Prospective observational cohort study of the change of the marginal bone crest in relation to the prosthetic abutment height and the peri-implant vertical mucosal thickness at implants positioned subcrestally.

AIM: To evaluate the influence on peri-implant crestal bone loss exerted by the vertical mucosal thickness and the abutment height over 12 months after placement of the restoration on subcrestal implants with change of platform, using a restoration abutment platform smaller than the implant platform. MATERIALS AND METHODS: A total of 99 implants were rehabilitated in the maxillary and mandibular posterior regions. A total of 22 implants were rehabilitated in the maxilla and 77 implants in the mandible, using digitally designed customized abutments with Atlantis weborder software, from the commercial house Dentsply Sirona (Dentsply Sirona S.A., Barcelona, Spain), version 4.6.5, adapting the height to the vertical thickness of the mucosa. Clinical and radiographic monitoring begins during the surgical procedure of placement of the implant and ends 12 months afterwards. Crestal bone loss was evaluated through the Carestream® CS8100 3D radiographic equipment. RESULTS: In all cases, the greatest loss of marginal bone occurred between the day of surgery (Tx) and placement of the rehabilitation (To). The average bone loss between both times was greater when the abutment height and vertical mucosal thickness did not exceed 3 mm. Subsequently, bone loss slowed and stabilized at 12 months. CONCLUSIONS: The minimum abutment height and the vertical mucosal thickness are factors to take into account when minimizing peri-implant marginal bone loss, the abutment height having the greatest importance according to the clinical data obtained.

Efficacy of different surgical techniques for peri-implant tissue preservation in immediate implant placement: a systematic review and meta-analysis.

INTRODUCTION: Preserving peri-implant tissues after immediate implant placement (IIP), especially in aesthetic zones, is a topic of interest. OBJECTIVES: This systematic review investigated the effects of currently available surgical procedures for preserving peri-implant tissue or ensuring dimensional stability following immediate implant placement. MATERIALS AND METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement's guidelines were followed, and articles were sought on the PubMed and Cochrane databases with no date restrictions. Only randomised clinical trials that evaluated changes in soft and hard tissues around immediately placed implants were included. Statistical analyses were performed, and the studies´ quality was assessed using the Cochrane Collaboration tool. The agreement between reviewers was assessed based on Cohen's kappa statistics. RESULTS: Of the 14 studies that met the inclusion criteria, 11 were analysed in the meta-analysis (kappa = 0.814; almost perfect agreement). The use of connective tissue grafts resulted in a significantly greater improvement of the facial gingival level (MD = -0.51; 95% CI: -0.76 to -0.31; p = < .001), and the placement of bone grafts significantly reduced the horizontal resorption of the buccal bone (MD = -0.59; 95% CI: -0.78 to -0.39; p < .001). CONCLUSION: Connective tissue grafts and bone grafts positively influence tissue preservation around immediately placed implants. Neither the flapless technique nor palatal implant positioning resulted in significant improvements to any of the investigated parameters. Additional longitudinal studies are required. CLINICAL RELEVANCE: This meta-analysis is useful for discerning the effects of soft tissue augmentation, bone grafting, the flapless technique, and palatal implant positioning on preserving peri-implant tissues after immediate implant placement.

Prophylaxis and antibiotic therapy in management protocols of patients treated with oral and intravenous bisphosphonates.

