Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2019. Vol. 24, no. 1

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    Antiplatelet therapy in patients undergoing oral surgery : a systematic review and meta-analysis
    (2019) Villanueva, Julio; Salazar, Josefina; Alarcón, Ana; Araya, Ignacio; Yanine, Nicolás; Domancic, Stefan; Carrasco-Labra, Alonso
    The number of patients under antiplatelet therapy (APT) continues to raise as current recommendations foster this practice. Although some recommendations to manage this treatment during oral surgery procedures exist, these have methodological shortcomings that preclude them from being conclusive. A systematic review and meta-analysis of the best current evidence was carried out; The Cochrane Library, EMBASE and MEDLINE databases were searched for Randomized Controlled Trials (RCT) concerning patients undergoing oral surgery with APT, other relevant sources were searched manually. 5 RCTs met the Inclusion criteria. No clear tendency was observed (RR= 0.97 CI 95%: 0,41?2,34; p=0,09; I2= 51%), moreover, they weren?t clinically significant. According to these findings and as bleeding is a manageable complication it seems unreasonable to undermine the APT, putting the patient in danger of a thrombotic event and its high inherent morbidity, which isn?t comparable in severity and manageability to the former.?
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    The effectiveness of decompression as initial treatment for jaw cysts : a 10-year retrospective study
    (2019) Marin, Sa?a; Kirnbauer, Barbara; Rugani, Petra; Mellacher, Alexandra; Payer, Michael; Jakse, Norbert
    Decompression is an approved alternative to cystectomy in the treatment of jaw cysts. This study aimed to evaluate its effectiveness as an initial procedure, as well as factors with potential to influence outcome. The frequency of decompression was analysed, whether completed in one session or followed by enucleation at the Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, from 2005 to 2015. Further analysis focussed on factors potentially influencing outcome: cyst location, histopathology, means of preserving the cyst opening, cyst size, patient age. In all, 53 patients with 55 jaw cysts (mean age of 35.1) were treated by initial decompression in the ten-year period. In the majority of cases, histopathological analysis revealed a follicular cyst (43.6%), followed by odontogenic keratocysts (23.7%), radicular cysts (21.8%), residual cysts (7.3%) and nasopalatine cysts (3.6%) Treatment was completed with a single decompression in 45.5% of the cases. Among those, 72.0% were follicular cysts and 8.0% odontogenic keratocysts. Subsequent enucleation was needed in 54.5% of all cases, with a majority in the keratocystic group (36.7%). Histological findings, means of keeping the cyst open, and patient age were found to influence the effectiveness of decompression. Decompression could be performed as a procedure completed in one session or combined with subsequent enucleation, mainly dependent on histopathological findings. Subsequent enucleation of odontogenic keratocysts is highly recommended.
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    Use of autologous tooth-derived graft material in the post-extraction dental socket. Pilot study
    (2019) del Canto-Díaz, Alejandra; de Elío-Oliveros, Joaquín; del Canto-Díaz, Mariano; Alobera Gracia, M.A.; Canto Pingarrón, M. del; Martínez González, José María
    The objectives of the present pilot study are to compare via CBCT the alveolar contraction suffered both vertically and horizontally between the control group and the group using autologous dental material (ADM), as well as to study the densitometric differences between both post-extraction sockets. A split-mouth study was performed in n = 9 patients who required two extraction of single-rooted teeth deemed suitable for deferred rehabilitation with osseointegrated implants. Two groups were formed ? a control group, in which the post-extraction socket was not filled, and an ADM group, in which the alveolar defect was filled with freshly processed autogenous dental material. Both dimensional and densitometric analyses of the alveoli were performed in both groups immediately after surgery (baseline), as well as 8 weeks and 16 weeks later. The mean height of alveolar bone loss was: VL (Control 1.77 mm, loss of 16.87% of initial alveolar height; ADM 0.42 mm, loss of 4.2% of initial alveolar height), HL-BCB (Control 2.22 mm, ADM 0.16 mm, p= 0.067 at 16 weeks). The mean bone loss of the vestibular width (VL-BCB) was much higher in the control group (1.91 mm at 1 mm, 1.3 mm at 3 mm, and 0.89 mm at 5 mm) than in the ADM group (0.46 mm at 1 mm, 0.21 mm at 3 mm, 0.01 at 5 mm, p=0.098 at 16 weeks). At 16 weeks, densitometric analysis of the coronal alveolar area revealed a bone density of 564.35 ± 288.73 HU in the control group and 922.68 ± 250.82 HU in the ADM group (p=0.045 ). In light of these preliminary results, autologous dentine may be considered a promising material for use in socket preservation techniques.
