A narrative review on the use of autologous platelet concentrates during alveolar bone augmentation: Horizontal (simultaneous/staged) & vertical (simultaneous/staged).

This review aimed to answer the general question of whether autologous platelet concentrates (APCs, an autologous blood-derivative) can improve the outcome of alveolar bone augmentation. Three clinical scenarios were assessed: horizontal/vertical bone augmentation in combination with implant placement (simultaneous approach), horizontal bone augmentation in a staged approach, and vertical bone augmentation in a staged approach. An electronic literature search strategy was conducted for each review from the outset to July 1st, 2023. The titles and abstracts (when available) of all identified studies were screened and imported into a database. If articles appeared to meet the inclusion criteria or their title and abstract had insufficient data, the full text was obtained to make the final decision. All studies that met the inclusion criteria underwent data extraction. Moreover, the references of the identified papers were screened for additional studies. After title and abstract screening and selection criteria application, 14 clinical studies were included for the qualitative analysis: seven for horizontal/vertical bone augmentation in a simultaneous approach, five for horizontal bone augmentation in a staged approach, and two for vertical bone augmentation in a staged approach. There is scarce literature regarding the added value of APCs in bone augmentation, and most studies had small sample sizes, a lack of standardized protocols, and different outcome variables, which makes comparisons between studies difficult. Out of the 14 studies, four were well-designed randomized clinical trials, where we could find better results for the APCs groups. Most studies, particularly comparative and well-designed studies, demonstrated beneficial and promising results of using APCs in alveolar bone augmentation. However, before high-level evidence-based conclusions can be drawn, more randomized clinical trials must compare the benefits of adding APCs to the gold-standard approach.

'Pillow technique' to improve lip support in the context of zygoma implant rehabilitation.

This study proposes a simple, off-the-shelf ancillary method for application in the dental rehabilitation of severe maxillary atrophy with zygoma implants, allowing simultaneous improvement of lip support in cases with a moderate lack of premaxillary projection. Three consecutive patients with an atrophic maxilla were evaluated retrospectively. All were treated with a fixed rehabilitation over four zygomatic implants and the pillow technique. The study variables included radiological assessment of the premaxilla volume, upper lip and perinasal soft tissue changes, clinical complications, and subjective evaluation of functional and aesthetic patient satisfaction based on a visual analogue scale. All of the zygomatic implants showed osseointegration. The survival rate was 100%. The immediate postoperative course was uneventful, and no surgical complications were noted at the follow-up visits. Radiological assessment of the premaxilla volume enhancement showed a final mean skeletal projection improvement of +9.4 mm, while the nasolabial angle decreased an average of + 0.6 mm. On the other hand, only small changes in nasal width were detected. Patient satisfaction with the functional and aesthetic outcomes at the 1-year follow-up was excellent. The pillow graft is an easy-to-handle technique that can be included in the armamentarium for moderately incrementing the maxillary sagittal dimension and enhancing lip support in the context of zygoma implant rehabilitation.

Validation of a Portuguese version of the Groningen radiotherapy-induced xerostomia questionnaire.

BACKGROUND: The aim of this study was to validate and determine at pretest level the reliability of the Portuguese version of the Groningen radiotherapy-induced xerostomia questionnaire. MATERIAL AND METHODS: This study employed 37 head and neck cancer patients. Each patient signed an informed consent and responded to the Portuguese version of the questionnaire in the form of an interview. This was repeated again after 2 weeks. A standard single question provided a validity check. Data were analyzed using Cronbach's α to test its reliability and total and interitem correlation, and intraclass correlation to determine its internal consistency and test-retest reliability. Construct validity supported by objective measurements as salivary secretion was also investigated. Significance was set at .05. RESULTS: Cronbach's α was 0.91 and 0.89 for the first and second test administrations, respectively, which indicates that the internal consistency was excellent. The intraclass correlation coefficient value for the test-retest reliability was 0.70. The correlation between the total score of the questionnaire and standard single dry mouth question was 0.72 for the first round, indicating a good correlation. CONCLUSIONS: Demonstrating very good psychometric properties, the Portuguese version of the Groningen radiotherapy-induced xerostomia questionnaire is a valid tool and can be considered a reliable instrument to measure xerostomia in head and neck cancer patients.

