Do comorbid personality disorders in cocaine dependence exacerbate neuroanatomical alterations? A structural neuroimaging study.

Cocaine dependence (CD) is highly comorbid with personality disorders, with implications for poorer treatment response. The neurobiological mechanisms of this comorbidity are unclear. We aimed to test the role of comorbid personality disorders in the neuroanatomy of CD. We examined 4 groups using high-resolution structural neuroimaging, psychological questionnaires and cognitive tests: CD (n = 19), CD and personality disorder type B (CD + B, n = 21), CD and personality disorder C (CD + C, n = 13) and 21 controls. We compared groups in neuroanatomy and hypothesised that (i) CD would show altered striatal areas ascribed to reward processing (i.e., accumbens, caudate and putamen), (ii) CD + B and CD + C would show altered areas supporting emotional regulation/social valuation and anxiety/avoidance (i.e., OFC and amygdala). The CD + B group had larger caudate volumes than CD (p = .01, d = 0.94) and reduced lateral OFC thickness than CD + C (p = .056, d = 0.71). Exploratory correlations showed that altered neural integrity of the OFC and of the caudate nucleus in these groups exacerbated with worse personality disorder severity and impulsivity scores. CD with and without comorbid personality disorders may have partially distinct underlying mechanisms and targets for treatment.

Evaluation of Motivation for the Treatment of Drug Addicts with Personality Disorders.

Lack of motivation for the treatment of drug addiction is associated with dropout and relapses. Further, personality disorders (PD) have traditionally been linked to low motivation and therapeutic failure. Thus, the present study aims to analyze the structure of the Motivation for Treatment Questionnaire (MTQ-8), as well as to determine differences in motivation due to the presence of PD and the impact of psychological adjustment on motivation. The sample included 125 patients (84% male) who started a treatment for their addiction to cocaine and alcohol. Rasch analysis was applied for the first objective, and means contrast and regression analysis for the others. The two subscales of the MTQ-8 fit the Rasch model, with appropriate psychometric characteristics when merging Items 5 and 7. The presence of PD was not associated with reduced motivation. Motivation for treatment was greater when abstinence was less than three weeks, and psychological distress predicted motivation for treatment. The present study confirms that MTQ-8 subscales are suitable for measuring motivation for treatment and readiness for change in drug-dependent patients. It is noted that the presence of PD should not be associated with a lower level of motivation, and that psychological distress influences motivation.

Evaluation of motivation for the treatment of drug addicts with personality disorders

Lack of motivation for the treatment of drug addiction is associated with dropout and relapses. Further, personality disorders (PD) have traditionally been linked to low motivation and therapeutic failure. Thus, the present study aims to analyze the structure of the Motivation for Treatment Questionnaire (MTQ-8), as well as to determine differences in motivation due to the presence of PD and the impact of psychological adjustment on motivation. The sample included 125 patients (84% male) who started a treatment for their addiction to cocaine and alcohol. Rasch analysis was applied for the first objective, and means contrast and regression analysis for the others. The two subscales of the MTQ-8 fit the Rasch model, with appropriate psychometric characteristics when merging Items 5 and 7. The presence of PD was not associated with reduced motivation. Motivation for treatment was greater when abstinence was less than three weeks, and psychological distress predicted motivation for treatment. The present study confirms that MTQ-8 subscales are suitable for measuring motivation for treatment and readiness for change in drug-dependent patients. It is noted that the presence of PD should not be associated with a lower level of motivation, and that psychological distress influences motivation

No disponible

Análisis densitométrico comparativo entre un nuevo biomaterial compuesto por fosfato cálcico vs. Hidroxiapatita bovina en preservació alveolar. Estudio Piloto / Comparative densitometric analysis between a new bone graft material composed by calcium phosphate vs. Bovine hydroxyapatite in alveolar ridge preservation. Pilot study

