2-years retrospective observational case-control study on survival and marginal bone loss of implants in patients with hereditary coagulopathies.

BACKGROUND: Evaluating 2-years implant loss and marginal bone loss in patients with hereditary coagulopathies, comparing with a healthy control group. MATERIAL AND METHODS: 37 implants in 13 patients (17 haemophilia A, 20 Von-Willebrand disease) versus 26 implants in 13 healthy patients. Data measured through Lagervall-Jansson index (after surgery, at prosthetic loading, at 2 years). STATISTICS: Chi-square, Haberman's, ANOVA, Mann-Whitney-U. Significance p<0.05. RESULTS: Haemorrhagic accidents in 2 coagulopathies patients (non-statistical differences). Hereditary coagulopathies patients suffered more hepatitis (p<0.05), HIV (p<0.05) and less previous periodontitis (p<0.01). Non-statistical differences in marginal bone loss among groups. 2 implants were lost in the hereditary coagulopathies and none in the control group (non-statistical differences). Hereditary coagulopathies patients had longer (p<0.001), and narrower implants (p<0.05) placed. 43.2% external prosthetic connection in hereditary coagulopathies patients (p<0.001); change of prosthetic platform more frequent in control group (p<0.05). 2 implants lost: external connection (p<0.05). Survival rate 96.8% (hereditary coagulopathies 94.6%, control group 100%). CONCLUSIONS: Implant and marginal bone loss at 2 years is similar in patients with hereditary coagulopathies and control group. Precautions should be taken on the treatment for hereditary coagulopathies patients, through prior haematological protocol. Implant loss only occurred in in a patient with Von-Willebrand´s 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.

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.

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.

Impact of rare diseases in oral health.

BACKGROUND: Rare diseases (RD) are those that present a lower prevalence than 5 cases per 10.000 population. The main objective of this review was to study the effect on oral health in rare diseases, while the secondary objective of the study is theme upgrade. MATERIAL AND METHODS: Comparative observational case-control studies were analysed and a systematic review was conducted in PubMed. Each rare disease listed on the statistical data record of the Health Portal of the Ministry of Equality, Health and Social Policies Board of Andalusia was associated with "oral health". The variables studied included dental, oral mucosa and occlusion alterations, oral pathologies (caries, periodontal disease) and other alterations (mouth breathing, parafunctional habits, etc). A bias analysis of the variable caries was conducted. RESULTS: Six RD were selected through our inclusion and exclusion criteria (hypogammaglobulinemia, Rett syndrome, Marfan syndrome, Prader-Willi syndrome, cystic fibrosis and Cri du chat syndrome) in a total of 8 publications, of which four trials were classified as high risk of bias and one of them as medium risk. There were not trials with low risk of bias. CONCLUSIONS: The main statistically significant differences found by Syndrome compared to a control group were in Hypogammaglobulinemia with a greater tendency to enamel hypoplasia and dry mouth. The Rett syndrome had, as well, a greater tendency to an anterior open bite, ogival palate, bruxism, mouth breathing and tongue thrusting. Prader-Willi syndrome had a tendency of dental erosion, and Cri du chat syndrome showed a higher association to Tannerella forsythia.

Endodontic medicine: connections between apical periodontitis and systemic diseases.

The prevalence of apical periodontitis (AP) in Europe has been reported to affect 61% of individuals and 14% of teeth, and increase with age. Likewise, the prevalence of root canal treatment (RCT) in Europe is estimated to be around 30-50% of individuals and 2-9% of teeth with radiographic evidence of chronic persistent AP in 30-65% of root filled teeth (RFT). AP is not only a local phenomenon and for some time the medical and dental scientific community have analysed the possible connection between apical periodontits and systemic health. Endodontic medicine has developed, with increasing numbers of reports describing the association between periapical inflammation and systemic diseases. The results of studies carried out both in animal models and humans are not conclusive, but suggest an association between endodontic variables, that is AP and RCT, and diabetes mellitus (DM), tobacco smoking, coronary heart disease and other systemic diseases. Several studies have reported a higher prevalence of periapical lesions, delayed periapical repair, greater size of osteolityc lesions, greater likelihood of asymptomatic infections and poorer prognosis for RFT in diabetic patients. On the other hand, recent studies have found that a poorer periapical status correlates with higher HbA1c levels and poor glycaemic control in type 2 diabetic patients. However, there is no scientific evidence supporting a causal effect of periapical inflammation on diabetes metabolic control. The possible association between smoking habits and endodontic infection has also been investigated, with controversial results. The aim of this paper was to review the literature on the association between endodontic variables and systemic health (especially DM and smoking habits).

