Oral maxillofacial surgeons and Orthodontists’ perceptions about anterior inferior crowding and indications of mandibular third molar extraction / Percepciones de los cirujanos maxilofaciales y ortodoncistas sobre el apiñamiento anteroinferior y las indicaciones de la extracción del tercer molar mandibular

Background: There are still many doubts about anterior inferior crowding and indications of mandibular third molar extraction, although it is very studied subject in the literature. The aim of this study was to evaluate the perceptions of oral maxillofacial surgeons (OMFSs) and orthodontists about anterior inferior crowding and indications of mandibular third molar extraction. Material and Methods: A web-based survey was developed and sent to professionals in order to collect their opinion about the fact that third lower molars cause crowding and questions about the indication of third molars for orthodontic treatment. Descriptive analysis was performed and Chi-square or G tests were applied with a 95% confidence interval. Results: The study included a total of 218 participants, of whom 115 were OMFSs and 103 were orthodontists. The results showed that 56.5% of OMFSs and 35.0% of orthodontists believe that the lower third molars cause anterior inferior crowding (p<0.001). A total of 91.3% of OMFSs and 70.9% of orthodontists indicate the extraction of lower third molars to aid orthodontic treatment (p<0.001). Conclusions: It can be concluded that in being an oral maxillofacial surgeon, a higher odds ratio is observed to consider that lower third molars cause dental crowding compared to those who are orthodontist. The indication of exodontia of lower third molars for orthodontic treatment was more frequent among OMFSs when compared to orthodontists.(AU)

Preservation of the inferior alveolar vasculonervous bundle in mandibular resective therapies: systematic review and report of two cases

Background: Segmental surgical resection is a frequently indicated procedure to treat aggressive mandibular tumors. One of the most important complications derived from this technique is permanent paresthesia of the inferior alveolar nerve (IAN), which significantly affects the quality of life of patients who experience it. This could be avoided through maneuvers that preserve the IAN. The objective of this paper is to review the main techniques for IAN preservation and to present 2 cases with the technique used by the author. Material and Methods: A systematic review was performed according to the PRISMA guidelines, apropos of two clinical cases reported in this study. The MEDLINE/PubMed and Scopus databases were searched. Several variables were considered and are presented in detail in the form of tables and figures. In addition, 2 case reports with NAI preservation techniques are presented. Results: 13 articles were finally obtained for analysis. 127 patients were evaluated, reporting mandibular resections associated with various pathologies. Various surgical techniques were used, all with the same goal of maintaining the IAN. In most of the patients, the maintenance of sensitivity was achieved, which was verified with different methods. Conclusions: Preservation of the IAN in maxillofacial surgical procedures where surgical resection of the mandibular bone has been performed is an alternative that has demonstrated successful results in terms of reducing postoperative sequelae and is currently positioned as a necessary and feasible procedure. (AU)

Perceived surgical difficulty of mandibular third molar extraction. A comparative cross-sectional study of dentists with postgraduate qualificationin oral surgery and maxillofacial surgeons in a Spanish subpopulation

Background: Mandibular third molar (MTM) extraction is one of the most frequently performed surgeries in the oral cavity. Establishing the level of surgical difficulty pre-operatively is an essential step to ensure correct treatment planning. In Spain, MTM extraction - especially in cases presenting greater difficulty - is normally performed by doctors specializing in oral and maxillofacial surgery, or by dentists with postgraduate qualifications in oral surgery. The present work set out to analyze the extent to which perceptions of surgical difficulty of the said intervention vary in relation to professional training. Material and Methods: This cross-sectional, descriptive, observational study took the form of a survey. Using a visual analog scale (VAS), participants evaluated both the perceived difficulty of 30 cases of MTM extraction described by means of digital panoramic radiographs and the perceived difficulty deriving from a series of factors conditioning MTM extraction. The results underwent statistical analysis with SPSS Statistics 28.0 software. Nonparametric tests (Mann Whitney test for independent samples and the Kruskal-Wallis test) were applied. Results: A total of 213 surveys were available for analysis. Both groups awarded the greatest importance to clinical experience, followed by anatomical and radiographic factors, root morphology obtaining the highest score among anatomical factors (9.01±1.42), while proximity of the MTM to the inferior alveolar nerve was regarded as the least important anatomical factor (8.11 ±2.54). Significant differences were only found for patient age, whereby maxillofacial surgeons awarded this factor more importance than dentists. Conclusions: The different training received by dentists specialized in oral surgery and maxillofacial surgeons did not influence either perceptions of surgical difficulty of MTM extraction, or opinions as to the factors influencing surgical difficulty. (AU)

