Study of two MTA cements.

INTRODUCTION: To determine and compare the pH, conductivity and calcium release of an experimental Portland cement (PE) consisting of trioxid mineral aggregate and a comercially available modified Portland cement (C.P.M.) after 1, 2, 3, 4, 8, 10, 15 and 30 days. MATERIAL AND METHODS: Cements were mixed following the manufacturer's instructions, with a powder: liquid ratio of 3:1. Each cement was placed in 12 PVC tubes 1 mm in diameter and 10 mm in length and allowed to set. Four empty tubes were used as negative controls. Tubes were submerged in plastic flasks containing 10 ml deionized water and stored at 37 C and 100% humidity. After 1, 2, 3, 4, 8, 10, 15 and 30 days tubes were removed from the flasks and these were refilled with deionized water. We measured pH, conductivity and calcium content of the recovered solution. Data were analyzed using repeated measures ANOVA. RESULTS: pH was 0.3 units more alkaline with PE cement (p=0.023). pH experienced a slight decrease with time (p<0.001), independently of the cement type (p>0.05). Conductivity of PE and CPM cements diminished at 4 days and almost recovered at 30 days (p<0.001). PE cement had a higher conductivity (p<0.001). Calcium release diminished from the first day and recovered at 30 days (p<0.001) similarly for both cements (p>0.05). CONCLUSIONS: PE cement raised pH slightly more and had higher conductivity than CPM. Calcium release diminished after the first day and recovered at 30 days, similarly for both cements.

Sharp mandibular bone irregularities after lower third molar extraction: incidence, clinical features and risk factors.

OBJECTIVES: The purpose of this study was to determine the incidence and clinical symptoms associated with sharp mandibular bone irregularities (SMBI) after lower third molar extraction and to identify possible risk factors for this complication. STUDY DESIGN: A mixed study design was used. A retrospective cohort study of 1432 lower third molar extractions was done to determine the incidence of SMBI and a retrospective case-control study was done to determine potential demographic and etiologic factors by comparing those patients with postoperative SMBI with controls. RESULTS: Twelve SMBI were found (0.84%). Age was the most important risk factor for this complication. The operated side and the presence of an associated radiolucent image were also significantly related to the development of mandibular bone irregularities. The depth of impaction of the tooth might also be an important factor since erupted or nearly erupted third molars were more frequent in the SMBI group. CONCLUSIONS: SMBI are a rare postoperative complication after lower third molar removal. Older patients having left side lower third molars removed are more likely to develop this problem. The treatment should be the removal of the irregularity when the patient is symptomatic.

Central odontogenic fibroma: retrospective study of 8 clinical cases.

INTRODUCTION AND OBJECTIVES: The central odontogenic fibroma (COF) is a benign odontogenic tumour derived from the dental mesenchymal tissues. It is a rare tumour and only 70 cases of it have been published. Bearing in mind the rareness of the tumour, 8 new cases of central odontogenic fibroma have been found by analyzing the clinical, radiological and histopathological characteristics of COF. PATIENTS AND METHOD: A retrospective study was carried out on 3011 biopsies in the Service of Oral and Maxillofacial Surgery of the Dental Clinic of Barcelona University between January 1995 and March 2008. 85 odontogenic tumours were diagnosed of which 8 were central odontogenic fibroma. The radiological study was based on orthopantomographs, periapical and occlusal radiographies and computerised tomographics. The variables collected were: sex, age, clinical characteristics of the lesion, treatment received and possible reappearances of the tumour. RESULTS: The central odontogenic fibroma represents 9.4% of all odontogenic tumours. Of the 8 cases, 5 were diagnosed in men and 3 in women. The average age was 19.9 years with an age range of 11 to 38 years. The most common location of the tumour was in the mandible. All cases were associated with unerupted teeth. Of the 8 tumours, 3 provoked rhizolysis of the adjacent teeth and 4 cases caused cortical bone expansion. 50% of the patients complained of pain associated to the lesion. No case of recurrence was recorded up to 2 years after the treatment. CONCLUSIONS: Central odontogenic fibromas usually evolve asymptomatically although they can manifest very aggressively provoking dental displacement and rhizolysis. Radiologically, COF manifest as a uni or multilocular radiotransparent image although they can be indistinguishable from other radiotransparent lesions making diagnosis more difficult. COF treatment involves conservative surgery as well as follow-up patient checks.

