Del COVID leve al síndrome persistente: evaluación integral de la salud oral / From mild COVID to long COVID: comprehensive oral health assessment

Introducción: El COVID-19 ha causado una amplia sintomatología, incluyendo la presente en la cavidad oral. Cada día cobra más importancia un nuevo síndrome relacionado: el COVID persistente. El objetivo de este trabajo es analizar el efecto de la infección por SARS-CoV-2 a nivel oral en sujetos diagnosticados de COVID persistente, en comparación con la infección aguda. Métodos: Se llevó a cabo un estudio de casos y controles con 102 sujetos reclutados entre 2021 y 2022, de los que se obtuvieron 34 variables de salud oral y posibles factores de riesgo. Resultados: El análisis estadístico reveló que los sujetos COVID persistente presentaban significativamente mayor prevalencia de: adenopatías, dolor de ATM, irritación faríngea, xerostomía, obturaciones, ausencias y coronas dentales, mayor valor en índices CAOM y CAOD y mayor número de síntomas odontológicos en total. Además, el estrés apareció como factor de riesgo; aquellos pacientes con COVID persistente que presentaron mayor nivel de estrés (7,73 ± 2,02) también eran los que sufrían, en mayor medida, xerostomía o bruxismo, responsable del dolor de ATM, también más prevalente en este grupo. Conclusiones: El COVID persistente provoca manifestaciones orales relacionadas, algunas de ellas, con el hecho de que la cavidad oral sea vía de entrada del virus, como la irritación mucosa; otras, relacionadas con su posible naturaleza autoinmune, como la xerostomía y, de la misma manera, otras relacionadas con el estrés, reflejado en la presencia de bruxismo. Resulta imprescindible desarrollar protocolos que mejoren tanto el diagnóstico precoz como el manejo de estos pacientes en nuestras clínicas. (AU)

Introduction: COVID-19 has caused a wide range of symptomatology, including that present in the oral cavity. A new related syndrome is gaining importance: Long COVID. The aim of this work is to analyse the effect of SARS-CoV-2 infection at the oral level in subjects diagnosed with Long COVID, compared to acute infection. Methods: A case-control study was conducted with 102 subjects recruited between 2021 and 2022, from whom 34 oral health variables and possible risk factors were obtained. Results: Statistical analysis revealed that Long COVID subjects had significantly higher prevalence of: adenopathies, TMJ pain, pharyngeal irritation, xerostomia, fillings, dental absences and dental crowns, higher CAOM and CAOD index values and higher total dental symptoms. In addition, stress appeared as a risk factor; those patients with Long COVID who presented a higher level of stress (7.73 ± 2.02) were also those who suffered, to a greater extent, from xerostomia or bruxism, responsible for TMJ pain, also more prevalent in this group. Conclusions: Long COVID causes oral manifestations related, some of them, to the fact that the oral cavity is a route of entry of the virus, such as mucosal irritation; others, related to its possible autoimmune nature, such as xerostomia and, in the same way, others related to stress, reflected in the presence of bruxism. It is essential to develop protocols that improve both the early diagnosis and management of these patients in our clinics. (AU)

A retrospective study on the effect of the COVID-19 pandemic on dental treatments in adults.

BACKGROUND: The aim was to analyze the prevalence of dental treatments that were not performed in a dental care university referral center in the capital of Spain during the first wave of the COVID-19 pandemic. METHODS: This was a retrospective observational study based on the registry of medical records. Sex, age, nationality, and the type of treatment that was not performed in the service of the Integrated Adult Dental Clinic subject of the Dentistry degree at the Rey Juan Carlos University of Madrid were analyzed. RESULTS: A total of 392 medical records were analyzed. The prevalence of the treatments that were not performed was 58.67% (95% CI 53.74-63.44) of conservative treatments, 47.45% (95% CI 42.55-52.39) of periodontal treatments, 27.30% (95% CI 23.12-31.91) and 13.52% (95% CI 10.49-17.26) of clinical activities. The patients most affected by the absence of dental treatment ranged in age from 35 to 74 years. Age, sex, and nationality were not influential in not performing dental treatments. CONCLUSIONS: The COVID-19 pandemic could have negatively influenced treatments, such as conservative and periodontal treatments, that increasing the risk of tooth loss in adults.

El reto del abordaje quirúrgico en la rehabilitación sobre un implante unitario en un caso de alto requerimiento estético del sector anterior. Descripción a propósito de un caso / The challenge of the surgical approach in the rehabilitation of a unitary implant in a case of high aesthetic requirements of the anterior sector. Case report