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    Stafne bone defects radiographic features in panoramic radiographs : assessment of 91 cases
    (2019) Hisatomi, Miki; Munhoz, Luciana; Asaumi, Junichi; Arita, Emiko-Saito
    To evaluate 91 cases of Stafne bone defect (SBD) in panoramic radiographs (PR) to determine the prevalence of different SBD variants, considering age, gender, and side. Additionally, to assess the most frequent imaging features of SBD. Participant data were collected from 91 SBD cases with PR imaging. First, SBDs were classified according to their location, as anterior, posterior, or ramus variant. SBD imaging features were classified according to radiographic imaging findings, assessing margins, degree of internal radiolucency, shape, topographic relationship between the defect and mandibular border, location of the defect according to mandibular teeth, and locularity. The topographic relationship between the SBD and the mandibular canal was described for the inferior variant only. Mean sizes were also described. A total of 92 SBD cases were evaluated from 91 radiographs. One case presented multiple defects. Mean patient age was 60.80 years. Men were more affected than women. The most frequent SBD variant was the posterior variant, and the least frequent was the ramus variant. The most observed radiographic features were thick sclerotic bone margin in the entire contour of the defect, partially radiolucent internal content, oval shape, continuity with mandible base without discontinuity of mandible border, third molar region location, and unilocular shape. With the posterior variant only, the most common topographic relationship between the defect and the upper wall of the mandibular canal was the defect located below the upper wall and continuous with the inferior wall of the mandibular canal. The knowledge of common SBD radiographic imaging features in PR can help dental practitioners with the differential diagnosis of SBD.
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    Analgesic efficacy of ketorolac associated with a tramadol/acetaminophen combination after third molar surgery - a randomized, triple-blind clinical trial
    (2019) Martins, Luciana-Dorochenko; Rezende, Márcia; Dourado Loguercio, Alessandro; Bortoluzzi, Marcelo Carlos; Reis, Alessandra
    This study compared the efficacy of ketorolac alone versus its combination with tramadol/acetaminophen for pain control after mandibular third molar surgery. A randomized, triple-blind clinical trial was carried out with 52 patients divided into 2 groups: Group K+T+A (1 tablet of Ketorolac 10 mg plus and 1 capsule of Tramadol 37.5 mg/acetaminophen 325 mg) and Group K (1 tablet of Ketorolac 10 mg plus and 1 placebo capsule). The treatments were given 1 h before the surgery and was repeated 4 times per day, for 48 h. The difference in postoperative pain was assessed by 4 primary end-points: pain intensity (VAS 100mm, for 48 h), rescue medication, overall assessment and adverse effects. Significant differences in pain intensity were observed in the different times (p<0.05). The comparison of groups in each time showed significant differences only of 9 h, with lower level of pain intensity for group K+T+A (p = 0.005). The need of analgesics was higher in Group K (p<0.001), the need of antiemetic were greater in Group K+T+A (p<0.0001). No significant difference between groups were observed in overall assessment. The adverse effects was higher in Group K+T+A. The current study showed that both ketorolac and the combination of ketorolac plus tramadol/acetaminophen showed good control of pain after the extraction of the lower third molars. Although the combination group showed lower pain at 9 h, the difference is small and not clinically relevant.
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    Efficacy of proteolytic enzyme bromelain on health outcomes after third molar surgery. Systematic review and meta-analysis of randomized clinical trials
    (2019) Mendes, Mário-Luis-Tavares; do Nascimento-Júnior, Edmundo-Marques; Reinheimer, Daniele-Machado; Martins Filho, Paulo R.