Clinical practice guideline of the spanish society of oral surgery for oral surgery in patients with coagulation disorders / Guía de práctica clínica de la sociedad española de cirugía bucal para cirugía oral en pacientes con trastornos de la coagulación

Background: The number of patients treated with coagulation disorders, and more specifically with anticoagulanttherapy, has increased worldwide in recent years due to increased life expectancy in developed countries. Theprotocols for managing this type of patient in oral surgery has varied over recent years, especially after the appear-ance of new direct-acting oral anticoagulants (DOACs). The assessment of risk of bleeding in this type of patientwhen undergoing a surgical procedure continues to be a controversial issue for patients, dentists and general prac-titioners. The objective of this document is to offer recommendations, based on evidence, for decision making forpatients with coagulopathies who require dental surgical intervention. Material and Methods: Based on the indications of the “Preparation of Clinical Practice guidelines in the NationalHealth System. Methodological manual”, we gathered a group of experts who agreed on 15 PICO questions basedon managing patients with coagulation disorders in dental surgical procedures, such as fitting of implants or dentalextractions.Results: The 15 PICO questions were answered based on the available evidence, being limited in most cases due tothe lack of a control group. Two of the PICO questions were answered by the experts with a grade C recommendation,while the rest were answered with grade D.Conclusions: The results of this review highlight the need to undertake well designed clinical trials with controlgroups and with a representative sample size.(AU)

Clinical practice guideline of the Spanish society of oral surgery for dental care in patients with oral cancer / Guía de práctica clínica de la sociedad española de cirugía bucal para el cuidado dental en pacientes con cáncer oral

Background: Oral cancer is the sixteenth most common malignant neoplasm worldwide, with a high mortalityrate, greater than 50% at five years, and high morbidity. The effect of oncological treatment in the oral cavity isbroad and has multiple levels, therefore knowing these effects and preventing them is essential for avoiding anincrease in the oral pathology related with oncological therapy, maintaining the quality of life of the patient, andimproving the efficacy of the treatment itself.Material and Methods: A group of experts belonging to the fields of Dentistry, Maxillofacial Surgery and Oncol-ogy of the University of Seville and the Virgen del Rocío University Hospital of Seville in collaboration with theUniversity of Valencia, University of Barcelona, and University of the Basque Country, developed this ClinicalPractice Guideline for the proper clinical management of patients diagnosed with oral cancer. The clinical ques-tions were formulated in PICO format. The databases consulted were Medline/PubMed and Embase/Elsevier. Thesystematic reviews published on the topic were identified on Tripdatabase, Cochrane Library and CRD (Centre forReviews and Dissemination). The recommendations were prepared based on the GRADE methodology.Results: Various recommendations were defined, derived from the 21 PICO questions, referring to prevention,treatment and care for alterations arising from the pathology of oral cancer itself and its treatment.Conclusions: The preparation of this clinical practice guideline allows recommendations to be generated basedon the scientific evidence available, on dentistry actions in patients with oral cancer and undergoing oncologicaltreatment, which may be of use to the multidisciplinary team treating this type of patient.(AU)

Cirugía periapical y regeneración: revisión sistemática / Periapical surgery and regeneration: systematic review