Introducción: En el presente estudio se evalúa la densidad ósea alcanzada, mediante las unidades Hounsfield, por un nuevo biomaterial, compuesto por fosfato cálcico con agregado de silicio, en comparación con la hidroxiapatita de origen bovino en la preservación alveolar pos-textracción. La preservación alveolar pos-textracción se presenta como una técnica quirúrgica dirigida a reducir el colapso del reborde alveolar tras la extracción dental mediante la utilización de un biomaterial. La finalidad del tratamiento es facilitar la posterior rehabilitación implantológica. Material y método: Se llevó a cabo un estudio sobre 6 pacientes procedentes de la Facultad de Odontología de la Universidad Complutense de Madrid a los que se les realizó la técnica de preservación alveolar postextracción. Se establecieron dos grupos: un grupo test en el que el alveolo se rellenó con fosfato cálcico con agregado de silicio y un grupo control en el que se rellenó con hidroxiapatita de origen bovino. Transcurridos 3 meses, se realizó una tomografía computerizada de haz de cono para evaluar la densidad ósea alcanzada por los biomateriales. Resultados: La densidad mineral media alcanzada en el grupo tratado con fosfato cálcico con agregado de silicio fue de 1.100,40 ± 111,19 unidades Hounsfield, mientras que en el grupo que fue tratado con hidroxiapatita de origen bovino fue de 1.029,46 ± 95,16 unidades Hounsfield. Conclusiones: Ambos biomateriales parecen presentar un comportamiento similar en cuanto a los resultados densitométricos obteniendo una densidad superior a 1.000 unidades Hounsfield, siendo el fosfato cálcico con agregado de silicio el que mayor densidad presenta

Introduction: In the present study, bone density from the new biomaterial composed by calcium phosphate and added silica is compared with bovine hydroxyapatite by means of Hounsfield units in alveolar ridge preservation. Alveolar ridge preservation is a surgical technique proposed to reduce bone resorption caused by dental extraction, using a bone graft. This technique ́s final goal is to facilitate implant insertion and rehabilitation. Materials and methods: A study was carried out on 6 patients from the Faculty of Dentistry of the Complutense University of Madrid performing the technique of alveolar ridge preservation. Two groups were established, a test group in which the alveolar socket was filled with calcium phosphate and added silica and a control group where the socket was filled with bovine hydroxyapatite. After 3 months, a cone-beam computed tomography was performed to evaluate the bone density achieved by both biomaterials. Results: The average bone density achieved in the group treated with calcium phosphate and added silica was 1100,40 ± 111,19 Hounsfield units whereas in the group treated with bovine hydroxyapatite the average bone density was 1029,46 ± 95,16 Hounsfield units. Conclusions: Both biomaterials seem to present a similar behaviour in terms of densitometric results obtaining a density greater than 1000 Hounsfield units, having the calcium phosphate and added silica the highest density

Consideraciones odontológicas del paciente con taurodontismo. A propósito de un caso / Dental considerations of the patient with taurodontism. Case report

Las malformaciones dentales son defectos formativos causados por alteraciones genéticas durante la morfogénesis den-tal. Pueden ser provocados por factores de índole hereditario, sistémico, traumático o local. Dentro de estas anomalías se encuentra el taurodontismo. Éste se caracteriza por presentar una alteración de la morfología dentaria en la que la porción coronaria del órgano dentario se encuentra alargada con una cámara pulpar ensanchada, a expensas de la porción radicular, disminuyendo la longitud y por tanto, produciéndose una migración apical de la furca del diente. El objetivo del presente artículo es describir las anomalías de forma dentaria y más concretamente el manejo clínico del paciente con taurodoncia en la clínica dental. Para ello se presenta el caso clínico de un paciente de 18 años de edad que acude al Hospital Universitario de la Princesa de Madrid para valorar la exodoncia de dos molares localizados en el primer y cuarto cuadrante. Tras un diagnóstico clínico y radiológico apropiado, se procedió a la exodoncia de los mismos

Dental anomalies are formative defects caused by genetic disturbances during tooth morphogenesis, can be caused by factors of a hereditary, systemic, traumatic or local nature. One such anomaly is taurodontism. It is characterized by pulp chamber enlargement, which may approximate of the root apex, with the body of the tooth enlarged at the expense of the roots and apically displaced furcation areas.The aim of this case report is to describe the abnormalities of tooth shape and particularly the management in the dental clinic of patients with taurodontism. For this purpose a case of a eighteen years patient visiting the Hospital Universitario de la Princesa of Madrid to assess the extraction of two molars located in the first and fourth quadrants. After a proper clinical and radiological diagnostic we proceeded to the extraction

Dysfunctional Personality Beliefs Linked to Emotion Recognition Deficits in Individuals With Cocaine Addiction and Personality Disorders.