Objetivo: Describir de forma detallada el abordaje clínico basado en la evidencia científica actual de un implante postextracción con carga y provisionalización inmediata. Caso clínico: Se presenta el caso de una paciente mujer de 32 años de edad, que acude por presentar una posible fractura radicular del incisivo central superior izquierdo (ICSI), acompañada de la aparición de un absceso periodontal en la región del fondo de vestíbulo de dicho diente. Tras llevar a cabo la exploración clínica y radiológica, se establece que el pronóstico del ICSI es desfavorable para llevar a cabo un tratamiento conservador del mismo. Tras la valoración de las características clínicas del caso presente, el plan de tratamiento se inclinó por la realización de la exodoncia del ICSI con la colocación simultánea de un IOI postextracción y la carga inmediata con una prótesis provisional del mismo. Conclusiones: La rehabilitación sobre implantes en situaciones de pérdida dental en el sector anterior estético y en especial, en pacientes jóvenes, requiere un plan de tratamiento multidisciplinar en cuanto a la extracción del diente y colocación del IOI en la posición tridimensional correcta, existiendo diferentes aspectos a tener en cuenta para ello, especialmente el remanente óseo residual, la posición del margen gingival, así como la preservación y acondicionamiento de los tejidos duros y blandos periimplantarios mediante injertos y un manejo correcto de una prótesis provisional hasta conseguir un perfil de emergencia y contorno gingival ideal antes de la corona definitiva. (AU)

Objective: To describe in detail the clinical approach based on current scientific evidence for a post-extraction implant with immediate loading and provisionalisation. Clinical case: We present the case of a 32-year-old female patient who presented with a possible root fracture of the upper left central incisor (ULCI), accompanied by the appearance of a periodontal abscess in the region of the bottom of the vestibule of said tooth. After carrying out the clinical and radiological examination, it is established that the ULCI prognosis is unfavourable for carrying out conservative treatment of the tooth. After assessing the clinical characteristics of the present case, the chosen treatment plan was to extract the ULCI with the simultaneous placement of a post-extraction osseointegrated implant (OII) and immediate loading of a provisional prosthesis on the implant. Conclusions: Rehabilitation on implants in situations of tooth loss in the aesthetic anterior sector, especially in young patients, requires a multidisciplinary treatment plan in relation to tooth extraction and placement of the OII in the correct three-dimensional position. There are various aspects to be taken into account, particularly the residual remaining bone, the position of the gingival margin, as well as the preservation and conditioning of the peri-implant hard and soft tissues by means of grafts and proper handling of a provisional prosthesis until an ideal emergence profile and gingival contour is achieved before the final crown. (AU)

Patogénesis del dolor en la mucositis oral. Revisión de la literatura / Pathogenesis of pain in oral mucositis. Review of the literature

INTRODUCCIÓN: La mucositis oral es una lesión dolorosa que tiene lugar en la mucosa de la cavidad oral, normalmente su etiología se encuentra asociada a tratamientos farmacológicos en pacientes oncológicos. Se presenta como úlceras bien delimitadas cuya sintomatología dolorosa supone en ocasiones la suspensión del tratamiento oncológico o la alimentación por vía parenteral, siendo por tanto un efecto adverso importante, marcando el devenir en este tipo de terapias contra el cáncer. OBJETIVO: El objetivo del presente artículo es poner en relieve cómo se produce el dolor en esta patología que acontece en la mucosa de la cavidad oral. DISCUSIÓN: La mucositis oral se va a presentar tras una cascada de eventos biológicos que implican diferentes procesos moleculares tras el tratamiento con quimioterapia o radioterapia. El dolor en la mucositis oral puede poseer un componente inflamatorio y también un componente neuropático. En su fisiopatología, el dolor va a estar mediado por diferentes familias de receptores y factores. CONCLUSIÓN: La mucositis oral presenta un gran componente doloroso asociado, en el que cobran especial protagonismo en su aparición, las familias de los receptores y factores TRP, ET-1, TNF y ROS, entre otros. El conocimiento de la patogénesis del dolor en esta patología permitirá desarrollar terapéuticas contra el dolor en estudios futuros

INTRODUCTION: Oral mucositis is a painful lesion that occurs in the mucosa of the oral cavity. Its aetiology is usually associated with drug treatments in cancer patients. It presents as well-defined ulcers whose painful symptoms sometimes lead to the suspension of cancer treatment or parenteral nutrition. They therefore represent a significant adverse effect that marks the future in this type of cancer therapy. OBJECTIVE: The objective of this article is to highlight how pain occurs in this pathology that takes place in the mucosa of the oral cavity. DISCUSSION: Oral mucositis will occur following a cascade of biological events involving different molecular processes following treatment with chemotherapy or radiotherapy. Pain in oral mucositis may have an inflammatory component as well as a neuropathic component. In its pathophysiology, pain will be mediated by different families of receptors and factors. CONCLUSION: Oral mucositis has a large associated painful component, in which the families of TRP, ET-1, TNF and ROS receptors and factors, among others, play a major role in its appearance. Knowledge of the pathogenesis of the pain in this pathology will allow pain therapies to be developed in future studies

Third molar autotransplant planning with a tooth replica. A year of follow-up case report.

