Digital workflow feasibility for the fabrication of intraoral maxillofacial prosthetics after surgical resection: a systematic literature review.

OBJECTIVES: To evaluate the current evidence of digital workflow feasibility based on the data acquisition methods and the software tools used to fabricate intraoral prostheses for patients with partial or total maxillary and mandibular defects. MATERIALS AND METHODS: An electronic search was performed in PubMed, SCOPUS, and Web of Science using a combination of relevant keywords: digital workflow, digital designing, computer-assisted design-computer aided manufacturing, 3D printing, maxillectomy, and mandibulectomy. The Joanna Briggs Institute Critical Appraisal Tool was used to assess the quality of evidence in the studies reviewed. RESULTS: From a total of 542 references, 33 articles were selected, including 25 on maxillary prostheses and 8 on mandibular prostheses. The use of digital workflows was limited to one or two steps of the fabrication of the prostheses, and only four studies described a complete digital workflow. The most preferred method for data acquisition was intraoral scanning with or without a cone beam computed tomography combination. CONCLUSION: Currently, the fabrication process of maxillofacial prostheses requires combining digital and conventional methods. Simplifying the data acquisition methods and providing user-friendly and affordable software may encourage clinicians to use the digital workflow more frequently for patients requiring maxillofacial prostheses.

Dental treatments under sedation-analgesia in patients who are unable to collaborate: a prospective observational study.

Background: Excessive fear of dental procedures leads to disruptive behavior during dental examinations and treatments. Dental examinations and treatments of these patients usually require additional techniques, such as sedation. The most commonly used techniques are inhalation of nitrous oxide, infusion of propofol with fentanyl, and premedication and infusion of midazolam. Methods: A prospective observational epidemiological study was conducted on patients who required sedoanalgesia techniques for dental exploration and procedures. The reasons for the inability of patients to cooperate (excessive fear or intellectual disability), age, sex, weight, systemic pathology, oral pathology, treatment performed, time of intervention, anesthetic technique performed, and occurrence of complications were recorded. Results: In total, 218 patients were studied. Sixty-five patients came for fear of dental treatment and 153 for presenting with a diagnosis of intellectual disability and not collaborating in the treatment with local anesthesia. The average age of all patients was 30.54 ± 17.30 years. The most frequent oral pathologies found in patients with excessive fear were tartar (6.8%) and wisdom teeth (6.4%), followed by missing teeth (5%). In patients with disabilities, a combination of tartar and cavities appeared most frequently (41.3%), followed by cavities (15.6%). The most frequently used sedoanalgesia technique was the infusion of propofol with fentanyl in both groups of patients, followed by nitrous oxide. Conclusion: The combination of propofol and fentanyl was the most frequently used alternative in patients who were unable to collaborate because of intellectual disability or carry out longer or more complex treatments. Inhaled nitrous oxide and midazolam were the sedative techniques of choice for simpler oral treatments, such as tartrectomies, shallow obturations, and shorter interventions, or in younger patients.

Complications associated with vertical bone augmentation techniques in implant dentistry: A systematic review of clinical studies published in the last ten years.

Vertical bone augmentation procedures are increasingly necessary in daily practice. However, it has been reported that vertical ridge augmentation is one of the least predictable techniques in terms of complications. The aim of this systematic review was to evaluate and compare complications in relation to the different procedures used for vertical bone augmentation prior to implant placement. This review was conducted according to PRISMA guidelines. An electronic search was carried out in four databases: The National Library of Medicine (MEDLINE/PubMed); Web of Science; SCOPUS; and Cochrane Central Register of Controlled Trials (CENTRAL). The Newcastle-Ottawa Quality Assessment Scale, the Cochrane Collaboration tool for assessing risk of bias, and The Joanna Briggs Institute Critical Appraisal tool were used to assess the quality of evidence in the studies reviewed. Twenty-five studies with a total of 749 vertically augmented sites were included in the review. Complication rates varied among the different procedures: 51.02% for distraction osteogenesis, 38.01% for bone blocks, and 16.80% for guided bone regeneration. Vertical bone augmentation procedures prior to implant placement are associated with frequent surgical complications and should be approached with caution due to their possible impact on clinical treatment success.

Current status of split-mouth controlled clinical trials comparing cyanoacrylate vs. conventional suture after lower third molar surgeries: a systematic literature review.

