Surgical approach combining implantoplasty and reconstructive therapy with locally delivered antibiotic in the treatment of peri-implantitis: A prospective clinical case series.

BACKGROUND: Nonsurgical treatment, resective surgery, reconstructive surgery, or combined approaches have been proposed for the treatment of peri-implantitis, with variable results. PURPOSE: To evaluate the 1-year clinical and radiographic outcomes following combined resective and reconstructive surgical treatment with topical piperacillin/tazobactam antibiotic in the management of peri-implantitis. MATERIAL AND METHODS: Forty-three patients diagnosed with peri-implantitis were included. Surgical treatment consisted of implantoplasty of the supra-crestal component of the defect, the application of a topical antibiotic solution over the implant surface, and subsequent reconstruction of the intra-osseous component of the peri-implant defect. The primary outcome was disease resolution, defined as the absence of bleeding on probing (BoP) and/or suppuration on probing (SoP), a peri-implant pocket probing depth (PPD) ≤5 mm, and no bone loss >0.5 mm 1 year after surgery. Secondary outcomes included changes in BoP, PPD, SoP, and peri-implant marginal bone levels. One implant per patient was included in the analysis. RESULTS: The treatment success rate of the 43 dental implants included in the study was 86% at 1 year after surgery. Mean PPD and BoP decreased from 6.41 ± 2.11 mm and 100% at baseline to 3.19 ± 0.99 mm (p < 0.001) and 14% (p < 0.001) at 1 year, respectively. SoP was significantly reduced from 48.8% at baseline to 0% 1 year after surgery (p < 0.001). Radiographically, a mean defect fill of 2.64 ± 1.59 mm was recorded (p < 0.001). CONCLUSIONS: The combination of a resective and reconstructive surgical approach together with locally delivered antibiotic achieved a high disease resolution rate after 1 year of follow-up and constitutes a viable option for the management of peri-implantitis.

Abordaje quirúrgico combinado para la desinfección y regeneración de defectos periimplantarios. A propósito de tres casos / Combined surgical treatment for the decontamination and regeneration of peri-implant defects. A three cases series

Los implantes dentales sufren una alta incidencia de mucositis y periimplantitis, que pueden llevar a su fracaso. Existen múltiples abordajes terapéuticos no quirúrgicos y quirúrgicos para estas patologías, si bien en caso de periimplantitis deberá realizarse tratamiento quirúrgico. El tratamiento quirúrgico puede ser mediante cirugía de acceso, tratamiento resectivo o regenerativo. Para lograr la remoción del biofilm y la mejora de los tejidos periimplantarios, debe realizarse siempre la descontaminación previa del implante. Para ello pueden emplearse métodos mecánicos, químicos, antibióticos o láseres. En el presente artículo se presentan tres casos clínicos en los que se empleó un abordaje quirúrgico combinado de implantoplastia, descontaminación con clorhexidina y ácido ortofosfórico, aplicación de antibiótico local (piperacilina/tazobactam) y regeneración mediante hidroxiapatita sintética y membrana reabsorbible, que ha mostrado resultados favorables concordantes con la bibliografía

Dental implants suffer a high occurrence of mucositis and peri-implantitis, which may lead to implant failure. There are several therapeutical approaches both surgical and non-surgical for the treatment of these pathologies, though in peri-implantitis lesions a surgical procedure must be conducted. Surgical treatment can be trough: access surgery, resective or regenerative surgery. In order to remove the biofilm and to improve peri-implant tissues, decontamination of implant surface must be performed beforehand. For this, mechanical, chemical, antibiotics or lasers may be employed. In this article, we present three clinical cases of combined surgical treatment by implantoplasty, chemical decontamination with clorhexidine and orthophosphoric acid, local antibiotic (piperazilin/tazobactam) and regenerative treatment with synthetic hydroxyapatite and resorbable membrane. This treatment has shown favourable results, coinciding with the results found in the literature

Efficacy of platelet-rich plasma applied to post-extraction retained lower third molar alveoli. A systematic review

