Laser Therapy and Occlusal Stabilization Splint for Temporomandibular Disorders in Patients With Fibromyalgia Syndrome: A Randomized, Clinical Trial.

Context • Patients with fibromyalgia syndrome (FMS) report frequent and severe symptoms from temporomandibular disorders (TMDs). The appropriate treatment of TMDs remains controversial. No studies have occurred on the efficacy of therapy with a laser or an occlusal stabilization splint in the treatment of TMDs in patients with FMS. Objective • The study intended to investigate the therapeutic effects of laser therapy and of an occlusal stabilization splint for reducing pain and dysfunction and improving the quality of sleep in patients with TMDs and FMS. Design • The research team designed a single-blinded, randomized clinical trial. Setting • The study took place in the research laboratory at the University of Granada (Granada, Spain). Participants • Participants were 58 women and men who had been diagnosed with FMS and TMDs and who were referred from the clinical setting. Intervention • Participants were randomly assigned to the occlusal-splint or the laser group. The laser group received a treatment protocol in which laser therapy was applied to the participant's tender points, and the occlusal-splint group underwent a treatment protocol in which an occlusal stabilization splint was used. Both groups underwent treatment for 12 wk. Outcomes Measures • Pain intensity, widespread pain, quality of sleep, severity of symptoms, active and passive mouth opening, and joint sounds were assessed in both groups at baseline and after the last intervention. The measurements used were (1) a visual analogue scale (VAS), (2) the Widespread Pain Index (WPI), (3) the Symptom Severity Scale (SSS), (4) the Patient's Global Impression of Change (PGIC), (5) the Pittsburgh Quality of Sleep Questionnaire Index (PSQI), (6) an assessment of the number of tender points, (7) a measurement of the active mouth opening, (8) a measurement of the vertical overlap of the incisors, and (9) the measurement of joint sounds during mouth opening and closing. Results • The group X time interaction for the 2 × 2 mixed analysis of variance found no statistically significant differences between the 2 treatment groups: (1) VAS, P = .591; (2) WPI, P = .112; (3) SSS, P = .227; (4) PGIC, P = .329; (5) number of tender points, P = .107; (6) right and left clicking sounds in the jaw joint during palpation at mouth opening, P = .723 and P = .121, respectively; and (7) right and left clicking sounds in the jaw joint during palpation at mouth closing, P = .743 and P = .698, respectively. Compared with baseline, the laser treatment showed significant improvements on several outcomes, including the VAS, P < .001; WPI, P = .003; and SSS, P = .001. Overall, the study found an average improvement in symptoms from baseline of 21% , P < .001, based on the PGIC. Conclusions • Laser therapy or an occlusal stabilization splint can be an alternative therapeutic treatment for reducing pain symptoms and the clicking sound for TMDs in patients with FMS.

[Clinical and periodontal predictive factors of severity in gingival recession (GR)]. / Parámetros clínicos y periodontales predictores de la severidad de la recesión gingival (RG).

INTRODUCTION: Gingival recession is an unsightly condition due to root exposure. It can lead to dental hypersensitivity, root caries, and tooth loss. OBJECTIVE: To determine the influence of different clinical and periodontal parameters on the severity of gingival recession evaluated at four periods: initial, 6, 12, and 18 months of follow-up. MATERIAL AND METHODS: Forty patients with gingival recession were included in the study. Sociodemographic data, systemic diseases, harmful habits, dental hygiene habits, parafunctional habits, and orthodontic treatment were collected. Periodontal status (plaque index, gingival bleeding index, attached gingiva loss, pocket probing depth, and attachment loss) was also measured. RESULTS: None of the clinical parameters studied influenced the number of teeth with gingival recession. Smokers showed a higher number of teeth with attached gingiva loss (p=0.03). A direct relationship between the severity of gingival recession and plaque index (p=0.02) or 4-6 mm attachment loss (p=0.04) was observed. At six months of follow-up, gingival index was the only parameter that influenced the severity of gingival recession (p=0.01).

Dental extraction in patients receiving dual antiplatelet therapy.