    Bromelain is a cysteine protease isolated from pineapple with a range of biological properties including platelet aggregation inhibition and anti-inflammatory effects. Recent studies have evaluated the clinical implications of bromelain in reducing postoperative inflammatory complications after third molar surgery, but the results are contrasting. This systematic review and meta-analysis evaluated the effects of bromelain on health outcomes in patients submitted to third molar surgery. The study was conducted following the PRISMA statement. Searches were conducted in six electronic databases and Google Scholar from inception to May 2018. The following elements were used to define eligibility criteria: (1) population: patients undergoing third molar surgery; (2) intervention and controls: bromelain vs placebo or no-treatment control group; (3) outcomes: quality of life, postoperative pain, rescue analgesic consumption, facial swelling, and trismus; and (4) study type: randomized clinical trials (RCTs). Treatment effects were defined as weighted (WMD) or standardized mean difference (SMD) and 95%CIs. Six RCTs were included in the meta-analysis. There was large effect size of bromelain on improving physical appearance (SMD -0.77, CI% 95 -1.11 to -0.42), social isolation (SMD -0.97, CI% 95 -1.74 to -0.21), and sleep quality (SMD -1.19, CI% 95 -1.97 to -0.40) during the first postoperative week. Differences in pain intensity were found during the first 24h (SMD -0.49, CI 95% -0.82 to -0.17) and 7 days after surgery (SMD -0.52, CI 95% -0.79 to -0.24). No evidence was found that bromelain was effective in reducing trismus and facial swelling. The currently available evidence suggests that bromelain has a beneficial effect in reducing pain and has a positive impact on patient quality of life after third molar surgery. However, therapeutic advances for the use of bromelain need a high level of evidence and further head-to-head RCTs are needed to inform clinical choices.
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    Biomarkers to predict the onset of biphosphonate-related osteonecrosis of the jaw : a systematic review
    (2019) Lorenzo Pouso, A.I.; Pérez-Sayáns, Mario; González Palanca, Sergio; Chamorro Petronacci, Cintia Micaela; Bagán Sebastián, José Vicente; García García, Abel
    The goal of this paper was to identify available biomarkers to predict the onset of biphosphonate-related osteonecrosis of the jaw (BRONJ). Case-control studies comparing the different concentrations of a series of molecules detected in serum and urine as matrices of BRONJ affected patients vs. non-affected were included. PRISMA guidelines for systematic reviews were used for the present paper. Two reviewers independently screened electronic databases (Medline, Web of science, and The Cochrane Library) and performed hand searches. Risk of bias assessment of selected studies was performed by the Newcastle-Ottawa Scale. This study is registered as PROSPERO CRD42017078149. From a total of 601 identified studies, 7 (4 articles with high methodological quality and 3 with medium) articles were included. They investigate 2623 patients, of whom 91 (3.47%) developed BRONJ. A total of 7 biomarkers were identified and classified into 3 groups: bone turnover, angiogenesis and endocrine markers. Conflicting results were found in relation to most biomarkers. The present review suggests that no useful markers are currently available to evaluate BRONJ risk. Nevertheless, the present paper indicates that a paradigm shift from bone turnover biomarkers to angiogenesis and endocrine markers could shed light on this search.
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    What are the risk factors for postoperative infections of third molar extraction surgery : a retrospective clinical study-?
    (2019) Sukegawa, Shintaro; Yokota, Kyoko; Kanno, Takahiro; Manabe, Yoshiki; Sukegawa-Takahashi, Yuka; Masui, Masanori; Furuki, Yoshihiko
    This study aimed to identify (1) the predilection site of postoperative infection after third molar extraction surgery, (2) risk factors associated with postoperative infection, and (3) the cause of the difference between delayed- and early-onset infections. This retrospective study included 1010 patients (396 male, 614 female) who had ?1 third molars extracted (2407; 812 maxilla, 1595 mandible). The risk factors were classified as attributes, general health, anatomic, and operative. Outcome variables were delayed- and early-onset infections. Postoperative infection was completely absent in the maxilla, and all infections occurred in the mandible, with a probability of 1.94% (31/1595). Bivariate analysis for postoperative infection showed depth of inclusion and intraoperative hemostatic treatment to be significantly associated with the development of infections. Bivariate analysis for delayed- and early-onset infections showed simultaneous extraction of the left and right mandibular third molars to be prominent risk factors. Postoperative infection occurs mainly in the mandible, and that in the maxilla is very rare. The risk of postoperative infection in the mandible was found to be related to the depth of inclusion and intraoperative hemostatic treatment. Simultaneous extraction of the left and right mandibular third molars appear to increase the risk of delayed-onset postoperative infection.
