Clinical practice guideline of the Spanish society of oral surgery for dental care in patients with oral cancer.

BACKGROUND: Oral cancer is the sixteenth most common malignant neoplasm worldwide, with a high mortality rate, greater than 50% at five years, and high morbidity. The effect of oncological treatment in the oral cavity is broad and has multiple levels, therefore knowing these effects and preventing them is essential for avoiding an increase in the oral pathology related with oncological therapy, maintaining the quality of life of the patient, and improving the efficacy of the treatment itself. MATERIAL AND METHODS: A group of experts belonging to the fields of Dentistry, Maxillofacial Surgery and Oncology of the University of Seville and the Virgen del Rocío University Hospital of Seville in collaboration with the University of Valencia, University of Barcelona, and University of the Basque Country, developed this Clinical Practice Guideline for the proper clinical management of patients diagnosed with oral cancer. The clinical questions were formulated in PICO format. The databases consulted were Medline/PubMed and Embase/Elsevier. The systematic reviews published on the topic were identified on Tripdatabase, Cochrane Library and CRD (Centre for Reviews and Dissemination). The recommendations were prepared based on the GRADE methodology. RESULTS: Various recommendations were defined, derived from the 21 PICO questions, referring to prevention, treatment and care for alterations arising from the pathology of oral cancer itself and its treatment. CONCLUSIONS: The preparation of this clinical practice guideline allows recommendations to be generated based on the scientific evidence available, on dentistry actions in patients with oral cancer and undergoing oncological treatment, which may be of use to the multidisciplinary team treating this type of patient.

Clinical practice guideline of the spanish society of oral surgery for oral surgery in patients with coagulation disorders.

BACKGROUND: The number of patients treated with coagulation disorders, and more specifically with anticoagulant therapy, has increased worldwide in recent years due to increased life expectancy in developed countries. The protocols for managing this type of patient in oral surgery has varied over recent years, especially after the appearance of new direct-acting oral anticoagulants (DOACs). The assessment of risk of bleeding in this type of patient when undergoing a surgical procedure continues to be a controversial issue for patients, dentists and general practitioners. The objective of this document is to offer recommendations, based on evidence, for decision making for patients with coagulopathies who require dental surgical intervention. MATERIAL AND METHODS: Based on the indications of the "Preparation of Clinical Practice guidelines in the National Health System. Methodological manual", we gathered a group of experts who agreed on 15 PICO questions based on managing patients with coagulation disorders in dental surgical procedures, such as fitting of implants or dental extractions. RESULTS: The 15 PICO questions were answered based on the available evidence, being limited in most cases due to the lack of a control group. Two of the PICO questions were answered by the experts with a grade C recommendation, while the rest were answered with grade D. CONCLUSIONS: The results of this review highlight the need to undertake well designed clinical trials with control groups and with a representative sample size.

Proposal for a preventive protocol for medication-related osteonecrosis of the jaw.

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse reaction experienced by some patients exposed to certain drugs (antiresorptives such as bisphosphonates or denosumab, and antiangiogenic drugs). From a review of the literature it appears that there is no uniform criterion when selecting preventive measures; these vary according to author. Likewise, the measures recommended are usually general, so that in few cases they result in specific actions to be applied depending on the different variables involved such as the type of drug used, the duration of its application, the underlying pathology, the presence or absence of risk factors, etc. The aim of this study has been to design a preventive protocol which can be easily applied in any clinic or by any dental care service. MATERIAL AND METHODS: We undertook an exhaustive literature review to find any articles related to the topic of study, namely, preventive measures for medication-related osteonecrosis of the jaw, on the one hand generically and on the other focusing on dental implant treatment. The most part the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. From 3946 items, we selected a total of 21 items. RESULTS: From the analysis of the selected articles, several protocols have been developed that are easy to apply in a dental clinic.: Protocol 1. Before starting treatment with antiresorptives (Patients who are going to be treated for osteoporosis / Patients who are going to be treated for cancer). Protocol 2. Once treatment is initiated with antiresorptives (Patients being treated for osteoporosis / Patients being treated for cancer). CONCLUSIONS: The application of these protocols requires an interdisciplinary team which can handle the various treatments and apply the measures contained in them. Along with a team of well-educated and trained dentists, it is equally important to maintain contact with the medical team involved in the treatment of the underlying pathology, especially rheumatologists, oncologists, internists and gynaecologists. All the above requires a great staff learning and organization effort, continuous training and coordination of the whole team involved in the preventive management of these patients.