Dental retentions have a high prevalence among the general population and their removal can involve multiple complications. The use of platelet rich plasma has been proposed in an attempt to avoid these complications, as it contains high growth factors and stimulates diverse biological functions that facilitate the healing of soft and hard tissues. OBJECTIVES: To evaluate the available scientific evidence related to the application of platelet-rich plasma in the post-extraction alveoli of a retained lower third molars. MATERIAL AND METHODS: A systematic review of published literature registered in the Medline, EMBASE, Cochrane and NIH databases. The following categories were included: human randomized clinical studies. Key search words were: platelet rich plasma; platelet rich plasma and oral surgery; platelet rich in growth factors and third molar. RESULTS: Of 101 potentially valid articles, seven were selected, of which four were rejected as they failed to meet quality criteria. Three studies fulfilled all selection and quality criteria: Ogundipe et al.; Rutkowski et al.; Haraji et al. The studies all measured osteoblast activity by means of sintigraphy, and also registered pain, bleeding, inflammation, temperature, numbness as perceived by the patients, radiological bone density and the incidence of alveolar osteitis. CONCLUSIONS: Scientific evidence for the use of PRP in retained third molar surgery is poor. For this reason randomized clinical trials are needed before recommendations for the clinical application of PRP can be made

Sialolitiasis submandibular. Presentación de un caso clínico y revisión de la literatura / Submandibular sialolithiasis. Presentation of a case report and literature review

INTRODUCCIÓN: Las lesiones de glándulas salivales representan un grupo diverso, en el que se encuentran patologías benignas y malignas que pueden ser difíciles de distinguir. La sialolitiasis es una de las patologías no neoplásicas más comunes. La obstrucción del conducto salival secundaria a la formación de cálculo es una alteración frecuente de la glándula submandibular que se manifiesta habitualmente como episodios de dolor acompañados de inflamación durante las comidas. CASO CLÍNICO: Se presenta un caso clínico de una paciente, mujer, de 70 años que acude a nuestro servicio por episodios de dolor e inflamación asociados con las comidas. A la exploración intraoral se observó una masa en la línea del conducto de Wharton en el lado derecho de 0,8x2,5 cm de diámetro, que presentaba consistencia dura a la palpación. Se procedió a la extirpación de la lesión, por vía intraoral, bajo anestesia local. Tras un seguimiento de dos años no se ha observado recurrencia. DISCUSIÓN: La mayoría de los sialolitos, se localizan en la glándula submandibular, con una prevalencia del 80-95%; mientras que el 5-20% se dan en la glándula parótida, y tan solo el 1-2% afectan a la glándula sublingual y a las glándulas salivales menores. Los métodos diagnósticos tradicionales incluyen radiografías panorámicas y oclusales, tomografía computerizada, sialografía, ultrasonido, y resonancia magnética. La elección del tratamiento dependerá del tamaño y la localización. CONCLUSIÓN: Existen factores anatómicos y salivales relacionados con el desarrollo de sialolitiasis. Se requieren más estudios para estandarizar el diagnóstico y el tratamiento de esta patología

INTRODUCTION: Salivary glandular lesions represent a diverse group, in which are found benign and malignant pathologies that can be difficult to distinguish. Sialolithiasis is one of the most common non-neoplastic pathologies. The obstruction of the salivary duct secondary to the formation of a stone is a frequent disorder of the submandibular gland that is usually manifested as episodes of pain accompanied by inflammation during meals. CLINICAL CASE: A clinical case is presented of a patient, female, 70 years of age who comes to our service for episodes of pain and inflammation associated with meals. In the intraoral exploration, a mass was Observed along the line of Wharton's duct on the right side measuring 0.8 X 2.5 cm in diameter, which presented a hard consistency during palpation. The lesion was extracted, by intraoral means, under local anaesthesia. After monitoring for two years, no recurrence has been observed. DISCUSSION: The majority of the salivary duct stones are located in the submandibular gland, with a prevalence of 80-95%; while 5-20% appear in the parotid gland, and only 1-2% affect the sublingual gland and the minor salivary glands. The traditional diagnostic methods include panoramic and occlusal X-rays, computerized tomography, sialography, ultrasound and magnetic resonance. The choice of treatment will depend on the size and the location. CONCLUSION: There are anatomical and salivary factors related to the development of sialolithiasis. They require further studies to standardise the diagnosis and the treatment of this pathology