Introducción: Tras un cirugía periapical, suele estar asociado un defecto óseo que puede ser regenerado o no según la literatura. El objetivo es analizar si la regeneración ósea asociada a la cirugía periapical tiene efectos beneficiosos en la curación de los diferentes defectos. Material y Mètodos: Revisión sistemática realizada en Medline-Pubmed, Scopus y Cochrane. Se consideraron criterios PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Ensayos clínicos aleatorizados, estudios de casos y controles, de cohortes y transversales publicados entre enero 2011 y abril 2022, que analizaran el èxito de la cirugía periapical combinada o no con diferentes tècnicas de regeneración ósea, idioma inglès o español, realizados en humanos y adultos (≥16años) fueron incluidos. Resultados: Se incluyeron un total de 8 artículos que analizaban una "n" total de 285 sujetos con 35 abandonos. Se analizan diferentes tipos de lesiones: lesiones transversales, defectos apicomarginales y lesiones periapicales, excepto un estudio que compara las tres. Se utilizan diferentes materiales de regeneración. Se obtuvo un rango de èxito de regeneración ósea entre 81,6% y 93,7%. Discusión: Los avances en equipos de magnificación visual aumento, instrumentos y materiales endodónticos son la razón de un mayor èxito de las cirugías periapicales. Las imágenes en 3D, son valiosas para obtener un mejor diagnóstico del tamaño y tipo de defecto, y planificar así el tratamiento considerando la necesidad de regenerar o no. Aunque los resultados siguen siendo inciertos parece ser que en los defectos transversales y apicomarginales es mejor regenerar, al contrario de los defectos periapicales. (AU)

Introduction: According to the literature, after a periapical surgery there usually remains a bone defect that may be regenerated or not. The aim of this review is to analyse whether bone regeneration associated with periapical surgery is favourable on the healing of different defects. Material and Methods: A systematic review was performed in Medline-Pubmed, Scopus and Cochrane. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria were considered. Randomized clinical trials, case-control, cohort and cross-sectional studies published between January 2011 and April 2022, that analyses the success of periapical surgery associated or not with different bone regeneration techniques, English or Spanish, humans and adults (≥ 16years) studies were included. Results: A total of eightreports were included. They evaluated 285 subjects, with 35 subjects that dropped out. Different types of lesions were analysed in each report: through-and-through lesions, apico-marginal lesions, and periapical lesions, except for one that compared all of them. Different kinds of bone regenerative materials were used. A range of success of between 81,6% and 93,7% of bone regeneration was achieved. Discussion: Improvements in augmentation equipment, instruments, and materials are the reason for the large success of periapical surgery. 3D images are useful to make a better diagnosis of the size and kind of the defect and, in this way, to plan the treatment considering the need to regenerate or not. Although the results remain uncertain, it seems that for through-and-thought and apico-marginal lesions, it is better to regenerate in contrast with periapical lesions. (AU)

Incidencia de osteítis alveolar por exodoncia de terceros molares mandibulares impactados: una revisión sistemática / Incidence of alveolar osteitis due to extraction of impacted mandibular third molars: a systematic review

La extracción de terceros molares mandibulares impactados trae consigo, en muchas oportunidades, complicaciones posoperatorias como la osteítis alveolar o comúnmente llamada alveolitis seca que dificulta la cicatrización del alveolo. En este sentido, el objetivo de la revisión fue determinar la incidencia de la osteítis alveolar por exodoncia de terceros molares mandibulares impactados. Se realizó la búsqueda bibliográfica sin restricción de año ni de idioma en PubMed, Scopus, Science Direct, Lilacs y Scielo, empleando tèrminos estandarizados en Medical Subject Headings (MeSH NLM). La confección de la investigación se realizó siguiendo los lineamientos PRISMA-2020 y para la evaluación de la calidad y sesgo de los artículos se empleó las herramientas de la National Heart Lung and Blood Institute (NHLBI). Se obtuvieron (n=4907) estudios, los cuales se subieron al aplicativo web Rayyan para seleccionarlos siguiendo los criterios de inclusión y exclusión planteados previamente. Tras el análisis crítico se eligieron 2 estudios para su revisión, cuyos datos se extrajeron según los indicadores establecidos por los autores. Se concluye que existe una incidencia baja de osteítis alveolar despuès de la extracción de terceros molares mandibulares impactados, descartándose la relación entre el gènero y el padecimiento de esta complicación. Además se resalta la irrigación con clorhexidina y suero fisiológico como tratamiento para esta afección. (AU)