BACKGROUND: Dual antiplatelet therapy consists of administering antiplatelet (antiaggregant) drugs (clopidogrel and aspirin) to prevent thrombotic processes, as a preventative measure in patients with acute coronary disease, or in patients subjected to percutaneous coronary intervention. OBJECTIVE: The purpose of this study was to evaluate the efficacy of a protocol for performing dental extraction in patients receiving dual antiplatelet therapy. MATERIAL AND METHODS: Thirty-two patients undergoing dental extractions were included in the study. The variables evaluated were: collagen-epinephrine fraction, collagen- adenosine diphosphate fraction, surgical surface, post-surgical measures, and adverse effects. Alveolar sutures and gauzes impregnated with an antifibrinolytic agent (tranexamic acid), which the patient pressed in place for 30 minutes, were applied to all patients as post-surgical measures. Descriptive statistics were calculated and analyzed with Student's t-test to compare pairs of quantitative variables; simple regression analysis was performed using Pearson's correlation coefficient. Statistical significance was set at p<0.05. RESULTS: Collagen/epinephrine fraction was 264.53±55.624 seconds with a range of 135 to 300 seconds, and collagen/ADP fraction was 119.41±44.216 seconds, both values being higher than normal. As a result of the post-surgical measures taken, no patients presented post-operative bleeding, hematoma or infection. CONCLUSIONS: Dental extraction was safe for patients receiving dual anti-platelet therapy when using sutures and gauze impregnated with tranexamic acid, which the patient pressed in place for 30 minutes.

Oral mucosal lesions in patients of Mérida,Venezuela. / Lesiones de la mucosa bucal en pacientes de Mérida, Venezuela.

There are very few epidemiological studies of oral mucosal lesions in Venezuela. None of these studies has been conducted in the state of Merida. The aim of this study was to determine the prevalence of oral mucosal lesions in a population from Merida, Venezuela, describe their oral lesions' characteristics and analyze the influence of parameters such as oral hygiene habits, harmful habits or parafunctional habits. Of the 8640 patients seen in public and private dental centers from Merida during one year, 120 (1.39%) had oral mucosal lesions. The oral mucosal lesions most frequently found were: traumatic ulcers (17.5%), recurrent herpes labialis (11.7%), denture stomatitis (10%), erythematous candidiasis (10%) and recurrent aphthous stomatitis (9.2%). The main features of these oral mucosal lesions were: more frequent in females and, main location on the gingiva. Moreover, most of them were acute lesions (< 7 days), non-recurring and painful lesions. Neither harmful habits nor parafunctional habits had influence on the clinical features of the lesion.

Maxillary mucormycosis and aspergillosis in post-COVID-19 patients in Mexico: A case series.

BACKGROUND: Fungal infections, during or as a consequence of SARS-CoV-2 infection, associated with uncontrolled diabetes mellitus and indiscriminate use of corticosteroids have been reported. In the jaw, mostly mucormycosis has been diagnosed in hospitals. METHODS: A retrospective, cross-sectional, descriptive study of the clinical, imaging, and histopathologic characteristics of maxillary invasive fungal infection in post-COVID-19 patients diagnosed in a private non-hospital oral pathology service in Mexico during 2020-2022 was conducted. RESULTS: We found 20 cases of maxillary invasive fungal infections in post-COVID-19 patients, 75% including a diagnosis of mucormycosis and 25% diagnosed as probable aspergillosis. The most common signs and symptoms were exposed necrotic bone followed by tooth mobility, discharge, and pain. On imaging, unilateral maxillary sinus involvement was observed in 6 cases (30%), and bilateral maxillary sinus involvement was observed in 3 cases (15%). CONCLUSIONS: It is essential to consider the association of osteonecrosis of the jaw in post-COVID-19 patients, with aspergillosis, not only mucormycosis, for early diagnosis and appropriate treatment.

Prevention of Occupational Hazards Due to Asbestos Exposure in Dentistry. A Proposal from a Panel of Experts.

Asbestos in all its forms is a Group 1 material agent with proven carcinogenic effects in the human being since 1977. Exposure to asbestos can be considered unsafe. The use of asbestos in the field of dentistry had a common use in the manufacture of dental prostheses in the 1960s and 1970s. Taking into account the long induction period of this agent and the plausibility for being a risk factor in dentistry, the objective of this study is to propose a plan for the prevention of occupational risks due to asbestos exposure in dentistry by means of the contribution of a panel of experts. An Expert Panel (EP) approach was used in which a group of nine experts identified and documented the use of asbestos in the dental profession. EP was created and followed the protocol in accordance with the EuropeAid Assessment Guidelines. As a result of this study, EP documented the common use and sources of asbestos in dentistry in prosthetic materials, dental dressings, and in the coating of casting cylinders. EP also created a consensus document on the priority measures for the Plan for the Prevention of Risks from Asbestos in Dentistry, based on previous reports from the European Commission Senior Labour Inspectors' Committee. The document concluded that obtainment of information, receiving specific training on the subject and performing epidemiological studies, and the proper risk assessments were the priority measures to adopt.