Effectiveness of salivary stimulation using xylitol-malic acid tablets as coadjuvant treatment in patients with gastro-oesophageal reflux disease: early findings.

BACKGROUND: Besides dental erosion syndrome, other oral syndromes could benefit from the stimulation of salivary secretion, in patients with gastro-oesophageal reflux disease (GORD). Our aims is evaluate the improvement of oral extra-oesophageal manifestations in patients with GORD using xylitol-malic acid tablets to stimulate salivary secretion. MATERIAL AND METHODS: The effectiveness of salivary stimulation using xylitol-malic acid tablets (as a supplement to omeprazole 40 mg/day) was assessed in a clinical trial (n = 14) lasting six months with patients with prior positive pH-metry, through GORD extra-oesophageal clinical signs, GerdQ and RDQ questionnaires, odontological variables, basal salivary secretion, stimulated salivary secretion, pH and buffer capacity, mucosal erythema index and dental wear. STATISTICS: chi-square (Haberman post-hoc), ANOVA, and Mann-Whitney U; variables between visits were evaluated with McNemar's Student's t and Wilcoxon tests; p < 0.05. RESULTS: 100% of patients not taking xylitol-malic acid presented xerostomia, but only 14.3% of patients taking xylitol-malic acid (p < 0.01) did. The mean saliva-buffer capacity at the last visit for patients not taking xylitol-malic acid was 2.14 ± 0.38, versus 2.71 ± 0.49 for patients taking xylitol-malic acid (p < 0.05). Retro-sternal burning (p < 0.05), heartburn (p < 0.05) and regurgitation (p < 0.05) were also reduced. CONCLUSIONS: Xylitol-malic acid tablets improve quality of life among patients with GORD, by reducing dry mouth, increasing saliva buffering and reducing heartburn, retro-sternal burning and regurgitation.

Comparison of diode laser - Oral tissue interaction to different wavelengths. In vitro study of porcine periodontal pockets and oral mucosa.

BACKGROUND: The aim of this in vitro study was to evaluate the effect of diode lasers at different wavelengths and power settings in handmade incisions in periodontal pockets and in oral mucosa of porcine tissue considering thermal damage, necrosis and the affected area of the soft tissue. MATERIAL AND METHODS: Combining the following laser wavelengths, 445nm, 532nm (KTP), 810nm, 980nm, 1064nm and 1470nm, and a power range from 0.5W to 2.0W in a continuous wave mode (CW), we made handmade incisions in porcine periodontal pockets and oral mucosa. After histological processing, we measured the area of ​​lost tissue, the area of ​​thermal damage and the area of ​​necrosis. Then, we performed ANOVA to evaluate the difference between groups and two-way ANOVA to identify the influence of the laser-type variables and the power on the results. RESULTS: We applied an ANOVA test to evaluate the results, where statistical analysis showed clear differences between the 1470nm and 810nm laser groups that refer to thermal damage and necrosis in the periodontal pocket surface. Regarding the oral mucosa surface, the 1064nm laser showed differences in the analysis of lost tissue. According to the applied power, all the variables we studied (lost tissue area, area of thermal damage and necrosis) showed higher values when using a power of 2.0W instead of 0.5W. CONCLUSIONS: According to our results, the 810nm diode laser for oral soft-tissue biopsy using power ranges between 0.5W and 2W would be the best choice to avoid thermal damage in peri-incisional margins.

Differential Expression of Inflammation-Related Genes in Down Syndrome Patients with or without Periodontal Disease.

AIM: Aware that Down Syndrome patients present among their clinical characteristics impaired immunity, the aim of this study is to identify the statistically significant differences in inflammation-related gene expression by comparing Down Syndrome patients with Periodontal Disease (DS+PD+) with Down Syndrome patients without Periodontal Disease (DS+PD-), and their relationship with periodontitis as a chronic oral inflammatory clinical feature. MATERIALS AND METHODS: Case study and controls on eleven Down Syndrome patients (DS+PD+ vs. DS+PD-). RNA was extracted from peripheral blood using a Qiagen PAXgene Blood miRNA Kit when performing an oral examination. A search for candidate genes (92 selected) was undertaken on the total genes obtained using a Scientific GeneChip® Scanner 3000 (Thermo Fisher Scientific) and Clariom S solutions for human, mouse, and rat chips, with more than 20,000 genes annotated for measuring expression levels. RESULTS: Of the 92 inflammation-related genes taken initially, four genes showed a differential expression across both groups with a p value of <0.05 from the data obtained using RNA processing of the patient sample. Said genes were TNFSF13B (p = 0.0448), ITGB2 (p = 0.0033), ANXA3 (p = 0.0479), and ANXA5 (p = 0.016). CONCLUSIONS: There are differences in inflammation-related gene expression in Down Syndrome patients when comparing patients who present a state of chronic oral inflammation with patients with negative rates of periodontal disease.