Objetive. During the last few years, cyanoacrylate has been used for wound closure in oral and maxillofacial surgery with growing frequency. When comparing cyanoacrylate with sutures, some authors report similar experiences, while others have found differences. Some agree on the similar outcomes obtained between cyanoacrylate and sutures, others have registered better effects with cyanoacrylate, and others with sutures. Therefore, the aim of this systematic review (SR) was to evaluate postoperative parameters - pain, swelling, trismus, healing and complications (bleeding and infection) - after lower third molar (LTM) removal using cyanoacrylate compared with sutures. Materials and methods. Electronic and manual literature searches were conducted independently by two reviewers up to March 2022. Results. Four studies met the pre-established inclusion criteria and were included for descriptive analysis. These were controlled clinical trials comparing the effects of cyanoacrylate with sutures in 116 patients and 232 split-mouth cases. Pain and haemostasis were significantly reduced on the cyanoacrylate group, swelling showed the same results on two of the studies analysed, trismus and healing had no significant differences between both groups. Conclusions. Both techniques were found to be effective in terms of wound closure, proposing cyanoacrylate as an effective resource that should be investigated in future research. Nevertheless, the literature on cyanoacrylate is scarce and lacks comparative studies of its outcomes and effects.

Dental treatment under general anesthesia in patients with severe intellectual disability at the Gregorio Marañón General University Hospital: a 10-year retrospective study.

OBJECTIVES: There is a high demand for dental treatment in a hospital setting for patients with severe intellectual disability (ID), due to their inability to cooperate. The objective was to determine the types of dental treatment carried out on patients with severe ID, as well as the possibility of performing clinical and radiographic examinations prior to treatment and to identify their characteristics. METHOD AND MATERIALS: A retrospective observational study was performed, based on the medical histories of patients with severe ID or a disability included in the portfolio of dental services of Community of Madrid, who underwent dental treatment at the Stomatology Service of the Gregorio Marañón General University Hospital from the year 2009 to 2019. Data on age, sex, etiology of disability, and dental treatment were obtained. RESULTS: A total of 1,845 patients were included. The type of disability in the majority of cases was unknown, followed by encephalopathy, cerebral paralysis, and Down syndrome. In total, 8,439 dental extractions were performed on 1,548 patients (83.9%). Clinical and radiographic exploration were carried out on 874 patients (47.4%). CONCLUSIONS: Ultrasonic scaling was the most frequently performed treatment in patients. Dental extractions were the next most common treatment. An increase in age showed a higher demand for surgical procedures and extractions. Over half of the patients (52.6%) did not tolerate clinical or radiographic examinations.

Influence of Serum Vitamin D Levels on Survival Rate and Marginal Bone Loss in Dental Implants: A Systematic Review.

This systematic literature review set out to investigate the relationship between serum vitamin D levels and dental implants in terms of survival rates, marginal bone loss, and associated complications. The review was conducted according to PRISMA guidelines, performing an electronic search in four databases (Pubmed, Web of Science, Cochrane, and Scopus), complemented by a manual search up to April 2022. Four articles were selected for analysis. The Newcastle-Ottawa Quality Assessment Scale tool was used to assess the quality of evidence of cohort studies, and the Cochrane bias assessment tool was used to assess the quality of evidence of randomized clinical trials. The study included 1089 patients restored with 1984 dental implants, with follow-up periods ranging from 20-240 months. Cases presenting lower serum vitamin D levels obtained slightly worse results in terms of marginal bone loss. Longer follow-up periods are needed in order to determine whether serum vitamin D levels affect implant survival rates and osseointegration over time.

Brain complications from odontogenic infections: A systematic review.

PURPOSE: Odontogenic infections can spread through different routes to more remote anatomical areas, such as the brain. Brain abscesses have an incidence of 0.3-1.3 / 100,000 population and only 2-5% are of dental origin. The main objective is to research brain complications derived from odontogenic infections. Secondary objectives were to identify the most common symptoms in brain abscess, to describe the microbiology involved in these infectious processes, report which parts of the brain complex are most commonly affected and report the sequelae of this patients. METHODS: A systematic review following the PRISMA Guide and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports was carried out in PubMed, Scopus and Web of Science. The search terms were: Brain infection, brain abscess, oral health oral origin, odont* infect*. RESULTS: The database search identified a total of 1000 articles. A total of 18 publications were identified after applying inclusion and exclusion criteria. A total of 38 patients were analyzed. Mean age was 49.64±18.80 years. CONCLUSION: The most common symptoms of patients with brain abscess are neurological affectations first and then fever and headache second, without necessarily presenting as a symptomatological triad. Microbiological diagnosis is key to determining the origin of the infection. Anaerobic pathogens such as Streptococcus (F. Milleri), Fusobacterium Nucleatum and Porfiromonas Gingivalis families are common bacterial agents. The frontal lobe is the most frequently affected, followed by the parietal and temporal lobe. The most frequent brain complications are neurological disorders. However, most patients with brain abscesses recover without sequelae.

