Anesthetic efficacy of Oraqix® versus Hurricaine® and placebo for pain control during non-surgical periodontal treatment.

OBJECTIVES: To evaluate the efficacy of Oraqix® during scaling and root planing (SRP) in comparison with 20% benzocaine and placebo. STUDY DESIGN: 15 patients requiring 4 sessions of SRP were enrolled. For each patient, Oraqix®, Hurricaine®, vaseline or no anesthetic product were randomly assigned each to a quadrant. Treatment pain was evaluated on a 100 mm Visual Analog Scale (VAS) and on a Verbal Rating Scale (VRS). The amount of product administered, the need to re-anesthetise, patient and operator satisfaction and the onset of side-effects were also recorded. RESULTS: Oraqix® was significantly better than nothing, with a reduction of VAS score to 13.3 units, but without significant differences with Vaseline or Hurricaine®. Oraqix® was better in VRS reduction than not using any anesthetic (p=0.001) or using vaseline (p=0.024), but similar to Hurricaine® (p=0.232). CONCLUSIONS: Oraqix® effectively controls pain in SRP procedures, with few side-effects and a good acceptance on the part of patients and clinicians.

A prospective, randomized, triple-blind comparison of articaine and bupivacaine for maxillary infiltrations.

OBJECTIVES: To compare the clinical anesthetic efficacy of 0.5% bupivacaine and 4% articaine (both with 1:200.000 adrenaline) for anterior maxillary infiltration in healthy volunteers. MATERIAL AND METHODS: A triple-blind split-mouth randomized clinical trial was carried out in 20 volunteers. A supraperiosteal buccal injection of 0.9 ml of either solution at the apex of the lateral incisor was done in 2 appointments separated 2 weeks apart. The following outcome variables were measured: latency time, anesthetic efficacy (dental pulp, keratinized gingiva, alveolar mucosa and upper lip mucosa and tissue) and the duration of anesthetic effect. Hemodynamic parameters were monitored during the procedure. RESULTS: Latency time recorded was similar for both anesthetic solutions (p>0.05). No statistically significant differences were found in terms of anesthetic efficacy for dental pulp, keratinized gingiva or alveolar mucosa. Articaine had a significant higher proportion of successful anesthesia at 10 minutes after infiltration in lip mucosa and lip skin (p=0.039). The duration of anesthesia was 336 minutes for bupivacaine and 167 minutes for articaine. (p<0.001). No significant hemodynamic alterations were noted during the procedure. CONCLUSIONS: Articaine and bupivacaine exhibited similar anesthetic efficacy for maxillary infiltrations. The duration of anesthesia was longer with the bupivacaine solution, but lip anesthesia was better with articaine.

In vitro evaluation of the temperature increment at the external root surface after Er,Cr:YSGG laser irradiation of the root canal.

OBJECTIVES: A study was made to determine the temperature increment at the dental root surface following Er,Cr:YSGG laser irradiation of the root canal. DESIGN: Human canines and incisors previously instrumented to K file number ISO 30 were used. Irradiation was carried out with glass fiber endodontic tips measuring 200 mm in diameter and especially designed for insertion in the root canal. The teeth were irradiated at 1 and 2 W for 30 seconds, without water spraying or air, and applying a continuous circular movement (approximately 2 mm/sec.) in the apico-coronal direction. RESULTS: At the 1 W power setting, the mean temperature increment was 3.84 degrees C versus 5.01 degrees C at 2 W. In all cases the difference in mean value obtained after irradiation versus the mean baseline temperature proved statistically significant (p<0.05). CONCLUSIONS: Application of the Er,Cr:YSGG laser gives rise to a statistically significant temperature increment at the external root surface, though this increment is probably clinically irrelevant, since it would appear to damage the tissues (periodontal ligament and alveolar bone) in proximity to the treated tooth.

Osteomas of the craniofacial region. Review of 106 cases.