Descriptive retrospective study analyzing relevant factors related to dental implant failure.

BACKGROUND: The objective of this retrospective descriptive study was to analyze the characteristics of incident reports provided by dentists while using a specific brand of dental implants. MATERIAL AND METHODS: The study was carried out in collaboration with Oxtein Iberia S.L., with the company providing access to the incident database in order to evaluate the characteristics of incidents from January 2014 to December 2017 (a total of 917 over four years). The data sheet recorded different variables during each of the stages of implant treatment, from initial implant placement to subsequent prosthetic rehabilitation. These variables included age, sex, systemic pathologies, smoking habits, bone quality, implant type, prosthesis type, and type of load applied, among others. SPSS Statistics was used to perform statistical analysis of the qualitative variables (univariate logistic regressions, χ2 test, Haberman's adjusted standardized residuals). RESULTS: The total study sample consisted of 44,415 implants shipped from Oxtein warehouses on the dates indicated, of which 917 implants (2.1%) were flagged due to reports of lack of primary stability, failed osseointegration, or implant failure within one year of placement. When analyzing incident reports, it was observed that 61.6% of incidents occurred in male patients, compared to 38.4% in female patients. The average age of patients in the reported cases was 56.12 ± 12.15 years. A statistically significant correlation was discovered between incidents of implant failure and tobacco use, diabetes, heart disease, poor oral hygiene, previous infection, poor bone quality, and bruxism (p < 0.05). A (statistically significant) higher rate of incidents was also observed in tapered, internal connection, Grade IV titanium, narrow, and short implants. CONCLUSIONS: Analysis of these implants reveals a higher rate of complication in short, tapered, internal connection and narrow-diameter implants. These data can help and encourage clinicians to use the utmost surgical precautions when placing these implants.

Analysis of marginal bone loss and implant stability quotient by resonance frequency analysis in different osteointegrated implant systems. Randomized prospective clinical trial.

BACKGROUND: The aim of the present prospective clinical study is to compare the stability of the implant-bone interface by the ISQ quotient and marginal bone loss (MBL) rate during one year of follow-up in four system implants with the same surface and different design. MATERIAL AND METHODS: Prospective randomized clinical trial of 21 patients in which four implant systems with the same surface and different design were placed. Patients were treated by the same operator following a similar surgical protocol with submerged technique. The second surgery to perform the prosthesis was performed at 3 months. All patients went to their review at 6 months and a year. A periapical radiograph for crestal bone analysis and an Implant stability quotient by resonance frequency analysis (ISQ) analysis were taken at baseline and the reviews. RESULTS: No statistically significant differences were found in the Implant stability quotient by resonance frequency analysis and Marginal Bone Loss in the four types of implants. The ISQ increased from the moment of insertion of the implant until the revision to the year, showing an increase of the stability implant, being this increasing less between the 6 months and the year. CONCLUSIONS: Differences in the design of the four implants tested in this study did not show statistically significant differences in any of the variables studied, so the implant design does not influence implant stability and marginal bone loss in the first year after placement.

Photobiomodulation with low-level laser therapy reduces oral mucositis caused by head and neck radio-chemotherapy: prospective randomized controlled trial.