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    Alveolar distraction osteogenesis for dental implant treatments of the vertical bone atrophy : a systematic review
    (2019) Toledano-Serrabona, Jorge; Sánchez-Garcés, María Angeles; Sánchez-Torres, Alba; Gay-Escoda, Cosme
    To determine if alveolar vertical distraction osteogenesis obtains better results compared to other bone regeneration treatments (guided bone regeneration with membranes and / or filling material, or autogenous bone graft) in terms of bone gain, complications, and implant survival and success rates. An electronic search was performed in Pubmed (MEDLINE), Cochrane Library and Scopus databases in March 2017. Besides, a manual search was carried out. Inclusion criteria were randomized controlled trials published within the last 10 years with at least 1 year of follow-up after implant placement. No language restriction was applied. Exclusion criteria were studies in patients with bone defects produced by trauma, congenital malformation or oncologic surgical treatment. The methodological quality of the selected studies was evaluated by means of the Cochrane Collaboration?s Tool for assessing risk of bias. The reports were classified into different levels of recommendation according to the ?Strength of Recommendation Taxonomy ?. Out of 221 articles, two randomized controlled trials were finally selected for the inclusion in the systematic review. Bone gain and complications were higher with the alveolar vertical distraction osteogenesis compared to the autologous bone graft. There was higher bone resorption with the autologous bone graft. Implant survival and success rates were similar between studies, despite of the used technique. Both alveolar distraction osteogenesis and autogenous bone graft are effective bone regeneration techniques for the treatment of mandibular vertical bone atrophy. A level B recommendation can be established for the use of alveolar vertical distraction osteogenesis for the treatment of the mandibular vertical bone atrophy.
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    Dental developmental alterations in patients with dilacerated teeth
    (2019) Ledesma Montes, Constantino; Jiménez Farfán Farfán, María Dolores; Hernández Guerrero, Juan Carlos
    The aim of this study was to record and analyze all DDAs associated to dilacerated teeth in patients attending the clinics of the Postgraduate Division, Facultad de Odontología, UNAM in Mexico City. Orthopantomograms from all patients seeking for stomatological attention in our institution were reviewed and those cases of dilaceration were separated. Age, gender, diagnosis, location, involved teeth and associated DDAs were recorded and analyzed. From 6,340 patients, 99 (1.6%) harbored 125 dilacerated teeth. Of them, 45 (45.5%) showed one or more DDAs. The most frequently detected DDAs were hypodontia, enamel pearls, taurodontism and microdontia. 45.5% is a very high proportion of DDAs in patients with dilacerated roots. Findings from this study strongly suggest that patients with dilacerated teeth should be carefully screened since many of them could present other DDAs. Simultaneous occurrence of dilaceration and DDAs suggests synchronic developmental defects during dental growth.