INTRODUCTION: Osteonecrosis of the jaw (MRONJ) linked to bisphosphonate treatment has specific characteristics that render its therapeutic management challenging for clinicians. Poor response to standard treatment makes it essential to take special precautions when treating this type of disease; therefore, antibiotic prophylaxis and/or antibiotic therapy have been proposed as effective and helpful tools in these situations. OBJECTIVES: This article seeks to assess published evidence in order to evaluate the different protocols used for antibiotic prophylaxis and/or antibiotic therapy in the general context of patients treated with bisphosphonates. MATERIAL AND METHODS: A literature review of the last 10 years was carried out in PubMed using the following keywords: "antibiotic prophylaxis and osteonecrosis," "bisphosphonates AND osteonecrosis AND dental management," "bisphosphonate AND osteonecrosis AND antibiotic prophylaxis AND oral surgery." A total of 188 articles were obtained, of which 18 were ultimately selected. RESULTS AND DISCUSSION: In patients treated with oral and intravenous bisphosphonates without chemotherapy-associated osteonecrosis of the jaw, antibiotic prophylaxis prior to oral surgery is an important tool to avoid osteonecrosis and promote healing of the affected area. If the patient previously exhibited chemotherapy-associated osteonecrosis after tooth extraction, antibiotic prophylaxis is indicated to prevent recurrent osteonecrosis and promote healing of the extraction site. If chemotherapy-associated osteonecrosis is already present, antibiotic therapy is a vital part of conservative management to reduce the symptomatology of MRONJ and keep it from worsening. Finally, a lack of clinical data and randomized controlled trials makes it difficult to choose the most appropriate protocol for the various clinical situations studied. Key words:Bisphosphonates, antibiotic prophylaxis, maxillary osteonecrosis, antibiotic treatment.

Maxillary peripheral keratocystic odontogenic tumor. A clinical case report.

The keratocystic odontogenic tumor is a benign odontogenic cystic neoplasia characterized by its thin, squamous epithelium with superficial parakeratosis. It has the potential for infiltration and local aggressiveness and has a high rate of recurrence. This neoplasia is predominantly found in males and people of white origin. The mandible is the most frequently involved site, in particular the third molar region, mandibular angle, and ramus. It has a mandible-maxilla ratio of 2:1. Only about twenty cases of peripheral keratocystic odontogenic tumors (PKCOT) have been reported in the international literature. This study presents a case of PKCOT localized in the anterior region of the maxilla, on the vestibular side of the upper left lateral incisor and the upper left canine. The diagnosis and treatment procedures, as based on the literature, are also discussed. Key words:Odontogenic cysts, odontogenic tumors, keratocyst, keratocystic odontogenic tumor.

Flapless implant surgery: A review of the literature and 3 case reports.

Since the 1970s, modern Implantology is based on a concept of surgery with flap elevation. Gradually, several clinical trials demonstrated that a mid-crestal incision gives similar success rates compared to those obtained using the classical protocol. However, over the past decade in medicine it has been established the concept of minimally invasive surgery, consisting in taking advantage of advancements experienced in diagnostic techniques and specific surgical instruments, to perform surgical procedures infringing as less damage as possible to the patient The present work aims to produce a thorough review of the literature published on the field of Implantology with flapless surgery, to determine the current scientific evidence of the technique, along with illustrating the results with different clinical cases. After presenting the clinical cases, and the review of literature, we can say that flapless surgeries should be restricted to well-selected cases in which a proper clinical and radiological planning has been made. Patients treated with anticoagulant drugs or medically compromised equally can get benefitted by this minimal invasion technique. Key words:Flapless, minimally invasive surgery, dental implant.

Influence of two different machined-collar heights on crestal bone loss.

PURPOSE: The purpose of this trial was to evaluate crestal bone level changes radiographically in a standardized fashion over a period of 12 months in humans for implants with a 0.7-mm machined collar (implant type A) versus type B implants with a 1.5-mm machined collar. MATERIALS AND METHODS: Twenty-five patients with multiple missing teeth in posterior sectors were randomly assigned to one of the two groups: A (0.7-mm machined-collar implants) or B (1.5-mm machined-collar implants). Changes at crestal bone level were assessed by measuring the shoulder-crest distance (SCD) on the mesial and distal aspects of each implant on customized periapical radiographs, which were taken on the day of surgery and 3, 6, and 12 months after surgery. RESULTS: Eighty-one implants were included in the study. Mean SCD was 0.54 ± 0.53 mm at baseline and 1.49 ± 0.40 mm after 12 months. For 0.7-mm-collar implants, mean SCD was 1.40 ± 0.39 mm, while it was 1.56 ± 0.40 mm for 1.5-mm-collar implants. Statistically significant differences were found only between the two types of implants for distal measurements at 3 and 12 months after placement. CONCLUSION: Both 0.7- and 1.5-mm machined-collar implants can be used with predictable results, as changes in peri-implant crestal bone levels are similar for both implant types and do not seem to be significant from a clinical point of view. The SCD may well depend more on the location of the abutment-implant interface than on machined-collar height.