Background: Facial emotion recognition is impaired in addiction and personality disorders. Dysfunctional personality beliefs reflect negative interpersonal schemas that may underpin emotion recognition deficits. We aimed to examine the association between personality beliefs and emotion recognition among participants with cocaine use disorder including those with comorbid personality disorders. Methods: We recruited 70 participants with cocaine use disorder aged between 19 and 52 who had used 14 g of cocaine over 4.8 years on average. Thirty-eight participants had an additional personality disorder (11 Borderline, 7 Histrionic, 5 Antisocial, 10 Avoidant, and 5 Obsessive-Compulsive). Dysfunctional beliefs were indicated with the Personality Belief Questionnaire, and facial emotion recognition was indicated with the Ekman's Test. We applied correlations/multiple regressions to test the relationship between beliefs and emotion recognition. Results: Personality beliefs reflecting paranoid, borderline, and antisocial schemas were negatively associated with emotion recognition. Antisocial beliefs were associated with poorer recognition of fear, and paranoid beliefs with poorer recognition of disgust. Antisocial beliefs were significantly associated with emotion recognition after adjusting for cocaine use. Conclusion: Dysfunctional personality beliefs are associated with poorer emotion recognition in cocaine addiction. Personality-related negative schemas about the self and others can impact social cognition and interaction during cocaine treatment.

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

Self-awareness deficits associated with lower treatment motivation in cocaine addiction.

BACKGROUND: Individuals with cocaine use disorder (CUD) often display behaviours that are paradoxically misaligned with their situation. Typical examples include poor treatment motivation and inconsistent self-reported craving. These behaviours may reflect impairments in the awareness of one's own behaviour. OBJECTIVES: We examined whether impaired self-awareness of addiction-related frontostriatal dysfunction (i.e., symptoms of apathy, disinhibition, and executive dysfunction) was associated with treatment motivation and craving. METHODS: Sixty-five outpatients with CUD (57 male) and their informants (those who knew the patient well) completed parallel self and informant versions of the Frontal Systems Behaviour Scale. Self-awareness was indexed through the discrepancy between self and informant scores in the three sub-scales; apathy, disinhibition and executive dysfunction. The University Rhode Island Change Assessment Scale assessed treatment motivation. Self-reported craving was assessed using a visual analogue scale. Multiple linear regression models examined associations between self-awareness and treatment motivation and craving, adjusting for sociodemographic factors and lifetime drug use. RESULTS: We found an inverse relationship between self-awareness of symptoms of disinhibition and treatment motivation maintenance. Although impaired awareness of disinhibition was also correlated with craving, this association was not significant after adjusting for sociodemographic factors and drug use. The apathy and executive dysfunction awareness scores were not associated with treatment motivation or craving. CONCLUSION: We show that people with lower insight into their disinhibition problems (e.g., impulsivity, mood instability) have more problems maintaining motivation when initiating treatment. Findings suggest that self-awareness interventions could be useful to prevent premature treatment dropout and improve addiction treatment outcomes.