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    Psychoeducational intervention to improve oral assessment in people with autism spectrum disorder, BIO-BIO region, Chile
    (2019) Orellana, Lorena Mirtala; Cantero-Fuentealba, Cecilia; Schmidlin-Espinoza, Lilian; Luengo Machuca, Luis
    Lichen planus (LP) is a chronic autoimmune disease that affects the oral mucosa as well as the skin, genital mucosa and other sites. Objective: to evaluate the correlation between oral, genital and cutaneous lichen planus, in a sample of LP patients. This descriptive study reviewed 274 clinical histories of patients, who all presented histological confirmation of lichen planus verified by a pathologist, attending research centers in Barcelona. A total of 40 LP patients (14.59%) presented genital lesions. Of 131 patients with cutaneous LP (47.8%), the most commonly affected zones were the body?s flexor surfaces, representing 60.1% of cases. 24% of patients (n=55) related the start of the lesions with previous stress events. Of the 131 subjects with cutaneous lesions, 19% (n=25) also presented oral lichen planus (OLP). Of the total sample, 53.6% (n=147) of patients presented oral lesions. The systemic diseases most commonly associated with this patient sample were psychological problems such as stress, anxiety and depression (48%), hypertension (27%), gastric problems (12%), and diabetes (9.7%). A family history of lichen planus was found in only 2 cases (0,72%) out of the total of 274. Any patient with OLP should undergo a thorough history and examination to investigate potential extraoral manifestations. The fact that 37 patients with OLP in this series were identified with simultaneous involvement at more than one site highlights the need for exhaustive evaluation and multidisciplinary approaches to this disease.
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    Evaluation of the analgesic efficacies of Dexketoprofen Trometamol and Dexketoprofen Trometamol + Thiocolchicoside combinations in the impacted third molar surgery : Randomised clinical trial
    (2019) Cigerim, Levent; Kaplan, Volkan
    Postoperative pain is one of the most common complications. The aim of this study is to evaluate the analgesic efficacies of dexketoprofen trometamol and two different dosages of dexketoprofen trometamol + thiocolchicoside combination in the impacted third molar tooth operation. This randomized, double-blind study included 75 patients who did not have any disease. Patients were assigned to 3 groups. Group 1 received 25 mg dexketoprofen trometamol + 4 mg thiocholchicoside, Group 2 received 25 mg dexketoprofen trometamol +8 mg thiocholchicoside, and Group 3 received 25 mg dexketoprofen trometamol. In each group, the analgesic medication was administered twice a day, starting 1 hour before the operation. The level of pain was assessed with VAS. Patient age varied from 18 to 36 years. Of all patients, 59.2% (n=42) were female and 40.8% (n=29) were male. Drug side effects were observed in 28.17% (n=20) of the patients. Mean 24th hour VAS score was lower in dexketoprofen trometamol + 8 mg thiocolchicoside group compared to dexketoprofen trometamol group (p<0.05). There was no statistically significant difference between the three groups regarding drug side effects (p>0.05). Dexketoprofen trometamol + 8 mg thiocolchicoside combination has higher analgesic efficacy compared to dexketoprofen trometamol. More studies are needed to interpret the analgesic and anti-inflammatory effects of thiocholchicoside + dexketoprofen trometamol combination.
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    Accuracy and the role of experience in dynamic computer guided dental implant surgery : an in-vitro study
    (2019) Jorba-García, Adrià; Figueiredo, Rui; González-Barnadas, Albert; Camps Font, Octavi; Valmaseda Castellón, E.
    To compare the accuracy of implant placement using the conventional freehand method and a dynamic navigation system; to assess the role of the surgeon?s experience in implant placement using these two methods. A randomized in-vitrostudy was conducted. Six resin mandible models and 36 implants were used. Two researchers with differing clinical experience (novice and experienced) placed implants using either the Navident dynamic navigation system (navigation group) or the conventional freehand method (freehand group). Accuracy was measured by overlaying the real position in the postoperative CBCT on the virtual presurgical placement of the implant in a CBCT image. Descriptive and bivariate analyses of the data were performed. The navigation group showed significantly higher accuracy for all the variables studied except 3D entry and depth deviation. This system significantly enhanced the accuracy of the novice professional in several outcome variables in comparison with the freehand implant placement method. However, when the implants were placed by the experienced clinician the dynamic navigation system only improved angulation deviation. Significant differences were found between the 2 professionals when the freehand method was employed. Similar deviations were observed for the implants placed with the navigation system. Dynamic computer assisted surgery systems allow more accurate implant placement in comparison with the conventional freehand method, regardless of the surgeon?s experience. However, this system seems to offer more advantages to novice professionals, since it allows them to reduce their deviations significantly and achieve similar results to those of experienced clinicians.
