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Language Medicina oral, patología oral y cirugía bucal. 2006. Vol. 11, no. 4
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- Bisfosfonatos y Patología Oral I: aspectos generales y preventivos(2006) Ponte Fernández, N.; Estefanía Fresco, Ruth; Aguirre Urízar, José ManuelLos bisfosfonatos constituyen un grupo de fármacos capaces de modular el recambio óseo y disminuir su remodelado cuando existe una reabsorción excesiva. Por ello están indicados en numerosas patologías óseas como la osteoporosis postmenopáusica o la osteolisis asociada al cáncer de mama o al mieloma múltiple. En los últimos años y a raíz de su utilización masiva se han ido publicando numerosos casos de complicaciones asociadas a su uso. Entre los posibles efectos adversos más importantes se encuentran los orales, con la aparición de ulceraciones y sobre todo los casos de osteonecrosis de los maxilares asociados a esta terapéutica. En esta revisión analizamos las características generales de estos medicamentos y su mecanismo de actuación, así como los efectos adversos descritos, especialmente los orales y maxilofaciales, haciendo una referencia especial sobre la prevención de la osteonecrosis de los maxilares, a la luz de los casos descritos en la literatura médica y odontológica. El protocolo preventivo refuerza el papel fundamental del odontólogo en la prevención efectiva de este proceso antes, durante y después del tratamiento.
- Tumor odontogenico adenomatoide folicular: estudio inmunohistoquimico(2006) Vera Sempere, Francisco José; Artes Martínez, María José; Vera-Sirera, Beatriz; Bonet Marco, JaimeAdenomatoid odontogenic tumor (AOT) is an uncommon benign odontogenic lesion that affects young patients, with female predominance, mainly in second decade, showing a radiolucent unilocular image associated with an unerupted tooth, usually a canine. In spite of previous and confusing denominations, such as adenoameloblastoma or adenomatoid ameloblastic tumor, AOT is a benign tumor with a very low rate of recurrence, that show a peculiar morphological picture (basaloid appearance with glandular-like structures, calcifying areas, and amiloid-like material) that allow its histopathological recognition. We present a clinicopathological analysis of a case of follicular AOT affecting the mandible in a 9 years-old female patient associated with unerupted lower left canine. Immunohistochemical study showed some data previously unrecognised. All cellular types that composed AOT showed nuclear positivity for p63 indicating a basal characterization in the different cellular components. According to its benign character and low potential for recurrence, AOT revealed a scant proliferative activity (2-3% nuclei showed Ki-67 positivity) limited to some epithelial nodules (AE1-3 +) of fusiform appearance. Absence of reactivity for hormonal receptors (RE and RPg) excluded a possible hormonodependence in AOT that could explain the observed female predominance.
- Uso de metilprednisolona versus diclofenaco en el control de la inflamación y el trismo tras la cirugía del tercer molar inferior(2006) López Carriches, M.C.; Martínez González, José María; Donado Rodríguez, ManuelObjective: To compare the efficacy of methylprednisolone (corticoid)versus diclofenac (nonsteroidal anti-inflammatory -NSAID-) in the treatment of inflammation and trismus after the surgical removal of lower third molars. Study design: Prospective study on 73 patients for the surgical removal of their lower third molars. These patients were separated in two groups at ramdom: the diclofenac group and the methylprednisolone group. A record card was filled in with preoperative and postoperative epidemiological and clinic data about inflammation and trismus (three facial measures and mouth opening). In order to make a broad study of data, BMDP program was used for statistics. Results: 24 hours after surgery, patients in the diclofenac group showed a more severe inflammation in one of the facial measurements (p<0.05). Trismus was very similar in both groups. Conclusions: There were no differences in trismus depending on the antiinflammatory used. Patients in the corticoid group showed less inflammation but the difference was not as important as to justify their use.
- Bursitis Hamular y su posible sintomatología craneofacial referida: reporte de dos casos(2006) Ramírez, Luis Miguel; Ballesteros, Luis Ernesto; Sandoval, Germán PabloThe diagnosis of craniofacial pain is conditioned by the interdisciplinary management of its presentation especially in the absence of unique and objective signs. Bursitis is a pathological entity recently found in the hamular area and should be included in the diagnosis for exclusion of temporomandibular disorders (TMD), ear-nose-throat pathologies, due to the similar symptomatology to other head and neck conditions. The hamular process bursitis is a painful condition that can easily be confused with glosopharinge or trigeminal neuralgia that generates an uncomfortable feeling in the oropharinge with ipsilateral referred ' heteretopic - symptomatology to the head. This pathology, in chronic states, can be responsible for the amplification of the pain perceived by the central excitation effect. In this report are presented two clinical cases of hamular bursitis and its conservative therapeutic management. The recognition of the inflammation of the bursa of the tensor veli palati muscle supplies the specialist with another tool in the management of craniofacial pain.
