Complications in the use of the mandibular body, ramus and symphysis as donor sites in bone graft surgery. A systematic review.

BACKGROUND: To develop a systematic review by assessing and comparing the different complications that occurs in bone graft surgery using the mandibular body, ramus and symphysis as donor sites. MATERIAL AND METHODS: In order to respond to the following question, a systematic review was developed: does the use of intraoral mandibular body and ramus as donor sites in bone graft surgery, produce fewer and less severe complications in comparison to the use of the mandibular symphysis in patients that present bone resorption that needs augmentation using autologous grafts? The review was carried out between January 1990 and 2015, during which only clinical essays with a minimum follow-up period of six months were included. RESULTS: The initial search yielded a total of 2912 articles, of which 6 were finally selected. In total, 259 graft surgeries were performed; 118 using the mandibular body and ramus as donor sites, and 141, the symphysis. The most frequent complications that arose when using the mandibular symphysis were temporary sensory alterations in the anterior teeth (33.87%), followed by sensory alterations of the skin and mucosa (18.57%). As for the mandibular body and ramus donor sites, the most frequent complications relate to temporary sensory alterations of the mucosa (8.19%) and to minor postoperative bleeding (6.55%). CONCLUSIONS: The analyzed results show a higher prevalence and severity of complications when using mandibular symphysis bone grafts, producing more discomfort for the patient. Therefore, it would be advisable to perform further clinical essays due to the lack of studies found.

Complications in the treatment with alveolar extraosseous distractors. Literature review.

BACKGROUND: To review the literature that analyses the types and frequency of complications associated with the use of extraosseous alveolar distraction from 2007 to 2013. MATERIAL AND METHOD: Review of the literature in PubMed, using these keywords; alveolar ridge, alveolar distraction osteogenesis, complication, literature review. Inclusion criteria were: articles published between 2007 and 2013 that included the distraction protocol, the complications encountered and the time when they occurred. RESULTS: According to the above criteria, 12 articles were included in this review, where 334 extraosseous distractors were placed and 395 complications were encountered, of which 19 (4.81%) were intraoperative, 261 (66.07%) postoperative and 115 (29.11 %) were post-distraction. The most common complication was the incorrect distraction vector found in 105 cases (26.58%), in 23 cases (5.82%) there were severe complications, of which 14 (3.54%) were mandibular fracture and 9 (2.27%) were fractures of the distractor elements. CONCLUSIONS: According to this review, although alveolar distraction is a safe and predictable technique, it can cause complications; however, they are usually minor and easily resolved without affecting the treatment outcome.

Oral tissues regeneration using intraoral mesenchymal stem cells.

BACKGROUND: Oral pathologies or some treatments can cause facial and functional alterations, being fundament to retrieve those functions restoring the original anatomy of the lost tissues. On this purpose, various techniques have been studied, one of these was the tissue engineering. Mesenchymal stem cells (MSC) are multipotent adult stem cells. The MSC in the oral cavity have been striking for regenerative therapies by its high plasticity, good interaction with scaffolds and growth factors, good proliferation and differentiation, they are also easy to obtain. Objective: The objective of this study was to describe the current uses of the intraoral MSC for the regeneration of the tissues of the oral cavity. MATERIAL AND METHODS: An electronic research was made in the databases PubMed, Cochrane Library, Google Scholar, Scopus and EBSCO between 2000 to 2018. RESULTS: 21 articles were included. 13 were studies in vivo and 8 were studies in humans. The site mostly used as a giver site was the dental pulp. Intraoral MSC are able to regenerate the pulp dentin complex, alveolar bone and periodontium. CONCLUSIONS: Intraoral MSC come from easy access areas, less traumatic interventions and have high potential to regenerate intraoral tissues in comparison to MSC from other sites of the body which allows a more predictable oral tissues regeneration. Key words:Oral stem cells, oral cavity, regeneration, tissue engineering.

