Oral manifestations of ellis-van creveld syndrome. A rare case report.

Ellis-van Creveld syndrome (EVC) or chondroectodermal dysplasia is an autosomal recessive disorder, characterized by dwarfism, polydactyly, hypoplastic fingernails and congenital heart defects, finding in most of the cases orofacial anomalies. We describe a clinical case of a 9 year old male patient diagnosed with EVC who visited our Maxillofacial private consultation at Alcorcon Southern Hospital, presenting typical oral manifestations such as dental agenesis, delayed eruption, hypoplasia of the enamel, dental dysmorphism, taurodontism and supernumerary teeth. EVC syndrome is a rare disease and requires a multidisciplinary approach. Oral features are constant and requires the jointly performance of Odontologist and Maxillofacial surgeon aiming to get an appropriate treatment sequence surgery-orthodontics in order to achieve a suitable functional result to improve the quality of life of these patients. Key words:Ellis-Van creveld syndrome, chondroectodermal dysplasia, oral manifestations, craniofacial manifestations.

Actualización en el manejo odontológico del paciente con patología hepática / Update on dental handling of the patient with liver disease

La enfermedad o disfunción hepática puede deberse a numerosas causas como infecciones adquiridas, patologías congénitas o el abuso de drogas. Cuando esta disfunción y el daño hepático se prolongan a lo largo del tiempo, puede desembocar en una cirrosis hepática, cuadro irreversible y de graves repercusiones para el enfermo. Las dos patologías hepáticas más frecuentes y principales causas de la cirrosis son la hepatitis o inflamación hepática, la cual se puede deber a numerosos factores siendo el más frecuente las infecciones por virus, y la enfermedad hepática alcohólica, provocada por el abuso de alcohol continuado durante un largo período de tiempo. El manejo odontológico de un paciente con alteraciones hepáticas supone un verdadero reto, ya que el hígado juega un papel vital en numerosas funciones metabólicas, como la secreción de bilis o la excreción de bilirrubina procedente del metabolismo de la hemoglobina. Un fallo en la función hepática puede suponer alteraciones en el metabolismo de aminoácidos, amoníaco, proteínas, hidratos de carbono y triglicéridos. Un paciente con patología hepática tendrá un metabolismo alterado de numerosos fármacos empleados habitualmente por el dentista, tendrá un mayor riesgo de hemorragia debido a anomalías en la síntesis de diferentes factores de coagulación, siendo además un paciente con mayor riesgo de infecciones. La gran repercusión de la enfermedad hepática, así como el notable desconocimiento de muchos profesionales odontólogos en su manejo, justifican este artículo donde se talla tanto las generalidades más importantes de esta entidad como sus principales manifestaciones orales y consideraciones en el manejo odontológico

Liver disease or dysfunction may be due to numerous causes such as acquired infections, congenital pathologies or drug abuse. When this dysfunction and liver damage are prolonged overtime, it can lead to hepatic cirrhosis, an irreversible condition and serious repercussions for the patient. The two most frequent liver diseases and major causes of cirrhosis are hepatitis or hepatic inflammation, which may be due to numerous factors being the most frequent virus infections, and alcoholic liver disease, caused by alcohol abuse continued during A long period of time. The dental management of a patient with liver disorders is a real challenge, since the liver plays a vital role in many metabolic functions, such as bile secretion or excretion of bilirubin from hemoglobin metabolism. A failure in liver function can lead to alterations in the metabolismof amino acids, ammonia, proteins, carbohydrates and triglycerides. A patient with liver disease will have an altered metabolism of numerous drugs commonly used by the dentist, will have a greater risk of hemorrhage due to abnormalities in the synthesis of different coagulation factors, being also a patient with a higher risk of infections. The great repercussion of liver disease, as well as the remarkable lack of knowledge of many dental professionals in its management, justify this article where it is detailed both the most important generalities of this entity as its main oral manifestations and considerations in dental management