Efectividad a Largo Plazo de la Terapia de Grupo Cognitivo-conductual del Alcoholismo: Impacto de la Patología Dual en el Resultado del Tratamiento / Long-term effectiveness of group cognitive-behavioral therapy for alcoholism: Impact of dual diagnosis on treatment outcome

El objetivo de este estudio fue analizar el resultado del tratamiento cognitivo-conductual grupal llevado a cabo en un centro ambulatorio para el tratamiento de las adicciones. La muestra estuvo compuesta por 130 hombres con trastorno por dependencia al alcohol. Se evaluaron los casos que reinician tratamiento tras el alta terapéutica en un rango de tiempo desde los dos años como mínimo hasta los 18. El 56.2% de la muestra finalizó el tratamiento con alta terapéutica, de los cuales el 75.3% no volvieron a iniciar tratamiento tras el alta, aumentando a 77.7% cuando el paciente completaba el periodo de revisión tras el alta. El 58% de los pacientes con trastornos de la personalidad finalizaron el tratamiento con alta terapéutica. El tratamiento cognitivo-conductual, cuyos componentes esenciales se detallan en este trabajo, es efectivo para el tratamiento grupal de los trastornos por dependencia del alcohol con comorbilidad de trastornos de la personalidad

The aim of the present study was to analyze the results of a cognitive-behavioral group therapy applied in an outpatient unit to treat drug addiction. The sample consisted of 130 males with an alcohol dependence disorder. Around 56% of the sample completed treatment - they were given therapeutic discharge. From those, 75.3% never resumed treatment, increasing to 77.7% when patients completed the check-up period after discharge. Follow-up from therapeutic discharge varies from 2 to 18 years; 58% of patients with personality disorders completed treatment with therapeutic discharge. Cognitive-behavioral treatment, whose essential components are detailed in the present study, is effective for the group treatment of patients with alcohol dependence and a comorbid personality disorder

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.

Brain substrates of social decision-making in dual diagnosis: cocaine dependence and personality disorders.

Cocaine dependence frequently co-occurs with personality disorders, leading to increased interpersonal problems and greater burden of disease. Personality disorders are characterised by patterns of thinking and feeling that divert from social expectations. However, the comorbidity between cocaine dependence and personality disorders has not been substantiated by measures of brain activation during social decision-making. We applied functional magnetic resonance imaging to compare brain activations evoked by a social decision-making task-the Ultimatum Game-in 24 cocaine dependents with personality disorders (CDPD), 19 cocaine dependents without comorbidities and 19 healthy controls. In the Ultimatum Game participants had to accept or reject bids made by another player to split monetary stakes. Offers varied in fairness (in fair offers the proposer shares ~50 percent of the money; in unfair offers the proposer shares <30 percent of the money), and participants were told that if they accept both players get the money, and if they reject both players lose it. We contrasted brain activations during unfair versus fair offers and accept versus reject choices. During evaluation of unfair offers CDPD displayed lower activation in the insula and the anterior cingulate cortex and higher activation in the lateral orbitofrontal cortex and superior frontal and temporal gyri. Frontal activations negatively correlated with emotion recognition. During rejection of offers CDPD displayed lower activation in the anterior cingulate cortex, striatum and midbrain. Dual diagnosis is linked to hypo-activation of the insula and anterior cingulate cortex and hyper-activation of frontal-temporal regions during social decision-making, which associates with poorer emotion recognition.

Neural correlates of impaired self-awareness of apathy, disinhibition and dysexecutive deficits in cocaine-dependent individuals.

Cocaine addiction is characterized by impaired self-awareness about cognitive and motivational deficits, leading to poor treatment outcomes. However, there is still limited understanding of the neurophysiological underpinnings of this impairment. We aimed to establish if impaired self-awareness is underpinned by brain structural phenotypes among cocaine-dependent individuals (CDI). Sixty-five CDI and 65 designated informants completed the Frontal Systems Behavior Scale, and a subsample of 40 CDI were scanned via magnetic resonance imaging. We applied multiple regression models to establish the association between levels of self-awareness indexed by Frontal Systems Behavior Scale's discrepancy scores (i.e. informant ratings minus self-reports of apathy, disinhibition and dysexecutive deficits) and gray matter volumes indexed by magnetic resonance imaging voxel-based measures within five brain regions of interest: anterior cingulate cortex, orbitofrontal cortex (OFC), striatum, insula and dorsolateral prefrontal cortex (DLPFC). We also examined the neural underpinnings of underestimation versus overestimation of deficits, by splitting the CDI group according to the positive or negative value of their discrepancy scores. We found that poorer self-awareness of apathy deficits was associated with greater gray matter volume in the dorsal striatum, and poorer self-awareness of disinhibition deficits was associated with greater gray matter volume in the OFC in the whole sample. More underestimation and more overestimation of executive deficits were linked to lower DLPFC volume. We show that impaired self-awareness of cognitive and motivational deficits in cocaine addiction has a neural underpinning, implicating striatum, OFC and DLPFC structural phenotypes.