The extraction of impacted mandibular third molars often brings with it postoperative complications such as alveolar osteitis or commonly called dry socket that makes it difficult for the alveolus to heal. In this sense, the objective of the review was to determine the incidence of alveolar osteitis due to extraction of impacted mandibular third molars. The bibliographic search was carried out without restriction of year or language in PubMed, Scopus, Science Direct, Lilacs and Scielo, using standardized terms in Medical Subject Headings (MeSH NLM). The preparation of the research was carried out following the PRISMA-2020 guidelines and the tools of the National Heart Lung and Blood Institute (NHLBI) were used to evaluate the quality and bias of the articles. Studies (n=4907) were obtained, which were uploaded to the Rayyan web application to select them following the inclusion and exclusion criteria previously stated. After critical analysis, 2 studies were chosen for review, whose data were extracted according to the indicators established by the authors. It is concluded that there is a low incidence of alveolar osteitis after the extraction of impacted mandibular third molars, ruling out the relationship between gender and suffering from this complication. In addition, irrigation with chlorhexidine and physiological serum is highlighted as a treatment for this condition. (AU)

Complicación en la colocación de implante dental con compromiso de nervio dentario inferior reporte de caso clínico, seguimiento de 3 años / Complication in the placement of dental implants with compromise of the inferior dental nerve clinical case report, 3-year follow-up

Introducción: Los accidentes o complicaciones durante la colocación de implantes dentales a pesar de la planeación quirúrgica deben ser manejados de manera inmediata y oportuna. Objetivo: Recomendar el mejor protocolo para manejar la lesión del nervio dentario inferior consecuencia de la colocación de implante dentario. Caso Clínico: Paciente asiste a clínica privada pararecibir atención odontológica de especialidad, edad 67 años, sexo femenino, presenta hipertensión arterial, resistencia a la insulina, premedicada con Hidronorol T y Metformina. Paciente informa deexodoncia de cuatro molares, colocaron inmediata de cuatro implantes dentales, sintió un adormecimiento del mentón con la perdida de efecto del anestèsico; 72 horas posterior se procedió a realizar tomografía Cone Bean, observándose implante contactando el nervio dentario inferior, planificándose de forma inmediata el retiro del implante dental. Resultados: Control a 3, 6, 9 meses, 1 , 2 y 3 años posterior a retiro de implante, aplicación de terapia farmacológica a base de corticoides, aines y vitamina B , con resultados favorables en el tratamiento de la parestesia. Conclusiones: La extracción del implante dental antes de las 72 horas y la terapia farmacológica adecuada resulto exitosa en el tratamiento de la lesión del nervio dentario inferior. (AU)

Introduction: Accidents or complications during the placement of dental implants despite surgical planning should be handled immediately and in a timely manner. Objective: To recommend the best protocol to manage the injury of the inferior dental nerve resulting from the placement of dental implant. Clinical Case: Patient attends private clinic to receive specialty dental care, age 67 years, female, presents arterial hypertension, insulin resistance, premedicated with Hydronorol T and Metformin. Pacientereports exodontics of four molars, immediate placement of four dental implants, felt a numbness of the chin with the loss of effct of the anesthetic; 72 hours later proceeded to perform Tomography Cone Bean, observing implant contacting the inferior dental nerve, immediately planning the removal of the dental implant. Results: Control at 3, 6, 9 months, 1, 2 and 3 years after implant removal, application of pharmacological therapy based on corticosteroids, NSAIDs and vitamin B, with favorable results in the treatment of paresthesia. Conclusions: The extraction of the dental implant before 72 hours and the appropriate pharmacological therapy was successful in the treatment of the lesion of the inferior dental nerve. (AU)

Investigación clínica a largo plazo del tratamiento con implantes dentales / Long-term clinical research of treatment with dental implants

