Osteonecrosis of the jaws in 194 patients who have undergone intravenous bisphosphonate therapy in Spain.

BACKGROUND: Osteonecrosis of the jaw (ONJ) is a destructive bone process in patients undergoing bisphosphonate therapy and it is modulated by local and systemic factors. The purpose of this article is to determine the prevalence of ONJ in patients who have undergone intravenous bisphosphonate therapy, and relate the risk factors described to establish a protocol to reduce the risk of developing ONJ. MATERIAL AND METHODS: We performed a retrospective study on 194 patients treated with IV bisphosponates, analyzing clinical and pathological variables. RESULTS: The prevalence of ONJ was 12.9 %. The most remarkable complication was pain, which was reported by 80% of patients. The average age of the patients undergoing bisphosphonate therapy was 68.91 years. Most of non-diabetic patients did not develop ONJ (92.3%) (p=0.048). During bisphosphonate therapy, 3.1% of patients underwent extractions in the same percentage in the maxilla and in the mandible; all of which, except for one patient, developed ONJ (p<0.001). In regards to the periodontal state, 94.3% of patients without periodontal problems did not develop ONJ (p=0.001). Almost 50% of the necrosis were located unifocally on the mandible (p<0.001). The number of affected patients and the aggressiveness of the disease increased significantly three years after starting treatment (p<0.001). CONCLUSIONS: Etiology still is a controversial issue and we should focus on known risk factors, such as the development of surgical procedures in patients undergoing bisphosphonate therapy, especially in patients who have already started their treatment, a group in which ONJ prevalence increases. Moreover, a bad periodontal state in these patients is also an important risk factor, and the control of diabetes reduces it. Due to the above, all patients should be diagnosed and educated in oral hygiene prior to treatment, performing periodical maintenance, to detect possible traumatisms and periodontal infection as soon as possible.

Dental implants placed on bone subjected to vertical alveolar distraction show the same performance as those placed on primitive bone.

INTRODUCTION: Vertical osteogenic alveolar distraction (VOAD) allows for the augmentation of the alveolar ridge for the placement of dental implants in atrophic alveolar ridges. The goal of this paper is to assess long-term peri-implant bone resorption in implants placed on bones subjected to VOAD, comparing it with a group of patients who had implants placed directly on the alveolar bone without previous bone regeneration. MATERIAL AND METHODS: We conducted a follow-up study on 32 patients who were divided into two groups: The Distraction Group (14 patients), and the Distraction-Free Group (18 patients), who received a total of 100 implants. Peri-implant bone loss was measured by means of panoramic X-rays, at the time of loading and one year later, and in 35 implants of each group after 3 years of functional loading. RESULTS: The peri-implant bone resorption (PBR) average observed in the Distraction Group at the time of prosthetic placement is higher (0.50 ± 0.09 mm) than in the Distraction-Free Group (0.25 ± 0.06 mm), showing statistically significant results (p=0.047). PBR levels 1 year after loading were the same for both groups (0.66 mm). At 3 years, they were higher in the Distraction Group (1.03 ± 0.22 mm vs. 0.68 ± 0.08 mm).

Correlation between clinical and pathologic diagnosis in oral leukoplakia in 54 patients.

The main aim of this study was to establish a correlation between the clinical and pathologic diagnosis of oral leukoplakia with a particular focus on epithelial dysplasia. We reviewed the medical records of 54 patients with a clinical and histologic diagnosis of oral leukoplakia who were seen at our center between 2002 and 2008. We found that the disease was more common in men (59.3%) than in women and we also detected a significantly greater prevalence of alcohol and tobacco consumption in men. The mean age of the patients was 62.57 years. Three patients had been histologically diagnosed with invasive cancer and 4 with carcinoma in situ. The most common lesion site for leukoplakias with severe dysplasia and invasive carcinoma was the lateral aspect of the tongue, the floor of the mouth, and the gums. It is therefore essential to include these sites in the clinical examination to aid early diagnosis. A higher degree of dysplasia should be suspected in non-homogeneous leukoplakias. While dysplasia is associated with a greater risk of malignant transformation, it is also important to monitor leukoplakias without dysplastic features as they can occasionally be the site of carcinoma.

Evaluation of the surgical difficulty in lower third molar extraction.