Hipofosfatasia y talasemia minor, una asociación poco frecuente: consideraciones odontológicas sobre un caso clínico / Hypophosphatasia and thalassemia minor a rare association: considerations in dentistry on a clinical case

Introducción: La hipofosfatasia es un trastorno raro hereditario caracterizado por un defecto en la mineralización del hueso y de los dientes y una disminución de la fosfatasa alcalina sérica que cursa con una mineralización anómala del hueso, exfoliación prematura de los dientes y atrofia ósea severa. Mientras que las talasemias son un grupo de anemias hereditarias caracterizadas por la disminución de la síntesis de cadenas polipeptídicas de la hemoglobina que cursan con desarrollo puberal tadío, fragilidad ósea, insuficiencia cardiaca y anemia. El objetivo de la presente publicación es exponer un caso clínico con la asociación de ambas enfermedades y evaluar su manejo odontoestomatológico. Caso clínico: Se presenta el caso de una mujer de 55 años remitida por problemas de estabilidad en su prótesis inferior. La paciente ha sido diagnosticada de hipofosfatasia en forma adulta y talasemia menor con antecedentes quirúrgicos de cesárea y seis intervenciones por fracturas. Tras valorar las diferentes opciones terapéuticas y una vez informada y habiendo obtenido el consentimiento por parte de la paciente se procedió a la adaptación de su prótesis inferior mediante el ajuste con dos locators. Conclusiones: La hipofosfatasia es una enfermedad rara que debe estar en conocimiento de los profesionales de la salud bucodental (AU)

Introduction: The hypophospatasia is a rare inherited disorder characterized by a defect in the mineralization of bone and teeth and a decrease in serum alkaline phosphatase that causes anormal bone mineralization, premature exfoliation of teeth and severe bone atrophy. While the thalassemia are a group of inherited anemias characterized by decreased synthesis of polypeptide chains of hemoglobin that course with late puberal development , brittle bones, heart failure and anemia. The purpose of this publication is to present a case with the association of both diseases and to evaluate its dental management. Case Report: a case report of a 55 year old woman referred by stability problems in the lower denture. The patient has been diagnosed in adult form of hypophosphatasia and β-thalassemia minor. She refers having been subjected to a caesarean and six surgical interventions for bone fractures. After assessing the different therapeutic options and having obtained the informed consent from the patient, her lower overdenture was adapted adding two locators. Conclusions: hypophosphatasia is a rare disease that should be in the knowledge of the professionals of the oral healt (AU)

Self-deception as a mechanism for the maintenance of drug addiction.

BACKGROUND: This study was aimed at: (i) examining levels of self-deception in substance dependent individuals following addiction treatment, and (ii) examining the association between participants’ levels of self-deception and (a) personality disorders, (b) addiction-related beliefs, (c) duration of abstinence, and (d) estimates of craving. METHOD: We administered self-report questionnaires of self-deception and mixtification, and core beliefs related to addiction and craving. The sample comprised 79 outpatients who were consecutively recruited at the Centro Provincial de Drogodependencias in Granada: 87.3% were males and the mean age was 37.68 years old. Thirty-four percent of participants were diagnosed with comorbid personality disorders. RESULTS: Results showed that individuals with substance dependence exhibit elevated scores of self-deception, particularly in the domains of active denial, selective amnesia, projection, and confabulation. Individuals with comorbid personality disorders display greater levels of self-deception compared to individuals without dual diagnosis. CONCLUSIONS: Moreover, there is a significant association between levels of self-deception and addiction-related beliefs and craving. In addition, there is a negative association between levels of self-deception and duration of abstinence.