Collagen Matrix vs. Autogenous Connective Tissue Graft for Soft Tissue Augmentation: A Systematic Review and Meta-Analysis.

Soft tissues have been shown to be critical for the maintenance of both teeth and implants. Currently, regenerative soft tissue techniques propose the use of collagen matrices, which can avoid the drawbacks derived from the obtainment of autogenous tissue graft. A systematic review and meta-analysis were conducted to ascertain the efficacy of collagen matrices (CM) compared to autogenous connective tissue graft (CTG) to improve soft tissue dimensions. An electronic and manual literature searches were performed to identify randomized clinical trials (RCT) or controlled clinical trials (CCT) that compared CTG and CM. Pooled data of width of keratinized tissue (KT) and mucosal thickness (MT) were collected and weighted means were calculated. Heterogeneity was determined using Higgins (I2). If I2 > 50% a random-effects model was applied. Nineteen studies were included based on the eligibility criteria. When using CTG a higher MT gain (0.32 mm, ranging from 0.49 to 0.16 mm) was obtained than when employing CM. Similar result was obtained for the width of KT gain, that was 0.46 mm higher (ranging from 0.89 to 0.02 mm) when employing CTG. However, it can be stated that, although autogenous CTG achieves higher values, CM are an effective alternative in terms of total width of KT and MT gain.

Antibiofilm Activity of Diclofenac and Antibiotic Solutions in Endodontic Therapy.

INTRODUCTION: The aim of this study was to compare the antibiofilm effects of a triple antibiotic solution (TAS); a double antibiotic solution (DAS); and 5%, 2.5%, and 1.25% diclofenac solutions (DCSs) against Enteroccocus faecalis biofilm. METHODS: Eighty-four sterile radicular dentin blocks were used as biofilm substrate for 3 weeks. The study groups were as follows: (1) 1 mg/mL TAS (minocycline, metronidazole, and ciprofloxacin), (2) 1 mg/mL DAS (metronidazole and ciprofloxacin), (3) 5% DCS, (4) 2.5% DCS, (5) 1.25% DCS, and (6) 0.9% saline solution. The antimicrobial activity was evaluated by bacterial count determinations and confocal laser scanning microscopy. The contact time for the antimicrobial tests was 5 minutes. Bacterial counts were expressed as the reduction percentage of colony-forming units; for the confocal laser scanning microscopic evaluation, the log10 total biovolume and percentage of green population (live cells) were calculated. RESULTS: The colony-forming unit reduction percentage ranged between 62.98 and 98.62, respectively, for TAS and 5% DCS. The DCS showed a concentration-dependent effect.For the confocal laser scanning microscopy, the log10 total biovolume in all groups was very similar and showed a scarce (1.39-1.02) but significant reduction with respect to the control; 5% and 2.5% DCSs gave the lowest viable cell percentage. The TAS and DAS groups showed intermediate values without significant differences between them. CONCLUSIONS: DCSs at 5% and 2.5% have greater antimicrobial effects than TAS and DAS and may be considered a valid alternative for controlling the infection of teeth with apical periodontitis.

Alveolar Bone Ridge Augmentation Using Polymeric Membranes: A Systematic Review and Meta-Analysis.

Alveolar bone ridge resorption occurred after natural teeth loss and it can restrict the possibility of dental implants placement. The use of bone regenerative procedures is frequently required. The existing evidence regarding the efficacy of horizontal bone ridge augmentation trough guided bone regeneration (GBR) using polymeric membranes was stated. A systematic review and meta-analysis were performed. Electronic and manual literature searches were conducted. Screening process was done using the National Library of Medicine (MEDLINE by PubMed), Embase, and the Cochrane Oral Health. Included articles were randomized controlled trials and observational studies. Weighted means were calculated. Heterogeneity was determined using Higgins (I2). If I2 > 50% a random-effects model was applied. It was found that the mean of horizontal bone gain was 3.95 mm, ranging from 3.19 to 4.70 mm (confidence interval 95%). Heterogeneity is I2 = 99% (confidence interval 95%) and significance of the random-effects model was p < 0.001. The complications rate was 8.4% and membrane exposure was the most frequent. Through this study, we were able to conclude that the existing scientific evidence suggests that GBR using polymeric membranes is a predictable technique for achieving horizontal bone augmentation, thus, permitting a proper further implant placement.