BACKGROUND: Osteoma is a benign osteogenic lesion characterized by the proliferation of compact or cancellous bone. Although this tumour has a considerable incidence, there are few reports with large samples on this subject. OBJECTIVES: To describe clinical features of the osteomas in the craniomaxilofacial region. MATERIAL AND METHODS: Retrospective study of 106 patients diagnosed with 132 osteomas of the craniomaxilofacial region between 1986 and 2003. RESULTS: The mean age was 50 years. Osteomas were more frequent in men. Forty-nine per cent were of peripheral type, 29% central osteomas and 21% were located in the paranasal sinuses. Eighty-nine cases (84%) were operated and 80 patients were regularly followed up. Out of these, 73 did not recur. The seven recurrences were central osteomas. CONCLUSIONS: Osteomas usually appear in patients with more than 30-year old. Peripheral type showed the highest incidence among these lesions. Central and peripheral osteomas usually do not originate clinical symptoms whereas the ones located in paranasal sinuses can provoke headache and neuralgia/paresthesia.

Efficacy of methylprednisolone injected into the masseter muscle following the surgical extraction of impacted lower third molars.

The aim of this study was to demonstrate the efficacy of methylprednisolone, as a single 40-mg dose, injected into the masseter muscle upon completion of extraction of impacted lower third molars. A prospective, randomized cross-over study was made of 35 healthy patients. The difficulty of extraction was similar in all cases. The study group received 40 mg of methylprednisolone injected into the masseter muscle via the intrabuccal approach, immediately after suturing of the surgical wound. The control group received no intramuscular corticoid. Evaluations were made of postoperative pain, trismus and swelling. Oral aperture was measured, along with the following distances for the assessment of swelling: tragus-lip commissure, gonion-lip commissure and gonion-external canthus of the eye, before and 2 and 7 days after surgery. The patients administered methylprednisolone showed superior results after surgery in terms of oral aperture, pain and all the facial swelling parameters, with statistically significant differences versus the controls (p<0.05). The results obtained show that 40 mg of methylprednisolone injected into the masseter muscle in the immediate postoperative period reduces swelling, trismus and pain.

Factors influencing the prophylactic removal of asymptomatic impacted lower third molars.

The aim of this study was to analyse factors indicating prophylactic removal of impacted lower third molars, and how they, and possibly surgeon experience, influence the therapeutic decision-making process. A descriptive observational study was made of 40 asymptomatic impacted lower third molars. Orthopantomographs were scanned and presented to four professionals with different degrees of surgical experience. The examiners received information relating to patient age and sex, molar inclination and degree of impaction, and expressed their opinion on the necessity for teeth removal. There was a statistically significant relationship between examiner decision and the estimated probability of pathology if the molars were not removed (P<0.05). The degree of influence on the decision to extract was in decreasing order: estimated risk of complications, inclination of molar, age, degree of impaction and patient sex. No statistically significant differences (P>0.05) were observed between residents and trainers in terms of the decision to remove or estimated risk of complications. The management approach adopted by oral surgeons regarding the removal of asymptomatic impacted lower third molars depends upon the perceived risk of complications if such teeth are not removed, other factors being secondary. The surgical experience of the professional does not seem to influence treatment decision.

Quality of life following lower third molar removal.

The objective of this study was to evaluate the quality of life (QoL) and degree of satisfaction among adult outpatients after surgical extraction of a lower third molar under local anaesthesia, and to assess the impact of thorough explanation of the anticipated postoperative course on their pain and daily activities. Ninety-two patients filled a questionnaire assessing social isolation, working isolation, eating ability, speaking ability, sleep impairment, physical appearance, discomfort at suture removal and overall satisfaction on days 4 and 7 after surgery. A 100-mm visual analogue scale (VAS) of pain was scored by the patients every day after extraction until day 7. Before extraction, patients were randomly allocated to one of two groups: the test group received detailed verbal instructions from a surgeon about the postoperative course after extraction of the third molars, together with a written text containing postoperative instructions. One day after extraction, they were asked by telephone about their status. The control group only received the written text with postoperative instructions, with a few basic oral explanations. Ninety-one patients (53 of them female) completed the questionnaires. The decrease in pain was linear over time. Men referred significantly less pain than women, but there were no statistically significant differences between the test and control groups. The test group was characterized by a significantly greater inability to work. Lower third molar surgery significantly affects patient quality of life and environment, particularly during the first 3 days after extraction.