Sensibility and taste alterations after impacted lower third molar extractions. A prospective cohort study.

OBJECTIVES: To determine the incidence, severity and duration of lingual tactile and gustatory function impairments after lower third molar removal. STUDY DESIGN: Prospective cohort study with intra-subject measures of 16 patients undergoing lower third molar extractions. Sensibility and gustatory functions were evaluated in each subject preoperatively, one week and one month after the extraction, using Semmes-Weinstein monofilaments and 5 different concentrations of NaCl, respectively. Additionally, all patients filled a questionnaire to assess subjective perceptions. RESULTS: Although patients did not perceive any sensibility impairments, a statistically significant decrease was detected when Semmes-Weinstein monofilaments. This alteration was present at one week after the surgical procedure and fully recovered one month after the extraction. There were no variations regarding the gustatory function. CONCLUSIONS: Lower third molar removal under local anesthesia may cause light lingual sensibility impairment. Most of these alterations remain undetected to patients. These lingual nerve injuries are present one week after the extraction and recover one month after surgery. The taste seems to remain unaffected after these procedures.

Quality of life following third molar removal under conscious sedation.

AIM: The aim of this study was to assess quality of life (QoL) and degree of satisfaction among outpatients subjected to surgical extraction of all four third molars under conscious sedation. A second objective was to describe the evolution of self-reported pain measured in a visual analogue scale (VAS) in the 7 days after extraction. STUDY DESIGN: Fifty patients received a questionnaire assessing social isolation, working isolation, eating and speaking ability, diet modifications, sleep impairment, changes in physical appearance, discomfort at suture removal and overall satisfaction at days 4 and 7 after surgery. Pain was recorded by patients on a 100-mm pain visual analogue scale (VAS) every day after extraction until day 7. RESULTS: Thirty-nine patients fulfilled correctly the questionnaire. Postoperative pain values suffered small fluctuations until day 5 (range: 23 to 33 mm in a 100-mm VAS), when dicreased significantly. A positive association was observed between difficult ranked surgeries and higher postoperative pain levels. The average number of days for which the patient stopped working was 4.9. CONCLUSION: The removal of all third molars in a single appointment causes an important deterioration of the patient's QoL during the first postoperative week, especially due to local pain and eating discomfort.

Bupivacaine 0.5% versus articaine 4% for the removal of lower third molars. A crossover randomized controlled trial.

OBJECTIVE: To compare the anesthetic action of 0.5% bupivacaine in relation to 4% articaine, both with 1:200,000 epinephrine, in the surgical removal of lower third molars. As a secondary objective hemodynamic changes using both anesthetics were analyzed. STUDY DESIGN: Triple-blind crossover randomized clinical trial. Eighteen patients underwent bilateral removal of impacted lower third molars using 0.5% bupivacaine or 4% articaine in two different appointments. Preoperative, intraoperative and postoperative variables were recorded. Differences were assessed with McNemar tests and repeated measures ANOVA tests. RESULTS: Both solutions exhibited similar latency times and intraoperative efficacy. Statistical significant lower pain levels were observed with bupivacaine between the fifth (p=0.011) and the ninth (p=0.007) postoperative hours. Bupivacaine provided significantly longer lasting soft tissue anesthesia (p<0.5). Systolic blood pressure and heart rate values were significantly higher with articaine. CONCLUSIONS: Bupivacaine could be a valid alternative to articaine especially due to its early postoperative pain prevention ability.

Informed consent in oral surgery: the value of written information.