Prevalence of maxillary sinus septa: systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to determine the prevalence and characteristics of maxillary sinus septa using cone beam computed tomography and computed tomography data. Publications were searched until October 5, 2020 in three electronic databases. Additionally, article bibliographies were searched, and authors were contacted if required. This review has been registered in PROSPERO (CRD42019124933). Two independent evaluators assessed methodological quality using the Joanna Briggs Institute levels of evidence; inter-rater reliability tests were performed (Cohen's κ). The prevalence of maxillary sinus septa was expressed as a proportion; differences according to sex were reported in terms of the odds ratio (OR) and 95% confidence interval (95% CI). Heterogeneity and sources of heterogeneity were evaluated by meta-regression. Publication bias was assessed by visual analysis of the funnel plot. Statistical significance was set at P < 0.05. The 62 studies identified and included in the review involved 13,701 patients (22,460 sinuses). The meta-analysis of 35 studies (14,664 sinuses) revealed an overall mean sinus septa prevalence per sinus of 33.2% (95% CI 27.8-38.5%; I2 = 98.32%). The meta-analysis of 42 studies (9631 patients) found an overall mean sinus septa prevalence per patient of 41.0% (95% CI 36.0-46.0%, I2 = 96.45%). The OR for the difference in septa prevalence between sexes was 0.785 (95% CI 0.590-1.046; P = 0.098, I2 = 73.24%). Septa were most frequent in the middle area of the sinus and with a transverse orientation (86.0%). Within the limitations, the results suggest a high proportion of septa in the sinus, commonly in the middle area, which can interfere with the success of sinus floor elevation required for implant rehabilitation.

Prevalence of C-shaped canal morphology using cone beam computed tomography - a systematic review with meta-analysis.

BACKGROUND AND AIM: To perform a systematic review of anatomical studies using cone beam computed tomography (CBCT) to assess the influence of demographic factors (age, gender and geographic region) on the prevalence of C-shaped canal anatomy in maxillary molars, mandibular premolars and molars. DATA SOURCES: A search was conducted between May and August 2018 in four electronic databases and five peer-reviewed journals. The authors of included articles were also contacted for additional studies and the bibliographic references hand-searched. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: The research protocol was previously registered in the International Prospective Register of Ongoing Systematic Reviews (CRD42018095201) and included defined inclusion/exclusion criteria. Prevalence studies on C-shaped canal anatomy in maxillary molars, mandibular premolars and molars were searched. STUDY APPRAISAL AND SYNTHESIS METHODS: The selected studies were submitted to full-text analysis and critical appraisal by two evaluators using the Joanna Briggs Institute Critical Appraisal tool. The final group of papers (n = 25) were pooled and forest plots with proportions and odds ratio with a 95% confidence interval performed. Meta-regression was undertaken to evaluate possible sources of heterogeneity and funnel plot visual analysis to assess publication bias. RESULTS: The included studies reported data on 25 445 teeth of 13 142 patients. A significant difference in the average prevalence proportion of C-shaped configuration was observed between mandibular first (0.3%; 0.1-0.6%) and second (12%; 10.3-13.7%) molars (P < 0.05). No significant difference in the prevalence of C-shaped configurations was observed comparing males (13.5%; 8.8-18.3%) and females (20.5%; 13.7-27.4%) in mandibular second molars (P > 0.05), although males were associated with significantly lower odds (0.573; 0.511-0.641) (P < 0.05). The pooled proportion of C-shaped anatomy in mandibular second molars in East Asian countries (39.6%; 36.0-43.1%) was significantly higher compared with other regions. LIMITATIONS: Because of the limited number of studies, no statistical analysis was performed for maxillary molars and mandibular premolars. CONCLUSION: Meta-analysis revealed that gender and geographic region may act as a confounding factor for the prevalence of C-shaped anatomy in mandibular second molars, whilst age did not influence the prevalence of C-shaped configurations in this tooth group. Knowing these preoperative factors would help to anticipate complex morphologies in clinics.