Increased corticolimbic connectivity in cocaine dependence versus pathological gambling is associated with drug severity and emotion-related impulsivity.

Neural biomarkers for the active detrimental effects of cocaine dependence (CD) are lacking. Direct comparisons of brain connectivity in cocaine-targeted networks between CD and behavioural addictions (i.e. pathological gambling, PG) may be informative. This study therefore contrasted the resting-state functional connectivity networks of 20 individuals with CD, 19 individuals with PG and 21 healthy individuals (controls). Study groups were assessed to rule out psychiatric co-morbidities (except alcohol abuse and nicotine dependence) and current substance use or gambling (except PG). We first examined global connectivity differences in the corticolimbic reward network and then utilized seed-based analyses to characterize the connectivity of regions displaying between-group differences. We examined the relationships between seed-based connectivity and trait impulsivity and cocaine severity. CD compared with PG displayed increased global functional connectivity in a large-scale ventral corticostriatal network involving the orbitofrontal cortex, caudate, thalamus and amygdala. Seed-based analyses showed that CD compared with PG exhibited enhanced connectivity between the orbitofrontal and subgenual cingulate cortices and between caudate and lateral prefrontal cortex, which are involved in representing the value of decision-making feedback. CD and PG compared with controls showed overlapping connectivity changes between the orbitofrontal and dorsomedial prefrontal cortices and between amygdala and insula, which are involved in stimulus-outcome learning. Orbitofrontal-subgenual cingulate cortical connectivity correlated with impulsivity and caudate/amygdala connectivity correlated with cocaine severity. We conclude that CD is linked to enhanced connectivity in a large-scale ventral corticostriatal-amygdala network that is relevant to decision making and likely to reflect an active cocaine detrimental effect.

The effects of healing abutments of different size and anatomic shape placed immediately in extraction sockets on peri-implant hard and soft tissues. A pilot study in foxhound dogs.

OBJECTIVES: The aim of this animal study was to compare the effects of narrow, concave-straight and wide anatomic healing abutments on changes to soft tissues and crestal bone levels around implants immediately placed into extraction sockets in foxhound dogs. MATERIALS AND METHODS: Forty-eight titanium implants (Bredent Medical GMBH, Germany) of the same dimensions were placed in six foxhound dogs. They were divided into two groups (n = 24): test (implants with anatomic abutment) and control (implants with concave-straight abutment). The implants were inserted randomly in the post extraction sockets of P2 , P3 , P4, and M1 bilaterally in six dogs. After eight and twelve weeks, the animals were sacrificed and samples extracted containing the implants and the surrounding soft and hard tissues. Soft tissue and crestal bone loss (CBL) were evaluated by histology and histomorphometry. RESULTS: All implants were clinically and histologically osseointegrated. Healing patterns were examined microscopically at eight and twelve weeks. After eight and twelve weeks, for hard tissues, the distance from the implant shoulder to the first bone-to-implant contact (IS-C) was higher for control group in the lingual aspect with statistical significance (P < 0.05). For soft tissues (STL), the distance from the top of the peri-implant mucosa to the apical portion of the junction epithelium (PM-Je) was significantly less on the lingual aspect in the test group (with wider abutment) at eight and twelve weeks (P < 0.05). The distance from the top of the apical portion of the junction epithelium to the first bone-to-implant contact (Je-C) was significantly higher in the test group (wider abutment) in the lingual aspect at eight and twelve weeks (P < 0.05). There was no connective tissue contact with any abutment surface. CONCLUSIONS: Within the limitations of this animal study, anatomic healing abutments protect soft and hard tissues and reduce crestal bone resorption compared with concave-straight healing abutments.