La implantología oral clínica ha evolucionado significativamente durante las últimas décadas. El desarrollo de los aspectos diagnósticos, quirúrgicos y prostodóncicos ha mejorado la predictibilidad de la oseointegración y los resultados clínicos a largo plazo del tratamiento con implantes. Además, algunos criterios de condiciones clínicas y radiográficas se han incorporado al concepto de éxito, como el nivel de los implantes, los tejidos periimplantarios, el nivel de la prótesis y el grado de satisfacción de los pacientes. La evidencia científica ha demostrado que el tratamiento con implantes es una excelente opción para la rehabilitación de los pacientes con parcial y total edentulismo. De hecho, los estudios a largo plazo reflejan el éxito de las rehabilitaciones fijas, sobredentaduras, puentes fijos y coronas unitaria. Sin embargo, algunas complicaciones biológicas y prostéticas han definido los conceptos diferentes de éxito y supervivencia de los implantes dentales. Conclusiones: Este trabajo indica que las restauraciones sobre implantes dentales en la rehabilitación de los pacientes parcial y totalmente edéntulos constituye un tratamiento odontológico con resultados clínicos a largo plazo con un elevado éxito. (AU)

Clinical implant dentistry has evolved significantly during last decades. The development of diagnostic, surgical and prosthetic aspects has improved the predictability of osseointegration and long-term clinical outcomes of the implant treatment. Moreover, several criteria of clinical and radiographic conditions have been incorporated in the concept of implant success, as implant level, peri-implant tissues, prosthetic level, and patient satisfaction. The scientific evidence of the literature demonstrates that implant treatment is an excellent option for the rehabilitation of patients with partial and total edentulism. In fact, long-term studies are reported the success of fixed total rehabilitation, overdentures, fixed bridges and single crowns. However, some biological and technical complications are defined the different concepts of success and survival of prosthetic and dental implants. Conclusions: This paper indicates that restorations with dental implants in the rehabilitation of partially and totally edentulous patients constitute a dental treatment with long-term clinical outcomes with a high success. (AU)

Retirada de elementos de osteosíntesis asociados a cirugías de trauma maxilofacial en hospital público de Santiago de Chile. Estudio retrospectivo de 4 años / Removal of osteosynthesis elements associated with maxillofacial trauma surgery in a public hospital in Santiago, Chile. Retrospective study of 4 years

Introducción: El manejo quirúrgico del trauma maxilofacial implica el uso elementos de osteosíntesis (OTS) para la reducción abierta y fijación interna rígida. Sin embargo, existen razones que determinan su retirada. El objetivo de este estudio fue evaluar la prevalencia de la retirada del material de osteosíntesis y sus causas en el Hospital San José de Santiago de Chile entre los años 2018 y 2021.Metodología: Estudio retrospectivo descriptivo. Se seleccionaron pacientes intervenidos quirúrgicamente por trauma maxilofacial durante el periodo de 4 años. Se analizaron número de pacientes operados, edad, género, comorbilidades, sitio de fractura, cantidad de cirugías de retirada y tiempo en posición de dichos elementos. Referente a la remoción, se obtuvo localización y etiología.Resultados: Las cirugías por trauma maxilofacial correspondieron a 176; de estas, 17 (9,66 %) requirieron la retirada de OTS, retirando un total de 19 elementos. La edad promedio fue 36,5 años. El género masculino predominó sobre el femenino (3,25:1). La zona anatómica frecuente de retirada fue la mandíbula (94,7 %), especialmente el ángulo mandibular. Las principales causas fueron exposición de placa y/o tornillos y la infección del sitio quirúrgico (36,8 %). La mayoría de las retiradas de OTS ocurrieron antes de los 12 meses (84 %) con un tiempo promedio en posición de 10,23 meses.Conclusiones: Los resultados encontrados muestran una baja prevalencia de la retira de OTS, los hombres son los más afectados, el sitio anatómico de retiro frecuente es el hueso mandibular, las causas principales son la exposición de la placa o infección. Estos hallazgos son concordantes con lo reportado en la literatura. (AU)

