Granulomatosis with Poliangeitis (Wegener's Granulomatosis): Orofacial Manifestations. Systematic Review and Case Report.

PURPOSE: To present an update the orofacial manifestations of granulomatosis with polyangiitis (GPA) and present a clinical case with the initial signs in the oral cavity. MATERIALS AND METHODS: A bibliographic search was performed on Pubmed with the keywords 'Wegener's granulomatosis', 'etiology', 'oral manifestations', 'oral cavity', 'gingiva'. The inclusion criteria were papers published in English in the last 10 years that made reference to clinical cases with in which the oral cavity was affected. The quality of the results was assessed with 'The 2013 Care Checklist'. RESULTS: Nineteen clinical cases were analysed. The average quality was 7.68/13 (range 5-10/13). 73.7% of patients were women, the most frequent area for the lesions was the gingiva and the most prevalent lesion was gingival hyperplasia. 68.4% of the patients had this lesion as a first sign, 21.1% as a progression and 10.5% as a recurrence. 68.4% of the lesions resolved once medical treatment was established. CONCLUSION: GPA is a multisystem disorder associated with considerable morbidity and mortality if not treated. Early diagnosis improves the prognosis. The first manifestation of the disease can be seen in the oral cavity. It is important that dentists recognise the oral manifestation in order to improve the prognosis. Key words: granulomatosis, polyangiiitis, Wegener's granulomatosis.

Corticotomy in orthodontic treatment: systematic review.

OBJECTIVE: The aim of this study is to evaluate corticotomies effects to accelerate or facilitate dental movements in different kind of orthodontic treatments. DATA: This report followed the PRISMA Statement. A total of 9 articles were included in review. SOURCES: Two reviewers performed a literature search up to December 2018 in four databases: PubMed, Web of Science, Scopus and SciELO. STUDY SELECTION: Controlled clinical trials and randomized controlled clinical trials conducted in human patients and published during the last 10 years in English were eligible to be selected. The articles should give detailed information about the results and treatment parameters. There were no limitations established in terms of the type of malocclusion to be corrected or the type of orthodontic treatment performed. RESULTS: The methodological quality and evidence of the selected studies was low. Most of the studies observed a statistically significant increase in the rate of dental movement, when performing alveolar corticotomies as coadjuvants of orthodontic treatment; either with the conventional technique or with piezocision. The effect of combining corticotomy with bone grafts was assessed. CONCLUSIONS: High heterogeneity among studies made it difficult to draw clear conclusions. However, within the limitations of this review, the corticotomy procedures were able to statistically and clinically produce significant temporary decrease in orthodontic tooth movement rate. This technique does not seem to involve major complications compared to conventional orthodontic treatments. CLINICAL RELEVANCE: The use of this technique can reduce treatment time and therefore the undesirable effects associated with prolonged treatments.

Functional outcomes after glossectomies: Pilot study on use of a thrombin-fibrinogen biosponge (TachoSil).

OBJECTIVE: The aim of this study was to investigate whether the use of a thrombin-fibrinogen biosponge (TachoSil) has any advantage in tongue healing. STUDY DESIGN: A retrospective study with 30 patients treated with partial glossectomy (below half a tongue) was designed. We compared the results from a group using the biosponge (n =15 patients) and a control group (n = 15). Variables taken into consideration were bolus clearance, frenulum flexibility, and oral transit time. With these parameters, we formulated a "tongue remaining functional" (TRF) scale to assess tongue functionality after the surgery. We also evaluated long-term quality of life by using the Functional Intraoral Glasgow Scale (FIGS). RESULTS: In this study, TRF score, bolus clearance, oral transit time, and frenulum flexibility were significantly improved in the biosponge group. However, there were no differences between the 2 groups in the FIGS scores. CONCLUSIONS: The use of the biosponge in this pilot study showed positive long-term effects in lingual healing and functionality after partial glossectomies.

Intraosseous Leiomyoma of the Jaw in an Adolescent.

Leiomyoma is a benign tumor of the smooth muscle that rarely occurs in the mouth as an intraosseous lesion. The purposes of this paper are to: (1) present a case of an intraosseous solid leiomyoma of the mandible in a 13-year-old child, who presented with a well-defined unilocular radiolucency in the right mandible incidentally discovered during a routine dental radiographic examination; and (2) conduct a review of the literature to describe clinicopathological features and management of intraosseous jaw leiomyoma (IJL). A total of 17 articles describing 18 cases of IJL satisfied the selection criteria; including the present patient, to date a total of 19 cases of IJL have been reported. IJL occurs mainly in young patients (36.8 percent), more often in boys (1:5:1 male-to-female ratio), and reaches a larger size in children than in adults. The treatment of choice for IJL is surgical excision, which should be as minimally invasive as possible, especially in children.