Morbidity associated with removal of the submandibular gland.

Postoperative complications in 206 submandibular gland excisions, excluding those resulting from benign or malignant tumours, carried out during a 15-year period were reviewed. Most patients (62%) had sialolithiasis. Coexistence of sialolithiasis and nephrolithiasis was documented in 5.5% of cases. Early postoperative complications (particularly infection) developed in 14.6% of the cases, whereas late complications appeared in 25.3% of the cases (residual inflammation in Wharton's duct 7.3%). Neurological complications were observed in 16% of the cases. In 7 cases (3.4%) several nerves were involved and almost always the hypoglossal nerve. In 37.4% of the cases, these lesions resolved spontaneously in a mean period of 4 months. In those cases with a permanent neurological deficit, the facial nerve was the most often affected (7.7%) followed by the hypoglossal (2.9%) and the lingual nerve (1.4%). A single case of gustatory sweating (Frey's) syndrome was observed.

Inferior alveolar nerve damage after lower third molar surgical extraction: a prospective study of 1117 surgical extractions.

PURPOSE: The purpose of this study was to determine the incidence of inferior alveolar nerve (IAN) damage after surgical removal of lower third molars, to identify the causes, and to construct a predictive model to assess the risk of IAN injury. STUDY DESIGN: We performed a nonrandomized forward prospective study of 946 consecutive outpatients subjected to surgical extraction of 1117 lower molars in the University of Barcelona Oral Surgery Department. Preoperative, intraoperative, and postoperative data were gathered, and suspected causal factors of IAN damage were identified by using nonparametric tests, the Pearson chi-square test, and the Fisher exact test. Logistic regression predicted the risk of IAN injury. RESULTS: Although only 1.3% of the extractions caused temporary nerve damage, 25% of the lesions were permanent. All of the following significantly increased the risk of IAN damage (P < .05): age, the radiologic relationship between the apices and the mandibular canal, deflection of the root when approaching the mandibular canal, distal ostectomy, the distance of the apices of the third molar to the mandibular canal, ostectomy, crown sectioning, pain during root luxation, primary closure of the wound, prolonged operating time, bleeding, exposure of the nerve, and postoperative ecchymosis. The first 4 factors were included in a predictive logit model. CONCLUSIONS: Patient age, ostectomy of the bone distal to the third molar, the radiologic relationship between the roots of the third molar and the mandibular canal, and deflection of the mandibular canal increased the risk of IAN damage. Older patients were at a higher risk for suffering permanent injuries.

Lingual nerve damage after third lower molar surgical extraction.

OBJECTIVES: Our objectives were to establish the incidence of lingual nerve damage after surgical removal of lower third molars, to identify the causes of the damage, and to construct a predictive model to assess the risk of lingual nerve injury. STUDY DESIGN: We conducted a nonrandomized prospective study of 946 consecutive outpatients subjected to surgical extraction of 1117 lower molars in a university department of oral surgery. Preoperative, intraoperative, and postoperative data were gathered, and causal factors of lingual nerve damage were identified by using nonparametric tests and Pearson chi-square and Fisher exact tests. A prediction of lingual nerve injury risk was obtained by using logistic regression. RESULTS: Of the extractions, 2.0% caused temporary nerve damage, though no lesion lasted more than 13 weeks. Lingual flap retraction, vertical sectioning of the tooth, surgeon inexperience, lingual angulation of the tooth, and prolonged operating time significantly increased the risk of nerve damage (P <. 05). The first 3 factors were included in a predictive logistic regression model. CONCLUSIONS: Anatomical factors such as lingual angulation of the third molar, surgical maneuvers such as retraction of the lingual flap or vertical tooth sectioning, and surgeon inexperience all increase the risk of lingual nerve damage, although permanent lesions seem to be very rare.

Comparative study of different syringes in positive aspiration during inferior alveolar nerve block.