Potential therapeutic uses of intraoral mesenchymal stem cells in other tissues of the body: A review.

BACKGROUND: Over the last few years, there has been a great advance in regenerative medicine, with various studies that have observed the ability to repair or regenerate dysfunctional tissues with the patient's own cells, such as with mesenchymal cells. In this area, mesenchymal stem cells (MSCs) from the oral cavity have attracted attention because of their easy access and multiple cellular differentiations. Multiple studies have shown the various clinical applications at the intraoral level, especially at the level of bone regeneration, but the potential applications of oral MSC at a systemic level have been scarcely described. Objective: The objective of this review was to describe the potential therapeutic uses of intraoral MSCs in other tissues of the organism. MATERIAL AND METHODS: A review of the literature between 2000 and 2019. Only included those studies done on animals or humans. RESULTS: Twenty five articles were selected, all performed on animals. The donor site most used were the temporary teeth exfoliated from humans, representing 56% of the total articles, followed by the dental pulp with 28% of the total articles included. Transplantation of intraoral mesenchymal cells in animals with neural tissue illness was the most studied therapy. CONCLUSIONS: Although obtaining MSC of intraoral origin has proven to be a good alternative in regenerative medicine, achieving therapeutic uses in bone tissue, nervous tissue, liver tissue, skin tissue, ocular tissue, reperfusion of tissues and in autoimmune diseases, there is a lack of clinical studies that allow its safe use in humans. Key words:Mesenchymal stem cells, stem cell transplantation, regenerative medicine, dental component.

Epidemiological and Accounting Analysis of Ground Ambulance Whole Blood Transfusion.

INTRODUCTION: In October 2017, the American Association of Blood Bankers (AABB; Bethesda, Maryland USA) approved a petition to allow low-titer group O whole blood as a standard product without the need for a waiver. Around that time, a few Texas, USA-based Emergency Medical Services (EMS) systems incorporated whole blood into their ground ambulances. The purpose of this project was to describe the epidemiology of ground ambulance patients that received a prehospital whole blood transfusion. The secondary aim of this project was to report an accounting analysis of these ground ambulance prehospital whole blood programs. METHODS: The dataset came from the Harris County Emergency Service District 48 Fire Department (HCESD 48; Harris County, Texas USA) and San Antonio Fire Department (SAFD; San Antonio, Texas USA) whole blood Quality Assurance/Quality Improvement (QA/QI) databases from September 2017 through December 2018. The primary outcome of this study was the prehospital transfusion indication. The secondary outcome was the projected cost per life saved during the first 10 years of the prehospital whole blood initiative. RESULTS: Of 58 consecutive prehospital whole blood administrations, the team included all 58 cases. Hemorrhagic shock from a non-traumatic etiology accounted for 46.5% (95% CI, 34.3%-59.2%) of prehospital whole blood recipients. In the non-traumatic hemorrhagic shock cohort, gastrointestinal hemorrhage was the underlying etiology of hemorrhagic shock in 66.7% (95% CI, 47.8%-81.4%) of prehospital whole blood transfusion recipients. The projected average cost to save a life in Year 10 was US$5,136.51 for the combined cohort, US$4,512.69 for HCESD 48, and US$5,243.72 for SAFD EMS. CONCLUSION: This retrospective analysis of ground ambulance patients that receive prehospital whole blood transfusion found that non-traumatic etiology accounted for 46.5% (95% CI, 34.3%-59.2%) of prehospital whole blood recipients. Additionally, the accounting analysis suggests that by Year 10 of a ground ambulance whole blood transfusion program, the average cost to save a life will be approximately US$5,136.51.

Effect of the lack of primary stability in the survival of dental implants.