OBJECTIVE: To evaluate the efficacy of the written explanation given to patients when obtaining informed consent for oral surgery, taking the surgical extraction of the impacted mandibular third molar as the clinical model for this study. PATIENTS AND METHODS: This study included 87 patients requiring surgical extraction of an impacted lower third molar. Residents of the Oral Surgery Department explained verbally and in writing 7 possible complications that could arise as a result of the operation, after which informed consent was obtained from the patient. These complications were as follows: altered sensation of the homolateral lower lip and chin; altered sensation of the tongue; swelling; trismus; pain; allergies; and infection. The patients completed a Corah anxiety test on the same day, as well as a preoperative questionnaire about their level of understanding of the informed consent. Seven days after the operation, the patients returned to have their stitches removed and for a postoperative interview. RESULTS: A total of 87 patients participated in the study. Of these, 64% (n = 56) had understood the objective of the informed consent. All but 1 (1%) of the patients remembered having been informed of the possible risks before the operation. Changes in sensation of homolateral lower lip and chin (98%, n = 85) and of the tongue (86%, n = 75) were among the complications most recalled by the patients. Ninety-six percent of patients (n = 84) preferred to be informed preoperatively, and 71% (n = 61) described the signs and symptoms to be exactly as explained by the residents. CONCLUSIONS: Patients do not remember the majority of the information they receive before giving informed consent. Paresthesia of the lower lip and chin on the operated side and of the tongue are among the most recalled complications. This may be due to the seriousness of this complication, to the effect it can have on the patients' daily life, and to the possibility that it may be irreversible.

Giant desmoplastic fibroma in the anterior zone of the maxilla.

Desmoplastic fibroma (DF) is a rare intraosseous benign neoplasm that represents less than 1% of the osseous tumors. This lesion can be locally aggressive, and the rate of recurrence is frequently high.A 34-year-old male patient was referred to our clinic presenting a tumor in the anterior zone of the maxilla. The oral examination revealed a hard and lobulated tumor, affecting teeth 13 to 26. The radiographic examination, orthopantomography, and computed tomography revealed a radiolucent, multilocular, well-defined image, which extended from tooth 13 to the mesial root of tooth 26, provoking marked expansion, thinning, and perforation of the buccal and palatal cortical plates. A provisional diagnosis of aggressive odontogenic tumor was made, and block resection of the tumor was carried out. Intraoperatively, the tumor was lobulated, composed of a homogenous fibrous tissue, hard, and white-yellowish. The histologic analysis leads to a diagnosis of DF.Desmoplastic fibroma of the oral cavity is a rare benign intraosseous tumor, especially when it involves the upper maxilla and the anterior region. The main clinical and pathologic differential diagnosis in our case was central odontogenic fibroma. The most suitable treatment option for DF of the oral cavity is a controversial issue, but block resection is the therapy reporting a lower recurrence. Finally, an interesting feature of this intraosseous neoplasm, if located in the oral cavity, refers to the different clinical pattern that might present depending on location.

Pilomatrixoma. Review of 205 cases.

AIMS: To determine the incidence and clinical features of patients diagnosed with pilomatrixoma. PATIENTS AND METHOD: A retrospective analysis was made of 205 cases of pilomatrixoma diagnosed according to clinical and histological criteria, with an evaluation of the incidence, patient age at presentation, gender, lesion location and size, single or multiple presentation, differential diagnosis, histopathological and clinical findings and relapses. RESULTS: Pilomatrixoma was seen to account for 1.04% of all benign skin lesions. It tended to present in pediatric patients--almost 50% corresponding to individuals under 20 years of age--with a slight male predilection (107/98). Approximately 75% of all cases presented as single lesions measuring less than 15 mm in diameter. Multiple presentations were seen in 2.43% of cases. The most frequent locations were the head and orofacial zones (particularly the parotid region), with over 50% of all cases, followed by the upper (23.9%) and lower limbs (12.7%). Only one relapse was documented following simple lesion excision. CONCLUSIONS: The frequency of pilomatrixomas was 1.04% of all benign skin lesions--the lesions being predominantly located in the maxillofacial area. Due to the benign features of this disorder, simple removal of the lesion is considered to be the treatment of choice, and is associated with a very low relapse rate.

Validation of a computer-assisted system on classifying lower third molars.

OBJECTIVES: The present study evaluates the reliability of the Radio Memory® software (Radio Memory; Belo Horizonte, Brasil.) on classifying lower third molars, analyzing intra- and interexaminer agreement of the results. STUDY DESIGN: An observational, descriptive study of 280 lower third molars was made. The corresponding orthopantomographs were analyzed by two examiners using the Radio Memory® software. The exam was repeated 30 days after the first observation by each examiner. Both intra- and interexaminer agreement were determined using the SPSS v 12.0 software package for Windows (SPSS; Chicago, USA). RESULTS: Intra- and interexaminer agreement was shown for both the Pell & Gregory and the Winter classifications, p<0.01, with 99% significant correlation between variables in all the cases. CONCLUSIONS: The use of Radio Memory® software for the classification of lower third molars is shown to be a valid alternative to the conventional method (direct evaluation on the orthopantomograph), for both clinical and investigational applications.