OBJECTIVE: The purpose of this study was to evaluate the detection of intravascular injection or hematic aspiration in relation to (a) the particular combination of syringe system and needle (there being 3 different syringe systems [2 self-aspirating and 1 non-self-aspirating] and 3 different needles); (b) the anesthetic technique used (direct or indirect) to induce inferior alveolar nerve block; (c) patient sex; and (d) the operator performing the block. STUDY DESIGN: Two operators performed 246 inferior alveolar nerve blocks (on 90 male and 156 female patients) using 3 syringe systems (1 non-self-aspirating (Uniject K) and 2 self-aspirating (Aspiject and Inibsaject)) and 3 types of needle in terms of length and gauge combination (30G/25 mm, 27G/25 mm, and 27G/35 mm) for conventional and surgical extractions of lower third molars. Three aspirations were made at each of 3 different times in each block. Hematic aspiration was accepted only if a blood jet rose forcefully along the cartridge on aspiration. In each block, the age and sex of the patient was recorded, along with the latency or time elapsed from introduction of the anesthetic solution to onset of the anesthetic effect, the depth of the needle at contact with the mandibular ramus, and the operator performing the block. RESULTS: Significant differences (P <.05) were observed with respect to hematic aspiration and the syringe system used, the Uniject K system yielding higher percentage hematic aspirations (5.69%) than either of the self-aspirating systems, Inibsaject (2.03%) and Aspiject (1. 21%). However, no significant differences (P >.05) were observed with respect to number of aspirations, needle length, needle gauge, anesthetic technique performed, patient's sex, or operator performing the inferior alveolar nerve block. The incidence of hematic aspirations was 8.9%. The mean latency time was 39.03 seconds, and the mean needle depth at contact with the mandibular ramus was 20.72 mm. CONCLUSIONS: The Uniject K non-self-aspirating syringe system was associated with a higher number of hematic aspirations than the self-aspirating systems (Inibsaject and Aspiject). However, the detection of hematic aspirations was not dependent on length or gauge of the needles used, anesthetic technique performed (direct or indirect), patient's sex, or operator who performed the block.

Transmigration of mandibular canines: report of six cases and review of the literature.

Six young adults were found to have transmigrated mandibular canines. One patient presented with two transmigrated canines. Of the seven impacted teeth, the left mandibular canines was involved in five instances and the right two. In all patients, the primary canine was present in the dental arch. A supernumerary tooth was disclosed on the panoramic radiograph of two patients. Five patients underwent surgical removal of the transmigrated tooth from an intraoral approach. One patient experienced transient postoperative paresthesia in the zone innervated by the mental nerve. When the transmigrated canine is accessible, and especially if it is symptomatic, removal of unerupted tooth is recommended. Otherwise, it should be left alone and kept under observation.

Broken anesthetic injection needles: report of 5 cases.

A broken anesthetic needle is a rare complication in clinical practice. This article reports on 5 patients referred for removal of broken needles. The needles were located in the pterygomandibular space or near the maxillary tuberosity. These complications were the result of an unexpected movement by the patient or an incorrect anesthetic technique. The article also describes the case of a patient in whom an image observed in a routine panoramic radiograph could have been caused by a broken needle.

Diagnostic predictability of digital versus conventional panoramic radiographs in the presurgical evaluation of impacted mandibular third molars.

Panoramic radiographs are the most widely used radiological diagnostic technique in dental practice, offering full vision of the maxillas and adjacent regions, but there are shortcomings regarding detailed dentoalveolar exploration. This study compared the precision of digital versus conventional panoramic radiographs in the presurgical evaluation of impacted lower third molars. 390 mandibular third molars were studied in 287 patients; their position, morphology and surgical technique used were recorded. 84 molars were evaluated with digital panoramic radiographs, and 306 with conventional panoramic radiographs. Four observers compared the presurgical data with the surgical findings and the diagnostic precision was established. There were statistically significant differences between the techniques; digital panoramic radiographs were more precise than conventional radiographs in providing the correct presurgical evaluation of the impacted third molars. Surgeon experience had a statistically significant influence on planning the presurgical study. Panoramic radiographs distort the position and morphology of the lower third molar, which may affect the presurgical strategy used. In this context, and because of their lesser experience, first year residents consider the operation to be more complicated, and tend to act less conservatively and cause increased trauma. In conclusion, digital panoramic radiographs offer significantly greater diagnostic precision than conventional panoramic radiographs.

Efficacy of methylprednisolone in controlling complications after impacted lower third molar surgical extraction.

