Implant survival in patients with oral cancer: A 5-year follow-up.

BACKGROUND: To evaluate the evolution of patients rehabilitated with endosseous implants after oral cancer treatment. MATERIAL AND METHODS: An observational retrospective study was carried out between 1991 and 2011 with a sample consisting of patients with oral cancer who had been referred for rehabilitation to the Prosthetics Rehabilitation Unit from the Oral and Maxillofacial Surgery Unit of the Virgen del Rocío University Hospital. All these patients have overcome oral cancer, and have a five-year follow-up after their oral rehabilitation. Age, sex, smoking habits, oral pathology, type of treatment of oral pathology, edentulism, receptor bone, prosthetic rehabilitation, timeouts, working time and evolution were studied. SPSS Statistics was used for statistical analysis of the variables studied. A chi-square test centered on the survival rate of implants placed in relation to the other recorded variables was performed. RESULTS: 17 patients were treated for cancer and rehabilitated with implant prosthetics, with a total of 106 implants placed. 32% were partially edentulous patients (4 patients), and 68.2% were completely edentulous patients (13 patients). An implant survival rate of 87.7% was observed at 5 years. In the upper maxilla, the survival rate was 79.2%, and in the mandible 93.7% (p = 0.03). 91 implants were placed in native receptor bones (85.8%), with only 15 implants placed in grafted receptor bone (14.2%). According to the type of receptor bone, in native receptor bones, 9 implants failed (90.1% of implant survival), while in grafted receptor bones, 4 implants failed (overall 73.3% implant survival rate) (p = 0.08). CONCLUSIONS: Although a high survival rate was obtained in this study (with lower survival rates seen in mandible and grafted bone), prospective long-term studies are needed to assess the relationship between radiotherapy doses and the time required for implant placement, prosthetic protocol used, and type of implants used in patients selected for prosthetic rehabilitation. Key words:Dental implant, oral cancer, survival.

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 Rocío". 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 (AU)

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Evolution of oral cancer treatment in an andalusian population sample: Rehabilitation with prosthetic obturation and removable partial prosthesis.

BACKGROUND: Radical surgical resection as a treatment modality for oral cancer often leads to an extensive deficit in both the maxillary and mandibular levels, where the use of a palatal obturator prosthesis (POP) or removable partial denture (RPP). The aim of this study was to evaluate the treatment with POP and RPP in patients treated for oral cancer in the Unit of Prosthetic Rehabilitation of the University Hospital Virgen del Rocío in a period of 20 years. MATERIAL AND METHODS: Retrospective descriptive study during the years 1991 and 2011 analyzing oral cancer type, characteristics, treatment and follow-up. The sample consisted of patients whose tumor had previously been removed and who had been referred to the Oncological Rehabilitation Unit of the Oral and Maxillofacial Surgery Unit of the "Virgen del Rocío" University Hospital for rehabilitation. The inclusion criteria were patients whose underlying pathology was any type of neoplasia, which after its treatment had been referred to the aforementioned Oncological Prosthetic Rehabilitation unit. RESULTS: Of the 45 patients included in our study, 15 patients were rehabilitated with palatal obturator (33.3%) and 5 patients with removable partial denture (11.1%). The mean age of the sample of patients with POP was 57.3 ± 9.23, while the mean age of the sample of patients with RPP was 58 ± 13.5. The most common underlying pathology in patients with POP was squamous cell carcinoma (60%), whereas in patients with RPP it was 100%. The most frequent location found among POP patients was the upper jaw, while in the PRP patients there was no predominant location. The univariate and multivariate logistic regressions did not show any statistically significant association between the independent variables age, sex, smoking habit and alcoholic habit with the dependent variable type of rehabilitating prosthesis. CONCLUSIONS: Based on our data, we can conclude that RPP is used in few cases of oncological rehabilitation. The POP has a greater use, as long as the defect in the bones of the facial middle third is limited. Key words:Head and neck cancer, reconstructive surgery, Palatal obturators, removable partial dentures.

Randomized, double-blind study of effectiveness of intra-alveolar application of chlorhexidine gel in reducing incidence of alveolar osteitis and bleeding complications in mandibular third molar surgery in patients with bleeding disorders.