Sistemas ultrasónicos para la irrigación del sistema de conductos radiculares / Ultrasonic devices for root canal system irrigation

La eliminación de los restos de tejido pulpar vital y necrótico y de los microorganismos del sistema de conductos radiculares, es esencial para el éxito en endodoncia. La desinfección del canal radicular mediante la irrigación e instrumentación es el factor más importante en la prevención y tratamiento de la periodontitis apical. Al ser imposible con la instrumentación llegar a todas las áreas del sistema de conductos, la irrigación cobra especial importancia. Por este motivo, en la última década se han desarrollado una serie de sistemas de dispensación y agitación de irrigantes, tales como los ultrasonidos. En concreto, en este artículo de revisión se evalúa la información disponible de los diez últimos años sobre la efectividad de los sistemas ultrasónicos para eliminar bacterias, tejido pulpar, restos de dentina y barrillo dentinario, la capacidad de estos dispositivos para hacer que el irrigante penetre en el sistema de conductos radiculares y la seguridad en su uso. Los resultados de la revisión muestran que los sistemas ultrasónicos son más eficaces en el desbridamiento químico, biológico y físico del sistema de conductos radiculares que los sistemas de irrigación convencional, a la vez que son seguros (AU)

Removal of vital and necrotic remnants of pulp tissues and microorganisms from the root canal system is essential for endodontic success. Disinfection of the root canal by irrigation and instrumentation are the most important factors in the prevention and treatment of apical periodontitis. As it is impossible for the instruments to reach all the areas of the root canal system, the irrigation has gained special importance. Due to this fact, technological advances during the last decade have brought new delivery and agitation devices, such as ultrasonic devices. Particularly, this review article assesses the available information from the last ten years about the effectiveness of ultrasonic devices to remove bacteria, pulp tissue, dentin debris and smear layer, and the ability of these devices to make the irrigant solution penetrate into the root canal system and the safety of its use. Nowadays scientific literature reveals that ultrasonic devices are more effective on chemical, biological and physical debridement of the root canal system than conventional technique and being safety devices at the same time (AU)

Patología implanto-endodóncica: concepto, tipos, diagnóstico, tratamiento y prevención / Endodontic-implant pathology: concept, types, diagnosis, treatment and prevention

La patología implanto-endodóncica (PIE) está descrita en la literatura implantológica como una de las causas de periimplantitis apical, entendida como la lesión osteolítica en la región apical del implante, con normal osteointegración de su porción coronal, provocada por la infección por contigüidad a partir de la lesión periapical del diente adyacente. Pero el concepto de PIE no sólo abarca la periimplantitis retrógrada por contaminación diente-a-implante, sino también los procesos inflamatorios periapicales en dientes adyacentes al implante por contaminación implante-a-diente, cuando la colocación del implante provoca la necrosis del diente adyacente y la consiguiente periodontitis apical. Incluso podríamos incluir dentro de la PIE los casos de periimplantitis apical en implantes postextracción provocada por la infección residual presente en el alvéolo de un diente extraído con periodontitis apical. En definitiva, la PIE incluye las lesiones endodóncicas e implantarias apicales que son el resultado de infecciones residuales o por contigüidad entre diente e implante. En esta revisión bibliográfica se define y clasifica la PIE, repasándose la casuística publicada así como su influencia en el resultado del tratamiento implantológico

The implant-endodontic pathology is described in the literature as a cause of apical periimplantitis, understood to be an osteolytic lesion that appears in the apical region of the implant during the coronal osseointegration normally. This implant-endodontic pathology researches the relation of endodontic and implants apical lesions leading to infection contiguity between teeth and implants. The first way of contamination is implant-tooth, when the implant placement causes necrosis of the adjacent tooth and subsequent contamination of the implant; the second way is tooth-implant, when there is an exacerbation of latent apical lesion in a tooth, root canal or not, after placing an implant adjacent to it, resulting in apical periimplantitis later. In this work we have summoned the cases of occurring periimplantitis by apical residual infection present in the socket of an extracted tooth with apical periodontal pathology and replaced by an implant. This review aims to make an update of the relationship between periimplantitis and endodontics

High prevalence of radiolucent periapical lesions amongst patients with inherited coagulation disorders.