Periodontal Treatment by Dental Undergraduate Students: Assessment of the Patient's Oral Quality of Life - A Prospective Pilot Study.

PURPOSE: To assess the impact of nonsurgical periodontal treatment, performed by undergraduate dental students, on oral health-related quality of life of patients with periodontitis. MATERIALS AND METHODS: An observational, prospective, single-arm cohort study with pre­post test involving 31 undergraduate dental students was performed. A complete periodontal examination was performed before and after receiving nonsurgical periodontal treatment. The main independent clinical variables assessed were the degree of periodontal inflammation and the number of teeth with periodontitis. Oral health-related quality of life was assessed before and after treatment through the Oral Impacts on Daily Performances (OIDP) questionnaire. The association between the extent of periodontal treatment (measured as number of treated teeth) and final OIDP score was assessed, adjusting for age, sex, and baseline OIDP, in a multiple regression model. RESULTS: Thirty-four patients were enrolled and treated by the undergraduate students. The mean OIDP value (global absolute score), representing the severity and frequency of the impacts, decreased from 26.2 to 12 after treatment. The mean percentage of impact, representing the number dimensions affected by oral health (global percent score), was reduced from 13% to 6%. However, no association between the number of treated teeth and post-treatment OIDP score was observed after adjusting for age, sex, and baseline OIDP score. CONCLUSION: Nonsurgical periodontal treatment performed by undergraduate dental students improved the oral health-related quality of life of periodontal patients, although no statistically significant association was found between the extent of periodontal treatment and the final OIDP score.

Efficacy of local antibiotic therapy in the treatment of peri-implantitis: A systematic review and meta-analysis.

OBJECTIVES: The aim of this systematic review and meta-analysis was to state the efficacy of local administration of antibiotics in the treatment of peri-implantitis in terms of peri-implant probing depth (PPD) and bleeding on probing (BoP) reduction. DATA, SOURCES AND STUDY SELECTION: Electronic and manual literature searches were conducted. Screening process was done using the National Library of Medicine (MEDLINE by PubMed), Embase and the Cochrane Oral Health. Included articles were randomized controlled trials and observational studies. Weighted means were calculated. Heterogeneity was determined using Higgins (I2). Due to the encountered heterogeneity between the studies being combined, random-effects models were applied in order to analyze effect sizes. Twelve studies (365 patients and 463 implants) were included in the systematic review. After peri-implantitis treatment with local antibiotics, PPD was reduced 1.40 mm (95% confidence interval: 0.82-1.98). When local antibiotics were applied, a 0.30 mm higher reduction of PPD was obtained than in the control group (95% confidence interval: 0.07-0.53). BoP attained an odds ratio value of 1.82 (95% confidence interval: 1.09-3.04), indicating that the likehood of bleeding is almost two-fold when antibiotics are not locally administrated. Adverse effects were not found after applying local antibiotics. CONCLUSIONS: The local antibiotic administration does reduce, without adverse effects, both peri-implant probing depths and bleeding on probing in patients affected by peri-implantitis, if compared to control groups without local antibiotic application. CLINICAL SIGNIFICANCE: Patients with dental implants frequently suffer from peri-implantitis. Clinical features of peri-implantitis lesions include the presence of bleeding on probing and increased peri-implant probing depths. Both BoP and PPD have become reduced after local administration of antibiotics.

Dentine tubule disinfection by different irrigation protocols.