Assessment of Osstell ISQ’s reliability for implant stability measurement: A cross-sectional clinical study

Resonance frequency analysis (RFA) allows assess implant stability by measuring implant oscillation frequency on the bone. RFA is an objective and non-invasive method for implant stability measurement, although scarce evidence has been provided so far on its reliability. Objective: Assess the Osstell ISQ system's reliability (i.e., its measurement reproducibility and repeatability) by means of the intraclass correlation coefficient (ICC) as statistical method. Design of the study: Two implant stability registers were completed by means of Osstell ISQ on 85 implants on 23 patients. Six measurements were completed on each implant by means of two different SmartPegs (types I and II); that is, three consecutive measurements with each transducer. Results: Average ISQ was 72.40, 72.22 and 72.79, and 72.06, 72.59 and 72.82 in the first, second, and third measurements with SmartPegs I and II, respectively. Equal values or differences below three ISQ points were observed in 52.9% and 62.4% of the cases with SmartPegs I and II, respectively. The intraclass correlation coefficient was 0.97 for both SmartPegs, and repeatability and reproducibility also reached 0.97 for both SmartPegs. Conclusions: The RFA system Osstell ISQ presents almost perfect repeatability and reproducibility after intraclass correlation coefficient analysis. Osstell ISQ measurements are highly reliable regarding reproducibility. Therefore, one measurement proves enough

Assessment of Osstell ISQ's reliability for implant stability measurement: a cross-sectional clinical study.

UNLABELLED: Resonance frequency analysis (RFA) allows assess implant stability by measuring implant oscillation frequency on the bone. RFA is an objective and non-invasive method for implant stability measurement, although scarce evidence has been provided so far on its reliability. OBJECTIVE: Assess the Osstell ISQ system's reliability (i.e., its measurement reproducibility and repeatability) by means of the intraclass correlation coefficient (ICC) as statistical method. DESIGN OF THE STUDY: Two implant stability registers were completed by means of Osstell ISQ on 85 implants on 23 patients. Six measurements were completed on each implant by means of two different SmartPegs (types I and II); that is, three consecutive measurements with each transducer. RESULTS: Average ISQ was 72.40, 72.22 and 72.79, and 72.06, 72.59 and 72.82 in the first, second, and third measurements with SmartPegs I and II, respectively. Equal values or differences below three ISQ points were observed in 52.9% and 62.4% of the cases with SmartPegs I and II, respectively. The intraclass correlation coefficient was 0.97 for both SmartPegs, and repeatability and reproducibility also reached 0.97 for both SmartPegs. CONCLUSIONS: The RFA system Osstell ISQ presents almost perfect repeatability and reproducibility after intraclass correlation coefficient analysis. Osstell ISQ measurements are highly reliable regarding reproducibility. Therefore, one measurement proves enough.

Current state of dental autotransplantation.

The aim of this study is to analyse the current situation in dental autotransplantations within the different therapeutic alternatives that the Dentist has available to replace a tooth in the dental arcade. For some authors this is an option headed for failure, whereas for others, it is an alternative to keep in mind. In this study we analyse the factors related to the predictability of the technique, based on an analysis of research work published in the scientific literature up to date. We also present two clinical cases performed by our team and their subsequent evaluation. In spite of the satisfactory results seen when reviewing the existing literature, we cannot say that dental autotransplantation is currently the technique of choice when a tooth is lost, given the predictability of osteointegrated implants.