Introduction: Surgical management of maxillofacial trauma involves the use of osteosynthesis elements (OTS) for open reduction and rigid internal fixation. However, there are reasons that determine their removal. The aim of this study was to evaluate the prevalence of osteosynthesis material removal and its causes at Hospital San José in Santiago de Chile between 2018 and 2021.Methodology: Retrospective descriptive study. Patients who underwent surgery for maxillofacial trauma during the 4-year period were selected. The number of operated patients, age, gender, comorbidities, fracture site, number of removal surgeries and time in position of these elements were analyzed. Regarding removal, location and etiology were obtained.Results: There were 176 surgeries for maxillofacial trauma, of which 17 (9.66 %) required the removal of OTS, removing a total of 19 elements. The average age was 36.5 years. The male gender predominated over the female (3.25:1). The frequent anatomical area of removal was the mandible (94.7 %), especially the mandibular angle. The main causes were plaque and/or screw exposure and surgical site infection (36.8 %). Most OTS removals occurred before 12 months (84 %) with an average time in position of 10.23 months.Conclusions: The results found show a low prevalence of OTS removal, males are the most affected, the frequent anatomical site of removal is the mandibular bone, the main causes are plaque exposure or infection. These findings are consistent with those reported in the literature. (AU)

Diseño y validación de un cuestionario para evaluar el nivel de conocimientos y hábitos de prescripción antibiótica en cirugía oral / Design and validation of a questionnaire to measure antibiotic knowledge and prescribing habits in oral surgery

Introducción: En las últimas décadas, la resistencia antibiótica se ha convertido en un problema mundial para la salud pública. Los odontólogos no deben permanecer ajenos a este grave problema, siendo responsables de en torno al 10 % de las prescripciones antibióticas que se producen en el ámbito extrahospitalario. El propósito del presente estudio fue diseñar y validar un instrumento para analizar los conocimientos y hábitos de prescripción antibiótica en cirugía oral. Material y métodos: El proceso de construcción y validación del instrumento constó de cinco fases: 1) diseño del instrumento a través de una exhaustiva revisión de la literatura publicada entre enero de 2016 y enero de 2021 en las bases de datos PubMed Medline y Cochrane Library; 2) validación del contenido por un grupo de 6 expertos; 3) pretest cognitivo para evaluar la consistencia interna (alfa de Cronbach); 4) evaluación de las propiedades métricas de la escala; y 5) aprobación por el Comité de Ética de la Investigación de la Universidad Europea. Resultados: Se obtuvo un instrumento conformado por 48 ítems: 20 referidos a conocimientos sobre antibioterapia y 28 correspondientes a hábitos de prescripción antibiótica. La validez de contenido del cuestionario, medida por el Índice de Validez de Contenido (CVI), fue de 0,85 con una fiabilidad de 0,80 y una estabilidad temporal casi perfecta (CCI = 0,95). Conclusiones: El riguroso diseño y validación de este estudio proporciona un instrumento con suficiente validez predictiva para su posterior aplicación y evaluación de los conocimientos y hábitos de prescripción antibiótica en cirugía bucal. (AU)

Objective: In recent decades, antibiotic resistance has become a global public health problem. Dentists should not remain oblivious to this serious problem, as they are responsible for around 10 % of antibiotic prescriptions in the out-of-hospital setting. The purpose of the present study was to design and validate an instrument to analyse the knowledge and antibiotic prescribing habits in oral surgery. Material and methods: The process of constructing and validating the instrument consisted of five stages: 1) Design of the instrument through and exhaustive review of the literature published between January 2016 and January 2021 in the PubMed-Medline and Cochrane Library databases; 2) Validation of the content by a panel of 6 experts; 3) Cognitive pretest to assess internal consistency (Cronbach’s alpha); 4) Evaluation of the metric properties of the scale; and 5) Approval by the Research Ethics Committee of the European University. Results: An instrument consisting of 48 items was obtained; 20 referring to knowledge of antibiotic therapy and 28 corresponding to antibiotic prescribing habits. The content validity of the questionnaire, measured by the Content Validity Idex (CVI) was 0.85 with a reliability of 0,80 and almost perfect temporal stability (CCI = 0,95). Conclusions: The rigorous design and validation of this study provides and instrument with sufficient predictive validity for subsequent application and assessment of antibiotic prescribing knowledge and habits in oral surgery. (AU)

Cirugía de elevación del seno maxilar: "Utilidad de las diferentes técnicas. "Caso clínico de elevación de seno y colocación de implantes Phibo TSH y TSA / Maxillary sinus lift surgery: "Usefulness of different techniques. "Clinical case of sinus lift and placement Phibo TSH and TSA implants