The purpose of this study was to test the antimicrobial activity and the smear layer removal of different irrigation protocols-sodium hypochlorite (NaOCl), NaOCl followed by ethylenediaminetetraacetic acid (EDTA), and NaOCl combined with etidronic acid (HEBP)-against infected dentine tubules during root canal preparation. Single rooted premolars contaminated with Enterococcus faecalis were chemomechanically prepared. Depending on the irrigation protocols, the roots were divided into the following groups: (1) distilled water during and after instrumentation; (2) 2.5% NaOCl during and after instrumentation; (3) 2.5% NaOCl/9% HEBP during and after instrumentation; and (4) 2.5% NaOCl during instrumentation followed by 17% EDTA after instrumentation. The percentage of dead cells and the biovolume in infected dentine tubules were measured using confocal laser scanning microscopy and the live/dead technique. Smear layer removal on root canal wall surfaces was observed by means of scanning electron microscopy. Results were compared through parametric tests (p < .05). The groups NaOCl, NaOCl/HEBP, and NaOCl+EDTA exerted the highest antimicrobial activity (p > .05), followed by the group irrigated with water. All the irrigation protocols-including water-significantly reduced the bacteria biovolume. No dentine tubules free of smear layer were found in the positive control or the 2.5% NaOCl group. With NaOCl/HEBP and NaOCl+EDTA, respectively, 90.41% ± 7.33 and 76.54% ± 15.30 of dentine tubules were free of smear layer (p = .01). NaOCl/HEBP and NaOCl+EDTA exerted an important antimicrobial activity against bacteria inside dentine tubules, lowering the bacteria biovolume and eliminating a high amount of the smear layer, particularly in the NaOCl/HEBP group.

Substantivity of zinc salts used as rinsing solutions and their effect on the inhibition of Streptococcus mutans.

The antimicrobial efficacy of zinc (Zn) salts (sulfate and acetate) against Streptococcus mutans (S. mutans) present in the oral cavity was tested in this study. The substantivity of Zn salts was assessed by determining the concentration of Zn in whole, unstimulated saliva and by measuring the magnitude of suppression of salivary S. mutans, 2h after rinsing. The concentration of Zn was measured by atomic absorption spectrometry (AAS) with electrothermal atomization (ET AAS) in saliva sampled before (basal) and 24h after mouth rinsing with different concentrations of Zn (0.1%, 0.5% and 1%) administrated as sulfate and acetate. The estimation of Zn levels in samples collected 30, 60, 90 and 120 min after rinsing was carried out by AAS with flame atomization (FAAS). Immediately after rinsing, the concentration of Zn in saliva sharply increased with respect to the baseline values (0.055+/-0.017 mg/L), followed by a sustained decrease, probably due to clearance of salivary flow or swallowing during sampling. A significant reduction (>87%) in the total mean S. mutans counts was found 2h after rinsing either with sulfate or acetate solutions, as evidence of the high substantivity and effectiveness of the Zn salts tested. A statistically significant inverse relationship (p<0.001 and the Pearson correlation coefficients between -34% and -50%) was found between Zn levels and the respective pH values measured in the samples collected 60 and 120 min after rinsing, sustaining the theory of bacterial glycolysis inhibition.

Antimicrobial residual effects of irrigation regimens with maleic acid in infected root canals.

BACKGROUND: The success of endodontic treatment depends largely on the control of microorganisms present in infected root canals. The aim of this study was to determine the residual antimicrobial activity of several final irrigation protocols with 7% maleic acid (MA) alone and combined with chlorhexidine (CHX), cetrimide (CTR) or both, in root canals infected with Enterococcus faecalis. Biofilms of E. faecalis were grown in uniradicular roots for 4 weeks. A total of 72 specimens were divided into 5 experimental groups according to the final irrigation regime used: Group 1: 2.5% NaOCl; Group 2: 7% MA; Group 3: 7% MA + 0.2% CTR; Group 4: 7% MA + 2% CHX; Group 5: 7% MA + 0.2% CTR + 2% CHX; and CONTROL GROUP: 0.9% saline solution. Twelve roots (2/group) that were instrumented and not infected served as negative or sterility controls. The proportion of ungrown samples over 60 days was evaluated using non-parametric Kaplan-Meier survival analysis. Differences among groups were tested using the log-rank test (p< 0.05). RESULTS: The association of MA with CHX and CHX + CTR as final irrigating solutions showed the best results, 5 and 4 samples out of 12, respectively, and without differences between them (p = 0.928), followed by 7% MA + 0.2% CTR with 7 out of 12. The 7% MA (11/12) group showed significant differences with respect to the groups in which MA was combined with CHX (p < 0.005) and CHX + CTR (p < 0.005). CONCLUSION: Final irrigating solutions of 7% MA combined with 2% CHX or 2% CHX + 0.2% CTR were found to effectively improve antimicrobial root canal disinfection.

Relationship between menopause and periodontal disease: a cross-sectional study in a Portuguese population.