INTRODUCTION: Impacted third molar extraction causes considerable swelling in the days immediately following surgery. The aim of the present investigation was to evaluate the efficacy of methylprednisolone as a single 40-mg intramuscular dose in controlling the complications of impacted lower third molar surgical removal. MATERIALS AND METHODS: Thirty-five patients were evaluated within the framework of a consecutive sampling and double-blind study with intrasubject measurements. Extraction comprised ostectomy with tooth sectioning of both lower third molars under local anesthesia. The study group received 40 mg of methylprednisolone injected into the gluteal region, while the controls received no such medication. In each individual one molar was randomly assigned to the study group and the other to the control series - with extraction of the two teeth being spaced 1 month apart. Evaluations were made of postoperative pain, trismus and swelling, and measurements were obtained for oral aperture and various distances (tragus-lip commissure, gonion-lip commissure and gonion-external canthus of the eye) before surgery and 2-7 days after extraction. Statistical correlations were made based on the Student t-test for the comparison of means of related samples. RESULTS: A statistically and clinically significant association was observed 2 days after surgery between methylprednisolone administration and increased oral aperture and diminished facial swelling. Likewise, less pain was recorded in the study group 6 h after surgery. CONCLUSION: The results confirm the efficacy of methylprednisolone in providing a more comfortable postoperative course after surgical extraction of impacted lower third molars.

Fibroma osificante periférico: Presentación de tres casos y revisión de la literatura / Peripheral ossifying fibroma: Report of three cases and review of the literature

El fibroma osificante periférico (FOP) es una entidad benigna que se incluye en el grupo de las lesiones gingivales reactivas, denominadas con el término genérico de épulis, y se origina, según la teoría más aceptada, en las células del ligamento periodontal. Se manifiesta en forma de tumoración de consistencia firme, bien circunscrita, de color rosado o rojizo y está situada normalmente en la zona incisivo-canina del maxilar superior, siendo rara su aparición en crestas edéntulas. Aparece a cualquier edad, con una mayor incidencia entre la segunda y tercera décadas de la vida, con una ligera predilección por el sexo femenino. Es una lesión de partes blandas, que en ocasiones puede estar asociada a una ligera erosión superficial del hueso subyacente. Se han revisado 3 casos de FOP que afectaban a 2 hombres y 1 mujer de edades comprendidas entre los 39 y los 73 años, presentándose uno de ellos en una cresta alveolar edéntula. En dos casos se observaba radiográficamente una ligera erosión del hueso subyacente y el tercer caso presentaba puntos radio opacos difusos intralesionales. El tratamiento consistió en realizar la exéresis-biopsia de las lesiones, efectuándose dos casos mediante bisturífrío y uno con láser de CO2. Uno de los casos presentó tres episodios de recidiva en el seguimiento postoperatorio (AU)

The peripheral ossifying fibroma (POF) is a reactive gingival disorder known under the generic term of epulis and is widely considered to originate from the cells of the periodontal ligament. It manifests as a tumor of firm consistency, well circumscribed, pink or red and is usually located in the incisor-canine area of the maxilla, being uncommon occurrence in edentulous alveolar ridges. Appears without ages difference, with a higher incidence between the second and third decades of life, with a slight predilection for females. It is a soft tissue injury, which can sometimes be associated with a slight erosion of the underlying bone surface. We have reviewed 3 cases of POF involving 2 men and 1 woman aged between 39 and 73 years, presenting one of them in edentulous alveolar ridge. In two cases showed radiological slight erosion of the underlying bone and the third case showed diffuse intralesional radiopaque points. Treatment consisted on resection of the lesions and biopsy of them, two cases to be carried out by cold scalpel and a CO2 laser. One case presented three episodes of recurrence in the postoperative follow (AU)

Cistoadenoma de glándulas salivales menores. Presentación de dos casos y revisión de la literatura / Cystoadenoma of minor salivary glands. Two case reports and review of the literature

