Assessment of Changes in the Outcome of Autogenous Tooth Grafts Over Time: A Clinical Study Evaluating Periodontal Healing in Bone Defects After Lower Third Molar Removal.

BACKGROUND: The removal of impacted lower third molars (ILTMs) is associated with bone defects in the distal area of second molars. Different methods have been described to minimize these defects. PURPOSE: The primary objective was to assess changes in probing depth (PD) over time (up to 36 months) between test (grafted) and control (ungrafted) groups; the graft was obtained from the extracted ILTM. STUDY DESIGN, SETTING, SAMPLE: This split-mouth randomized clinical trial was conducted at the Postgraduate Course in Oral Surgery of the Faculty of Dentistry of the Complutense University of Madrid. Adult patients requiring bilateral ILTM extraction with adjacent second molars were recruited, excluding pregnant/lactating women, patients in treatment with nonsteroidal anti-inflammatory drugs and patients with periodontal diseases. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The predictor variable was the graft technique. The bone defect after ILTM removal was treated with autogenous tooth graft (ATG) in the test group, leaving the control group ungrafted. MAIN OUTCOME VARIABLE: PD on the distobuccal, distomedial, and distolingual surfaces was recorded in both groups and averaged at baseline (T0), 3 (T1), 6 (T2), and 36 months (T3) postoperatively. COVARIATES: Sex, age, surgical time, ILTM situation and position between groups were assessed. ANALYSES: ANOVA repeated measures for comparisons between groups and the Friedman test for comparisons within the groups over time were applied. Statistical significance was established with a confidence interval of 95% (P < .05). RESULTS: The sample comprised 22 patients (6 males, 16 females) with a mean age of 21.68 ± 2.19 years; 44 ILTM extractions were performed. Statistically significant differences in PD average were found between groups (P < .001, 95% confidence interval) at 3 (1.63 ± 0.29), 6 (1.76 ± 0.3), and 36 months (1.74 ± 0.36). Reductions from T0 to T3 of 2.74 ± 0.28 (P < .001) and 0.54 ± 0.3 (P = .43) were observed in test and control groups, respectively. CONCLUSION AND RELEVANCE: ATG placed on the distal surface of lower second molars and almost completely filling the extraction socket improved PD 3, 6 and 36 months after ILTM. Furthermore, no significant changes in PD were observed over time; no major complications occurred. ATG appears to be a viable alternative graft material for this procedure.

Autogenous Dentin Graft in Bone Defects after Lower Third Molar Extraction: A Split-Mouth Clinical Trial.

Various biomaterials are currently used for bone regeneration, with autogenous bone being considered the gold standard material because of its osteogenic, osteoconductive, and osteoinductive properties. In recent years, the use of autogenous dentin as a graft material has been described. This split-mouth clinical trial assesses the efficacy of autogenous dentin for the regeneration of periodontal defects caused by bone loss associated with impacted lower third molar extraction. Fifteen patients underwent bilateral extraction surgery (30 third molars) using dentin as a graft material on the test side, and leaving the control side to heal spontaneously, comparing the evolution of the defects by evaluating probing depth at three and six months post-operatively. Bone density and alveolar bone crest maintenance were also evaluated six months after surgery, and pain, inflammation, mouth opening capacity on the second and seventh days after surgery. Probing depth, radiographic bone density, and alveolar bone crest maintenance showed significant differences between the test and control sides. Autogenous dentin was found to be an effective biomaterial for bone regeneration after impacted lower third molar extraction.

Epidemiological Features and Clinical Repercussions of Supernumerary Teeth in a Multicenter Study: A Review of 518 Patients with Hyperdontia in Spanish Population.