Manifestaciones orales relacionadas con la artritis reumatoide. Revisión a propósito de un caso / Oral manifestations related to rheumatoid arthritis. Case report and literature review

Objetivo: Mostrar las manifestaciones orales cuya etiología está relacionada con la artritis reumatoide (AR), revisando la literatura más reciente, a propósito de un caso. Caso clínico: El tratamiento de la AR está basado principalmente en la terapia farmacológica, siendo esta responsable de manifestaciones a nivel de la cavidad oral. Se presenta el caso de una mujer de 65 años con AR en tratamiento bajo metotrexato y tocilizumab, que acude a consulta por presentar desde hace 40 días una úlcera en el borde lateral de la lengua. Conclusión: Las manifestaciones orales de la AR derivan principalmente de la terapia farmacológica, que se debe conocer para el correcto diagnóstico y tratamiento de la patología oral de estos pacientes

Objective: The aim of the present article was to describe the oral manifestations whose etiology is related to rheumatoid arthritis (RA), reviewing the most recent literature, in relation to a case. Clinical case: The treatment of RA is based mainly on pharmacological therapy, being responsible for the manifestations at the level of the oral cavity. We present the case of a 65-year-old woman with RA on treatment with methotrexate and tocilizumab, which occurs through 40 days on the lateral border of the tongue. Conclusion: The oral manifestations of RA are derived mainly from pharmacological therapy, which should know the correct diagnosis and treatment of the oral pathology of these patients

Tratamiento odontológico en pacientes con patología hormonal paratiroid / Dental treatment in patients with hormonal pathology paratiroidea

Las glándulas paratiroides son glándulas endocrinas que se encuentran situadas en la parte anterior del cuello, rodeando a la tráquea y a la laringe. Secretan hormonas que van a desempeñar funciones esenciales para el desarrollo del organismo. La alteración en la secreción de dichas hormonas va a producir patologías de cierta importancia que deberán tenerse en cuenta a la hora de realizar los tratamientos odontológicos. Antes de realizar cualquier actuación terapéutica en odontología, se debe valorar el control de las diferentes patologías y, en el caso de que estén bien controladas, se tendrán en cuenta una serie de consideraciones para evitar complicaciones derivadas de las mismas (AU)

The parathyroid glands are endocrine glands that are located in the anterior part of the neck, surrounding the trachea and the larynx. They secrete hormones that are going to have essential functions for the development of the organism. The alteration in the secretion of hormones to produce pathologies of a certain importance that can be taken into account when performing dental treatments. Before carrying out any action, in dentistry, the control of the different pathologies must be assessed and, if they are well controlled, a series of considerations must be taken into account to avoid derivatives of them (AU)

The role of Leucocyte-rich and platelet-rich fibrin (L-PRF) in the treatment of the medication-related osteonecrosis of the jaws (MRONJ).

BACKGROUND: For the treatment of the bisphosphonates and other drugs related osteonecrosis of the jaws, currently medication-related osteonecrosis of the jaws (MRONJ), have been established different conservative therapeutic approaches, avoiding surgery except in cases of extreme need. Given the controversy and lack of current consensus regarding MRONJ therapy in patients, new techniques have been developed among which the use of fibrin membranes rich in platelets and leukocytes (L-PRF). The objective of this review is to evaluate whether L-PRF treatment is really effective, as well as the results that can be achieved by this therapeutic alternative. MATERIAL AND METHODS: A review of the literature in the PubMed/Medline database of all those studies using L-PRF in the treatment of osteonecrosis using the keywords "Osteonecrosis", "Jaws", "L-PRF" and " Leucocyte-rich platelet-rich fibrin ". RESULTS: The use of L-PRF for the treatment of MRONJ is really effective, especially when it is performed with a simultaneous application of L-PRF and morphogenetic protein-2 (BMP-2), even in patients submitted for long periods of time to therapy with intravenous bisphosphonates. However, success will depend on several factors such as the previous existence of infection or the clinical stage in which the patient is. CONCLUSIONS: The current literature demonstrates the effectiveness of the use of L-PRF in osteonecrosis, and it can be considered as a real alternative in the treatment of this entity. However, more clinical studies are needed to really assess this new therapy. Key words:Osteonecrosis, Jaws, L-PRF, Leucocyte-rich platelet-rich fibrin.