Palatal atypical histiocytic granuloma

In this report, we examine a clinical entity called atypical histiocytic granuloma (AHG), which is characterized byulceroproliferative lesions that clinically simulate a squamous cell carcinoma or specific granulomatous lesions.AHG histologically shows a histiocytic proliferation and is characterized by specific mitotic activity, which hasthe potential to be confused with malignant processes of a lymphoid origin. There are few cases reported in theliterature, and an adequateknowledge of the process is required in order to avoid a misdiagnosis, especially as regardsmalignant processes. To our knowledge, a case of this type of lesion in the palate has not yet been described.We present a case of an atypical histiocytic granuloma which occurred in the form of an ulcerated pediculatedlesion in the palatine mucosa (an uncommon localization that not yet has been researched). This case histologicallyshowed a histiocytic infiltration with an increase in the mitotic index, eosinophils and an accumulation ofhaemosiderin. The lesion resolved spontaneously after the biopsy, without recurring after a period of five years.This report stresses the important value of immunohistochemistry in diagnosing the lesion and also discusses thesimilarities and differences between other lesions that may be confused, potentially leading to a misdiagnosis (AU)

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Palatal atypical histiocytic granuloma.

In this report, we examine a clinical entity called atypical histiocytic granuloma (AHG), which is characterized by ulceroproliferative lesions that clinically simulate a squamous cell carcinoma or specific granulomatous lesions. AHG histologically shows a histiocytic proliferation and is characterized by specific mitotic activity, which has the potential to be confused with malignant processes of a lymphoid origin. There are few cases reported in the literature, and an adequate knowledge of the process is required in order to avoid a misdiagnosis, especially as regards malignant processes. To our knowledge, a case of this type of lesion in the palate has not yet been described. We present a case of an atypical histiocytic granuloma which occurred in the form of an ulcerated pediculated lesion in the palatine mucosa (an uncommon localization that not yet has been researched). This case histologically showed a histiocytic infiltration with an increase in the mitotic index, eosinophils and an accumulation of haemosiderin. The lesion resolved spontaneously after the biopsy, without recurring after a period of five years. This report stresses the important value of immunohistochemistry in diagnosing the lesion and also discusses the similarities and differences between other lesions that may be confused, potentially leading to a misdiagnosis.

Gel de Clorhexidina intra-alveolar en la prevención de la alveolitis tras la extracción de terceros molares inferiores. Estudio piloto / Intra-alveolar Chlorhexidine gel for the prevention of dry socket in mandibular third molar surgery. A pilot study

Introducción: La clorhexidina es un buen agente profiláctico de la alveolitis post-extracción. La aparición del gel bioadhesivo conteniendo clorhexidina al 0,2% podría mejorar esta acción. Su colocación intraalveolar permitiría una actuación más directa sobre el alveolo y una actuación más prolongada del fármaco. Pacientes y método: Presentamos un estudio a simple ciego, randomizado, sobre 30 pacientes, valorando la influencia de la colocación en una sola vez y de forma intraalveolar gel bioadhesivo conteniendo clorhexidina al 0,2% tras la extracción de terceros molares incluidos, en la aparición de alveolitis y en el postoperatorio de los pacientes. Resultados: Encontramos una reducción del 42,65% en la tasa de alveolitis y un postoperatorio más favorable en el grupo experimental. En el grupo control, la alveolitis apareció en un 30,76% frente a un 17,64 % en el grupo experimental. Discusión y conclusiones: Tras comparar nuestros datos con otros estudio, pensamos que el gel bioadhesivo de clorhexidina al 0,2%, aplicado en una sola vez de forma intraalveolar parece ser una opción adecuada para la prevención de la alveolitis. Esta actuación mejora la apertura bucal y el edema en el postoperatorio, aunque son necesarios nuevos estudios realizados a doble ciego y con muestras más amplias para confirmar nuestros datos