The advantages of dental autotransplantation and its high level of clinical success mean that it should be considered as a therapeutic option when replacing a lost tooth. In order to achieve optimum results, it is necessary to know the technique of dental autotransplantation, promoting its use whenever the clinical conditions to perform it are present. The objective of this article is to describe the technique in detail by means of a clinical case of a dental autotransplant whose donor tooth was a third unerupted molar. A 39-year-old male patient with no medical history of interest. On clinical examination, tooth 2.6 shows vertical fracture with indication of exodontia. A compatibility study is carried out using a CBCT and after this, a subsequent preparation of a 3D-printed replica of the donor tooth 2.8 is made. A step-by-step description is given of the autotransplantation technique from 2.8 to 2.6. After this, antibiotic coverage, semi-rigid splinting and root canal treatment are carried out in a short time. Results are shown at 12 months. The main factor for the success of this technique is the preservation of periodontal ligament cells. The unerupted teeth are the only ones that fully preserve the periodontal ligament, but they require greater surgical skills. Autotransplantation is a predictable treatment alternative to dental implants, being above all an option indicated to replace teeth with dental fissures or vertical root fractures or poor restorative and/or endodontic prognosis. The third molars are the most used teeth for transplantation, due to their indications for extraction in a high percentage preserving the entire periodontal ligament. The diagnosis by CBCT and the use of 3D- printed replicas of the tooth to be transplanted have meant a highly significant improvement in the prognosis and predictability of the technique. Key words:Dental autotransplant, tooth replica, third molar.

The challenge of the surgical approach in the rehabilitation of an anterior sector unitary implant in a case of high aesthetic requirements; case report

Objective: Provide a detailed description of the current evidence-based clinical approach to a post-extraction implant with immediate loading and provisionalisation. Clinical case: A 32-year-old female patient who attended for a possible root fracture of the upper left central incisor (ULCI), accompanied by a periodontal abscess at the bottom of the vestibule of the same tooth. A clinical and radiological examination established that the prognosis of the ULCI was unfavourable for conservative treatment. After evaluating the clinical features of the case, the treatment plan to extract the ULCI followed immediately by an osseointegrated implant (OII) and loading of a provisional prosthesis on the implant. Conclusions: Rehabilitation on implants in situations of tooth loss in the aesthetic anterior sector, especially in young patients, requires a multidisciplinary treatment plan to extract the tooth and insert an OII in the correct 3-dimensional position. Various aspects need to be taken into account for this, particularly the residual remaining bone, the position of the gingival margin and preservation and conditioning of the peri-implant hard and soft tissues by means of grafts and proper handling of provisional prosthesis, until an ideal emergence profile and gingival contour is achieved before the final crown. (AU)

Mucocele de retención. Revisión a propósito deun caso / Retention mucocele. A case report

El mucocele oral es una lesión de los tejidos blandos con alta prevalencia en la cavidad oral, siendo motivo de consulta dadas las alteraciones funcionales y es-téticas asociadas al mismo. Su etiología está relacionada con la alteración en las glándulas salivales, correspondiendo la localización más frecuente al labio inferior. Su tratamiento, aunque en la mayoría de los casos es expectante, consiste en la extirpación quirúrgica debido a que pue-den llegar a ser de tamaño considerable. A continuación se describe el caso de un paciente varón, de avanzada edad, que presenta un mucocele de gran tamaño localizado en el labio inferior, región en la que se practicó su remoción quirúrgica y posterior análisis histopatológico

The oral mucocele is a soft tissue lesion with high prevalence in the oral cavity, the oral mucocele can be find associated with functional and aesthetic alterations. The etiology is related to the alteration in the salivary glands, the most frequent location corresponding to the lower lip. The treatment consists in surgical removal because they can be of considerable size. The following describes the case of a male patient, of advanced age, who has a large mucocele located in the lower lip, a region in which surgical removal was performed and subsequent histopathological análisis

Complications in the treatment of mandibular condylar fractures: Surgical versus conservative treatment.

OBJECTIVES: In the present article, we aim to review the main intra- and post-operative complications associated with two different therapeutic approaches for treating mandibular condylar fractures: conservative (CTR) and surgical treatment (ORIF, Open Reduction and Internal Fixation). MATERIAL AND METHODS: We have carried out a retrospective, meta-analytic, observational study using literature review, covering the period between 2000- September 2017. The data obtained were processed using statistical software SPSS v.0.18 and R v.2.11.1. The chi-squared test was used for comparison of relative frequencies for independent samples. RESULTS: A total of 2458 patients with 2810 fractures were collected for study. Patients treated with CTR and ORIF were an average of 29 years old, of those treated with CTR, 72.37% and 27.63% were male or female respectively and, of those treated with ORIF, 70.36% and 29.64% were male or female respectively. The main complications suffered by CTR and ORIF patients were: asymmetry (10.2%/6.4%), residual pain (6.5%/5.6%), temporomandibular joint and articular imbalance (15.9%/10.3%) and malocclusion (11.1%/4.0%), respectively. We only found significant differences between CTR and ORIF in the number of cases of temporomandibular joint and articular imbalance and malocclusion. Facial nerve damage was found exclusively among ORIF patients (8.6%) of which 8.3% were temporary and 0.3% permanent. CONCLUSIONS: The complications associated with either technique are minimal and infrequent, resulting in successful outcomes with minimal morbidity. CTR are associated with complications deriving from delayed mobilization leading to functional limitation, whereas the main complication associated with ORIF treatment was facial nerve damage.