Diseño y validación de un cuestionario para evaluar el nivel de conocimientos y hábitos de prescripción antibiótica en cirugía oral / Design and validation of a questionnaire to measure antibiotic knowledge and prescribing habits in oral surgery

Introducción: En las últimas décadas, la resistencia antibiótica se ha convertido en un problema mundial para la salud pública. Los odontólogos no deben permanecer ajenos a este grave problema, siendo responsables de en torno al 10 % de las prescripciones antibióticas que se producen en el ámbito extrahospitalario. El propósito del presente estudio fue diseñar y validar un instrumento para analizar los conocimientos y hábitos de prescripción antibiótica en cirugía oral. Material y métodos: El proceso de construcción y validación del instrumento constó de cinco fases: 1) diseño del instrumento a través de una exhaustiva revisión de la literatura publicada entre enero de 2016 y enero de 2021 en las bases de datos PubMed Medline y Cochrane Library; 2) validación del contenido por un grupo de 6 expertos; 3) pretest cognitivo para evaluar la consistencia interna (alfa de Cronbach); 4) evaluación de las propiedades métricas de la escala; y 5) aprobación por el Comité de Ética de la Investigación de la Universidad Europea. Resultados: Se obtuvo un instrumento conformado por 48 ítems: 20 referidos a conocimientos sobre antibioterapia y 28 correspondientes a hábitos de prescripción antibiótica. La validez de contenido del cuestionario, medida por el Índice de Validez de Contenido (CVI), fue de 0,85 con una fiabilidad de 0,80 y una estabilidad temporal casi perfecta (CCI = 0,95). Conclusiones: El riguroso diseño y validación de este estudio proporciona un instrumento con suficiente validez predictiva para su posterior aplicación y evaluación de los conocimientos y hábitos de prescripción antibiótica en cirugía bucal. (AU)

Objective: In recent decades, antibiotic resistance has become a global public health problem. Dentists should not remain oblivious to this serious problem, as they are responsible for around 10 % of antibiotic prescriptions in the out-of-hospital setting. The purpose of the present study was to design and validate an instrument to analyse the knowledge and antibiotic prescribing habits in oral surgery. Material and methods: The process of constructing and validating the instrument consisted of five stages: 1) Design of the instrument through and exhaustive review of the literature published between January 2016 and January 2021 in the PubMed-Medline and Cochrane Library databases; 2) Validation of the content by a panel of 6 experts; 3) Cognitive pretest to assess internal consistency (Cronbach’s alpha); 4) Evaluation of the metric properties of the scale; and 5) Approval by the Research Ethics Committee of the European University. Results: An instrument consisting of 48 items was obtained; 20 referring to knowledge of antibiotic therapy and 28 corresponding to antibiotic prescribing habits. The content validity of the questionnaire, measured by the Content Validity Idex (CVI) was 0.85 with a reliability of 0,80 and almost perfect temporal stability (CCI = 0,95). Conclusions: The rigorous design and validation of this study provides and instrument with sufficient predictive validity for subsequent application and assessment of antibiotic prescribing knowledge and habits in oral surgery. (AU)

Frequency of surgical bone augmentation methods complementary to dental implant placement: A study evaluated with cone beam computed tomography.

Background: The success of dental implants largely depends on the quantity and quality of available bone. Occasionally, it is necessary to perform additional surgical techniques alongside implant placement to increase the available bone volume and ensure the success and survival of treatments. The objective of this study was to evaluate, through cone beam computed tomography, the need for supplementary bone augmentation methods in implant placement. Additionally, the study aimed to assess the frequency of such techniques based on gender, anatomical sectors, and types of bone augmentation procedures. Material and Methods: The analysis included 106 cone beam computed tomography images obtained from 77 patients over the age of 18 who sought oral rehabilitation with implants at the University Clinic of the Master's Program in Oral Implantology at the European University of Valencia. Results: A total of 201 edentulous sextants were analyzed. It was observed that 63.68% of the sextants required a bone augmentation technique, and there was a statistically significant difference (p=0.039) regarding the need for supplementary techniques in women. The need for bone augmentation by sectors was most prevalent the horizontal type (48.11%) and in the mandible (29.41%). About crestal and lateral approaches for sinus elevation, there was a higher need for the lateral technique (49.38%), and a statistically significant difference was evident (p=0.015). Conclusions: A high frequency of bone augmentation need for implant placement was demonstrated. It was shown that some form of supplementary surgical method was required in implant placement (63.68%). The highest need for bone augmentation was observed in the posterior maxillary sector, primarily in the vertical type (29.27%), accompanied by lateral window sinus elevation technique (49.38%). Key words:Bone graft, Dental implant, Guided bone regeneration, Sinus floor augmentation, Cone beam computed tomography.