The application of diode laser in the treatment of oral soft tissues lesions. A literature review.

BACKGROUND: Since its appearance in the dental area, the laser has become a treatment of choice in the removal of lesions in the oral soft tissues, due to the numerous advantages they offer, being one of the most used currently the diode laser. The aim of this review was to determine the efficacy and predictability of diode laser as a treatment of soft tissue injuries compared to other surgical methods. MATERIAL AND METHODS: A literature review of articles published in PubMed/MEDLINE, Scopus and the Cochrane Library databases between 2007 and 2017 was performed. "Diode laser", "soft tissue", "oral cavity" and "oral surgery" were employed for the search strategy. Only articles published English or Spanish were selected. RESULTS: The diode laser is a minimally invasive technology that offers great advantages, superior to those of the conventional scalpel, such as reduction of bleeding, inflammation and the lower probability of scars. Its effectiveness is comparable to that of other types of lasers, in addition to being an option of lower cost and greater ease of use. Its application in the soft tissues has been evaluated, being a safe and effective method for the excision of lesions like fibromas, epulis fissuratum and the accomplishment of frenectomies. CONCLUSIONS: The diode laser can be used with very good results for the removal of lesions in soft tissues, being used in small exophytic lesions due to their easy application, adequate coagulation, no need to suture and the slightest inflammation and pain. Key words:Diode laser, soft tissues, oral cavity, oral surgery.

¿Es la regeneración periodontal eficaz en el mantenimiento a largo plazo de dientes con periodontitis avanzada? a propósito de un caso clínico / Is periodontal regeneration effective in a long-term maintenance of teeth with advanced periodontitis? a case report

Objetivo: El objetivo del presente artículo fue describir un caso clínico sobre regeneración periodontal y determinar, a propósito del mismo, la eficacia y la predictibilidad de las diferentes técnicas regenerativas en el tratamiento de defectos intraóseos causados por la periodontitis. Caso clínico: Se presenta el caso de un paciente varón de 65 años con periodontitis crónica avanzada localizada en el incisivo central superior derecho donde se planificó, en la fase de reevaluación, cirugía de regeneración debido a un defecto intraóseo visible radiográficamente, que se correspondía con una profundidad de sondaje de 11 mm. La lesión, que afectaba a la pared vestibular, distal y palatina, fue tratada con una combinación de xenoinjerto óseo (IOs), membrana de colágeno reabsorbible (RTG) y proteínas derivadas de la matriz del esmalte (PMEs), obteniendo como resultado una reducción en la profundidad de sondaje de hasta 7 mm después de nueve meses. Conclusión: La regeneración periodontal ha demostrado ser eficaz para el tratamiento de defectos intraóseos que comprometen la supervivencia del diente, ayudando al propio paciente a mantener una correcta salud y función oral (AU)

Aim: The aim of the present article was to describe a clinical case on periodontal regeneration and to assess the efficacy and predictability of different regenerative techniques for the treatment of intrabony defects caused by periodontitis. Case report: It presents the case of a 65- year-old male patient with localized severe chronic periodontitis where, after receiving basic periodontal treatment, regeneration surgery in tooth #11 was planned due to a radiographically visible intraosseous defect, corresponding to a pocket depth of 11 mm. The lesion, affecting the buccal, distal and palatal walls, was treated with a combination of bone xenograft (BGs), resorbable collagen membrane (GTR) and enamel matrix proteins (EMPs), resulting in a reduction in pocket depth up to 7 mm after nine months. Conclusion: Periodontal regeneration has been shown to be effective for the treatment of an intrabony defect that compromises tooth survival by helping the patient to maintain proper oral health and function (AU)

Sarpe. Técnica de anclaje óseo. Revisión de la literatura a propósito de un caso clínico / Sarpe. Bone anchoring technique. Case report and review