Periodontal health and esthetic results in impacted teeth exposed by apically positioned flap technique.

OBJECTIVES: This study evaluates the periodontal health status and the esthetic results of teeth subjected to orthodontic traction, after their exposure by an apically positioned flap. STUDY DESIGN: Fifteen patients were included in the study, ages between 11 and 28 years old. The fenestrated teeth and their homologous contralateral normally erupted teeth, used as control, were evaluated. RESULTS: Statistically significant differences were found in the position of the gingival margin (p = 0.005), with an average distance between cemento-enamel junction (CEJ) and gingival margin of 2.47 mm (SD 1.19) in control teeth and of 1 mm (SD 1.31) in the operated teeth, and in the depth of palatal probing (p = 0.031), with 2.1 mm (SD 0.9) for the experimental teeth and 1.7 mm (SD 0.8) for the control teeth. The gingival index, the bleeding during probing and the probing depth did not show statistically significant differences. The patient's subjective esthetic evaluation was more favorable for the control teeth in most of the cases. CONCLUSIONS: The surgical approach for the impacted teeth by means of the apically positioned flap resulted to be a predictable technique allowing the maintenance of the periodontal health on a long-term basis.

Advantages and esthetic results of erbium, chromium:yttrium-scandium-gallium-garnet laser application in second-stage implant surgery in patients with insufficient gingival attachment: a report of three cases.

Traditional implant placement involves two surgical stages. Although the second stage is comparatively less aggressive for the patient, postoperative pain and swelling can be further reduced by the use of laser instead of a scalpel. Correct handling of peri-implant soft tissue is of major importance in obtaining adequate gingival tissue attachment around implants. The presence of this keratinized gingiva ensures adequate esthetic results and maintains implant health. We report on three patients with implants in the anterior area who were operated on under the above conditions. Traditionally, the tissue overlying the implants is removed and eliminated. In seeking a way to preserve the attached gingiva, we raised a trapezoidal flap, uncovering each implant and allowing apical repositioning and transpositioning of keratinized gingiva to the buccal side. The results obtained were compared with those from other patients operated on by conventional scalpel. The erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser minimized postoperative pain, and the time to prosthetic rehabilitation was also shortened. The esthetic results were far superior, and no complications were recorded.

Application of ultrasound in bone surgery: two case reports.

The present study describes some of the applications of ultrasound in bone surgery, based on the presentation of two clinical cases. The Piezosurgery® ultrasound device was used (Tecnología Mectron Medical, Carasco, Italy). In one case the instrument was used to harvest a chin bone graft for placement in a bone defect at level 1.2, while in the other case a bony window osteotomy was made in the external wall of the maxillary sinus, in the context of a sinus membrane lift procedure. The Piezosurgery® device produces specific ultrasound frequency modulation (25-29 kHz), and has been designed to secure increased precision in application to bone surgery. This instrument produces selective sectioning of the mineralized bone structures, and causes less intra- and postoperative bleeding. One of the advantages of the Piezosurgery® device is that it can be used for maxillary sinus lift procedures in dental implant placement. In this context it considerably lessens the risk of sinus mucosa laceration by preparing the bony window in the external wall of the upper maxilla, and can be used to complete the lifting maneuver. The use of ultrasound in application to hard tissues can be regarded as a slow technique compared with the conventional rotary instruments, since it requires special surgical skill and involves a certain learning curve.

Clinical features of oral lichen planus. A retrospective study of 65 cases.