The objective of this study was to assess the effectiveness of photobiomodulation with low-level laser therapy (LLLT) as a preventive and therapeutic procedure for the treatment of oral and oropharyngeal mucositis caused by radio-chemotherapy in patients diagnosed with oral squamous cell carcinoma (SCC). An experimental, prospective, double-blind, randomized controlled study was conducted involving patients diagnosed with oral SCC undergoing oncological treatment. The variables analyzed included grade, appearance, and remission of mucositis. A final sample of 26 patients was included: 11 (42.3%) in the study group and 15 (57.7%) in the control group; their average age was 60.89±9.99years. Statistically significant differences between the groups were observed from week 5 of oncological treatment; 72.7% of the laser group showed normal mucosa (mucositis grade 0), while in the control group, 20.0% showed grade 0 mucositis and 40.0% showed grade 2 mucositis (P<0.01). No statistically significant difference between the groups was found regarding the application or use of medication throughout the study period (P>0.05). The tolerance evaluation did not show any statistically significant difference between the groups regarding the occurrence of side effects or adverse events during the trial (P>0.05). Photobiomodulation with LLLT reduces the incidence and severity of mucositis in patients treated with radiotherapy±chemotherapy.

Straight and tilted implants for supporting screw-retained full-arch dental prostheses in atrophic maxillae: A 2-year prospective study.

BACKGROUND: To evaluate, over a 2-year period, the treatment outcomes for maxillary full-arch fixed dental prostheses (FDPs) supported by a combination of both tilted and axially-placed implants and to compare the marginal bone loss (MBL) and implant survival rates (SR) between tilted and axial implants. MATERIAL AND METHODS: A retrospective study has been carried out. Thirty-two patients (16 males and 16 females) treated with maxillary full-arch FDPs were included in this retrospective study. A total of 187 implants were inserted to rehabilitate the fully edentulous maxillary arches: 36% of them were tilted (T group, n = 68) and the remaining 64% were axially placed (A group, n = 119). From the total, 28% of the implants (n=53) were immediately loaded with screw-retained provisional acrylic restorations, whereas 72% underwent conventional delayed prosthetic loading 6 months post-operatively. Definitive restorations were hybrid implant prostheses (metal framework covered with high-density acrylic resin) and metal-ceramic screw-retained implant prostheses, and were placed 6 months after surgery. Such definitive restorations were checked for proper function and aesthetics every three months for two years. Peri-implant marginal bone levels were assessed by digital radiographs immediately after surgery and MBL was assessed at definitive implant loading (baseline) and 2 years afterwards. RESULTS: The 2-year implant SR were 100% for axially placed implants and 98.5% for tilted implants. No significant differences were found amongst the A and T implant groups. Marginal bone loss measured at 2 years after definitive prosthetic loading was of -0.73 ± 0.72 mm (maximum MBL of 1.43 mm) for axially positioned implants vs. -0.51 ± 0.92 mm for tilted implants (maximum bone 1.45 mm). Differences in MBL were statistically significant when comparing immediately and delayed loaded implants. CONCLUSIONS: Based on the results of this retrospective clinical study, full-arch fixed prostheses supported by a combination of both tilted and axially placed implants may be considered a predictable and viable treatment modality for the prosthetic rehabilitation of the completely edentulous maxilla.

Postoperative effects on lower third molars of using mouthwashes with super-oxidized solution versus 0.2% chlorhexidine gel: A randomized double-blind trial.

BACKGROUND: The main objective of the present study is to evaluate the effects and possible benefits with regard to the postoperative period of lower third molar extractions, comparing the intraalveolar application of a bioadhesive gel of 0.2% chlorhexidine (CHX) to the use of a mouthwash with a super-oxidized solution, (SOS) Dermacyn® Wound Care (Oculus Innovative Sciences lnc., California, USA). MATERIAL AND METHODS: A randomized double-blind study was carried out in 20 patients with a split-mouth design, with a total of 40 extractions of symmetrically impacted bilateral lower third molars. Patients were divided into two groups, a control group (C = 20) and an experimental group (D = 20). Any infectious complications, wound healing, plaque accumulation in the stitches, and presence of trismus and inflammation were evaluated using the distance between different facial points, at three, eight, and fifteen days after extraction. Pain, swelling, and amount of analgesics taken were evaluated using the VAS scale throughout the 15 days following extraction. Tolerance to treatment was evaluated using a verbal scale. Results were statistically compared using the Student's t- and chi-squared tests. RESULTS: No statistically significant differences were found between the two groups with regard to infectious complications, swelling, or wound healing. Use of analgesics and self-reported pain levels were slightly lower in the experimental group than in the control group during days 6 and 7 of the study (p < 0.05). The global treatment tolerance was satisfactory and similar in both groups. CONCLUSIONS: Both CHX and SOS are effective at improving the postoperative period after extraction of lower third molars.