Quality assessment of systematic reviews on vertical bone regeneration.

The aim of this study was to evaluate and compare the quality of systematic reviews of vertical bone regeneration techniques, using two quality-assessment tools (AMSTAR and ROBIS). An electronic literature search was conducted to identify systematic reviews or meta-analyses that would evaluate at least one of the following outcomes: implant survival, success rates, complications or bone gain after vertical ridge augmentation. Methodological quality assessment was performed by two independent evaluators. Results were compared between reviewers, and reliability measures were calculated using the Holsti's method® and Cohen's kappa. Seventeen systematic reviews were included, of which seven presented meta-analysis. Mean ±95% confidence interval AMSTAR score was 6.35 [4.74;7.97], with higher scores being correlated with a smaller risk of bias (Pearson's correlation coefficient=-0.84; P<0.01). Cohen's inter-examiner kappa showed substantial agreement for both checklists. From the available evidence, we ascertained that, regardless of the technique used, it is possible to obtain vertical bone gains. Implant success in regenerated areas was similar to implants placed in pristine bone with results equating between 61.5% and 100% with guided bone regeneration being considered the most predictable technique regarding bone stability, while distraction osteogenesis achieved the biggest bone gains with the highest risk of possible complications.

Differences in root canal system configuration in human permanent teeth within different age groups.

AIM: To analyse the differences in root canal system configuration in patients belonging to different age groups using cone beam computed tomography (CBCT) technology. METHODOLOGY: CBCT examinations from a pre-existing database were accessed. Patients were divided according to age groups: '≤20 years', '21-40 years', '41-60 years' and '≥61 years'. Each group included tooth data regarding their root canal system configurations according to the Vertucci classification and its supplementary configurations. Cohen kappa coefficient of agreement was calculated to evaluate observer reliability. RESULTS: Overall 12 325 teeth from 670 patients were included. Most of the root groups had higher or equal prevalence of Vertucci type I configurations in the younger groups whilst presenting a greater tendency for multiple root canal system configurations in older patients, mainly Vertucci type II in both maxillary and mandibular second premolars and in the distal root of the mandibular first molar. The Cohen kappa coefficient of agreement was 89.4 ± 1.8%. CONCLUSION: Clinicians should be aware that the root canal system configuration changes over a lifetime. In this study, the most affected teeth were the second premolars and the distal root of mandibular first molars.

Effect of cross-linked vs non-cross-linked collagen membranes on bone: A systematic review.

The aim of this study was to conduct a systematic review to compare the clinical outcomes of two different resorbable collagen membranes in terms of regenerated bone volume, postoperative complications and membrane degradation during bone regeneration procedures. Randomized controlled trials (RCT) or controlled trials (CT) that compared both techniques were reviewed on four electronic databases up to December 2015, a manual search was performed on the bibliography of the collected articles and the authors were contacted for additional references if undetected on the electronic and manual search. Membrane exposure was evaluated as a dichotomous outcome and the statistical unit was the membrane. The results were presented as relative risk (RR) with a 95% confidence interval. Eight RCTs and one CT were included in this study. The majority of the studies depicted a bone augmentation area, which ranged from 46.15% to 94.6% for the non-cross-link membranes and from 44% to 92.6% for the cross-link membranes at the 4-6 month re-entry surgery. From a total of 289 patients, a forest plot concerning the membrane exposure was constructed using the obtained RR of the included studies. The overall RR was 1.43 (95% CI: 0.85-2.39) with no statistically significant differences between the two groups, although with a marginal tendency towards higher exposure in the cross-link membrane group. This systematic review suggests the different membranes present themselves as appropriate for bone regeneration procedures, although cross-link membranes present higher rates of postoperative complications. However, more RCT with higher sample sizes are needed to evaluate the different membranes. The suggested lack of clinical differences between the compared membranes suggest that further cost-benefit ratio, tissue integration and postoperative complication oriented studies should be performed so that clinicians can take a patient-centred, evidence-based decision.