BACKGROUND: The survival of dental implants has been linked to primary stability. The aim of this study is to analyse the factors that influence the survival of dental implants placed without primary stability. MATERIAL AND METHODS: A cohort study of implants placed without primary stability was carried out between September 2011 and July 2016. All cases with registered information on the patient and surgical intervention were used. Cases that did not have a 12-month follow-up after implant placement were excluded. RESULTS: Out of 2,400 analysed implants, 92 were placed without primary stability. The absence of primary stability was classified as B in 49 cases, C in 38 cases and D in 5 cases. No statistically significant influence of the patient's age, primary stability, brand, or implant size in terms of implant survival was established. A tendency towards greater early implant loss was observed in implants whose absence of primary stability was classified as C. CONCLUSIONS: Poor primary stability is not statistically significant in the loss of dental implants of the characteristics studied. Any of the factors studied are related with early implant loss as a main factor. Key words:Primary stability, survival, dental implants.

Alternative intraoral donor sites to the chin and mandibular body-ramus.

BACKGROUND: Provide a review of alternative intraoral donor sites to the chin and body-ramus of the mandible that bring fewer complications and that may be used to regenerate small and medium defects. MATERIAL AND METHODS: A review was conducted using the search engine PUBMED and looking manually into scientific journals. RESULTS: From the 35 articles included, 6 corresponded to the coronoids, 3 corresponded to the zygomatic body, 5 corresponded to the anterior maxillary sinus wall, 3 corresponded to the zygomatic alveolar process, 2 corresponded to the incisive fossa, 2 corresponded to the anterior nasal spine, 2 corresponded to the palatal region, 5 corresponded to the tuberosity, and 7 corresponded to the palatal and mandibular tori. CONCLUSIONS: Although there are few complications described when using alternative intraoral donor sites, the main problem with these types of grafts is their scarce bone volume, with only the zygomatic body, anterior sinus wall, and palate sites being able to be used in medium defects. More clinical trials are necessary in order to evaluate the behavior of the alternative donor sites over time. Key words:Grafting, autologous bone, autografts, mandible, maxilla, palate hard, zygoma.

Analysis of Resorption and Need for Overcorrection in Alveolar Distraction Osteogenesis.

PURPOSE: The aim of this study was to evaluate the degree of resorption that occurs following a period of consolidation in alveolar distraction osteogenesis and assess the amount of overcorrection necessary to achieve the planned height. MATERIALS AND METHODS: A retrospective observational study was conducted comprising 19 surgically treated patients, where a total of 19 extraosseous distractors were placed. All patients undergoing surgery had a panoramic radiograph and a computed tomography scan, both at the end of distraction and at the end of the consolidation period. To assess the degree of resorption, the distance from the mandibular border, maxillary sinus floor, or nasal floor to the limit of the crestal bone following consolidation was compared with the height recorded at the end of the distraction period. RESULTS: Resorption occurred in all cases ranging from 7% to 25%. CONCLUSION: The presence of resorption reported from this study indicates that an overcorrection of at least 20% may be necessary when distraction osteogenesis is performed.

Análisis de los grosores tisulares a nivel de nasion y glabela según sexo y biotipo, en pacientes entre 20 y 27 años de edad / Nasion and glabela thickness tissue according to sex and biotypein patients between 20 and 27 years of age

La población chilena se caracteriza por ser una población muy heterogenea, debido a la gran mezcla exístente entre las distintas etnias y razas a lo largo del tiempo. Esto supone una gran diversidad de formas, tamaños y grosores de estructuras anatómicas, dentro de las cuales ubicamos a los grosores faciales. Si bien existen bases de datos de los grosores tisulares faciales en la población chilena, éstas han sido realizadas a través de técnicas como la ultrasonografía y punción, sin existir estudios realizados en Chile utilizando técnicas radiológicas para medir, como es la telerradiografía de perfil. Los objetivos fueron: 1. Medir los grosores tisulares a nivel de GB y NA, 2. Evaluar correlación de grosores según distribución por sexo y biotipo, 3. Comparar grosores entre distintos grupos, 4. Creación de una base de datos de referencia de la población chilena sobre el espesor del tejido blando a nivel de GB y Nay 5. Comparar los resultados obtenidos con otros estudios de grosores realizados en la población chilena. Se escogió al azar a 99 alumnos de odontología entre 20 a 27 años que necesitaban tratamiento de ortodoncia, a los cuales se les solicita una telerradiografía de perfil, en donde se mide los grosores de tejidos blandos a nivel de glabela y nasion, se clasifican a los pacientes según sexo y biotipo utilizando el análisis de Roth-Jaraback. Al analizar los resultados según sexo se observó siempre un grosor mayor en hombre que en mujer, con diferencia significativa a nivel de glabela y nasion. Al evaluar los resultados según biotipo no se observa diferencias siginificativas entre un biotipo y otro. Los hombres presentan un mayor grosor de tejido blando a nivel de glabela y nasion, con diferencia significativa en ambos. Se propone una nueva clasificación según biotipo, pero no se encuentra resultados concluyentes.