OBJECTIVES: To describe the clinical features of patients diagnosed with oral lichen planus (OLP) and to establish the prevalence of its malignant transformation in our setting. STUDY DESIGN: A retrospective study was made of 65 patients clinically and histologically diagnosed with OLP in the Service of Oral Surgery (Dental Clinic of the University of Barcelona, Spain) in the period 1990-2005. A descriptive and bivariate statistical analysis was made. RESULTS: The mean patient age was 59 years (SD +/- 14.9). Most of the patients (61%) were women, and the most frequent location of the lesions was the buccal mucosa (90.8%). White forms of OLP were noted in 66% of the cases, and 46.2% of the patients reported symptoms of some kind. The patients diagnosed with diabetes mellitus (20%) showed a larger proportion of red lesions (p=0.088). No statistically significant association was observed between chronic liver disease and the OLP lesion types or symptoms. Two cases of squamous cell carcinoma were identified in two patients previously or simultaneously diagnosed with OLP. A statistically significant correlation was observed between dysplastic changes / malignization of the lesions and smoking habit (p=0.019). An association to alcohol abuse was also noted, though in this case statistical significance was not reached (p=0.085). CONCLUSIONS: The clinical features of our study population were similar to those described in other studies. Diabetic patients with OLP were seen to be more susceptible to the development of atrophic-erosive lesions. Smokers and/or patients with alcohol abuse in turn showed a greater tendency to develop dysplastic changes / malignization in the histopathological study of the lesions.

Histologic evaluation of thermal damage produced on soft tissues by CO2, Er,Cr:YSGG and diode lasers.

OBJECTIVE: The aim of this in vitro experimental study was to perform histological evaluation of the thermal effect produced on soft tissue irradiated with CO2, Er,Cr:YSGG or diode lasers. STUDY DESIGN: Porcine oral mucosa samples were irradiated with Er,Cr:YSGG laser at 1 W with and without water / air spray, at 2 W with and without water / air spray, and at 4 W with water / air spray, with CO2 laser at 1 W, 2 W, 10 W, 20 W continuous mode and 20 W pulsed mode and diode laser at 2 W, 5 W, and 10 W pulsed mode. The thermal effect was evaluated measuring the width of damaged tissue adjacent to the incision, stained positively for hyalinized tissue with Hematoxylin-Eosin and Masson Trichrome stains. Besides, histological changes in the irradiated tissue were described using subjective grading scales. RESULTS: The evaluated lasers developed a wide range of thermal damage with significant differences between groups. The samples with lowest thermal effect were those irradiated with Er,Cr:YSGG laser using water / air spray, followed by CO2 and diode lasers. CONCLUSIONS: Emission parameters of each laser system may influence the thermal damage inflicted on the soft tissue, however, the wave length of each laser determines the absorption rate characteristics of every tissue and the thermal effect.

Multiple supernumerary teeth not associated with complex syndromes: a retrospective study.

OBJECTIVES: To determine the epidemiology and describe the clinical and radiographic characteristics, the type of treatment, and the possible delayed appearance of new supernumerary teeth in patients with non-syndromic multiple hyperdontia. PATIENTS AND METHODS: We conducted a small retrospective observational study of 8 patients diagnosed with non-syndromic multiple hyperodontia. Multiple hyperdontia not associated to complex syndromes was defined as apparently generally healthy patients with one or more supernumerary teeth in two or more areas. RESULTS: The average patient age was 16.23 years; males predominated (3:1). Multiple hyperodontia with a minimum of 2 and a maximum of 9 supernumerary teeth was found (total: 34 mean: 4.25). The most frequent location was the upper jaw (76.47%). Eumorphic teeth were seen at lower premolar level, while the rest were all heteromorphic. There was altered eruption of the contiguous teeth of 4 of the impacted supernumerary teeth all the rest being asymptomatic. Extraction was the treatment in all patients, and in one of them the delayed appearance of 4 supernumerary teeth was detected. CONCLUSIONS: Multiple hyperodontia rarely occurs without being associated with complex syndromes. Prophylactic surgical removal of the supernumerary teeth is generally the treatment of choice.

Ellis-van Creveld syndrome. Case report and literature review.

Ellis-van Creveld syndrome is a genetic disorder that was first described by Richard Ellis and Simon van Creveld in 1940. The four principal characteristics are chondrodysplasia, polydactyly, ectodermal dysplasia and congenital heart defects. The orofacial manifestations include multiple gingivolabial musculofibrous fraenula, dental anomalies, hypodontia and malocclusion. The disease can be diagnosed at any age, even during pregnancy. The differentiation should be made between Jeune syndrome and other orofaciodigital syndromes.