Treatment Outcomes of Implant-Supported Maxillary Obturator Prostheses in Patients with Maxillary Defects: A Systematic Review.

PURPOSE: To systematically review the current evidence on clinical and patient-reported outcomes of implant-supported palatal obturator prostheses. MATERIALS AND METHODS: An electronic search of the PubMed, Web of Science, and Cochrane databases was carried out in June 2019. The titles and abstracts of all articles were screened by two independent reviewers. The references of the subsequently selected studies were further screened for potential articles. Assessment of the selected full texts was performed independently according to established inclusion and exclusion criteria. The quality of the selected studies was determined using the Newcastle-Ottawa scale. Interrater agreement on study selection was calculated using Cohen kappa statistic. RESULTS: The search yielded a total of 2,797 records. Ten studies were selected for data extraction, with a Cohen kappa value of 0.856. Five studies were prospective, and five were retrospective. The survival rates for conventional implants ranged from 21.42% to 100%, whereas for zygomatic implants, the survival rates varied from 30% to 100%. Four studies reported prosthodontic complications, with screw loosening being the most common. Patient quality of life (QoL) was analyzed in six studies. CONCLUSION: In spite of the limitations of the present review, it can be concluded that the clinical outcomes are acceptable in terms of survival rates, implant and prosthodontic complications, and QoL associated with implant-supported maxillary obturator prostheses. QoL of implant-supported prostheses in these patients are acceptable. The general study design was not homogenous between studies.

Effect of the lack of primary stability in the survival of dental implants.

BACKGROUND: The survival of dental implants has been linked to primary stability. The aim of this study is to analyse the factors that influence the survival of dental implants placed without primary stability. MATERIAL AND METHODS: A cohort study of implants placed without primary stability was carried out between September 2011 and July 2016. All cases with registered information on the patient and surgical intervention were used. Cases that did not have a 12-month follow-up after implant placement were excluded. RESULTS: Out of 2,400 analysed implants, 92 were placed without primary stability. The absence of primary stability was classified as B in 49 cases, C in 38 cases and D in 5 cases. No statistically significant influence of the patient's age, primary stability, brand, or implant size in terms of implant survival was established. A tendency towards greater early implant loss was observed in implants whose absence of primary stability was classified as C. CONCLUSIONS: Poor primary stability is not statistically significant in the loss of dental implants of the characteristics studied. Any of the factors studied are related with early implant loss as a main factor. Key words:Primary stability, survival, dental implants.

Electrophysiology of Muscle Fatigue in Cardiopulmonary Resuscitation on Manikin Model.

Cardiopulmonary resuscitation requires the provider to adopt positions that could be dangerous for his or her spine, specifically affecting the muscles and ligaments in the lumbar zone and the scapular spinal muscles. Increased fatigue caused by muscular activity during the resuscitation could produce a loss of quality and efficacy, resulting in compromising resuscitation. The aim of this study was to evaluate the maximum time a rescuer can perform uninterrupted chest compressions correctly without muscle fatigue. This pilot study was performed at Universidad Complutense de Madrid (Spain) with the population recruited following CONSORT 2010 guidelines. From the 25 volunteers, a total of 14 students were excluded because of kyphoscoliosis (4), lumbar muscle pain (1), anti-inflammatory treatment (3), or not reaching 80% of effective chest compressions during the test (6). Muscle activity at the high spinal and lumbar (L5) muscles was assessed using electromyography while students performed continuous chest compressions on a ResusciAnne manikin. The data from force exerted were analyzed according to side and muscle groups using Student's t test for paired samples. The influence of time, muscle group, and side was analyzed by multivariate analyses ( p ≤ .05). At 2 minutes, high spinal muscle activity (right: 50.82 ± 9.95; left: 57.27 ± 20.85 µV/ms) reached the highest values. Activity decreased at 5 and 15 minutes. At 2 minutes, L5 activity (right: 45.82 ± 9.09; left: 48.91 ± 10.02 µV/ms) reached the highest values. After 5 minutes and at 15 minutes, activity decreased. Fatigue occurred bilaterally and time was the most important factor. Fatigue began at 2 minutes. Rescuers exert muscular countervailing forces in order to maintain effective compressions. This imbalance of forces could determine the onset of poor posture, musculoskeletal pain, and long-term injuries in the rescuer.