Objetivo: Conocer las principales ventajas, inconvenientes y nuevas alternativas del tratamiento de expansión rápida palatina quirúrgicamente asistida o ‘SARPE’ (Surgically Assisted Rapid Palatal Expansion), realizando para ello una revisión de la literatura científica a propósito de un caso clínico de una compresión transversal del maxilar en un paciente adulto. Caso clínico: Paciente mujer de 19 años con mordida cruzada posterior bilateral asociada a hipoplasia del maxilar a la que se decide realizar un tratamiento de expansión rápida quirúrgicamente asistida. La peculiaridad de este caso se encuentra en que antes de la cirugía se colocó un disyuntor hecho a medida anclado directamente al hueso palatino. Se realizó la cirugía, la expansión y el posterior tratamiento de ortodoncia y, tras un período de seguimiento, se pudo observar una significativa expansión maxilar, evitando los inconvenientes dentales y periodontales de la técnica tradicional. Conclusiones: Los nuevos procedimientos tienden a realizar un anclaje del disyuntor al hueso palatino mediante microtornillos, consiguiendo una expansión palatina satisfactoria, pero evitando los inconvenientes que provoca utilizar un disyuntor dentoanclado (AU)

Objective: To know the main advantages, disadvantages and new alternatives of the treatment of Surgically Assisted Rapid Palatal Expansion (SARPE), making for it a review of the scientific literature on purpose of a clinical case. Clinical case: A 19-year-old female patient with bilateral posterior crossbite associated with maxillary hypoplasia who was decided to perform a surgically assisted rapid expansion treatment. The peculiarity of this case is that before the surgery was placed a custom-made distractor anchored directly to the palatal bone. Surgery, expansion and subsequent orthodontic treatment were performed and, after a follow-up period, a significant maxillary expansion was observed, avoiding the dental and periodontal drawbacks of the traditional technique. Conclusions: New procedures tend to make a direct bone placement of the distractor by means of microimplants, achieving satisfactory palatal expansion but avoiding the inconveniences of using a dental anchorage disjunctor (AU)

Implantes cigomáticos: una puesta al día / Zygomatic implants: an up-to-datepatient

Un maxilar con reabsorción ósea moderada o severa representa un reto para la implantología contemporánea. El tratamiento convencional con implantes no puede ser realizado en situaciones de pérdida ósea avanzada, ni en situaciones que impliquen proximidad del seno maxilar al lugar de la intervención, dado que no hay suficiente hueso para anclar los implantes sin la realización de técnicas de regeneración ósea. El objetivo de este trabajo es estudiar la viabilidad de los implantes cigomáticos como alternativa a las técnicas de regeneración ósea, así como la técnica quirúrgica y sus variantes, complicaciones y la supervivencia. La evaluación clínica indica un alto índice de supervivencia. Los resultados sugieren que la rehabilitación sobre implantes cigomáticos en grandes atrofias maxilares es segura y predecible, siendo una excelente alternativa a los injertos óseos. Por este motivo los implantes cigomáticos constituyen un posible nuevo ‘Gold Standard’ para el manejo de la reabsorción ósea avanzada (AU)

The severely atrophic maxilla represents a challenge for the contemporaneous implantology. Conventional treatment using dental implants cannot be performed in situations where there is an advanced bone loss, neither in situations, involving extensive maxillary sinuses which lead to inadequate amount of bone tissue for the anchorage of implants without the performance of bone grafting techniques. The aim of this paper is to study the viability of the use of zygomatic implants as an alternative to bone augmentation procedures. A revision of surgical techniques, variations, complications and survival is included. Clinical assessment indicates a high survival rate. The reviewed results suggest that oral rehabilitation using zygomatic implants, in severely atrophic maxillas is a safe and predictable procedure. Being an excellent alternative to bone augmentation techniques, the use of zygomatic implants represents a possible new Gold Standard in the treatment of advanced bone resorption (AU)