Influencia de la densidad ósea y sus estados patológicos en la osteointegración / Impact of bone density and its pathological states on osseointegration

El éxito en el tratamiento implantológico está determinado por varios factores (cantidad de hueso, relación prótesis-implante, cargas biomecánicas, técnica quirúrgica, etc.). La densidad ósea es uno de ellos y su influencia en la osteointegración es máxima. El objetivo del presente artículo ha sido realizar una revisión bibliográfica narrativa sobre la influencia de la densidad ósea en la osteointegración y éxito implantológico, así como los posibles efectos de su patología (osteoporosis, periodontitis, etc.). El conocimiento de la densidad ósea del lecho implantológico es de vital importancia para el odontólogo y cirujano bucal, que deben tener en cuenta este parámetro y sus posibles estados patológicos para conseguir un resultado satisfactorio (AU)

The successful implants treatment is determided by several factors (bone quantity, prosthesis-implant relationship, biomechanical loads, surgical technique, etc.). Bone density is one of them and its influence in osseointegration is maximum. The aim of this article has been to make a narrative bibliographic review about the influence of bone density in osseointegration and implants success, as well as the possible effects of its diseases (osteoporosis, periodontal disease, etc.). Knowledge of the bone density of implant sites is very important to the dentist and oral surgeon, who must consider this parameter and its possible pathology to achieve a satisfactory result (AU)

Evaluación de la densidad ósea: técnicas densitométricas / Bone density evaluation: densitometric techniques

La densidad ósea es uno de los factores de osteointegración y éxito implantológico más importante y por ello su evaluación es de máxima relevancia. Para ello se han utilizado técnicas densitométricas como la Radiología (convencional y digital), la Absorciometría Radiológica de Doble Energía (DXA) y la Tomografía Computerizada (TC). En esta última se incluyen la TC médica y la TC dental o CB-CT (Cone Beam Computerized Tomography). Al aplicar a la TC programas informáticos de valoración densitométrica obtenemos la TC cuantitativa o QCT (por Quantiative Computerized Tomography) y la CB-CT cuantitativa o QCB-CT, que nos proporcionan una densidad expresada en unidades hounsfield (uh) y en algunos casos en mg ha/cm3. El estudio de otras posibles técnicas como la Resonancia magnética (MRI) y la ultrasonografía Cuantitativa (QuS) está en fase experimental. El objetivo del presente artículo ha sido realizar una revisión bibliográfica narrativa sobre las principales técnicas densitométricas utilizadas en Cirugía Bucal e Implantología. De todas ellas la más exacta es la TC cuantitativa o QCT. Con la DXA obtenemos una densidad expresada en mg ha/cm2, más precisa que la radiológica, pero plantea problemas técnicos y es de difícil aplicación en los pequeños espacios maxilofaciales. La Radiología, a pesar de ser una técnica subjetiva, empírica y poco sensible, sigue siendo útil en la práctica clínica cotidiana (AU)

Bone density is one of the most important factors of osseointegration and implants success and therefore its evaluation is highly relevant. For this purpose densitometric techniques have been used as Radiology (conventional and digital), Double X-Ray Absorptiometry (DXA) and Computed Tomography (CT). Within this latter, medical CT and dental CT or CB-CT (Cone Beam Computerized Tomography) are included. Applying to CT densitometric evaluation softwares we obtain the quantitative CT (QCT) and quantitative CBCT (QCB-CT), which provides a density expressed in hounsfield units (hu) and in some cases ha mg/cm3. The study of alternative techniques such as Magnetic Resonance Imaging (MRI) and Quantitative ultrasound (QuS) remains, for now, experimental. The aim of this article has been to make a narrative bibliographic review about the main densitometric techniques used in Oral Surgery and Implantology. From all of them, the most exact is the quantitative CT or QCT. With the DXA we obtain a density expressed in mg ha/cm2, more accurate than radiologic one, but poses technical problems and is difficult to apply in the small maxillofacial spaces. Radiology, despite being a subjective and empirical technique, remains useful in the daily clinical practice (AU)

Tratamiento quirúrgico simultáneo de terceros y cuartos molares impactados: A propósito de un caso / Surgical simultaneous treatment of impacted third and fourth molars: Clinical case