Chilean population is characterized for being heterogeneous, due to a large variety and mix of different ethnicities and races. This includes diversity in shapes, sizes and thickness of anatomic structures, part of which is facial thickness. Even though there are databases of facial tissue thickness for Chilean population, these have been carried out through techniques such as ultrasonography and puncture, without taking into consideration radiologic techniques, such as profile teleradiography. The aims of the study were: 1. Measure tissue thickness at GB and NA level, 2. Evaluate correlation in thickness according to distribution per sex and biotype. 3. Compare thickness among the groups. 4. Create a database of soft tissue thickness at GB and NA level in Chilean population, 5. Compare results with other studies regarding tissue thickness in Chilean population. Ninety-nine dentistry students between 20 and 27 years of age, candidates for orthodontic treatment, were randomly chosen. Lateral teleradiography was requested from all individuals, soft tissue thickness was measured at GB and NA level, classifying patients according to Roth-Jaraback analysis. When analysing the results according to sex, larger thickness was observed in men each time, with a significant difference at GB and NA levels. When evaluating biotype differences no significant difference was observed. Men showed thicker soft tissue at NA and GB level than women, with a significant difference between both. A new classification is proposed according to biotype, but no concluding data is found.

Revisión bibliográfica del uso de láser de baja potencia como tratamiento en alteraciones del nervio alveolar inferior en osteotomía sagital de rama / Literature review of the use of low power laser therapy for treating inferior alveolar nerve disorder in sagittal ramus osteotomy

Una de las principales complicaciones al realizar la osteotomía sagital de rama, es la presencia de alteraciones sensitivas que se producen a nivel del nervio alveolar inferior. La parestesia luego de esta técnica reporta una incidencia entre el 85-87 por ciento, de los cuales entre el 0-24 por ciento queda con parestesia permanente. Dentro de los tratamientos utilizados para recuperar las alteraciones sensitivas se encuentra el uso de láser de baja frecuencia; el cual se utiliza para acelerar la recuperación sensitiva y la reparación neuronal, disminuir el dolor y restaurar el funcionamiento normal del nervio injuriado. Los objetivos de esta investigación fueron realizar una revisión bibliográfica sobre los resultados obtenidos en pacientes sometidos a osteotomía sagital de rama que presentaron alteraciones sensitivas y en cuyo tratamiento se utilizó el láser, y crear un protocolo de tratamiento con láser en pacientes sometidos a osteotomía sagital de rama madibular. Se realizó una revisión de artículos entre los años 1990-2010, utilizando buscadores como: EBSCO, Cochcrane, TripDataBase, Medline, Lilacs, Pubmed y Decs, además de una búsqueda en revistas científicas. Los resultados de los artículos seleccionados señalan el efecto beneficioso que conlleva el uso del láser, demostrando su eficacia en la recuperación precoz de la sensibilidad postoperatoria. El uso del láser de baja frecuencia es una alternativa favorable para pacientes con alteraciones sensitivas que fueron sometidos a cirugía sagital de rama, debido a su pronta, mejor y mayor recuperación de la sensibilidad...