Alternative intraoral donor sites to the chin and mandibular body-ramus.

BACKGROUND: Provide a review of alternative intraoral donor sites to the chin and body-ramus of the mandible that bring fewer complications and that may be used to regenerate small and medium defects. MATERIAL AND METHODS: A review was conducted using the search engine PUBMED and looking manually into scientific journals. RESULTS: From the 35 articles included, 6 corresponded to the coronoids, 3 corresponded to the zygomatic body, 5 corresponded to the anterior maxillary sinus wall, 3 corresponded to the zygomatic alveolar process, 2 corresponded to the incisive fossa, 2 corresponded to the anterior nasal spine, 2 corresponded to the palatal region, 5 corresponded to the tuberosity, and 7 corresponded to the palatal and mandibular tori. CONCLUSIONS: Although there are few complications described when using alternative intraoral donor sites, the main problem with these types of grafts is their scarce bone volume, with only the zygomatic body, anterior sinus wall, and palate sites being able to be used in medium defects. More clinical trials are necessary in order to evaluate the behavior of the alternative donor sites over time. Key words:Grafting, autologous bone, autografts, mandible, maxilla, palate hard, zygoma.

Complications in the use of the mandibular body, ramus and symphysis as donor sites in bone graft surgery. A systematic review.

BACKGROUND: To develop a systematic review by assessing and comparing the different complications that occurs in bone graft surgery using the mandibular body, ramus and symphysis as donor sites. MATERIAL AND METHODS: In order to respond to the following question, a systematic review was developed: does the use of intraoral mandibular body and ramus as donor sites in bone graft surgery, produce fewer and less severe complications in comparison to the use of the mandibular symphysis in patients that present bone resorption that needs augmentation using autologous grafts? The review was carried out between January 1990 and 2015, during which only clinical essays with a minimum follow-up period of six months were included. RESULTS: The initial search yielded a total of 2912 articles, of which 6 were finally selected. In total, 259 graft surgeries were performed; 118 using the mandibular body and ramus as donor sites, and 141, the symphysis. The most frequent complications that arose when using the mandibular symphysis were temporary sensory alterations in the anterior teeth (33.87%), followed by sensory alterations of the skin and mucosa (18.57%). As for the mandibular body and ramus donor sites, the most frequent complications relate to temporary sensory alterations of the mucosa (8.19%) and to minor postoperative bleeding (6.55%). CONCLUSIONS: The analyzed results show a higher prevalence and severity of complications when using mandibular symphysis bone grafts, producing more discomfort for the patient. Therefore, it would be advisable to perform further clinical essays due to the lack of studies found.

Effects of local melatonin application on post-extraction sockets after third molar surgery. A pilot study.

OBJECTIVES: The purpose of this study was to assess the anti-inflammatory, analgesic and osteogenic early effects of melatonin on post-extraction sockets of patients requiring third molars extraction. STUDY DESIGN: A randomized, triple-blind clinical trial was made using a split-mouth design. Both lower third molars of 10 patients were extracted and 3 mg of local melatonin or placebo were applied. Concentrations of interleukin-6 and nitrotyrosine were determined on samples of the clot from the socket by independent ELISA tests. Radiographic bone density was evaluated by measuring Hounsfield Units in panoramic and cross sections obtained by digital scanner. Statistical analysis by Kolmogorov-Smirnov test was performed for ELISA data. Bone density was analyzed by Shapiro-Wilk test. Subsequently t test was applied. P<0.05 was considered to be significant. RESULTS: The concentration of interleukin-6 increased with the application of melatonin without statistically significance (361.32 ± 235.22 pg/ml vs 262.58 ± 233.92 pg/ml). Nitrotyrosine concentrations showed values below to the detectability pattern (<0.001 nM) in Optic Density curve. Bone density in panoramic sections at socket after melatonin application showed no significant difference (561.98 ± 105.92 HU vs 598.82 ± 209.03 HU). In cross sections, bone density in the alveolar region showed no significant difference(377.42 ± 125.67 HU vs 347.56 ± 97.02 HU). CONCLUSIONS: Within the limitations of this pilot study, no differences with the application of melatonin were found in terms of the concentration of interleukin-6 and bone density in post-extraction socket of retained mandibular third molars.