Root and root canal morphology of the permanent dentition in a Caucasian population: a cone-beam computed tomography study.

AIM: To investigate in vivo the number of roots, the configuration of the root canal system and the root canal splitting and merging levels in the permanent dentition of a Caucasian population. METHODOLOGY: A total of 11 892 teeth were inspected in cone-beam computed tomography examinations that were collected from a pre-existing database. The number of roots was identified, and canal configurations were classified according to Vertucci's classification and its supplemental configurations. In addition, the merging and separation positions along the length of the root canal were identified. The Z-test was used to analyse the differences between independent groups. A value of P < 0.05 was considered significant. RESULTS: The majority of tooth types had considerable variation in the number of roots and root canal configuration types. Radix entomolaris and paramolaris were rare occurrences. The mesiobuccal root of the maxillary first and second molars had two root canals in 71% and 44% of cases, respectively. Nearly 30% of the mandibular incisors had two root canals. Root canal merging and splitting appeared more often in mandibular teeth. Merging was more common in the middle third of the root canal in the maxillary teeth and in the middle and apical thirds in mandibular teeth. Root canal splitting did not exhibit a tendency, and their position along the length of the root canal varied from tooth to tooth. CONCLUSION: Clinicians must be aware that each tooth may display several types of root canal configuration. However, a greater variability in root canal configuration was found in maxillary second premolars and in the mesiobuccal roots of maxillary molars. Main root canal merging and splitting may also be expected to occur at any level of the root canal.

Leydig cell tumour: enucleation as a therapeutic choice in a case with atypical symptoms.

OBJECTIVE: Testicular tumours are rare in paediatric patients, accounting for only 1% of tumours in boys. Leydig cell tumours are the most common gonadal stromal tumours. Since these tumours are functionally active, secreting testosterone, they characteristically produce isosexual pseudoprecocious puberty (IPP), the customary therapeutic choice being radical orchiectomy. Nowadays, considering that Leydig cell tumour in boys are invariably benign, some authors suggest a more conservative choice of therapy. METHODS: This article presents the case of a patient with a cytological and immunohistochemical diagnosis of Leydig cell tumour with no clinical symptoms of IPP. The treatment carried out was enucleation of the tumour through a transcrotal access with subsequent follow-up monitoring. RESULTS: After 2 years of follow up the patient remains free of symptoms and shows a degree of sexual development corresponding to his age. CONCLUSIONS: We consider enucleation of the tumour to be a safe and effective therapy as an alternative to radical orchiectomy.

Tumor de celulas de leydig: enucleación como tratamiento en un caso de presentación atípica / Leydig cell tumour: enucleation as a therapeutic choice in a case with atypical symptoms

OBJETIVO: Los tumores testiculares son poco frecuentes en edad pediátrica representando tan solo el 1% de los tumores infantiles . El tumor de células de Leydig es el más frecuente de los tumores del estroma gonadal. Debido a que estos tumores son funcionalmente activos secretando testosterona, característicamente suelen causar pseudopubertad precoz isosexual(PPI) siendo su tratamiento habitual la orquiectomía radical. OBJETIVOS: En la actualidad considerando que el tumor de células de Leydig en niños muestra un comportamiento invariablemente benigno algunos autores sugieren un tratamiento más conservador. MÉTODOS: En este artículo presentamos el caso de un paciente con diagnóstico citológico e inmunohistoquímico de tumor de células de Leydig que cursaba sin manifestaciones clínicas de PPI y en el que el tratamiento fue la enucleación tumoral transescrotal y seguimiento posterior. RESULTADOS: Tras 2 años de seguimiento el paciente se mantiene asintomático y con desarrollo sexual acorde a su edad. CONCLUSIONES: consideramos la enucleación tumoral un tratamiento eficaz, seguro y alternativo a la orquiectomía radical(AU)