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    Comparative in vitro study of the accuracy of impression techniques for dental implants : direct technique with an elastomeric impression material versus intraoral scanner
    (2019) Rech Ortega, Cristina; Fernández Estevan, Lucía; Solá Ruiz, María Fernanda; Agustín Panadero, Rubén; Labaig Rueda, Carlos
    The aim of this study was to compare a conventional technique (elastomeric impression material - EIM) and a digital technique (scanner digital model ? SDM) on a six-analog master model (MM) to determine which was the most exact. Twenty impressions were taken of a master model (EIM) and twenty scanned impressions (SDM) (True Definition). A coordinate measuring machine (CMM) was used to measure the distances between adjacent analogues (1-2, 2-3, 3-4, 4-5, 5-6), intermittently positioned analogues (1-4, 3-6) and the most distal (1-6). Reference values were established from the master model, which were compared with the two impression techniques. The significance level was established as 5% (p<0.05). The precision of each technique was compared with MM. For adjacent analogues (1-2), no significant differences were found between EIM-MM (p=0,146). For intermittently positioned analogues (1-4), SDM did not show significant differences with MM (p=0.255). For the distance between distal analogues (1-6), significant differences were found between both techniques and MM (p=0.001). In a clinical situation with < three implants, EIM is more exact than SDM, but in cases of four implants SDM is more exact. For rehabilitations (> four implants), neither technique can be considered accurate although error falls within the tolerance limits established in the literature (30-150µm).
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    Tumors of the oral cavity : CO2 laser management
    (2019) Luna Ortiz, Kuauhyama; Hidalgo-Bahena, Sergio C.; Muñoz-Gutiérrez, Tania L.; Mosqueda Taylor, Adalberto
    Cancer of the oral cavity combined with oropharyngeal cancer is the sixth leading cause of death for cancer worldwide. Surgery remains the standard treatment for this disease in early clinical and locally advanced stages. Numerous studies have shown that laser management is useful for premalignant lesions in the oral cavity; however, there is no conclusive evidence that its use is appropriate in cancer of the oral cavity and that results are comparable with traditional surgery. The objective of this study is to determine cancer control after wide local resection with CO2 laser for oral malignant neoplasms. Retrospective study in patients with tumors of the oral cavity who were considered for surgical resection with CO2 laser from January 2006-December 2015. Demographic data, treatment modalities, histopathological diagnosis and clinical stage variables were obtained. All resections were done with the use of the microspot. Patients with cancer of the tongue were not included because a specific protocol for these patients does exist in our institution. There were twenty patients, 10 male and 10 female with a average age of 58 years (range: 20-92 years). Mean age was 53.5 years for females and 63 years for males. Twelve (60%) patients are alive and disease free and four (20%) were lost free of disease. CO2 laser is an acceptable surgical method for the management of small lesions in the oral cavity. We cannot rule out that small lesions of the oral cavity with positive neck could be managed in this manner, adding treatment to the neck, producing an adequate local regional control. However, this hypothesis requires additional studies.
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    The assesment of relationship between the angulation of impacted mandibular third molar teeth and the thickness of lingual bone : a prospective clinical study
    (2019) Menziletoglu, Dilek; Tassoker, Melek; Kubilay-Isik, Bozkurt; Esen, Alparslan
    Our purpose was to investigate the relationship between the angulation of mandibular third molars and the thickness of the lingual bone, which can affect the risk of lingual nerve damage during lower third molars surgical extraction. This study consisted of 104 patients (42 males and 62 females), aged between 18-42 years (24.67 ± 6.11 years). Cone Beam Computed Tomography (CBCT) images were taken for preoperative assessment. The teeth were divided into four groups according to their positions: mesioangular, distoangular, vertical and horizontal. Lingual bone thickness around impacted teeth were measured at three points: cementoenamel junction (CEJ) of the mandibular second molar, mid-root of the impacted third molar, and apex of the impacted third molar root. Two predisposing factors of lingual nerve damage were recorded: lingual bone perforated by the impacted tooth and lingual bone thinner than 1 mm. Additionally, buccolingual angulations of the teeth in each group were measured. Impacted mandibular third molars were removed in usual way. One week after surgery, the patients were evaluated regarding lingual nerve paresthesia. None of the 104 patients experienced paresthesia, including the ones who had teeth with close proximity with lingual nerve. The mean thickness of bone was 1.21±0.63 mm at CEJ of the second molar; 1.25±1.02 mm at the mid-root; and 1.06±1.31 mm at the apex. Horizontally impacted teeth had thinner lingual bone at mid-root level (p=0.016). Buccolingual angulated teeth were more often associated with perforated lingual bone (p=0.002). Buccolingual and mesial/distal angulation had negative correlation with lingual bone thickness (p<0.05). As the buccolingual and mesiodistal angulations increase, lingual bone thickness decreases. Horizontally impacted teeth seemed to compromise the integrity of the lingual bone more than impacted teeth in other positions. During the surgery, thin or perforated lingual bone may result in displacement of the impacted tooth lingually.