OBJECTIVES: The aim of this study was to establish the prevalence of supernumerary teeth (ST) in a sector of the population of Madrid, as well as possible complications associated with the presence of these teeth. MATERIALS AND METHODS: The study investigated patients (n = 28,114) who sought dental care at the Oral Surgery Service of three different centers between May 2005 and April 2018. Cases that did not present this numeric dental developmental variation were discarded, registering only those presenting ST. STATISTICAL ANALYSIS: Statistical analysis consisted of univariate analysis (mean, standard deviation, median, etc.), bivariate analysis applying the chi-squared test, whereby statistical significance was established with a confidence interval (CI) of 95% (p < 0.05), and multivariate analysis by means of classification and decision trees. RESULTS: The study found ST in 518 patients, representing a prevalence of 1.84%. The 518 patients presented a total of 726 ST. Distomolars were the most common, representing 37.7% of the sample, followed by premolars (20.1%). About 70.5% of the sample were located in the maxilla and 78% of ST were impacted. Radiographs revealed that 39.7% of STs were associated with disorders. Supplementary morphology appeared in 52.1% of the sample. CONCLUSIONS: Although mesiodens is considered the most common ST, the present study found distomolars and supernumerary premolars to be the most frequently occurring. Pathology was associated with 39.7% of the ST sample. Early diagnosis allows optimal patient management and treatment planning, with intervention at an appropriate time to prevent complications in development and so reduce later treatment need.

Comparison of peri-implant soft tissues in submerged versus transmucosal healing: A split mouth prospective immunohistochemical study.

OBJECTIVE: The present split-mouth prospective study involves an immunohistochemical evaluation of peri-implant soft tissue healing after the osseointegration period, comparing submerged and transmucosal approaches using two-piece implant systems. The null hypothesis was that both surgical procedures elicit a similar immune response of the peri-implant soft tissues. DESIGN: Thirty-one healthy patients were included in this study, in which two implants were placed in the right and left maxillary pre-molar regions. A total of 62 dental implants were analyzed, establishing a control side with 31 submerged implants, and a study side with 31 exposed implants bearing healing abutments. After a three-month healing period, a soft tissue biopsy was collected and prepared for immunohistochemical analysis of the proportions of different lymphocyte subpopulations. RESULTS: The comparative analysis between the submerged and transmucosal approaches failed to identify statistically significant differences in CD19+ B cells, CD4+ T cells, CD8+ T cells, CD25+ T cells or γd T cells. However, significant differences in NK lymphocytes (p = 0.012) were recorded with the submerged surgical procedure. CONCLUSIONS: Peri-implant soft tissue immune response with submerged or transmucosal healing protocols demonstrated comparable outcomes after the osseointegration period. There is sufficient evidence that the null hypothesis of no difference cannot be rejected. To the best of our knowledge, this is the first study of its kind. Further research is therefore needed to further clarify the role of these lymphocyte subpopulations in peri-implant soft tissues.

Clinical and radiographic evaluation of implants placed by means of inferior alveolar nerve lateralization: a 5-year follow-up study.

OBJECTIVE: To evaluate clinical and radiological responses of implants placed in combination with inferior alveolar nerve lateralization, analyzing survival and success rates over 5 years functional loading. MATERIALS AND METHODS: This prospective, longitudinal, single-center study recruited 40 patients with mandibular atrophy in the posterior sectors, who underwent lateralization of the inferior alveolar nerve. Three months after surgery and implant placement, the implants were loaded by means of screw-retained implant-supported partial prostheses or fixed complete prostheses. Clinical and radiographic examinations were performed immediately after implant placement and at 12, 24, 36, 48 and 60-month follow-up visits. RESULTS: The 40 patients received a total of 129 implants (Phibo TSA™ , Phibo Dental Solutions, Sentmenat, Barcelona, Spain). Two implants were lost in the first month after surgery, generating an implant cumulative survival rate (CSR) of 98.44%. The success rate after 5 years of loading was 98.44%. No intra-operative or postoperative soft tissue or prosthetic complications occurred during the 5-year follow-up. CONCLUSIONS: Inferior alveolar nerve lateralization performed to allow placement of (Phibo TSA™ ) implants in patients with mandibular atrophy obtained predictable clinical and radiological results over five years of functional loading.

Dental considerations in diagnosis of maxillary sinus carcinoma: A patient series of 24 cases.

