Diagnostic predictability of digital versus conventional panoramic radiographs in the presurgical evaluation of impacted mandibular third molars.

Panoramic radiographs are the most widely used radiological diagnostic technique in dental practice, offering full vision of the maxillas and adjacent regions, but there are shortcomings regarding detailed dentoalveolar exploration. This study compared the precision of digital versus conventional panoramic radiographs in the presurgical evaluation of impacted lower third molars. 390 mandibular third molars were studied in 287 patients; their position, morphology and surgical technique used were recorded. 84 molars were evaluated with digital panoramic radiographs, and 306 with conventional panoramic radiographs. Four observers compared the presurgical data with the surgical findings and the diagnostic precision was established. There were statistically significant differences between the techniques; digital panoramic radiographs were more precise than conventional radiographs in providing the correct presurgical evaluation of the impacted third molars. Surgeon experience had a statistically significant influence on planning the presurgical study. Panoramic radiographs distort the position and morphology of the lower third molar, which may affect the presurgical strategy used. In this context, and because of their lesser experience, first year residents consider the operation to be more complicated, and tend to act less conservatively and cause increased trauma. In conclusion, digital panoramic radiographs offer significantly greater diagnostic precision than conventional panoramic radiographs.

Implantes en pacientes VIH-positivo. A propósito de tres casos / Dental implants in HIV-positive patients. A presentation of three cases

El aumento de la calidad y la esperanza de vida de los pacientes VIH-positivo, ha hecho que la solicitud de tratamiento estético dental se haya incrementado significativamente en estos pacientes, considerándose actualmente las prótesis implanto soportadas como una opción terapéutica válida. Se presentan 3 pacientes varones, VIH-positivo que acudieron a nuestro Servicio de Implantología Bucofacial, para valorar una posible rehabilitación implanto soportada. La evolución clínica de los pacientes había sido estable durante un periodo mínimo de 4 años. Se colocaron un total de 12 implantes (caso1: 4 implantes Defcon®, 2 en maxilar superior y 2 en mandíbula; caso 2: 2 implantes ITI® en mandíbula; caso 3: 6 implantes Brånemark System® en maxilar superior), todos ellos bajo anestesia lo corregional y siguiendo la técnica habitual. No se llevó a cabo ningún tipo de técnica de regeneración ósea guiada. No se presentaron complicaciones intra y/o postoperatorias. Tampoco se produjo ninguna alteración de los parámetros biológicos de control de la enfermedad de base tras la intervención quirúrgica. Los implantes han sido considerados como una opción de tratamiento en este tipo de pacientes pese a que su fiabilidad, no ha sido todavía establecida a largo plazo. A excepción de dos artículos (implante unitario inmediato y una rehabilitación bucal completa), ningún otro estudio ha sido publicado referente a la rehabilitación con implantes en pacientes VIH-positivo. En ambos artículos se corrobora la hipótesis que la cirugía bucal menor no aumenta el riesgo de infección loc orregional en los pacientes VIH-positivo correctamente controlados, como evidenciamos en nuestros 3 casos. En el postoperatorio inmediato, no se observó ninguna disminución significativa del marcador CD4 ni de ningún otro parámetro biológico, tal como se describe en la literatura, obteniéndose una excelente curación de los tejidos blandos y duros (AU)

The improvement in survival and quality of life of HIV-positive patients has led to a significant rise in demand for esthetic dental treatment among these patients. In this context, implant-supported prostheses are currently considered a valid treatment option. We present three HIV-positive males seen in our Service of Oral Implantology for the evaluation of possible implant-supported rehabilitation. The clinical course of the patients had remained stable for a minimum of four years. A total of 12 implants were positioned (case 1: 4 Defcon® implants, 2 in the upper maxilla and 2 in the mandible; case 2: 2 ITI® implants in the mandible; and case 3: 6 Brånemark System® implants in the upper maxilla;), all under locoregional anesthesia and applying the usual technique. No guided bone regeneration procedures were applied. There were no intra and/or postoperative complications, and no alterations in the biological parameters of background disease control following the surgical intervention. Implants have been considered a treatment option in patients of this kind, despite the fact that their long-term reliability has not been established. With the exception of two articles (respectively involving immediate singe implant placement and complete oral rehabilitation), no other study has been published on rehabilitation with implants in HIV-positive patients. Both of these articles corroborate the hypothesis that minor oral surgery does not increase the risk of locoregional infection in correctly controlled HIV-positive patients, as reflected in our three cases. In the immediate postoperative period, there were no significant variations in CD4+ cell count or in any other biological parameter, as described in the literature, with excellent soft and hard tissue healing (AU)