Purpose: Chlorhexidine is a good prophylactic agent for post-extraction dry socket alveolitis. The bio-adhesive 0.2% chlorhexidine gel could improve this action since its intra-alveolar positioning would allow a more direct action on the alveolus and more prolonged action of the medication. Materials and Method: We present a single blind, randomised study on 30 patients to evaluate the efficacy of the bio-adhesive 0.2% chlorhexidine gel, placed only once within the alveolus, on the reduction of the incidence of impacted third molar post-extraction dry socket alveolitis and its post-operative effects on patients. Results. A reduction of 42.65% in the occurrence of alveolitis and a more favourable post-operative period in the experimental group was observed. In the control group, the appearance of alveolitis was 30.76% opposite to 17.64 % in the experimental group. Conclusions: The bio-adhesive 0.2% chlorhexidine gel, applied only once after the extraction of impacted third molars, seems to be an appropriate option for the reduction of alveolitis. It improves the buccal aperture and oedema in the post-operative period, although further double blind studies with larger samples are necessary

Intra-alveolar chlorhexidine gel for the prevention of dry socket in mandibular third molar surgery. A pilot study.

PURPOSE: Chlorhexidine is a good prophylactic agent for post-extraction dry socket alveolitis. The bio-adhesive 0.2% chlorhexidine gel could improve this action since its intra-alveolar positioning would allow a more direct action on the alveolus and more prolonged action of the medication. MATERIALS AND METHOD: We present a single blind, randomised study on 30 patients to evaluate the efficacy of the bio-adhesive 0.2% chlorhexidine gel, placed only once within the alveolus, on the reduction of the incidence of impacted third molar post-extraction dry socket alveolitis and its post-operative effects on patients. RESULTS: A reduction of 42.65% in the occurrence of alveolitis and a more favourable post-operative period in the experimental group was observed. In the control group, the appearance of alveolitis was 30.76% opposite to 17.64 % in the experimental group. CONCLUSIONS: The bio-adhesive 0.2% chlorhexidine gel, applied only once after the extraction of impacted third molars, seems to be an appropriate option for the reduction of alveolitis. It improves the buccal aperture and oedema in the post-operative period, although further double blind studies with larger samples are necessary.

Alveolitis seca. Actualización de conceptos / Update on dry socket: A review of the literature

La alveolitis seca es una complicación postoperatoria que acontece tras la extracción dental, quedando definida como una inflamación del alveolo. En el caso que esta inflamación sobrepase las paredes alveolares, estaríamos ante una osteítis localizada. La frecuencia de aparición de la alveolitis se ha referido en un margen muy amplio, desde el 1 % hasta el 70 %. Generalmentese acepta que la mayor incidencia de alveolitis acontece tras la extracción de terceros molares retenidos, en los que la aparición de esta complicación se tasa en un 20-30 % de las extracciones,diez veces más que en el resto de extracciones dentales. En el presente artículo se revisan la forma de aparición clínica,los factores de riesgo relacionados con el cuadro y las teorías etiopatogénicas que intentan explicar su aparición. También se examinan las pautas utilizadas actualmente en su tratamiento. Acorde con las teorías patogénicas de la alveolitis seca, para su prevención se han estudiado agentes fibrinolíticos, lavados, antisépticos y antibióticos. Analizamos los distintos fármacos utilizados, criticando los resultados obtenidos. Como conclusión, y a partir de los datos revisados, pensamos, sin abandonar el territorio de la hipótesis, que es posible defender un modelo patogénico en el que los mecanismos fibrinolíticos bacterianos y del propio organismo colaboren para producir la alveolitis seca

Dry socket is a postoperative complication that occurs after adental extraction and has been defined as an inflammation of the alveolus. If this inflammation should surpass the alveolar walls, it would result in a located osteitis. The frequency of appearance of dry socket has been reported in a very wide margin, from 1%until 70%. It is generally accepted that most dry sockets appear after extraction of third retained molars, in which the occurrence of this complication is about 20-30% of dental extractions, ten times more than in the rest of dental extractions. In this work we review the forms of clinical appearance, the riskfactors related to this affection and the etiopathogenic theories that try to explain its appearance. The treatment management is also examined. Fibrinolitic agents, laundries, antiseptic, and antibiotics have been studied for its prevention, according to the pathogenic theories of dry socket. We analyze and critize the different drugs and their results. In conclusion from the revised data, we think it is possible to defend a pathogenic model in which the bacterial fibrinolytic mechanisms and the microorganism of the own patient may contribute to produce the dry socket

Update on dry socket: a review of the literature.