Advantages of surgical simulation in the surgical reconstruction of oncological patients.

BACKGROUND: Stereolithography, which consists of computer-aided designed/computer-aided manufactured (CAD-CAM) and computer simulations, is a manufacturing technologies used for the production of definitive models and prototypes printed in three dimensions, and is widely used in Oral and Maxillofacial Surgery. Surgical procedures using models made by these technologies offer several advantages. MATERIALS AND METHODS: This article describes three clinical cases of our experiences with patients diagnosed with squamous cell carcinoma and mandibular osteosarcoma, who underwent surgical removal of the lesions and subsequent mandibular reconstruction with a free fibula graft using surgical guides. RESULTS: In all three clinical cases, surgical guides were used for the mandibular osteotomy, fibula osteotomy, and graft placement in the recipient area. DISCUSSION: Surgical guidelines are useful for improving the accuracy of surgical interventions and are appropriate for many types of resection and mandibular reconstruction.

Influence of dental treatment in place on quality of life in oral cancer patients undergoing chemoradiotherapy.

BACKGROUND: This study aims to assess, in the population of patients with oral cancer treatment, the influence on the quality of life of two protocols of dental treatment: not ruled hospital treatment versus ruled hospital treatment. Matrial and Methods: A quasi-experimental approach justified on ethical grounds was used. A total of 41 patients were included in the control group (not ruled treatment outpatient health center) and 40 in the experimental group (ruled hospital treatment). A total of 14 questions to both groups were conducted in three stages: before starting cancer treatment, during treatment and after treatment. the proportions of positive responses in groups and different times were compared using the chi-square test. RESULTS: Based on similar situations during cancer treatment were identified as six issues favorable to the experimental group difference. This number rose to nine after finishing oncological treatment. CONCLUSIONS: From our data we can confirm that planned dental treatment performed during the oral cancer treatment produces an improvement in the quality of life in patients with oral cancer.

Survival rates and bone loss after immediate loading of implants in fresh extraction sockets (single gaps). A clinical prospective study with 4 year follow-up.

BACKGROUND: The aim of this prospective study was to report the outcome of treatment with implants inserted after tooth extraction and immediately loaded. MATERIAL AND METHODS: Fifty-six patients with single tooth loss were treated with 116 IPX Galimplant® implants with internal connections and a sandblasted, acid-etched surface. All implants were placed after tooth extraction using a flapless approach without bone regeneration, and they were then immediately loaded with cemented acrylic prostheses. After a period of three months, definitive cemented ceramic prostheses were placed. Patients were examined throughout a total of 4 years of follow-up. Marginal bone loss and survival rates were evaluated using digital periapical radiographs, taking into account clinical variables such as age, gender, smoking, history of periodontitis, etiology of extraction, placement site, diameter, and implant length. The Mann-Whitney U and Kruskal-Wallis non-parametric tests were used to compare differences between subgroups created based on the different clinical variables identified. RESULTS: Clinical results indicate an implant survival and success rate of 97.4%. Three implants were lost. Of the 116 immediate acrylic single crowns initially placed, 113 were replaced with definitive ceramic crowns after 3 months. A total of 77.8% of implants were inserted in the maxilla, while 22.2% were inserted in the mandible. No further complications were reported after the follow-up period (4 years). The mean marginal bone loss was 0.67 mm ± 0.40 mm. No differences were found among the subgroups of study patients. CONCLUSIONS: This study indicates that dental implants that are inserted after tooth extraction and immediately loaded may constitute a successful and predictable alternative implant treatment.

Evolution of oral neoplasm in an andalusian population (Spain).