Se realizó una revisión bibliográfica sobre los procedimientos para el aumento o elevación del seno maxilar para la colocación posterior o conjunta de implantes endoóseos. Nuestro objetivo es presentar un caso clínico y revisar la literatura existente. Se puede apreciar que el tema ha sido tratado ampliamente por distintos especialistas, describiendo las distintas técnicas, y también que es un procedimiento con un alto porcentaje de éxito. Por otro lado, habitualmente se puede realizar en consulta ambulatoria, respetando los conceptos de asepsia que se ha de cuidar en los procedimientos de cirugía oral: correcta preparación del equipo, esterilización del instrumental y desinfección del campo quirúrgico. Es decir, todo el instrumental en bolsas herméticas previamente esterilizadas, campos quirúrgicos y guantes estériles, mesa y equipamiento debidamente todo desinfectado. Además de que tanto el equipo de asistencia como el cirujano deben contar con gorros y batas desechables quirúrgicas estériles. Es importante resaltar que al manejar rellenos óseos deben también con los máximos protocolos de esterilización envasado para su utilización. (AU)

A bibliographic review was carried out on the procedures for the augmentation or elevation of the maxillary sinus for the posterior or/and placement of endosseous implants. Our objective is to present a clinical case and review the existing literature. It can be seen that the subject has been extensively treated by different specialists, describing the different techniques, and also that it is a procedure with a high percentage of success. On the other hand, it can usually be performed in a common dental office with the appropriate aseptic measures; that means: correct preparation of the equipment, sterilization of the instruments and disinfection of the surgical field. That is, all the instruments should be packed in hermetic bags previously sterilized, surgical fields and sterile gloves, table and equipment all properly disinfected. In addition to the fact that both the surgical-nurse team and the surgeon must have disposable sterile surgical caps and gowns. It is important to highlight that when handling bone fillers, they must also comply with the maximum packaging sterilization protocols for their use. (AU)

Epidermoid cyst of the tonge: two new cases of an extremely uncommon entity / Quiste epidermoide de la lengua: dos nuevos casos de una entidad extremadamente infrecuente

El quiste epidermoide (QE) es una lesión benigna que emerge como un aumento indoloro y fluctuante del volumen. Es una lesión rara en la cavidad oral y su diagnóstico a través de exámenes clínicos y radiografía convencional proporciona resultados limitados. Por lo tanto, el propósito del presente trabajo es reportar dos casos de lesiones raras de la lengua diagnosticadas como QE en dos pacientes adultos tratados quirúrgicamente. Un hombre de 65 años y una mujer de 40 años se quejaban de una “bolita” en la lengua. Los pacientes presentaron lesiones en la lengua en sitios anatómicos con distintas presentaciones clínicas. El tratamiento adoptado fue una resección de la lesión y, tras un análisis histopatológico, el diagnóstico final apuntó a un quiste epidermoide. En los casos actuales, la lesión ocurrió en el vientre y el dorso de la lengua, y ambos fueron tratados quirúrgicamente. Así, se convirtieron en los casos 14 y 15 de QE en lenguas encontradas en la literatura, confirmando así la relevancia del trabajo actual. (AU)

Epidermoid cyst (EC) is a benign lesion that emerges as a painless and fluctuating increase of volume. EC is a rare injury in the oral cavity and its diagnostic through clinical exams and conventional radiography provides limited results. Thus, the purpose of the current work is to report two cases of rare tongue lesions diagnosed as EC in two adult patients treated surgically. A 65-year old man and a 40-year old woman were complaining of a “little ball” in their tongue. The patients presented tongue lesions in anatomical sites with distinct clinical presentations. The adopted treatment was a resection of the lesion and, after a histopathological analysis, the final diagnostic pointed to an epidermoid cyst. In the current cases, the lesion occurred in the belly and dorsum of the tongue, and both were treated surgically. And so they became the 14th and 15th cases of EC in tongues found in the literature, thus confirming the relevance of the current work. (AU)