Erupted odontomas: a report of three cases and review of the literature.

INTRODUCTION: Odontomas are benign odontogenic tumors composed of enamel, dentine, cement and pulp tissue. They are usually clinically asymptomatic, but often associated with tooth eruption disturbances. In exceptional cases the odontoma erupts into the mouth . The present study reports three cases of odontomas erupted into the oral cavity and reviews the literature. CLINICAL CASES: The first case was an 11-year-old girl with impacted 4.6 associated to a radiopaque mass measuring about 2 cm in diameter. The histological diagnosis was complex odontoma. A clinical and radiological follow-up of 4.6 was carried out until its spontaneous eruption. The second case was a 26-year-old male presenting a hard, yellowish-brown mass located distal to the upper left second molar. Computed tomography confirmed the presence of a radiopaque lesion, and the histopathological study confirmed a complex odontoma. The third patient was a 27-year-old male reporting tongue irritation due to tooth eruption in the inferior lingual region. A periapical radiograph revealed a mixed radiopaque lesion associated to impacted 3.2. The histological report in this case indicated a compound odontoma. DISCUSSION: Odontomas erupting into the oral cavity are rare. The first case was published in 1980, and since then only 17 cases have been reported in the literature. Eight of the 17 cases were complex odontomas; the rest were compound odontomas. Pain, swelling and infection were the most common symptoms, and 13 cases presented an impacted tooth associated with the lesion.

Antibiotic prophylaxis to prevent local infection in Oral Surgery: use or abuse?

Antibiotics have a well-documented efficacy in the treatment of established infections and as prophylactic agents in medically compromised patients. However, the systematic administration of antibiotics to prevent local infections in fit patients is much more controversial. The aim of this paper is to reflect on the justification for prophylactic usage of antibiotics to prevent wound infection and to reason out the most appropriate antibiotic guidelines taking into account available scientific data and studies by other authors. Numerous clinical trials question the efficacy of antibiotics in preventing wound infection. While some studies establish that antibiotics reduce the incidence of postoperative infections, others compare their efficacy to that of placebo. Thus, scientific literature suggests that every oral surgical intervention is not tributary of systematic antibiotic prophylaxis to prevent local infections. Intrinsic surgical risk factors and the patient's individual circumstances must be taken into account. Even though the efficacy of other antibiotics cannot be ruled out due to our limited comprehension of the bacteriologic interrelations intervening in the pathogenesis of postextraction local infection, the amoxicillin-clavulanic acid combination theoretically covers the complete odontogenic bacterial spectrum in Spain. When the prophylactic use of antibiotics is indicated, this should be performed preoperatively, at high doses, and its extent should not exceed 24 hours. Special attention should be paid to antiinfectious local measures that can minimize infection risk during the wound's healing period.

Traumatic bone cyst: a retrospective study of 21 cases.

OBJECTIVE: To describe the clinical and radiological characteristics, and surgical findings of traumatic bone cysts. STUDY DESIGN: A retrospective observational study was made of 21 traumatic bone cysts. The diagnosis was based on the anamnesis, clinical exploration, and complementary tests. Panoramic and periapical X-rays were obtained in all cases, together with computed tomography as decided by the surgeon. A descriptive statistical analysis was made of the study variables using the SPSS v12.0 for Windows. RESULTS: There was a clear female predominance (14:7). The mean age was 26.5 years (range 8-45 years). The cysts in all cases constituted casual findings during routine radiological exploration. In those cases where computed tomographic images were available, preservation of the vestibular and lingual cortical layers was observed. Five of the 21 patients (23.8%) reported a clear antecedent of traumatism in the affected zone. All the lesions were subjected to surgery, and the cavities were found to be vacant in 90.5% of the cases. In only two patients were vascular contents seen within the cavity. Two of the patients presented postoperative paresthesia of the inferior dental nerve that subsided within two weeks. The 19 patients in whom adequate postoperative follow-up proved possible all showed complete bone healing. CONCLUSIONS: Traumatic bone cysts were a casual finding. During the surgery, most cases showed to be vacant cavity without an ephitelial lining. Careful curettage of the lesion favors progressive bone regeneration, offering a good prognosis and an almost negligible relapse rate. Other treatment options only would be justified in cases of relapse.