Clinical effect of diode laser on peri-implant tissues during non-surgical peri-implant mucositis therapy: Randomized controlled clinical study.

BACKGROUND: The aim of this study is to evaluate the response to the non-surgical treatment of peri-implant mucositis using the diode laser as an adjuvant therapy in patients with implant-supported restorations, in terms of clinical variables, with respect to those patients in whom conventional non-surgical therapy is used. MATERIAL AND METHODS: Randomized controlled clinical trial with simple blind 3 months follow-up. Two groups of patients were established, the non-surgical mechanical debridement of the affected implants was performed in the control group (n = 34) and the diode laser therapy was also performed in the test group (n = 34). The implant was considered the study subject; the variables considered were plaque index, bleeding on probing depth, depth of probing and recession of the peri-implant mucosa. The t-Student test was used to establish the intergroup statistical differences and the analysis of variance (ANOVA) was used to measures intragroup differences over time. RESULTS: In the revaluation at 6 weeks, we observed statistically significant differences (p<0.05) between the variables of plaque index and depth of probing between both groups. The test group obtained an average of 0.248 ± 0.3155 in plaque index and 0.833 ± 0.374mm in the depth of probing compared to the results obtained in the control group that was 0.558 ± 0.526 and 1,137 ± 0.222mm respectively. In the 3-month reevaluation, was also obtained great statistical significance between both groups for bleeding on probing (p<0.001), with values of 0.568 ± 0.282 for the control group and 0.480 ± 0.336 for the test group. CONCLUSIONS: The use of diode laser as an adjunctive therapy to the conventional treatment of peri-implant mucositis showed promising results, being more effective reducing the inflammation of the peri-implant tissue, positioning itself as a valuable tool for the treatment of peri-implant pathologies. Key words:Peri-implant diseases, peri-implant mucositis, laser therapy, diode laser, biostimulation.

Retinoids and proliferative verrucous leukoplakia (PVL). A preliminary study

Objective. A study is made of the efficacy and adverse effects of retinoid therapy applied to the white lesions ofproliferative verrucous leukoplakia (PVL). Material and methods. The results of retinoid therapy were evaluatedin 17 patients diagnosed with PVL. Topical retinoids were used in 5 patients, in the form of two daily applicationsof 0.1% 13-cis-retinoic acid in orabase for an average of 6.17+/-3.13 months. Systemic retinoids were used in 11patients, with the administration of 25 mg/day of acitretin in tablet form for an average of 5.41+/-2.02 months.One patient successively received the topical and systemic retinoid formulations. The course and results wereevaluated on a blind basis by two investigators. The adverse effects of the medication were also assessed. Results.Clinical improvement was recorded for 7 lesions (38.8%) (six involving systemic treatment and one as a resultof topical application). Clinical worsening was recorded in the same proportion (5 lesions with systemic therapyand two with topical treatment), while four lesions (22.4%) showed no changes (one lesion with systemic therapyand three with topical treatment). Adverse effects were documented in all the patients administered the systemicformulation, versus in only one patient administered topical retinoids. The most frequent problems were desquamationand pruritus. Conclusion. Although topical or systemic retinoic acid produces some improvement in aboutone-third of all patients with PVL, further studies are needed to assess the efficacy and safety of these products,in view of the important percentage of individuals who worsen despite therapy, and the frequent appearance of adverse effects (AU)

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Retinoids and proliferative verrucous leukoplakia (PVL). A preliminary study.