- Uso de la tomografía computarizada en el diagnóstico de la anquilosis de la articulación temporomandibular: presentación de dos casos clínicos(2006) Casanova, Marcia Spinelli; Tuji, Fabrício Mesquita; Ortega, Ana Isabel; Yoo, Hea Jung; Haiter-Neto, FranciscoAnkylosis of the temporomandibular joint is characterized by restriction or limitation of mandibular movement. It presents as a classic symptom a limited range of motion on opening. Radiographically, ankylosis presents features that facilitate the diagnosis. However, its visualization is not clear in most of the cases involving conventional radiographic techniques. With the evolution of radiographic techniques, computed tomography (CT) became an important examination in the diagnosis of the ankylosis of temporomandibular joint. Due to the increasing use of the CT and its importance in the diagnosis of this disease, the aim of this paper is to present and describe tomographic images of ankylosis of this joint by presenting two clinical cases, using several slices as axial, coronal, and three-dimensional reformatted images.
- Fibropapilomatosis oral múltiple como manifestación inicial de Síndrome de Cowden: caso clínico(2006) Capitán Cañadas, L.M.; Salinas Sánchez, J.; Martínez Castillo, S.L.; Labrot Moleón, I.L.; Durán Moreno, DavidCowden syndrome is a rare hereditary disease included within hamartoma-type gastrointestinal polyposis. It is characterised by associated mucocutaneous anomalies and by the extraordinary tendency to develop malignant neoplasia, mainly in the breast and thyroid. Early diagnosis of the syndrome and adequate tumoral screening in patients with mucocutaneous papillomatosis make it possible to make an earlier diagnosis of associated pathologies which have great morbidity when detected late. We present the case of a patient diagnosed with Cowden syndrome after consultation for labial papillomatous lesions of long evolution who was subsequently treated for breast and kidney cancer in initial stages. The correct diagnosis of a banal pathology of oral mucosa made it possible for us to take early action against the neoplastic pathology associated with this disease.
- Adenoma sebáceo de la glándula parótida(2006) Vicente Rodríguez, Juan Carlos de; Fresno Forcelledo, Manuel Florentino; González García, Manuel; Aguilar Andrea, CarolinaTumors of the salivary glands constitute an important field of oral and maxillofacial pathology. The majority of salivary gland neoplasms are benign, with malignant salivary tumors accounting for 15 to 32 percent. The most common site for salivary gland tumors is the parotid gland, accounting up to 80 percent of all cases. This article reports the pathologic picture in a case of sebaceous adenoma of the parotid gland. The tumor was composed of epithelial cells lining ducts and closely associated with broad areas of sebaceous differentiation. The growth pattern was predominantly cystic, with cavities filled with sebaceous material. Areas of oncocytic metaplasia were also seen. The presence of sebaceous glands in salivary neoplasms is frequent, however, and in spite of this, salivary neoplasms constituted partially or entirely of these cells are rarely observed. To the surgeon and pathologist, the major problem in dealing with sebaceous adenoma is the recognition of this rare entity, avoiding confusing with other more aggressive neoplasms. The treatment involves surgical excision. The addition of the current case to the previously published data brings the total number of parotid sebaceous adenoma to seven.
- Incidencia de comunicación bucosinusal tras la extracción de 389 terceros molares superiores(2006) del Rey Santamaría, Marta; Valmaseda Castellón, E.; Berini Aytés, Leonardo; Gay Escoda, CosmeIntroduction. The incidence of oral sinus communications (OSC) following the extraction of an upper third molar remains uncertain. Objectives. The purpose of this study was to determine the incidence of OSC following the extraction of 389 consecutive upper third molars during 2003 in the Master of Oral Surgery and Orofacial Implantology (Barcelona University, Spain). Patients and method. Different variables were recorded, including patient age, sex, molar angulation, surgical technique and radiological sinus proximity, to determine the relation between third molar extraction and the incidence of OSC. Results. Only 5.1% (95% CI: 2.2-7.3%) of the upper molar surgical extractions produced OSC, the risk of which was found to be similar in all age groups and increased with the depth of third molar inclusion, the complexity of the surgical technique and the performance of an ostectomy
- Estudio retrospectivo de 145 dientes supernumerarios(2006) Fernández Montenegro, P.; Valmaseda Castellón, E.; Berini Aytés, Leonardo; Gay Escoda, CosmeObjective: The goal of the present retrospective study is to describe the distribution of the supernumerary teeth in a population of patients that have been attended at the Public Clinic of the Department of Oral Surgery. Background: Supernumerary teeth and multiple hyperdontia are usually associated with different syndromes, such as Gardner syndrome, or with facial fissures; however, they can appear in patients without any pathology. Their prevalence oscillates to 0.5-3.8% in patients with permanent teeth and to 0.35-0.6% in patients with primary teeth. Patients and Methods: A total of 36,057 clinical histories of patients that were admitted at the clinic between September of 1991 and March of 2003 were revised. The following data were extrapolated: age, sex, number of extracted supernumerary teeth, localization, morphology and type of supernumerary teeth. Consequently, 102 patients were included into the present study. Results: Of the 147 supernumerary teeth identified in the oral cavities of patients 145 were extracted. The most frequent supernumerary teeth identified were mesiodens (46.9%), followed by premolars (24.1%) and fourth molars or distal molars (18%). As for location, 74.5% of the supernumerary teeth were found in the superior maxillary bone and 46.9% of the supernumerary teeth were present in the palatine/lingual area. Heteromorphology was found in two thirds of the supernumerary teeth, with conical shape being the most frequent. Finally, 29.7% of the supernumerary teeth had occlusion with permanent teeth, and mesiodens were the predominating type of supernumerary teeth that showed this feature. Conclusions: Mesiodens very frequently cause retention of permanent incisors, which erupt spontaneously after the extraction of supernumerary teeth, if there is sufficient space in the dental arch and if they conserve the eruptive force. Generally, supernumerary premolars are eumorphic and are casually discovered during radiological exam, if not producing any symptomology.