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    Associated factors with health-compromising behaviors among patients treated for oral cancer
    (2019) Barrios Rodríguez, Rocío; Gil Montoya, José Antonio; Montero Martín, Javier; Rosel Gallardo, Eva; Bravo Pérez, Manuel
    To improve eradication strategies of health-compromising behaviors between oral cancer survivors, this study aimed to explore the extent of clustering of risk behaviors and to assess possible factors associated. A cross-sectional study was carried out among oral cancer patients at least 6 months after treatment. They completed a questionnaire about smoking, alcohol consumption, oral hygiene habits and dental visits. Presence of clusters was evaluated through pairwise Pearson correlations and principal component analysis. Factors associated with each identified cluster were analyzed with multivariate models. Among 142 patients, 14.8% smoked, 51.7% consumed alcohol, 52.1% performed oral hygiene less than twice a day, and 74.6% visited to dentist when there was a problem or never. There were two distinct clusters: smoking-alcohol consumption (general risk behaviors cluster) and oral hygiene-dental attendance (oral risk behaviors cluster). Multivariate analysis showed significant associations between males and both clustering patterns of health compromising behaviors, patients with clinical stage I or with longer follow-up and the presence of general risk behaviors cluster and worse social class and the presence of oral risk behaviors cluster. A high proportion of patients treated for oral cancer presented health-compromising behaviors occurring in clusters which reinforce the need for health promotion strategies to target multiple behaviors. Factors analyzed suggest that chances of having detrimental behavioral clustering are higher in male, patients with clinical stage I, with lower social class and those with longer follow-up after treatment.
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    Cutaneous, genital and oral lichen planus : a descriptive study of 274 patients
    (2019) Cassol-Spanemberg, Juliana; Blanco Carrión, Andrés; Rodríguez de Rivera Campillo, M. E.; Estrugo Devesa, ALbert; Jane Salas, Enric; López López, José
    Lichen planus (LP) is a chronic autoimmune disease that affects the oral mucosa as well as the skin, genital mucosa and other sites. Objective: to evaluate the correlation between oral, genital and cutaneous lichen planus, in a sample of LP patients. This descriptive study reviewed 274 clinical histories of patients, who all presented histological confirmation of lichen planus verified by a pathologist, attending research centers in Barcelona. A total of 40 LP patients (14.59%) presented genital lesions. Of 131 patients with cutaneous LP (47.8%), the most commonly affected zones were the body?s flexor surfaces, representing 60.1% of cases. 24% of patients (n=55) related the start of the lesions with previous stress events. Of the 131 subjects with cutaneous lesions, 19% (n=25) also presented oral lichen planus (OLP). Of the total sample, 53.6% (n=147) of patients presented oral lesions. The systemic diseases most commonly associated with this patient sample were psychological problems such as stress, anxiety and depression (48%), hypertension (27%), gastric problems (12%), and diabetes (9.7%). A family history of lichen planus was found in only 2 cases (0,72%) out of the total of 274. Any patient with OLP should undergo a thorough history and examination to investigate potential extraoral manifestations. The fact that 37 patients with OLP in this patient series were identified with simultaneous involvement at more than one site highlights the need for thorough evaluation and multidisciplinary approaches to this disease.