Apical periodontitis (AP) is an inflammatory lesion around the apex of a tooth caused by bacterial infection of the pulp canal system. AP appears radiographically as a radiolucent periapical lesion (RPL). The elective treatment for teeth with AP is root canal treatment (RCT). No study is available about the frequency of RPL and RCT in patients with inherited coagulation disorders (ICD). The aim of this study was to investigate the prevalence of RPL and RCT in patients with ICD and control subjects. In a cross-sectional study, the radiographic records of 58 patients with haemophilia A, haemophilia B or von Willebrand's disease (study group) and 58 control subjects were examined. The frequency of RPL and RCT was assessed using digital panoramic radiographs and the Periapical Index. RPL in one or more teeth was found in 67.2% of patients with ICD and in 48.3% of control subjects (odds ratio = 2.20; P = 0.038). At least one RCT was found in 34.5% and 65.5% of subjects in the study and control groups respectively (odds ratio = 0.28; P = 0.001). Multivariate logistic regression analysis indicated that subjects with ICD had RPL with higher likelihood than control subjects (odds ratio = 7.4; P = 0.0005). Patients with ICD disorders showed a significantly higher prevalence of RPL and lower frequency of RCT than control patients.

Anomalías y displasias dentarias de origen genético-hereditario / Inherited dental abnormalities and dysplasias

Las alteraciones del desarrollo embriológico de la dentición provocan anomalías y displasias dentarias. Los factores etiopatogénicos implicados en las alteraciones del desarrollo dentario son básicamente dos: genéticos y ambientales. Según la fase del desarrollo en que afecten al órgano del esmalte y a los tejidos dentarios, aparecerán diferentes anomalías y/o displasias dentales. El control genético del desarrollo dentario se lleva a cabo mediante dos procesos: a) control de la histogénesis del esmalte y la dentina, y b) la especificación del tipo, tamaño y posición de cada diente. La mutación de los genes implicados en la amelogénesis (AMELX, ENAM, MMP20 y KLK4) o en la dentinogénesis (DSPP) produce alteraciones del desarrollo dentario aisladas o no sindrómicas. Por el contrario, las mutaciones de los genes reguladores morfogenéticos involucrados en la determinación de la posición y el desarrollo precoz de los órganos dentarios (genes homeobox), además de alterar la morfodiferenciación dentaria, tienen efectos pleiotrópicos y afectan a otros órganos, provocando síndromes hereditarios en los que uno de sus rasgos es la alteración dentaria. En este artículo se revisan las principales anomalías y displasias dentarias de causa genético-hereditaria (AU)

Alterations of the embryologic development of the dentition cause dental anomalies and dysplasias. The causing factors involved in the disturbances of tooth development are basically two: genetic and environmental factors. Depending on the phase of tooth development when the factors act, they will appear different dental anomalies and dysplasias. Genetic control of tooth development is carried out through two processes: a) control of amelogenesis and dentinogenesis, and b) the specification of the type, size and position of each tooth. Mutation of genes involved in amelogenesis (AMELX, ENAM, MMP20 and KLK4) and dentinogenesis (DSPP) produces non-syndromic alterations of tooth development. On the contrary, mutations in morphogenetic regulatory genes involved in determining the position and the early development of the teeth (homeobox genes), not only alter teeth morpho differentiation, but also have pleiotropic effects affecting other organs, causing hereditary syndromes in which one of its features is the presence of dental abnormalities. Dental anomalies and dysplasias of genetic origin are reviewed in this article (AU)

Diabetes mellitus, periapical inflammation and endodontic treatment outcome.