Analytical parameters and vital signs in patients subjected to dental extraction.

BACKGROUND: Dental consultation may provoke stress to the patient, especially when a dental surgery is going to be performed, stressful situations can cause a reaction in the sympathetic nervous system that could lead to cardiovascular alterations. Blood pressure and cardiac frequency are used often as an indirect measurement and this parameters combined can serve as good indicators of stress. Objective: Analyze the changes in vital signs and analytical parameters induced by a dental extraction. MATERIAL AND METHODS: 24 healthy patients who required a simple dental extraction underwent to a blood test and motorization of their pre- and post-extraction vital signs before, at 2 and 48 hours after the procedure. Data analysis was performed by means of repeated measures one way ANOVA followed by multiple comparisons Bonferroni's Post-hoc test. RESULTS: The evaluated patients were 13 women and 11 men with an average age of 35.1. Thirteen patients (54.17% of the sample) were smokers and five were regular drinkers (20.8%). No significant differences were observed in the vital signs with the exception of diastolic blood pressure and cardiac rate that were slightly lower after extraction. Only two analytical parameters showed statistical significant changes. Total bilirubin was significantly higher at 48 hours after extraction and leukocyte count was significantly lower at this time. In any case, the magnitude of the changes observed was very low. The analytical parameters and the vital signs did not show any relevant change. CONCLUSIONS: Eventual alterations found after simple tooth extraction should not be attributed to the procedure. Key words:Blood pressure, heart rate, monitoring physiologic, oxygen saturation, tooth extraction.

TETIS study: evaluation of new topical hemostatic agent TT-173 in tooth extraction.

OBJECTIVES: TT-173 is a new hemostatic agent consisting of yeast-derived microvesicles containing a modified version of recombinant human tissue factor. In the present work, the procoagulant activity of TT-173 has been evaluated for the first time in humans. METHODS: This is a phase I, randomized, placebo-controlled study to evaluate the efficacy, safety, systemic absorption, and immunogenicity of TT-173 in healthy volunteers undergoing tooth extraction. Subjects received TT-173 or placebo into the alveolar cavity, just after tooth extraction. Time to clot formation, bleeding time, and adverse events were recorded. RESULTS: Treatment with TT-173 reduced the bleeding time and the time to clot formation. No adverse events related with product administration were reported. In the same way, neither systemic absorption nor immunogenic reaction against the product was detected. Our findings pave the way to evaluate the usefulness of this new topical hemostatic agent in more complex oral surgeries and in those patients affected with coagulation disorders that may compromise the realization of dental procedures. CONCLUSION: The new hemostatic agent TT-173 has proven efficacious and safe in healthy subjects undergoing tooth extraction supporting its further evaluation in more complex surgeries. CLINICAL RELEVANCE: The development of this new topical hemostatic agent could contribute to bleeding control in oral and maxillofacial surgery.

The importance of a good evaluation in order to prevent oral nerve injuries: a review.

OBJECTIVE: Oral nerve injuries are a less frequent complication but they involve a decrease in the patient life quality. The purpose of the current review is to know the described risk factors to prevent injuries and to know the therapies against an established injury. MATERIALS AND METHODS: A Pubmed search of the English and Spanish language literature from 2000-2012 using the keywords 'oral surgery' or 'trigeminal nerve injuries' or 'lingual nerve injuries' or 'mandibular nerve injuries' was performed. Review articles were included and important articles from the references were added. RESULTS: A total of 662 were obtained from the search, from which 25 were selected accomplishing the inclusion criteria. Moreover, seven important articles were selected from the references of the ones mentioned, obtaining a total of 32 articles for the review. CONCLUSIONS: There is a relationship between the position of the extracted tooth and the incidence of the inferior alveolar nerve and lingual nerve injuries; as well as the age of the patient, the intra-operatory exposition of the nerve, the technique access for the lower third molar extraction and the surgeon's inexperience. The radiological examination is useful to evaluate the nerve damage and to decide on the surgical technique.