Introducción: El diente supernumerario o hiperodoncia es una alteración infrecuente, caracterizada por el aumento en el número de dientes de un individuo y cuya etiología, en la actualidad, continúa siendo controvertida. Esta anormalidad presenta una mayor prevalencia por el sexo femenino y su localización más habitual es a nivel del maxilar, preferentemente en la línea media. Objetivos: El presente trabajo describe el tratamiento quirúrgico simultáneo de los terceros y cuartos molares impactados, así como el protocolo diagnóstico necesario para la realización del mismo. Caso Clínico: Presentamos el caso de una paciente mujer de 48 años que acude al Servicio de Cirugía e Implantología Bucofacial del hospital Virgen de la Paloma, remitida por su odontólogo habitual. Tras la realización de un estudio radiológico, a través de una radiografía panorámica, se evidenció la presencia de distomolares inferiores bilaterales impactados junto a los terceros molares y su relación con el nervio dentario inferior determinó la realización de un estudio tomográfico. Una vez informada la paciente y habiendo obtenido el consentimiento informado se procedió a la extracción quirúrgica simultánea de los cuatro molares inferiores. Conclusiones: El tratamiento de los molares supernumerarios debería realizarse lo antes posible, con la finalidad de evitar el desplazamiento y la alteración de la erupción de dientes permanentes (AU)

Introduction: supernumerary teeth or hiperodontia are infrequent alterations characterized by a higher number of tooth, and, to date, with a controversial ethiology. This abnormality presents a higher prevalence in women, and its preferent location is maxilar, near the midline. Objectives: The present paper describes the simultaneous surgical treatment of third and fourth impacted molars, as well as its necessary diagnostic protocol. Clinical case: We present a 48 year-old woman that comes into the Surgery and Implantology Service of the Virgen de la Paloma hospital, sent by her usual dentist. After performing a radiologic study, through panoramic radiograph, it was evidenced the presence of bilateral mandibular impacted distomolars next to third molars, which relation to the inferior dental nerve was determined by a tomographic study. Once informed, and having obtained the informed consent, the simultaneous extraction of the four inferior molars was done. Conclusions: The treatment of supernumerary molars should be performed as soon as possible, with the purpose of avoiding displacement and eruption of permanent teeth (AU)

Cocaine-specific neuroplasticity in the ventral striatum network is linked to delay discounting and drug relapse.

AIMS: To contrast functional connectivity on ventral and dorsal striatum networks in cocaine dependence relative to pathological gambling, via a resting-state functional connectivity approach; and to determine the association between cocaine dependence-related neuroadaptations indexed by functional connectivity and impulsivity, compulsivity and drug relapse. DESIGN: Cross-sectional study of 20 individuals with cocaine dependence (CD), 19 individuals with pathological gambling (PG) and 21 healthy controls (HC), and a prospective cohort study of 20 CD followed-up for 12 weeks to measure drug relapse. SETTING AND PARTICIPANTS: CD and PG were recruited through consecutive admissions to a public clinic specialized in substance addiction treatment (Centro Provincial de Drogodependencias) and a public clinic specialized in gambling treatment (AGRAJER), respectively; HC were recruited through community advertisement in the same area in Granada (Spain). MEASUREMENTS: Seed-based functional connectivity in the ventral striatum (ventral caudate and ventral putamen) and dorsal striatum (dorsal caudate and dorsal putamen), the Kirby delay-discounting questionnaire, the reversal-learning task and a dichotomous measure of cocaine relapse indicated with self-report and urine tests. FINDINGS: CD relative to PG exhibit enhanced connectivity between the ventral caudate seed and subgenual anterior cingulate cortex, the ventral putamen seed and dorsomedial pre-frontal cortex and the dorsal putamen seed and insula (P≤0.001, kE=108). Connectivity between the ventral caudate seed and subgenual anterior cingulate cortex is associated with steeper delay discounting (P≤0.001, kE=108) and cocaine relapse (P≤0.005, kE=34). CONCLUSIONS: Cocaine dependence-related neuroadaptations in the ventral striatum of the brain network are associated with increased impulsivity and higher rate of cocaine relapse.