OBJECTIVE: A study is made of the efficacy and adverse effects of retinoid therapy applied to the white lesions of proliferative verrucous leukoplakia (PVL). MATERIAL AND METHODS: The results of retinoid therapy were evaluated in 17 patients diagnosed with PVL. Topical retinoids were used in 5 patients, in the form of two daily applications of 0.1% 13-cis-retinoic acid in orabase for an average of 6.17+/-3.13 months. Systemic retinoids were used in 11 patients, with the administration of 25 mg/day of acitretin in tablet form for an average of 5.41+/-2.02 months. One patient successively received the topical and systemic retinoid formulations. The course and results were evaluated on a blind basis by two investigators. The adverse effects of the medication were also assessed. RESULTS: Clinical improvement was recorded for 7 lesions (38.8%) (six involving systemic treatment and one as a result of topical application). Clinical worsening was recorded in the same proportion (5 lesions with systemic therapy and two with topical treatment), while four lesions (22.4%) showed no changes (one lesion with systemic therapy and three with topical treatment). Adverse effects were documented in all the patients administered the systemic formulation, versus in only one patient administered topical retinoids. The most frequent problems were desquamation and pruritus. CONCLUSION: Although topical or systemic retinoic acid produces some improvement in about one-third of all patients with PVL, further studies are needed to assess the efficacy and safety of these products, in view of the important percentage of individuals who worsen despite therapy, and the frequent appearance of adverse effects.

A review of temporomandibular joint disease (TMJD). Part II: Clinical and radiological semiology. Morbidity processes

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The clinical signs and symptoms of greatest semiologic value in temporomandibular joint disease (TMJD) are muscle pain, joint pain, limitations in mandibular movement, and joint sounds. Imaging studies of the joint are very useful for establishing the diagnosis and for discarding other disease processes, though in many cases diagnostic error results from the detection of a large proportion of patients with alterations in the imaging studies but with no associated clinical manifestations. Panoramic X-rays and magnetic resonance imaging are the most commonly used complementary techniques for diagnosing TMJD. MRI may be regarded as the imaging technique of choice, particularly when studying the soft tissues. Biochemical evaluation of the joint synovial fluid has improved our understanding of TMJD pathogenesis, though to date such parameters have not been extended to clinical practice.Myofascial pain with positive painful palpation of the masticatory muscles; joint disc displacements with reduction characterized by the presence of opening or opening and closing clicks; disc displacements without reduction characterized by limitations in oral aperture; and osteoarthritis / osteoarthrosis characterized by the auscultation of friction sounds during mandibular movement, are the morbidity processes most often seen in the context of TMJD. The present study offers a review of the semiology and morbidity processes of the temporomandibular joint

A review of temporomandibular joint disease (TMJD). Part II: Clinical and radiological semiology. Morbidity processes.

The clinical signs and symptoms of greatest semiologic value in temporomandibular joint disease (TMJD) are muscle pain, joint pain, limitations in mandibular movement, and joint sounds. Imaging studies of the joint are very useful for establishing the diagnosis and for discarding other disease processes, though in many cases diagnostic error results from the detection of a large proportion of patients with alterations in the imaging studies but with no associated clinical manifestations. Panoramic X-rays and magnetic resonance imaging are the most commonly used complementary techniques for diagnosing TMJD. MRI may be regarded as the imaging technique of choice, particularly when studying the soft tissues. Biochemical evaluation of the joint synovial fluid has improved our understanding of TMJD pathogenesis, though to date such parameters have not been extended to clinical practice. Myofascial pain with positive painful palpation of the masticatory muscles; joint disc displacements with reduction characterized by the presence of opening or opening and closing clicks; disc displacements without reduction characterized by limitations in oral aperture; and osteoarthritis / osteoarthrosis characterized by the auscultation of friction sounds during mandibular movement, are the morbidity processes most often seen in the context of TMJD. The present study offers a review of the semiology and morbidity processes of the temporomandibular joint.

Review of temporomandibular joint pathology. Part I: classification, epidemiology and risk factors.