PURPOSE: Chlorhexidine (CHX) is an antimicrobial agent used in the prevention of tooth decay, periodontal disease, and postextraction alveolar osteitis (AO). Recently, a bioadhesive gel to deliver the active substance, CHX, was introduced. The intra-alveolar placement of the bioadhesive gel allows a more direct and prolonged therapeutic effect of CHX, which is useful in the prevention of AO after extraction of impacted third molars. The intra-alveolar application of the bioadhesive CHX gel in patients with bleeding disorders may increase the risk of postoperative bleeding complications. Inversely, bleeding disorders might influence the efficacy of CHX for AO prevention. The purpose of the present study was to evaluate the effectiveness of the bioadhesive 0.2% CHX gel in reducing the incidence of impacted third molar postextraction AO in patients with bleeding disorders. MATERIALS AND METHODS: We performed a double-blind, randomized, parallel-group study of 38 patients with bleeding disorders. The experimental group (n = 14) was treated with bioadhesive 0.2% CHX gel applied intraoperatively once after surgical removal of the third molar. The control group (n = 24) was treated in an identical fashion with placebo gel. RESULTS: We observed a 57.15% reduction in the incidence of AO in the experimental group. The control group had a 17% incidence of AO and the experimental group had a 7% incidence of AO (P = .402). Bleeding complications occurred in 21% of the experimental group compared with 29% of the control group (P = .601). CONCLUSIONS: As described in previous studies, the single intra-alveolar application of the bioadhesive 0.2% CHX gel in an intraoperative fashion seems to reduce the incidence of AO after removal of impacted third molars in patients with bleeding disorders. On the basis of the reported percentage of bleeding complications, the routine use of postoperative local hemostatic measures is recommended.

Effectiveness of chlorhexidine gel versus chlorhexidine rinse in reducing alveolar osteitis in mandibular third molar surgery.

PURPOSE: Chlorhexidine is an antimicrobial agent used in the prevention of postextraction alveolar osteitis, tooth decay, and periodontal diseases. There are various forms of chlorhexidine application. The most extensively studied is one that uses the rinse as the form of application. Recently, a bioadhesive gel form has become available. Its main advantage is that it prolongs the bioavailability of chlorhexidine in the application area. The purpose of this study was to compare the effectiveness of chlorhexidine gel versus a chlorhexidine rinse in reducing postoperative alveolar osteitis after the extraction of mandibular third molars. MATERIALS AND METHODS: The experimental or gel group (n = 41) applied the bioadhesive 0.2% chlorhexidine gel to the wound during the first postoperative week and a control or rinse group (n = 32) used a 0.12% chlorhexidine rinse during the first week postextraction. RESULTS: We observed a 70% decrease in postoperative alveolar osteitis in the gel group (P = .040). The rinse group had 25% incidence postoperative alveolar osteitis, while the gel group had 7.5%. CONCLUSIONS: It was concluded that the topical application of bioadhesive chlorhexidine gel to the surgical wound during the postoperative week may decrease the incidence of alveolar osteitis after extraction of the mandibular third molars.

Transmigración del canino inferior incluido. Presentación de un caso y revisión de la literatura / Transmigration of impacted lower canine. Case report and review of literature

La retención, es decir, la no erupción de un diente permanente más allá de un año después de la edad normal de erupción, es relativamente poco frecuente si exceptuamos el caso de los terceros molares y los caninos superiores. La transmigración se define como el fenómeno en el cual un diente incluido no erupcionado traspasa en más de la mitad de su longitud la línea media. Exponemos el caso clínico de una paciente de 20 años de edad, que presentaba la transmigración del canino inferior izquierdo, con un patrón de migración tipo 4 de Mupparapu. De igual forma, realizamos una revisión bibliográfica de los casos publicados de transmigración, actualizando los principales aspectos de esta patología

Retention, that is, a permanent tooth which is unerupted more than a year after the normal age of eruption, is a relatively rare event, except in the case of the third molars and the upper canines. Transmigration is defined as the phenomenon of more than half an unerupted impacted tooth crossing the midline. We report the clinical case of a twenty-year-old patient presenting transmigration of the lower left canine, with a type 4 transmigration pattern (Mupparapu). Likewise, we carried out a review of the literature of the cases that have been published on transmigration, updating the main aspects of this pathology

Transmigration of impacted lower canine. Case report and review of literature.

Retention, that is, a permanent tooth which is unerupted more than a year after the normal age of eruption, is a relatively rare event, except in the case of the third molars and the upper canines. Transmigration is defined as the phenomenon of more than half an unerupted impacted tooth crossing the midline. We report the clinical case of a twenty-year-old patient presenting transmigration of the lower left canine, with a type 4 transmigration pattern (Mupparapu). Likewise, we carried out a review of the literature of the cases that have been published on transmigration, updating the main aspects of this pathology.