BACKGROUND: Menopause is associated with important systemic and oral changes. Many researchers have tried to evaluate the influence of hormonal changes associated with menopause in the periodontium, however results are contradictory. OBJECTIVE: Evaluate the possible effects of menopause on the severity of periodontal disease and tooth loss, by considering several general, oral and periodontal parameters. METHODS: 102 women with chronic periodontitis, and at least six teeth, were divided into two groups: a study group (SG) consisting of 68 menopausal women and a control group (CG) consisting of 34 premenopausal women. The participants had extensive anamnesis, made by a single senior periodontologist, which collected demographic data, medical and gynaecological history and habits. Additionally, oral and periodontal parameters including: number of teeth, plaque index, presence of calculi, probing depth, bleeding on probing, gingival recession and attachment loss were recorded. The following statistical tests were used: Chi-square, Fisher's t-test for independent samples, non-parametric Wilcoxon-Mann-Whitney, and linear multiple regression. RESULTS: The number of teeth was significantly lower in postmenopausal women (SG 10.8 ± 5.9, CG 6.8 ± 4.6), however, after adjusting for age, smoking and plaque index, the difference was no longer statistically significant (P=0.169). The attachment loss was slightly higher in the study group, although the difference is not significant (SG 4.31 ± 1.08, CG 4.05 ± 1.28). CONCLUSIONS: Menopause does not appear to significantly influence the severity of periodontal disease and tooth loss. Other factors may exert a greater influence on the progression of periodontal disease rather than menopause itself.

Treatment of severe chronic oral erosive lesions with clobetasol propionate in aqueous solution.

OBJECTIVE: We sought to analyze the results of topical treatment with a mouthwash of 0.05% clobetasol in aqueous solution in 30 patients with severe oral erosive lesions. STUDY DESIGN: Over a 48-week period, we evaluated the evolution of pain, ulcerations, atrophy, and interference of the disease in the patient's daily life, classifying the response as complete (100% remission/recovery), excellent (75%), good (50%), poor (<50%), or failed. RESULTS: The pain and ulceration totally disappeared in 93.3% of cases and 90% reported a full recovery in their daily life activities. Atrophy response was complete in 28.5%, excellent in 60.7%, and good in 3.5%. Two patients showed no response to the treatment. Five patients suffered mild adverse effects (moon face and hirsutism) between week 4 and week 6 of treatment, which were speedily reversed by reducing the frequency of mouthwash. CONCLUSIONS: Clobetasol mouthwash is a safe and efficacious option for the treatment of severe oral erosive lesions.

Treatment of severe erosive gingival lesions by topical application of clobetasol propionate in custom trays.

OBJECTIVE: We sought to describe the response of patients with severe erosive gingival lesions to treatment with clobetasol propionate in Orabase paste administered in trays. The adverse effects were also recorded. STUDY DESIGN: A descriptive pretest/posttest clinical study with no control group (33 patients total) was developed. All patients received repeated applications of 0.05% clobetasol propionate plus 100,000 IU/cc of nystatin in Orabase paste. Over the 48-week period, the pain levels, ulcerations, presence of atrophy, and the patients' daily activities were recorded, and Likert scales were used to classify each outcome as either a complete recovery, excellent, good, poor, or failed. The presence of any adverse effect was also noted. RESULTS: At the end of the study period, the pain and ulceration had disappeared (complete response) in 100% of the sample (33/33; 95% confidence interval = 89.4%-100%), and there was a complete recovery of daily activities and remission of atrophy in 93.9% (31/33; 95% confidence interval = 79.8%-99.3%) and 21.2% (7/33; 95% confidence interval = 9.0%-38.9%) of the patients, respectively. No adverse effects related to the treatment were observed. CONCLUSIONS: The application of an Orabase paste of 0.05% clobetasol 17-propionate plus 100,000 IU/cc of nystatin by means of a tray appears to be an efficacious treatment for severe erosive gingival lesions.

Revisiting peri-implant soft tissue - histopathological study of the peri-implant soft tissue.