El cistoadenoma es un tumor salival benigno de origen epitelial muy infrecuente que se caracteriza por presentar múltiples proyecciones papilares y espacios microquísticos recubiertos de células cilíndricas o cuboideas. La OMS define el cistoadenoma como una neoplasia salival muy similar al tumor de Warthin, que carece de componente linfoide. La mayoría de cistoadenomas se han descrito a nivel de la laringe, la nasofaringe, así como en la glándula parótida y las glándulas lacrimales. Sin embargo, pueden localizarse con menor frecuencia en las mucosas labial y bucal, en la fosa tonsilar y en el paladar. El 35% se sitúan en las glándulas salivales menores. Casos clínicos: Se presentan dos casos clínicos diagnosticados histológicamente de cistoadenoma de una glándula salival menor, que acudieron al Servicio de Cirugía Bucal de la Clínica Odontológica de la Universidad de Barcelona. Se trata de dos varones de 79 y 86 años respectivamente, con antecedentes de diabetes no-insulinodependiente y úlcera gastroduodenal en el primer caso y de depresión en el segundo caso. Clínicamente, ambos pacientes presentaban una tumoración bien delimitada, de consistencia blanda, no ulcerada y sin adherencias a planos profundos. En el primer caso, la tumoración se situaba en la mucosa labial inferior, medía 1x0,7 cm, era de coloración idéntica a la mucosa adyacente y existía dolor a la palpación. En el segundo caso la tumoración era asintomática, de coloración azulada, se localizaba en la región del trígono retromolar derecho y medía 1,7x1 cm. El tiempo de evolución para las lesiones fue de 3 y 2 meses respectivamente. El tratamiento en ambos casos fue la exéresis de la tumoración con márgenes de seguridad y el posterior examen anatomopatológico. Discusión: El cistoadenoma es una neoplasia salival benigna rara, descrita por primera vez por Skorpil en el año 1941, cuya definición y naturaleza ha sido controvertida. La clasificación de los tumores salivales de la OMS del año 1972 incluyó esta entidad dentro del apartado de adenomas monomorfos, sin embargo, en la última revisión del año 2005, el cistoadenoma constituye una variedad histológica independiente. En nuestra casuística, hemos encontrado 2 casos de cistoadenoma diagnosticados entre los años 1997 y 2006. Según la revisión de la literatura, el cistoadenoma constituye entre el 2 y el 4,7% de todas las neoplasias de glándulas salivales menores. No existe acuerdo sobre la etiopatogenia del cistoadenoma, ya que hay autores que la consideran una verdadera neoplasia, mientras que otros autores creen que se trata de una hiperplasia del epitelio ductal glandular. Coincidiendo con los casos clínicos presentados, en la literatura se describe una predilección por el sexo masculino, siendo la edad de presentación más frecuente entre la 6a y la 8a décadas de la vida. El tratamiento de elección es la exéresis local, siendo infrecuente la recurrencia, siempre que la extirpación quirúrgica sea completa (AU)

Introduction: Cystoadenomas are considered uncommon neoplasms of epithelial salivary origin and are characterized by having multiple papillary projections and microcystic spaces recovered by cuboid and cilindric cells. Cystoadenoma is defined by the WHO as a salivary neoplasia very similar to Warthin´s tumour, but lacking lymphoid cells. The most common sites are the larynx, nasopharynx and lachrymal gland, although in some occasions these lesions can be found in the lips, buccal mucosa, palate and tonsillae. Thus 35% of cystoadenomas have minor salivary gland locations. Case reports: Histological samples revealed 2 cases of minor salivary glands cystoadenomas in patients who attended the Oral Surgery department of the University of Barcelona. A man aged 79 years old with medical history of non insulin-dependent diabetes and gastric ulcer and another male patient with 86 years old with a previous history of depression. Macroscopic examination showed a well-limited tumour of tender consistency, mobile and without ulcerous surface. In the first case, the tumour was located in the lower lip, it measured 1 cm of length and 0.7 cm of width, had the same colour as the adjacent mucosa and was slightly painful when pressured. In the second case, the tumour was over the right retromolar area, and presented no symptoms and had a blue colour. The lesion measured 1.7 cm of length and 1 cm of width. The patients referred that the lesions were present for 2 to 3 months approximately. Surgical removal with margins was performed in both cases and the samples were sent for histological analysis. Discussion: Cystoadenomas are uncommon salivary benign neoplasms described for the first time by Skorpil in 1941, and there has been some controversy about its origin and definition. WHO classification of salivary tumours in 1972 included this lesion as an adenoma. However in the latest review made in 2005, the cystoadenoma is considered a separate histological entity. We found two patients with these lesions diagnosed between 1997 and 2006. According to the literature, the frequency of cystoadenomas varies between 2% and 4.7% of all the minor salivary gland tumours. No etiopatogenic factors have been described and some authors consider this to be a real neoplasia, while others believe it is a ductal epithelium hyperplasia. Cystoadenomas are usually diagnosed between the 6th and the 8th decades of life. The treatment of choice is the local excision. No recurrences have been reported unless the lesion isn't fully removed (AU)