OBJECTIVE: Testicular tumours are rare in paediatric patients, accounting for only 1% of tumours in boys. Leydig cell tumours are the most common gonadal stromal tumours. Since these tumours are functionally active, secreting testosterone, they characteristically produce isosexual pseudoprecocious puberty (IPP), the customary therapeutic choicebeing radical orchiectomy. Nowadays, considering that Leydig cell tumour in boys are invariablybenign, some authors suggest a more conservative choice of therapy. METHODS: This article presents the case of a patient with a cytological and Immunohistochemical diagnosis of Leydig cell tumour with no clinical symptoms ofIPP. The treatment carried out was enucleation of the tumour through a transcrotal accesswith subsequent follow-up monitoring. RESULTS: After 2 years of follow up the patient remains free of symptoms and showsa degree of sexual development corresponding to his age. CONCLUSIONS: We consider enucleation of the tumour to be a safe and effectivetherapy as an alternative to radical orchiectomy(AU)

[Myofascial trigger point disease--a multidisciplinary disorder]. / Dor miofascial por pontos gatilho--uma doença multidisciplinar.

UNLABELLED: Trigger Point Disease is a complex clinical condition. Physicians are required to take a multidisciplinary and preventive approach towards the treatment of this disorder, in order to avoid the chronicity of symptoms. The aim of this review is to perform an update on this subject. MATERIALS AND METHODS: An extensive bibliographic review was carried out based on reference text books and published articles. A thorough search through PubMed using the keywords "trigger point", "myofascial pain", "temporomandibular system", and "tender points" was completed. The review was performed in English and the time limit was April 10th 2008. RESULTS: Trigger Point Disease is a disorder not completely clarified - its pathophysiology has been postulated throughout the years, however there is no conclusive theory. CONCLUSION: The articles and texts reviewed underline the need for an early diagnosis of this disease in order to treat its aetiology and avoid the chronicity of symptoms.

[Effect of hepatic resection on development of liver metastasis]. / Efecto de la resección hepática sobre el desarrollo de metástasis en el hígado.

In the early stages of metastasis, development of the disease is dependent on growth factors produced by the host. There are clinical situations associated with an increase in these factors, such as partial resection of metastasized liver. Given the important role of hepatotrophic factors in liver regeneration, we have studied the effect of partial hepatectomy on the development of residual micrometastases in the liver, and on the neoplastic process as a whole. We used a murine model in which a rabdomiosarcoma was established by subcutaneous inoculation of syngeneic tumor cells in male Wag rats. Subsequently, the primary tumor was resected and/or a 40% hepatectomy was performed. The effect of these two surgical procedures on the tumor process was analyzed on the 25th and 35th days post-inoculation, and the percentage of regenerating hepatocytes was assessed. Both the tumorectomy and liver resection, when not combined, produced an increase in regional adenopathies without modifying the evolution of metastasis in the liver. However, when tumor excision and partial hepatectomy were performed simultaneously, there was a net increase in the metastatic process. In addition to a rapid spread of the disease (lung, mediastinum, retroperitoneum), the number of liver metastases increased by 300%. This development coincided with a steep rise in the percentage of regenerating hepatocytes, which nearly doubled that of the group subjected only to liver resection. We conclude that liver resection, alone or combined with excision of the primary tumor, may enhance tumor progression, both locally and at the metastasic level.

[Immunotherapy in superficial bladder carcinoma]. / Inmunoterapia en el carcinoma vesical superficial.

OBJECTIVE: To review the current status of superficial bladder cancer treatment with several immune response modifiers. METHODS: A review of the advances in the treatment of superficial bladder cancer with BCG, interferon, interleukin-2, bropirimine and keyhole-limpet hemocyanin was performed. RESULTS: Treatment with BCG has been demonstrated to be superior to intravesical chemotherapy and other immune response modifiers in the trials reviewed. BCG therapy, however, carries a higher toxicity. Several trials have demonstrated that in low and medium risk patients, it is better to administer low BCG doses to reduce the toxicity. Furthermore, the trials confirm the utility of maintenance schedules with BCG. CONCLUSION: The Calmette-Guérin Bacillus is the most effective adjuvant treatment in superficial bladder cancer, especially in the high risk patients. The other immune response modifiers are an alternative to this treatment.