Pathology of the temporomandibular joint (TMJ) affects an important part of the population, though it is not viewed as a public health problem. Between 3-7% of the population seeks treatment for pain and dysfunction of the ATM or related structures. The literature reports great variability in the prevalence of the clinical symptoms (6-93%) and signs (0-93%), probably as a result of the different clinical criteria used. In imaging studies it is common to observe alterations that have no clinical expression of any kind. Radiographic changes corresponding to osteoarthrosis are observed in 14-44% of the population. Age is a risk factor, though with some particularities. In elderly patients there is an increased prevalence of clinical and radiological signs, though also a lesser prevalence of symptoms and of treatment demands than in younger adults. Approximately 7% of the population between 12 and 18 years of age is diagnosed with mandibular pain-dysfunction. Temporomandibular dysfunction (TMD) is more frequent in females. No clear relationship has been established between occlusal alterations and TMJ disease. Only disharmony between centric relation and maximum intercuspidation, and unilateral crossbite, have demonstrated a certain TMJ disease-predictive potential. Both local and systemic hyperlaxity has been postulated as a possible cause of TMD. Parafunctional habits and bruxism are considered risk factors of TMD with odds ratios (ORs) of up to 4.8. Psychophysiological theory holds stress as a determinant factor in myofascial pain. Genetic factors and orthodontic treatment have not been shown to cause TMD.

Review of temporomandibular joint pathology. Part I: Classification, epidemiology and risk factors

La patología de la articulación temporomandibular (ATM) afecta a un colectivo importante de población aunque no se considere un problema de salud pública. Entre el 3 y el 7% de la población busca tratamiento a causa del dolor y la disfunción de sus ATMs o estructuras anexas. Los estudios encuentran una extraordinaria variabilidad en cuanto a prevalencia de síntomas (6-93%) y en cuanto a signos clínicos (0-93%), variación que está probablemente relacionada con los diferentes criterios clínicos utilizados. En los estudios de imagen es frecuente el hallazgo de signos sin que estos se traduzcan en sintomatología clínica alguna. Se observan cambios radiográficos de osteoartrosis entre el 14 y el 44% de la población. La edad constituye un factor de riesgo aunque con matices. En pacientes ancianos hay mayor prevalencia de signos clínicos y radiográficos, pero menor prevalencia de síntomas y de demanda de tratamiento que en pacientes de edad adulta. Alrededor del 7% de la población entre 12 y 18 años es diagnosticada de dolor-disfunción mandibular

Pathology of the temporomandibular joint (TMJ) affects an important part of the population, though it is not viewed as a public health problem. Between 3-7% of the population seeks treatment for pain and dysfunction of the ATM or related structures. The literature reports great variability in the prevalence of the clinical symptoms (6-93%) and signs (0-93%), probably as a result of the different clinical criteria used. In imaging studies it is common to observe alterations that have no clinical expression of any kind. Radiographic changes corresponding to osteoarthrosis are observed in 14-44% of the population. Age is a risk factor, though with some particularities. In elderly patients there is an increased prevalence of clinical and radiological signs, though also a lesser prevalence of symptoms and of treatment demands than in younger adults. Approximately 7% of the population between 12 and 18 years of age is diagnosed with mandibular pain-dysfunction. Temporomandibular dysfunction (TMD) is more frequent in females. No clear relationship has been established between occlusal alterations and TMJ disease. Only disharmony between centric relation and maximum intercuspidation, and unilateral crossbite, have demonstrated a certain TMJ disease-predictive potential. Both local and systemic hyperlaxity has been postulated as a possible cause of TMD. Parafunctional habits and bruxism are considered risk factors of TMD with odds ratios (ORs) of up to 4.8. Psychophysiological theory holds stress as a determinant factor in myofascial pain. Genetic factors and orthodontic treatment have not been shown to cause TMD

Basal cell nevus syndrome. Presentation of six cases and literature review.