BACKGROUND: Maxillary sinus carcinoma is a rare entity with an incidence of 0.2% and a low patient survival rate due to the frequency of late diagnosis. METHODS: In this multicenter, transversal, retrospective, observational study, the authors analyzed patients who had received a diagnosis of maxillary sinus carcinoma, registering their oral symptoms, histologic type, treatment efficacy, and survival rate. RESULTS: Maxillary sinus carcinoma was diagnosed in 24 patients (15 men and 9 women), of which 75% were squamous cell carcinomas. All patients had dental mobility, and some had swelling, orosinus fistula, or some dental loss. Mean patient survival rate was 38.83 months. CONCLUSIONS: A history of pain or swelling of unknown origin, an unexplained widening of periodontal ligament space, or mobility of the teeth should be considered warning signs of maxillary sinus carcinoma. PRACTICAL IMPLICATIONS: Recognition of oral symptoms by the dentist would help in making an early diagnosis of maxillary sinus carcinoma, improving the patient's chances of survival and quality of life.

Does the postoperative administration of antibiotics reduce the symptoms of lower third molar removal? A randomized double blind clinical study.

BACKGROUND: To date there is little scientific evidence that clarifies the therapeutic effect of antibiotics for managing the postoperative symptoms of impacted third molar surgery. The aim of this study was to evaluate the efficacy of antibiotic treatment for reducing non-infectious clinical symptoms. MATERIAL AND METHODS: Patient data was collected from the patients´ medical records and the results were statistically evaluated with SPSS versión 21.0; SPSS, IBM; Chicago, IL, USA). This longitudinal prospective study consisted of a randomized simple-blind clinical assay of 293 patients attending the Department of Oral Medicine and Surgery, Faculty of Dentistry at the Complutense University of Madrid (Spain). The predictive variable evaluated was the effect of antibiotic treatment on non-infectious symptoms after third molar extraction. The variables evaluated were pain, swelling, and oral aperture. RESULTS: The 293 patients were divided into 2 groups: a control group of 147 patients treated with analgesics and anti-inflammatories after surgery and a study group of 146 patients, who were also administered antibiotics. Better outcomes were observed in the study group treated with antibiotics. Pain, swelling and oral aperture variables presented better results in the antibiotic group with statistically significant difference. CONCLUSIONS: The results suggest that antibiotic administration decreases the post-operative non-infectious clinical symptoms of impacted third molar surgery. However, the prolonged administration of antibiotics had no real medical indications to justify their use and can cause serious health problems in the long term. Key words:Antibiotic, post-operative, impacted lower third molar.

Prosthetic hygiene and functional efficacy in completely edentulous patients: satisfaction and quality of life during a 5-year follow-up.

OBJECTIVES: The aim of this study was to compare satisfaction with function and hygiene maintenance in completely edentulous elderly patients rehabilitated with implant-supported fixed prostheses, overdentures, and conventional prostheses. MATERIALS AND METHODS: A total of 150 geriatric patients were divided into three groups: Group 1 (CD) patients rehabilitated with complete dentures; Group 2 (FP) patients with implant-supported fixed prostheses; Group 3 (OD) patients with overdentures. The patients responded to a questionnaire based on the Oral Health Impact Profile and the Dental Impact Profile to evaluate satisfaction with their prostheses. Data were analyzed using ANOVA F and the Kruskal-Wallis nonparametric test, with significance established as P < 0.05. RESULTS: Significant differences were found between the three groups. For oral hygiene, the group with overdentures showed better results, and the group with fixed prostheses was more satisfied with function. CONCLUSIONS: Satisfaction among these completely edentulous patients varied in relation to prosthetic type. The level of general satisfaction among patients with implant-supported prostheses was greater than the group using conventional dentures. Patients rehabilitated with fixed prostheses enjoyed a higher level of satisfaction than patients with overdentures.

Impact of prosthetic rehabilitation type on satisfaction of completely edentulous patients. A 5-year prospective study.

OBJECTIVE: The aim of this study was to evaluate the satisfaction of rehabilitated edentulous patients in relation to implant prosthetic type. MATERIALS AND METHODS: This prospective cohort study included 40 completely edentulous patients wearing conventional prostheses. They were divided into two study groups: Group A contained 20 patients rehabilitated with implant-supported fixed prostheses and Group B contained 20 patients with overdentures. Subjects were evaluated by means of a specially designed questionnaire before treatment and after 1, 3 and 5 years. RESULTS: Group A exhibited better results in terms of esthetics, function and personal satisfaction, although without statistically significant differences. However, statistically significant differences were found within parameters of oral hygiene after 1 year in favor of Group B. CONCLUSIONS: Overall satisfaction was seen to increase after implant rehabilitation, regardless of the type of prosthesis used. The satisfaction of edentulous patients differs depending on prosthetic type. Patients rehabilitated with fixed prostheses obtain a generally higher level of satisfaction than patients wearing overdentures.