[Genital autoaggression. An unusual presentation]. / Autoagresión genital. Una forma de presentación poco habitual.

Self-injuries are relatively common and usually consist in incisive injuries on the penis and the scrotum. This paper presents one case of genital self-injury by injection of petrol on the back of the penis. A description is offered of the clinical form of presentation, as well as the good evolution following medical treatment. Finally, a revision of likely complications is included.

[Recurrent nonparasitic chyluria]. / Quiluria redicivante no parasitaria.

OBJECTIVE: To describe a case of recurrent chyluria and review the diagnostic and therapeutic methods. METHODS/RESULTS: A case of non parasitic recurrent chyluria is presented. Retrograde pyelography demonstrated pyelolymphatic reflux. The patient presented chemical pyelitis secondary to the contrast medium which caused remission of the condition. CONCLUSIONS: Chyluria is uncommon in our setting. Postprandial cystoscopy permits identification of the compromised renoureteral unit and perform pyelic instillation of sclerosing agents. Surgery should be reserved for those cases in whom conservative management has failed.

[Use of Tc 99m DTPA in the follow-up of 2 pediatric patients diagnosed with megacalycosis or Puigvert's disease]. / Utilización del Tc 99 m DTPA en el seguimiento de 2 pacientes pediátricos diagnosticados de megacaliosis o enfermedad de Puigvert.

OBJECTIVE: Megacalycosis or Puigvert's disease is a congenital anomaly of renal development characterized by caliceal dilatation, an increased number of calyces, associated with hypoplasia of the pyramids of Malpighi, and a normal renal pelvis. Renal function is always normal and there is no evidence of obstruction to urinary flow. The foregoing are important in distinguishing megacalycosis from congenital hydronephrosis. We have studied two pediatric patients with this renal anomaly by means of non invasive techniques, in order to demonstrate they had no urinary flow obstruction despite the caliceal dilatation. METHODS: Two cases of megacalycosis that had been diagnosed at our hospital from 1991 to 1995 are described and the literature is reviewed. Diagnosis was basically by intravenous urography. A diuretic renogram with technetium 99m diethylenetriaminepentaacetic acid (Tc 99m DTPA) showed no urinary flow obstruction in the anomalous kidney. This test was repeated several times, together with renal function studies like the technetium 99m dimercaptosuccinic acid scan (DMSA Scan). RESULTS: Both patients are asymptomatic and have a normally functioning kidney with no scars demonstrable on the DMSA scan. Renal urinary flow studies have remained within the normal ranges (elimination of more than 40% of the radionuclide 20 min after the administration of furosemide). US control evaluations have shown adequate renal growth and persistent caliceal dilatation in both cases. CONCLUSIONS: This congenital malformation must be considered when investigating renal dilatation, since megacalycosis does not require surgical treatment. Intravenous urography is useful in the diagnosis of this condition and Tc 99m DPTA is the best test for subsequent control evaluations.

[Benign gingival granular cell tumor in the newborn: congenital epulis]. / Tumor gingival benigno de células granulares en el recién nacido: epulis congénito.

Gingival granular cell tumor, or congenital epulis, was first described by Neumman in 1871 and subsequently 201 cases have been published in 173 patients. It is an uncommon benign tumor that is present like a pedunculated, smooth surfaced, isolated lesion on the alveolar mucosa of the maxillar of the newborn child. Its firm consistency and variable size can occasionally cause problems in the child's breathing or feeding. This tumor is easily diagnosed clinically and, although spontaneous regression of the tumor mass has occasionally been reported, the current treatment is surgical removal. Two new cases of congenital epulis are reported and a literature review is included.