- Actualización de la cirugía periapical en los implantes dentales(2006) Peñarrocha Diago, Miguel; Boronat López, Araceli; Lamas Pelayo, JoanaLa lesión periapical implantaria es una patología infecciosa-inflamatoria localizada alrededor del ápice del implante. Puede ser provocada por diversas causas, entre ellas: la contaminación en el momento de la instrumentación, el sobrecalentamiento óseo y la presencia de una patología preexistente en el hueso. Su diagnóstico es sintomático y radiográfico, y puede observarse una imagen radiolúcida alrededor del periápice. Clasificamos las lesiones según el momento evolutivo en lesión aguda (no supurada y supurada) y crónica o absceso periapical. El tratamiento de esta patología es la cirugía periapical con legrado e irrigación en la fase aguda; y la extracción del implante cuando se involucre la superficie ósea y/o se pierda la fijación primaria (fase crónica).
- Alteraciones salivares en pacientes con diabetes tipo 2(2006) Carda Batalla, María del Carmen; Mosquera Lloreda, Nezly; Salom, Lucas; Gómez de Ferraris, María Elsa; Peydró Olaya, AmandoLa diabetes mellitus tipo 2 es el desorden metabólico más frecuente, siendo además causante de una importante morbi-mortalidad. En estos pacientes se han descrito alteraciones estructurales de la parotida (sialosis) que podrían comportar modificaciones en la composición salivar, así como un incremento de patología dental y periodontal. Objetivos: establecer las alteraciones bioquímicas de la saliva y su posible correlación con los hallazgos morfológicos. Diseño del estudio: se realizo un estudio clínico de 33 pacientes, 17 de ellos con diabetes tipo 2. Se recogieron muestras de saliva para análisis bioquímico y suero para control metabólico. Resultados: en la saliva de los pacientes diabéticos encontramos un incremento de la urea y las proteínas totales, así como una reducción de la microalbumina. La glucosa salivar estaba solo aumentada en los diabéticos con mal control metabólico. Los síntomas de xerostomía se detectaron en el 76,4% de los casos y las lesiones dentales y periodontales en el 100% de los pacientes. Conclusión: estos desordenes bioquímicos en la saliva de los pacientes con diabetes tipo 2 se pueden correlacionar con las alteraciones estructurales descritas previamente.
- Profilaxis antibiótica en odontología infantil: puesta al día(2006) Planells del Pozo, Paloma; Barra Soto, Mª José; Santa Eulalia Troisfontaines, EvaMost orofacial infections are of odontogenic origin, and are of a self-limiting nature, characterized by spontaneous drainage. The causal bacteria are generally saprophytes. On the other hand, invasive dental interventions give rise to transient bacteremia. When an oral lesion is contaminated by extrinsic bacteria, the required antibiotic treatment should be provided as soon as possible. In the case of pulpitis, such treatment is usually not indicated if the infection only reaches the pulp tissue or the immediately adjacent tissues. In the event of dental avulsion, local antibiotic application is advised, in addition to the provision of systemic antibiotics. The dental professional must know the severity of the infection and the general condition of the child in order to decide referral to a medical center. Prophylaxis is required in all immunocompromised patients, as well as in individuals with cardiac problems associated with endocarditis, vascular catheters or prostheses. Penicillin V associated to clavulanic acid and administered via the oral route is known to be effective against odontogenic infections. In the case of allergies to penicillin, an alternative drug is clindamycin. Most acute infections are resolved within 3-7 days. In recent years, the tendency is to reduce general antibiotic use for preventive or therapeutic purposes.