The ability to predict the surgical difficulty of lower third molar extraction facilitates the design of treatment plans by minimizing complications and improving the preparation of patients and assistants in terms of the postoperative management of inflammation and pain. The aims of this study were to evaluate the value of panoramic radiographs in predicting lower third molar extraction difficulty and technique and to determine if the experience of the practitioner had any influence on this predictive ability. Fourteen dental practitioners with varying levels of experience evaluate the difficulty of lower third molar extraction in a group of patients using a 100-mm visual analog scale (VAS) and a modified version of a surgical difficulty scale. The results were then compared to postoperative scores calculated using the same scale. A tendency to underestimate the difficulty of procedures that was more pronounced in observers with greater levels of experience was observed. A low level of agreement between preoperative and postoperative evaluations using the surgical difficulty scale as well as an association between difficulty assessed preoperatively using the VAS and difficulty assessed postoperatively using the surgical difficulty scale was also found. The use of panoramic radiographs does not allow practitioners to accurately predict lower third molar extraction difficulty and technique, regardless of their level of experience.

Pederson scale fails to predict how difficult it will be to extract lower third molars.

We report a consecutive series of 105 extractions of impacted lower third molars, in each of which operative difficulty was predicted preoperatively using the Pederson scale (radiographic appearance of the anatomical position of the lower third molar), and postoperative difficulty was scored with a modified version of the Parant scale (operative manoeuvres that were needed for extraction of the third molar). Preoperative classification as "difficult" on the Pederson scale was not an accurate predictor of true difficulty (postoperative classification as "difficult" on the modified Parant scale). There was no significant association between the Pederson score and duration of operation, but high Parant scores were significantly associated with longer operations. We suggest that scales for the prediction of operative difficulty in the extraction of impacted lower third molars should take into account factors other than the anatomical position of the tooth.

Postoperative recovery after removal of a lower third molar: role of trait and dental anxiety.

OBJECTIVE: The aim of this study was to evaluate trait and dental anxiety influence on postoperative recovery after lower third molar surgery and to determine the effect of anxiety on surgery duration. STUDY DESIGN: A prospective study was performed of 145 patients who underwent lower third molar extractions. Dental anxiety was evaluated using the Corah Dental Anxiety Scale (DAS), Kleinknecht Dental Fear Survey (DFS), and the state anxiety scale of the State-Trait Anxiety Inventory (STAI). Trait anxiety was measured with the trait anxiety scale of the STAI. Surgery duration, postoperative pain, swelling, and trismus were also recorded. RESULTS: Patients with high trait anxiety showed more pain according to all of the postoperative measures and to a significant degree in the last 2 postoperative days evaluated. Patients with high dental anxiety had greater trismus according to the DAS and to the dental stimuli dimension of the DFS. The average surgery time was higher in patients with high anxiety, for all of the measures used, although this difference was not statistically significant. CONCLUSION: Patients with high trait or dental anxiety may tend to require longer surgery times and have poorer postoperative recovery.

Relationships between surgical difficulty and postoperative pain in lower third molar extractions.

PURPOSE: To investigate the influence of surgical difficulty on postoperative pain after extraction of mandibular third molars. MATERIALS AND METHODS: A prospective study was performed of 139 patients who underwent a total of 157 mandibular third molar extractions. For evaluation of surgical difficulty, a 4-class scale was completed after surgery: I, extraction with forceps only; II, extraction requiring osteotomy; III, extraction requiring osteotomy and coronal section; IV, complex extraction (root section). The duration of surgery was also recorded. Postoperative pain was evaluated using a visual analog scale that each patient completed daily until day 6 postsurgery, at which time the sutures were removed. RESULTS: A statistically significant relationship was observed between surgical difficulty (as rated on the scale) and postoperative pain. Longer interventions generally produced more pain. CONCLUSIONS: Pain after extraction of a mandibular third molar increases with increased surgical difficulty and duration of the intervention.

Dental anxiety before removal of a third molar and association with general trait anxiety.

PURPOSE: The aim of the present study was to evaluate dental anxiety in patients consulting for third molar removal, and to assess possible relationships with general trait anxiety. MATERIALS AND METHODS: Dental anxiety was measured using Corah's Anxiety Scale (DAS), the Dental Fear Survey (DFS), and the state anxiety scale of the State-Trait Anxiety Inventory (STAI). Trait anxiety was measured with the trait anxiety scale of the STAI. RESULTS: Trait anxiety showed significant positive correlations with both DAS score and DFS score. The 3 measures of dental anxiety all showed significant positive correlations with each other. The difference between men and women was only statistically significant in the case of trait anxiety. CONCLUSION: These results suggest that trait anxiety may be a useful predictor of a patient's predisposition to dental anxiety.

Horizontal alveolar distraction: a surgical technique with the transport segment pedicled to the mucoperiosteum.