Peri-implant soft tissues are essential for osseointegration. The peri-implant mucosa may lack vascular supply, and histological observation, even without plaque, shows the presence of inflammatory cells. The objectives of this study were to assess the histopathological changes of the epithelium and connective tissue around the implant. Twenty patients of both genders were studied. Twelve weeks after implant placement, fragments of peri-implant gingival sulcus were harvested and processed for light microscopy. Group I (10): without clinical inflammatory signs (control); Group II (10): with clinical inflammatory signs. Histopathological parameters were analyzed and classified in 3 grades: mild, moderate or severe (grade 1, 2 or 3). Control group showed only slight changes, grade 1. In group II we found edema with moderate to severe cellular and nuclear changes. There are more women than men with all grades of inflammation. All patients with moderate edema are male and all patients with severe edema are female. A significant association (p=0.007) exists between these two variables. Significant differences were found when comparing the degree of inflammation with nuclear alterations (p=0.001) and the same results when comparing the degree of edema and nuclear changes (p<0.001). This study demonstrates that clinical examination can be used, with a small margin of error, to monitor and control the state of the peri-implant mucosa. In clinics the predisposition of female patients to greater degree of edema and inflammation should be accounted for.

Antimicrobial substantivity over time of chlorhexidine and cetrimide.

INTRODUCTION: To reach an adequate control of dentin infection and to promote success in endodontic therapy, antimicrobial irrigating solutions with confirmed substantivity are recommended. The aim of the present study was to evaluate the antimicrobial substantivity against Enterococcus faecalis of a dentin-volumetric unit exposed for 1 minute to chlorhexidine (CHX) and cetrimide (CTR). METHODS: Standardized coronal dentin blocks of human molars, with and without collagen, were treated for 1 minute with 0.2% and 2% CHX and 0.2% CTR. Afterwards, they were exposed to E. faecalis suspension to determine the antimicrobial substantivity over a period of 60 days. Results were analyzed by means of Kaplan-Meier survival analysis (P < .05). RESULTS: A direct relationship was seen between CHX concentration and survival time, and the most statistically significant results were obtained in specimens with collagen. CTR showed intermediate survival values close to those of 2% CHX. CONCLUSIONS: The present study shows that 2% CHX used for 1 minute provides the longest substantivity followed by 0.2% CTR when applied to a dentin-volumetric model.

Lesiones de la mucosa bucal en pacientes de Mérida, Venezuela / Oral mucosal lesions in patients of Mérida, Venezuela

Existen muy pocos estudios sobre lesiones de la mucosa bucal en Venezuela y ningún estudio de la epidemiología de estas lesiones en el estado de Mérida. El objetivo de este estudio fue determinar la prevalencia de lesiones de la mucosa bucal en una población atendida en centros odontológicos de Mérida, describir las características de las mismas y analizar la influencia de otros parámetros tales como los hábitos de higiene buco-dental, los hábitos nocivos o los hábitos parafuncionales. De los 8640 pacientes atendidos en centros odontológicos públicos y privados durante un año, 120 (el 1,39%) presentaron lesiones de la mucosa bucal. Las lesiones bucales más frecuentemente encontradas fueron úlceras traumáticas (17,5%), herpes recurrente labial (11,7%), estomatitis por prótesis (10%), candidiasis eritematosa (10%) y estomatitis aftosa recurrente (9,2%). Las lesiones de la mucosa bucal fueron más frecuentes en el sexo femenino y su principal localización fue la gingival. La mayoría eran lesiones agudas (< 7 días), no recurrentes, con sintomatología dolorosa y sin factor etiológico atribuible por parte del paciente. Ni los hábitos nocivos, ni los hábitos parafuncionales tuvieron influencia sobre las características clínicas de las lesiones.

There are very few epidemiological studies of oral mucosal lesions in Venezuela. None of these studies has been conducted in the state of Merida. The aim of this study was to determine the prevalence of oral mucosal lesions in a population from Merida, Venezuela, describe their oral lesions’ characteristics and analyze the influence of parameters such as oral hygiene habits, harmful habits or parafunctional habits. Of the 8640 patients seen in public and private dental centers from Merida during one year, 120 (1.39%) had oral mucosal lesions. The oral mucosal lesions most frequently found were: traumatic ulcers (17.5%), recurrent herpes labialis (11.7%), denture stomatitis (10%), erythematous candidiasis (10%) and recurrent aphthous stomatitis (9.2%). The main features of these oral mucosal lesions were: more frequent in females and, main location on the gingiva. Moreover, most of them were acute lesions (< 7 days), non-recurring and painful lesions. Neither harmful habits nor parafunctional habits had influence on the clinical features of the lesions.