The possible connection between chronic oral inflammatory processes, such as apical periodontitis and periodontal disease (PD), and systemic health is one of the most interesting aspects faced by the medical and dental scientific community. Chronic apical periodontitis shares important characteristics with PD: 1) both are chronic infections of the oral cavity, 2) the Gram-negative anaerobic microbiota found in both diseases is comparable, and 3) in both infectious processes increased local levels of inflammatory mediators may have an impact on systemic levels. One of the systemic disorders linked to PD is diabetes mellitus (DM); is therefore plausible to assume that chronic apical periodontitis and endodontic treatment are also associated with DM. The status of knowledge regarding the relationship between DM and endodontics is reviewed. Upon review, we conclude that there are data in the literature that associate DM with a higher prevalence of periapical lesions, greater size of the osteolityc lesions, greater likelihood of asymptomatic infections and worse prognosis for root filled teeth. The results of some studies suggest that periapical disease may contribute to diabetic metabolic dyscontrol.

Endodoncia preventiva: Protección pulpar mediante la técnica de eliminación de la caries en etapas (stepwise excavation) / Preventive endodontics: pulp protection using stepwise caries removal procedure

El tratamiento de la caries dentinaria profunda en dientes permanentes se ha venido realizando, generalmente, mediante la remoción completa y en una sola sesión de la dentina cariada, incluyendo la dentina blanda desmineralizada, sin tener en cuenta el potencial regenerador de la pulpa dental. Una complicación frecuentemente ligada a esta actitud es la exposición pulpar intraoperatoria que, en muchos casos, termina en tratamiento de conductos. Varios estudios han demostrado que la eliminación de la caries dentinaria profunda por etapas, en dos visitas con varios meses de diferencia, protege a la pulpa, disminuyendo la frecuencia de exposiciones pulpares, a la vez que permite la formación de dentina terciaria, con la consiguiente disminución del porcentaje de casos que requieren tratamiento endodóncico. En este artículo se analiza el estado del conocimiento y la evidencia científica sobre este tema (AU)

The treatment of deep dentine carious lesions in permanent teeth has included, generally, complete removal of affected dentin in a single session, including soft demineralized dentin, regardless of the regenerative potential of dental pulp. One complication often linked to this attitude is the pulp exposure, in many case sending in root canal treatment. Several studies have shown that the elimination of deep dentine caries instages, in two visits to several months apart, protects the pulp, reducing the frequency of pulp exposures, while allowing the development of tertiary dentin, with the consequent decrease in the percentage of cases requiring endodontic treatment. This article discusses the state of knowledge and scientific evidence on this topic (AU)

Asociación entre la diabetes mellitus y las infecciones crónicas orales de origen endodóncico / Association between diabetes mellitus and chronic oral infectious processes of endodontic origin

La evidencia científica disponible en la actualidad aporta abundantes datos a favor de la existencia de una relación entre la diabetes mellitus (DM) y dos infecciones crónicas orales de muy alta prevalencia, la enfermedad periodontal (EP) y la periodontitis apical crónica. Ambas infecciones crónicas orales comparten dos características importantes: 1) una microbiota anaerobia Gram negativa común y 2) en ambas aumentan los niveles locales de mediadores inflamatorios, pudiendo repercutir sobre los niveles sistémicos. La interrelación DM – infecciones crónicas orales se produciría a través del eje inflamación-estrés oxidativo. La DM se asocia a formas agresivas de enfermedad periodontal y a una mayor prevalencia de lesiones periapicales, a un mayor tamaño de las lesiones, a una mayor probabilidad de infecciones periapicales asintomáticas y a un peor pronóstico para los dientes tratados endodóncicamente. Por otra parte, la periodontitis apical crónica podría contribuir al descontrol metabólico del paciente diabético (AU)

The literature provides evidence on the relationship between diabetes mellitus (DM) and two chronic oral infections of high prevalence: periodontal disease (PD) and chronic apical periodontitis. Both infectious processes of the oral cavity share two characteristics: 1) a common gram-negative anaerobic microbiota and 2) increased local levels of cytokines and inflammatory mediators, which may affect the systemic levels. The interaction between DM and chronic oral infections is based in the inflammation-oxidative stress axis. DM is associated to aggressive forms of PD, higher prevalence and greater sizes of periapical lesions, and to worse prognosis for endodontically treated teeth. The results of some studies suggest that apical periodontitis could contribute to metabolic dyscontrol on diabetic patients (AU)