A major complication that occurs at the sagittal ramus osteotomy, is the presence of damage occurring at the inferior alveolar nerve. An incidence of paresthesia after this technique reported at 85-87 percent, of which between 0-24 percent are left with permanent paresthesia. Among the treatments used to restore sensitivity is the use of low level laser therapy, which is used to speed recovery and repair sensitive neurons, reduce pain, and restore normal functioning to injured nerve. The aims were to undertake a literature review of empiric research on the results obtained in patients under going sagittal ramus osteotomy, who has sensory disturbances and in wich laser treatment was used, and create a laser treatment protocol in patients undergoing sagittal ramus osteotomy. A review of articles between the years 1990-2010, using search engines such as EBSCO, Cochcrane, Tripdatabase, Medline, Lilacs, Pubmed and Decs. The review also included a search in scientific journals. The results of the reviewed literature showed the beneficial effect of the use of laser, demonstrating its effectiveness in the early recovery of postoperative sensitivity. The use of low level laser therapy is a favorable alternative for patients with sensory impairment who underwent sagittal ramus osteotomy due to its rapid and greater sensitivity recovery...

Análisis de la ubicación vertical y profundización del pin frontal en cirugía ortognática / Analysis of the vertical position and depth of the external pin in orthognatic surgery

Introducción. Al reposicionar verticalmente el maxilar es necesario contar con un aditamento externo llamado pin, que permite realizar las mediciones durante la cirugía, y así movilizar el maxilar según lo planificado. Los sitios más utilizados para introducir el pin son el nasion y glabela, pero ¿cuál de estos es el ideal?, siendo ideal aquella zona que de mayor retención, estabilidad y menor posibilidad de complicaciones. Objetivo. Analizar desde un punto de vista anatómico el mejor sitio para la introducción del pin, y proponer una ubicación única universal tanto en sentido vertical como sagital, utilizable para todo tipo de paciente. Material y método. Se realizó un estudio exploratorio, seleccionando al azar 99 pacientes de edad entre los 21 a los 27 años, todos estudiantes de odontología de la Universidad de los Andes Santiago de Chile, a los cuales se les efectuó una radiografía de perfil, midiendo el grosor de tejido óseo y blando a nivel del nasion y glabela. Se dividió a los pacientes por sexo y biotipo con el fin de evaluar similitudes en las mediciones de grosores. Resultados. Se encontró gran diferencia de los grosores en los distintos grupos tanto en nasion como en glabela. Se determinó un mayor grosor de tejido óseo y blando a nivel de nasion, resultando un grosor mínimo total de 13,83mm en nasion y 6,37mm en glabela. Conclusión. Debido al gran margen de grosores es muy difícil determinar un valor único estándar en la introducción del pin, considerando como sitio de elección el nasion (AU)

Introduction. To vertically reposition the maxilla it is necessary to have an attachment called the external pin, which allows for measurements to be taken during surgery. The sites most often used to insert the pin are the nasion and glabella, but the question remains as to which of these two sites is the optimum as regards increased retention, stability, and less chance of intraoperative and postoperative complications. Objectives. The objective of this study is to analyze the best place for the introduction of the pin from an anatomical point of view, and propose a universal unique location in both vertical and sagittal directions that will be usable for all types of patients. Materials and methods. We performed an exploratory study, randomly selecting 99 patients aged 21 to 27 years, all of whom were dental students at the University of the Andes, Santiago de Chile. They all had a lateral radiograph, measuring the bone and soft tissue thickness at nasion and glabella level. The patients were grouped by sex and biotype to assess similarities in the thickness measurements. Results. There were no significant differences in the thicknesses of the nasion and glabella in the various groups. Greater bone and soft tissue thickness was found at nasion level (a total minimum thickness of 13.83mm) than in the glabella, 6.37mm. Conclusion. Due to the wide range of thicknesses it was impossible to determine a single value standard for the introduction of the pin, with the nasion being considered the site of choice (AU)