BACKGROUND: Head and neck cancer are one of the most common neoplasm pathologies in humans. The aim of this study was to analyze the type, characteristics, treatment and evolution of oral neoplasm or precancerous lesion in a sample of Andalusian population (Spain) derived from the Oncology Rehabilitation Hospital Unit during a period of 20 years. MATERIAL AND METHODS: A retrospective descriptive study was carried out during the years 1991 and 2011 analyzing the type, characteristics, treatment and follow-up of oral neoplasm in the Oral and Maxillofacial Surgery Unit of the Universitary Hospital Virgen del Rocio. The inclusion criteria were patients whose underlying pathology was any type of benign or malignant neoplasm or presence of precancerous lesion that, after treatment, had been referred to the Prosthetic Rehabilitation Unit. RESULTS: Of the initial analyzed sample of 60 patients, only 45 patients met the inclusion criteria. Of the final sample analyzed, 31 subjects were men (68.9%) and 14 women (31.1%) (p = 0.0169). The mean age of the sample was 57 years ± 13.83, been more frequently in older people with more than 50 years (73.3%) (p = 0.0169). The most common type of neoplasm was epidermoid carcinoma (64.4%). The site most frequently found in squamous cell carcinoma was the floor of the mouth (31%). The most frequent treatment modality was surgery with postoperative radiotherapy (42.2%). All patients had a minimum follow-up of 5 years, and a recurrence in this period was identified in 11.1% of the sample. Multivariate logistic regression showed a statistically significant association for the variables age (p = 0.0063) and smoking (p = 0.0434). CONCLUSIONS: Epidermoid carcinoma is the most frequent tumor in the oral cavity, where increase age and smoking are confirmed as associated risk factors.

Prospective study of the 532 nm laser (KTP) versus diode laser 980 nm in the resection of hyperplastic lesions of the oral cavity.

BACKGROUND: The aim of this study is to evaluate the resection of hyperplastic lesions on the buccal mucosa comparing the 532nm laser (KTP), versus diode 980nm laser, considering pain, scarring, inflammation and drug consumption that occurred postoperatively with each lasers. MATERIAL AND METHODS: A prospective study of consecutive series of 20 patients in two groups that presents hyperplastic lesions on the buccal mucosa. The choice of the KTP laser or diode 980nm laser for the surgery was made randomly. The power used was 1.5W in both groups in a continuous wave mode with a 320 µm optical fiber. Parameters of pain, scarring, inflammation and consumption of drugs were recorded by a Numerical Rating Scale and evaluated postoperatively. These recordings were made the day of the surgery, 24 hours after, 14 and 28 days after. RESULTS: Pain and inflammation was light - moderate. The consumption of paracetamol was somewhat higher in the diode 980nm laser versus the KTP laser after 24 hours, although data was not statistically significant; significant differences were found after 28 days in regards to pain (p = 0.023) and inflammation (p = 0.023), but always in the absence parameter so we find no pain in both lasers. Scarring in the two types of laser showed no differences along the visits, with not detected scar retractable. CONCLUSIONS: Although there is a slight histological difference regarding the KTP laser in the oral soft tissues for clinical use, both wavelengths are very suitable for excision of oral fibroma.

Botulinum toxin A for patients with orofacial dystonia: prospective, observational, single-centre study.

The objective of this study was to demonstrate the efficacy of intramuscular botulinum toxin type A (BTX-A) as a method of controlling the symptoms of focal facial dystonia. A prospective, longitudinal, observational, pre-post (case-series) single-centre study was conducted over a period of 3 months, involving 30 patients with focal dystonia. The patients were enrolled on a first-come, first-served basis. For all patients, the abnormal movements were evaluated using the Abnormal Involuntary Movement Scale (AIMS). The AIMS results were recorded immediately before BTX-A injection (primary predictor variable) and after 3 months (the toxin reaches its maximum effect 2 weeks after injection, and the effect is maintained for 3 months). An improvement in AIMS score was the primary outcome variable. Treatment efficacy was evaluated using the Pearson correlation index with a level of significance of P<0.05. The average age of the study subjects was 70.9±12.7years (20 female, 10 male). The mean dose of BTX-A used was 27.4±20.5U. The mean improvement in AIMS score after treatment was 5.2±4.2. A significant correlation was found between the dose applied and the reduction in AIMS score (P<0.05). BTX-A can be used in the treatment of focal dystonia and provides reproducible results.

Reduction rate by decompression as a treatment of odontogenic cysts.

BACKGROUND: Odontogenic cysts are defined as those cysts that arise from odontogenic epithelium and occur in the tooth-bearing regions of the jaws. Cystectomy, marsupialization or decompression of odontogenic cyst are treatment approach to this pathology. The aim of this study was to evaluate the effectiveness of the decompression as the primary treatment of the cystic lesions of the jaws and them reduction rates involving different factors. MATERIAL AND METHODS: 23 patients with odontogenic cysts of the jaws, previously diagnosed by anatomical histopathology (follicular cysts (7) and radicular cysts (16)) underwent decompression as an initial treatment. Clinical examination and pre and post panoramic radiograph were measured and analyzed. In addition, data as gender, age, time reduction and location of the lesion were collected. RESULTS: Significant results were obtained in relation to the location of lesions and the reduction rate (p<0.01). In a higher initial lesion, a greater reduction rate was observed (p<0.05). CONCLUSIONS: Decompression as an initial treatment of cystic lesions of the jaws was effective; it reduces the size of the lesions avoiding a possible damage to adjacent structures. Cystic lesions in the mandible, regardless of the area where they occur will have a higher reduction rate if it is compared with the maxilla. Similar behavior was identified in large lesions compared to smaller.

