion: The initial manifestations of most autoimmune diseases occur in the oral mucosa. An earlier diagnosis and proper therapeutic protocol will delay the dissemination of the lesions, thus greatly contributing to a better prognosis and quality of life of the patient.