Epignatus: manejo quirúrgico y multidisciplinar. Un caso clínico / Epignathus: surgical and multidisciplinary management. A case report

El epignatus es una forma poco frecuente de teratoma que puede localizarse en cualquier punto de la cavidad oral o faringe. Son tumores con una elevada mortalidad debido a la obstrucción severa de vía aérea que producen, por lo que el diagnóstico prenatal es importante para establecer un plan terapéutico. El procedimiento ex-utero intrapartum treatment, o EXIT, es el método gold standard que permite asegurar la vía aérea de estos pacientes. La resección del tumor debe ser precoz y completa, ya que posee valor pronóstico. Existen numerosas patologías y secuelas derivadas del epignatus, la mayoría de ellas debido al efecto de masa que produce durante el desarrollo. Algunas de ellas incluyen fisura palatina, micrognatia o discrepancia anteroposterior mandibulomaxilar con mordida abierta anterior. Describimos este caso con el fin de remarcar la importancia del tratamiento quirúrgico del epignatus y mostrar el complejo manejo multidisciplinar que se realizó para esta patología tan infrecuente. Además de ello, se proponen maneras de mejorar dicha cirugía, como la implementación de modelos estereolitográficos o la reconstrucción virtual tridimensional (3D). (AU)

Epignathus are a rare presentation of congenital teratomas. As they arise from the oral cavity and pharynx they often cause severe airway obstruction leading to high mortality rates. Therefore, prenatal diagnosis is essential to establish a treatment plan. The “ex-utero intrapartum treatment” or EXIT is the gold standard procedure to ensure the upper airway flow. If feasible, early complete resection should be performed as it plays a key role in the prognosis. Several malformations are related to epignathus, most of them due to the mass effect of the epignathus growth during fetal development. Some of them include cleft palate, micrognathia or anterior-posterior maxillomandibular discrepancy with open bite. We report this case to highlight the importance of an optimal surgical treatment for epignathus, and to describe an example of the complex multidisciplinary management needed for this rare entity. Furthermore, we also propose some techniques that could be implemented to improve the surgical outcomes, like stereolithographic models or virtual three-dimensional reconstruction (3D). (AU)

El pabellón de oficiales (2001) Heridas faciales en la primera guerra mundial / The Officers ́ Ward (2021): Facial Wounds during First World War

Adrien Fournier; un joven teniente francés de ingenieros es herido por uno de los primeros obuses de la Primera Guerra Mundial. Aunque sobrevive, presenta unas importantes lesiones en cara y cavidad oral por lo que es trasladado a un hospital de Paris. En el pabellón de oficiales del hospital, hay otros soldados con importantes heridas faciales. En la película se refleja el miedo al rechazo social, los intentos de suicidio, la labor de las enfermeras y del cirujano, así como la camaradería y el apoyo entre pacientes. (AU)

Adrien Fournier; A young French lieutenant of engineers, is wounded by one of the first bombs of the First World War. Although he survives, he has important injuries to his face and oral cavity for which he is transferred to a hospital in Paris. In the officers' ward of the hospital, there are other soldiers with significant facial injuries. The film reflects the fear of social rejection, suicide attempts, the work of the nurses and the surgeon, as well as the camaraderie and support among patients. (AU)

Dientes supernumerarios: reporte de un caso / Supernumerary teeth: report of a case

Los dientes supernumerarios son unidades dentales que numéricamente exceden la cantidad de dientes normal, un fenómeno también conocida como hiperdontia, los dientes supernumerarios más comunes son mesiodens, que ocurren entre los incisivos centrales. El presente artículo tiene como objetivo describir un reporte de caso de una paciente de género femenino, de 21 años de edad, que presenta 13 dientes incluidos, de los cuales 6 son supernumerarios, los mismos que fueron extraídos en dos tiempos quirúrgicos. (AU)

Supernumerary teeth are dental units that numerically exceed the normal number of teeth, a phenomenon also known as hiperdontia. The most common supernumerary teeth are mesiodens, which occur between the central incisors. This article aims to describe a case report of a female patient, 21 yearsold, who has 13 included teeth, of which 6 are supernumerary, thesameones that were extracted in two surgical times. (AU)