Production of bone mineral material and BMP-2 in osteoblasts cultured on double acid-etched titanium.

BACKGROUND: The study of osteoblasts and their osteogenic functions is essential in order to understand them and their applications in implantology. In this sense, this study try to study BMP-2 production and bone matrix deposition, in addition to other biological variables, in osteoblasts cultured on a rough double acid-etched titanium surface (Osseotite®, Biomet 3i, Palm Beach Garden, Florida, USA) in comparison to a smooth titanium surface (machined) and a control Petri dish. MATERIALS AND METHODS: An in vitro prospective study. NHOst human osteoblasts from the femur were cultured on three different surfaces: Control group: 25-mm methacrylate dish (n = 6); Machined group: titanium discs with machined surface (n = 6) and Experimental group: titanium discs with a double acid-etched nitric and hydrofluoric Osseotite® acid surface (n = 6). A quantification of the mitochondrial membrane potential, and studies of apoptosis, mobility and adhesion, bone productivity (BMP-2) and cellular bone synthesis were carried out after culturing the three groups for forty-eight hours. RESULTS: A statistically significant difference was observed in the production of BMP-2 between the experimental group and the other two groups (22.33% ± 11.06 vs. 13.10% ± 5.51 in the machined group and 3.88% ± 3.43 in the control group). Differences in cellular bone synthesis were also observed between the groups (28.34% ± 14.4% in the experimental group vs. 20.03% ± 6.79 in the machined group and 19.34% ± 15.93% in the control group). CONCLUSIONS: In comparison with machined surfaces, Osseotite® surfaces favor BMP-2 production and bone synthesis as a result of the osteoblasts in contact with it.

Analysis of different therapeutic protocols for osteonecrosis of the jaw associated with oral and intravenous bisphosphonates.

INTRODUCTION: Chemotherapy-associated osteonecrosis of the jaw caused by bisphosphonates is an exposure of necrotic bone with more than eight weeks of evolution that is attributable to bisphosphonates and no prior radiation therapy. Its etiopathogenesis remains unknown, although there are two hypotheses that may explain it: the drug's mechanism of action, and the risk factors that can lead to osteonecrosis. There is a wide range of treatment options for managing chemotherapy-associated osteonecrosis of the jaw, from conservative treatments to surgical procedures of varying levels of invasiveness, which are sometimes supplemented with adjuvant therapies. OBJECTIVE: The objective of this article is to group the therapeutic options for osteonecrosis of the jaw (ONJ) into seven different protocols and to evaluate their effectiveness in relation to stage of ONJ. MATERIAL AND METHODS: A literature review was carried out in PubMed following the PRISMA criteria. A total of 47 were collected after compiling a series of variables that define ONJ, applied treatments, and the clinical results obtained. RESULTS AND DISCUSSION: The 47 articles selected have a low to average estimated risk of bias and are of moderate to good quality. According to the data obtained, Protocol 3 (conservative treatment, clinical and radiological follow-up, minimally invasive surgical treatment, and adjuvant therapies) is the most favorable approach for ONJ lesions caused by oral bisphosphonates. For lesions caused by intravenous bisphosphonates, Protocol 2 (conservative treatment, clinical and radiological follow-up, minimally invasive surgical treatment, and no adjuvant therapies) is the best approach. When comparing the different stages of ONJ, Protocol 1 (conservative treatment, clinical and radiological follow-up) promotes better healing of Stage 1 ONJ lesions caused by orally administered bisphosphonates, and Protocol 3 is recommended for Stage II. For ONJ lesions attributable to intravenous bisphosphonates, Protocol 7 (conservative treatment, clinical and radiological follow-up, and adjuvant therapies) provides the best results in Stage 0; in Stages I, II, and III, Protocol 1 gives better results.