Basal cell nevus syndrome, also known as Gorlin-Goltz syndrome, is an autosomal dominant inherited disorder which is characterised by the presence of multiple maxillary keratocysts and facial basal cell carcinomas, along with other less frequent clinical characteristics such us musculo-skeletal disturbances (costal and vertebrae malformations), characteristic facies, neurological (calcification of the cerebral falx, schizophrenia, learning difficulties), skin (cysts, lipomas, fibromas), sight, hormonal, etc. On occasions it can be associated with aggressive basal cell carcinomas and malignant neoplasias, for which early diagnosis and treatment is essential, as well as family detection and genetic counselling. Currently there are new lines of investigation based on biomolecular studies, which aim at identifying the molecules responsible for these cysts and thus allowing an early diagnosis of these patients. In its clinical management and follow up, the odonto-stomatologist, the maxillofacial surgeon and several other medical specialists are involved. In this paper a review of the literature, and six cases of patients affected by multi-systemic and varied clinical expression of basal cell nevus syndrome, are presented.

Cavidad de Stafne de localización inusual en el sector anterior mandibular / A Stafne's cavity with unusual location in the mandibular anterior area

La típica cavidad de Stafne, localizada en el sector posterior de la mandíbula, es una entidad relativamente poco frecuente, pero cuando el defecto se sitúa en la región anterior mandibular, es bastante raro, habiéndose descrito hasta ahora sólo 36 casos en la literatura científica. La mayoría de estos defectos aparecen entre la quinta y la sexta décadas de la vida, están localizados en el área de caninos y premolares, y muestran también una predilección por el sexo masculino. El canal dentario inferior, uno de los hitos anatomo-radiológicos principales que ayudan al diagnóstico de la cavidad de Stafne en la zona posterior, raramente está presente anteriormente al agujero mentoniano. Por ello, por su apariencia radiográfica más variable que en el defecto posterior, por soler encontrarse superpuesta a los ápices de los dientes, y por la rareza de presentación en el sector anterior mandibular, es mucho más difícil establecer un diagnóstico definitivo de cavidad de Stafne en esta localización, y por tanto es más fácil que pueda haber un error en el diagnóstico, sobre todo inicialmente. Presentamos un nuevo caso, en un varón de 68 años, en el que el diagnóstico fue fortuito, y revisamos especialmente sus aspectos etiopatogénicos, clínicos, y de diagnóstico diferencial

The typical Stafne’s cavity, located on the posterior portion of the mandible, is a relatively uncommon entity. However, when the defect is located in the anterior region of the mandible, it is quite rare, having thus far been described in only 36 cases in the scientific literature. Most of these defects appear in the fifth and sixth decades of life, are localized to the area of the canines and premolars, and have a predilection for males. The inferior dental canal, one of the anatomical-radiographic landmarks that aid in the diagnosis of Stafne’s cavity in the posterior region, is rarely present anterior the mental foramen. For this reason, because of its more variable radiographic appearance compared to the posterior defect, its tendency to be superimposed over the apices of the teeth, and the rarity of its localisation to the anterior mandible, it is much more difficult to establish a definitive diagnosis of a Stafne’s cavity in this location. It is therefore more likely that a diagnostic error can occur, especially early on. We present a new case in a 68-year-old male in which the diagnosis was serendipitous, and we review in particular the aetiology and pathogenesis, clinical aspects, and differential diagnoses for this condition

A Stafne's cavity with unusual location in the mandibular anterior area.

The typical Stafne's cavity, located on the posterior portion of the mandible, is a relatively uncommon entity. However, when the defect is located in the anterior region of the mandible, it is quite rare, having thus far been described in only 36 cases in the scientific literature. Most of these defects appear in the fifth and sixth decades of life, are localized to the area of the canines and premolars, and have a predilection for males. The inferior dental canal, one of the anatomical-radiographic landmarks that aid in the diagnosis of Stafne's cavity in the posterior region, is rarely present anterior the mental foramen. For this reason, because of its more variable radiographic appearance compared to the posterior defect, its tendency to be superimposed over the apices of the teeth, and the rarity of its localisation to the anterior mandible, it is much more difficult to establish a definitive diagnosis of a Stafne's cavity in this location. It is therefore more likely that a diagnostic error can occur, especially early on. We present a new case in a 68-year-old male in which the diagnosis was serendipitous, and we review in particular the aetiology and pathogenesis, clinical aspects, and differential diagnoses for this condition.