Dry socket is a postoperative complication that occurs after a dental extraction and has been defined as an inflammation of the alveolus. If this inflammation should surpass the alveolar walls, it would result in a located osteitis. The frequency of appearance of dry socket has been reported in a very wide margin, from 1% until 70%. It is generally accepted that most dry sockets appear after extraction of third retained molars, in which the occurrence of this complication is about 20-30% of dental extractions, ten times more than in the rest of dental extractions. In this work we review the forms of clinical appearance, the risk factors related to this affection and the etiopathogenic theories that try to explain its appearance. The treatment management is also examined. Fibrinolitic agents, laundries, antiseptic, and antibiotics have been studied for its prevention, according to the pathogenic theories of dry socket. We analyze and criticize the different drugs and their results. In conclusion from the revised data, we think it is possible to defend a pathogenic model in which the bacterial fibrinolytic mechanisms and the microorganism of the own patient may contribute to produce the dry socket.

Orofacial infections of odontogenic origin.

The polymicrobial nature of the odontogenic infections as well as the variety of associated conditions are a consequence of the diversity of the buccal microbiota and the anatomical and functional complexity of the oral cavity. In addition to this, all these processes can give way to multiple complications which range from the local to the systemic level. The appropriate choice of antibiotic and posology is crucial in the successful management of these infections. Pharmacodynamics provides those parameters that make it possible to assess how antibiotics activity varies in time. As a general rule, the first step in the initial management of orofacial infections in adults, included odontogenic infections, will be the administration of 875 mg of amoxicillin and 125 mg of clavulanic every 8 hours. Therapeutic compliance is paramount to avoid resistance, therefore patient acceptance must be sought. In this sense, it has been proved that Augmentine Plus (2000/125) every twelve hours both as profylaxis and as treatment significantly decreases the rate of infective complications associated to extraction of the third molar.

Differential diagnosis and therapeutic approach to periapical cysts in daily dental practice.

The diagnosis and therapeutic approach to periapical cysts is an extremely controversial concern for dentists. Furthermore, as this complaint represents the most frequent cystic lesion of the maxilla, together with the fact that its differential diagnosis with chronic apical periodontitis presents special difficulty, the question takes on even greater importance. The purpose of this article is to assess the validity of the various diagnostic techniques used to differentiate between both pathologies and make a critical analysis of the controversy surrounding the therapeutic approach to suspected periapical cysts through non-surgical and follow-up treatment, or surgical enucleation and histopathological analysis.

Diagnóstico diferencial y enfoque terapéutico de los quistes radiculares en la práctica odontológica cotidiana / Differential diagnosis and therapeufic approach to periapical cysts in daily dental practice

El diagnóstico y enfoque terapéutico de los quistes radiculares supone una cuestión extremadamente controvertida para el odontólogo. Teniendo en cuenta que representa la lesión quística más frecuente de los maxilares, y que su diagnóstico diferencial con la periodontitis apical crónica presenta una especial dificultad, la cuestión adquiere una mayor trascendencia. El objetivo del presente artículo es valorar la validez de las distintas técnicas diagnósticas que nos permiten diferenciar ambas patologías y analizar críticamente la controversia sobre el enfoque terapéutico de los supuestos quistes radiculares hacia una actuación no quirúrgica y de seguimiento, o bien hacia la enucleación quirúrgica y análisis histopatológico de los mismos (AU)