PURPOSE: The study goal was to describe a surgical technique for performing horizontal alveolar distraction with the aim of increasing the width of alveolar ridges that are too narrow for dental implant placement. MATERIALS AND METHODS: A transport segment is cut from the vestibular side of the ridge, using osteotomes, and maintaining extensive attachment to the mucoperiosteum. The distraction screw is placed through the vestibular mucosa and the transport segment, in vestibular-palatal direction. Distraction is then performed to increase ridge width. RESULTS: We successfully applied this technique in a patient who required 2 dental implants at adjacent sites in the upper jaw but whose alveolar ridge was too narrow for direct implantation. With horizontal distraction, ridge width was successfully increased, allowing placement of the 2 implants (diameter, 3.3 and 4.1 mm). CONCLUSION: This technique shows promise for patients requiring implants in a narrow alveolar ridge. Depending on each patients specific requirements, we suggest that it be taken into account as a possible alternative to existing techniques.

Peripheral giant-cell granuloma. Review of 13 cases.

Peripheral giant-cell granuloma is an infrequent exophytic lesion of the oral cavity, also known as giant-cell epulis, osteoclastoma, giant-cell reparative granuloma, or giant-cell hyperplasia. The present study reports 13 cases on patients that visited the Oral Medicine department of the Dental Faculty in the Santiago de Compostela University. We report the location, size, course and treatment of each lesion, comparing the results obtained to those reported in the literature. We discuss differential diagnosis with respect to other entities, in particular brown tumor of hyperparathyroidism, cherubism, and aneurysmal bone cyst, all of which show very similar histological appearance to peripheral giant-cell granuloma.

A preliminary morphologic classification of the alveolar ridge after distraction osteogenesis.

PURPOSE: We sought to develop and evaluate a preliminary morphologic classification of the alveolar ridge after distraction osteogenesis. MATERIALS AND METHODS: Twelve patients (7 women and 5 men; mean age, 42.6 years; age range, 30 to 57 years) underwent a total of 17 alveolar ridge distractions before the placement of a total of 44 dental implants. Ridge bone morphology was evaluated and categorized at implant placement, with subsequent evaluation of the frequency and type of complications in each category. RESULTS: Four morphologic categories were identified, as follows. Category I consisted of wide alveolar rim and no bone defects; 7 (41.2%) of the 17 ridges were assigned to this category, and a total of 22 implants were placed with no complications. Category II consisted of wide alveolar rim, lateral bone surface concavity; 4 (24%) of the 17 ridges were assigned to this category, and a total of 8 implants were placed, with fenestration defects being the most frequent complication (2 of 8 implants [25%]). Category III consisted of narrow alveolar rim, lateral bone surface concavity; 5 (29.4%) of the 17 ridges were assigned to this category, and a total of 13 implants were placed, with dehiscence defects being the most frequent complication (4 of 13 implants [31%]). Category IV consisted of distraction transport segment forming a bridge, without bone formed beneath, necessitating guided bone regeneration; 1 (6%) of the 17 ridges was assigned to this category, and following bone regeneration 1 implant was placed, without complications. Subcategory D consisted of lingual deviation of the distraction axis, occurring in any of categories I to IV, and when severe requiring corrective osteotomy to free and reposition the transport segment and neoformed bone; 4 (24%) of the 17 ridges were assigned to this subcategory (ie, to subcategory ID, IID, IIID, or IVD); in 1 case, the deviation was severe, requiring corrective osteotomy; in this case 3 implants were placed, without complications. CONCLUSION: This preliminary morphologic classification of the postdistraction alveolar ridge effectively categorizes the variation observed in our patients and in our experience provides a useful basis for decision-making regarding implant placement. However, further studies are required to confirm the generality of this classification and incidences of complications in each category.

Citologia esfoliativa da mucosa oral: comparação citomorfométrica da mucosa oral normal em pacientes com câncer oral e indivíduos sadios / Exfoliative cytology of the oral mucosa: a cytomorphometric comparison of healthy oral mucosa in oral cancer patients and healthy subjects

O objetivo do presente trabalho foi identificar as diferenças citomorfométricas entre a mucosa oral de pacientes com câncer oral e indivíduos sadios. Sistema de análise de imagens foi utilizado para determinar a área nuclear (AN), área citoplasmática (AC) e a relação AN/AC em 1.000 células da mucosa oral de 10 pacientes com carcinoma oral e 10 indivíduos sadios. Nos pacientes com câncer oral, a amostra foi obtida de áreas visivelmente não afetadas pelo carcinoma. A média AN encontrada nos pacientes com câncer foi 103 mm2 e 105 mm2 nos indivíduos sadios; a média AC no grupo com câncer foi 2482 mm2 e 2677 mm2 nos indivíduos sadios; e a relação AN/AC observada nos pacientes com câncer foi de 0.05 e 0.04 nos indivíduos sadios. Nenhuma das diferenças foi estatisticamente significativa em um nível de 5 por cento. Pode-se concluir que nem a área citoplasmática, a área nuclear e a AN/AC são diferentes na mucosa oral de pacientes com câncer e indivíduos sadios