Sinusitis maxilar iatrogénica tras la colocación de implantes: A propósito de un caso / Iatrogenic maxillary sinusitis related to implant placement: A case report

La perforación del suelo del seno maxilar y de las fosas nasales durante la colocación de implantes en las crestas alveolares situadas por debajo no es un hecho infrecuente. Pequeñas comunicaciones producidas durante el fresado para la preparación del lecho implantario cierran espontáneamente, pero es un requisito indispensable para evitar futuras complicaciones que el implante quede estable, si no deberá ser retirado. Presentamos el caso de una mujer de 54 años de edad que acude refiriendo cacosmia y halitosis permanentes y episodios esporádicos de dolor en la zona infraorbitaria derecha asociados a rinorrea purulenta, que no ceden a la administración de distintos antibióticos. Las pruebas radiológicas muestran tres implantes dentales en el primer cuadrante sustituyendo a 1.2, 1.3 y 1.6: el primero perforando la fosa nasal, y el tercero con el extremo apical en el interior del seno maxilar derecho con una imagen radioopaca bien delimitada asociada. Confirmada la existencia de una comunicación bucosinusal de más de dos años de evolución, y establecida esta como la causa del cuadro de sinusitis maxilar crónica que la paciente padece, se determina como plan de tratamiento la extracción de los tres implantes y la reconstrucción del plano óseo mediante un injerto de hueso autólogo de mentón. Al retirar el implante en posición 1.6 se observa material de aspecto resinoso adherido a toda su superficie, con fines probablemente retentivos, y que habrá contribuido en gran medida a incrementar el proceso irritativo local. El defecto remanente es tan importante en este sector que se hace imposible anclar un injerto óseo en este área, por lo que se legra la mucosa sinusal enferma a su través, enviando muestra para su posterior análisis anatomopatológico, y se consigue el cierre primario mediante un injerto pediculado de la bola adiposa de Bichat. Los controles postoperatorios fueron favorables consiguiendo de esta forma la remisión total de la sintomatología y la recuperación completa (AU)

Perforation of the floor of the maxillary sinus or nasal cavity during implant placement in the residual bone located below is not an infrequent situation. It's been strongly reported that slight membrane puncture while preparing implant bed does not play a significant role in clinical outcome, as it heals spontaneously, but it is an essential requirement that the implant remains intraoperatory stable. We present the case of a 54 yr. old woman that consulted in our office referring permanent cacosmia and halitosis associated to sporadic episodes of pain and purulent rhinorrhea, that didn't ease to the administration of several different antibiotics. Radiological findings show three dental implants in the first quadrant replacing teeth 1.2, 1.3 and 1.6: first one piercing the nostril and the third one with its apical end completely into the right maxillary sinus with a delimitated radiopaque mass associated. Once confirmed the existency of an oroantral fistula and its involvement in the two-year evolution chronic sinusitis diagnosed, the treatment established included the extraction of the three implants and the simultaneous osseous reconstruction with an autologous bone chin graft. After the removal of implant 1.6, a composite resin-like material is found stuck to its surface with supposedly retentive purposes, contributing in this way in a very strong way to increase irritation. Remanent defect is so important that makes impossible bone grafting in this area, so we proceed to curette harmed sinusal mucosa, sending a sample for histological evaluation, and close with a Bichat fat pad pedicled flap. Postoperatory follow-up and evolution was favourable, achieving total remission of sympthomatology and complete recovery (AU)