Nonsyndromic multiple hyperdontia in a series of 13 patients: epidemiologic and clinical considerations.

BACKGROUND: The authors conducted a retrospective-casuistic study to determine the prevalence of nonsyndromic multiple hyperdontia in a sample of the population of Madrid, as well as possible complications associated with the presence of such supernumerary teeth. METHODS: The study included a data assessment of all patients seeking dental care at a hospital's department of oral surgery across four years. The authors studied data from patients who had nonsyndromic multiple hyperdontia. We used univariate and bivariate analysis to make comparisions between variables. RESULTS: The authors identified nonsyndromic multiple hyperdontia in the records of 13 patients (0.1 percent) of the total population studied. These patients had 55 supernumerary teeth. Premolars were the most frequently seen type of supernumerary tooth and constituted 45.5 percent of the sample. CONCLUSIONS: Nonsyndromic multiple hyperdontia usually is diagnosed as a coincidental radiographic finding in the course of routine examination rather than as the result of an associated disease. However, the authors found a higher percentage of comorbidity than they initially expected; mechanical or obstructive pathology was associated with 20.0 percent of the supernumerary teeth and enlargement of the follicular sac of more than 3 millimeters was present in 23.6 percent of the sample. CLINICAL IMPLICATIONS: The early diagnosis and follow-up of patients with multiple supernumerary teeth should help clinicians prevent the diseases associated with this kind of hyperodontia.

Quantification of growth factors by using a new system for obtaining platelet-rich plasma.

OBJECTIVE: To verify the performance of a new method for obtaining platelet-rich plasma, while avoiding contamination of the sample during its processing. STUDY DESIGN: Twenty healthy patients were selected, from whom 21 ml of blood was extracted. We then proceeded to study the platelets and growth factors in basal blood after centrifuging the sample by using a new closed system for obtaining platelet-rich plasma (PRP). RESULTS: After centrifuging the blood sample, double the amount of platelets as that found in basal blood was obtained. Of the four growth factors analyzed, only the factor similar to insulin (IGF) contained the same concentration after the centrifuge process. The platelet-derived growth factor (PDGF) and the vascular growth factor (VGF) were multiplied by six with respect to the basal values and disproportionately increased the levels of the transforming growth factor ß (TGF-ß). CONCLUSIONS: The new closed method for obtaining PRP, after avoiding contamination of the sample following its use, offers levels of platelet concentrate and growth factors necessary for regeneration.

Odontostomatological therapeutic possibilities in patients with sleep apnea.

OBJECTIVES: To evaluate the different therapeutic possibilities for treating Sleep Apnea/ Hypoapnea Syndrome (SAHS), as well as the effectiveness of such treatments, and to evaluate the epidemiological and clinical aspects of this syndrome. STUDY DESIGN: We carried out a meta-analytical, observational and retrospective study by selecting a total of 13 articles, which provided a sample size of 642 diagnosed cases of SAHS. RESULTS: SAHS was more prevalent among males (88.7%) and the average age of diagnosis was 49.75 years old. In the majority of cases, these patients were found to be overweight, with an average body mass index of 28.32 Kg/m(2). The average apnea / hypoapnea index was 31.64 apneas / hypoapneas per hour, which is therefore considered to be a moderate type of SAHS. The therapeutic approach involved intraoral mandibular advancement devices in 77.96% of the cases, followed by 16% of the patients who were treated with continuous positive airway pressure devices during sleep (CPAP), and lastly, 7% underwent surgical treatment. CONCLUSIONS: SAHS is a complex clinical condition that requires a multidisciplinary team in order to diagnose and treat it. There are several therapeutic possibilities available to professionals, which have obtained highly satisfactory results.