Comparison of intra-articular injection of plasma rich in growth factors versus hyaluronic acid following arthroscopy in the treatment of temporomandibular dysfunction: A randomised prospective study.

PURPOSE: The main objective of our study was to evaluate the effectiveness of the injection of plasma rich in platelet-derived growth factors (PRGF) versus hyaluronic acid (HA) following arthroscopic surgery in patients diagnosed with internal derangement of the temporomandibular joint (TMJ) with osteoarthritis (OA). MATERIALS AND METHODS: A total of 100 patients were randomised into two study groups. Group A (n = 50) received an injection of PRGF, and Group B (n = 50) received an injection of HA. The mean age was 35.5 years (range 18-77 years), and 88% of the patients were women. The pain intensity (visual analogue scale) and the extent of maximum mouth opening before and after the procedure were statistically analysed. RESULTS: Better results were observed in the group treated with PRGF, with a significant reduction in pain at 18 months, compared with HA treatment. Regarding mouth opening, an increase was observed in both groups, with no significant difference. CONCLUSIONS: The injection of PRGF following arthroscopy is more effective than the injection of HA with respect to pain in patients with advanced internal derangement of the TMJ.

Complications of temporomandibular joint arthroscopy using two-portal coblation technologies: A prospective study of 475 procedures.

PURPOSE: To study the complications of temporomandibular joint (TMJ) arthroscopic procedures using two-portal coblation technologies. MATERIALS AND METHODS: The 397 consecutive patients (475 joints) who underwent arthroscopic surgery were prospectively analyzed. RESULTS: Complications were observed in 39 (8.21%) procedures. Complications recognized during or immediately after surgery were observed in 25 cases (5.26%). Vascular injury in the points of trocar insertion was observed in seven cases. Lesions of the fibrocartilage layer of the joint secondary to introduction of instruments were observed in 12 cases. Bleeding within the superior joint space was observed in 21 cases. Extravasation of irrigation fluid appeared in five patients, affecting the oropharyngeal space in one case. In 20 patients, more than one complication at the time of surgery occurred. Delay postoperative complications were noted in 14 patients. Blood clots in the external auditory canal were found in eight cases and lacerations in two cases. One patient experienced partial hearing loss, and two patients experienced vertigo. Temporary hypoesthesia of the auriculotemporal nerve was seen in two patients. Temporary damage to the V cranial nerve was observed in four patients. Temporary paralysis of the zygomatic branch of the facial nerve was seen in one patient. CONCLUSION: TMJ arthroscopy using coblation technologies is a safe surgical procedure when performed by experienced surgeons.

Subnasal modified Le Fort I osteotomy: indications and results.

PURPOSE: To study the possible morphologic changes in the nose after subnasal modified Le Fort I maxillary osteotomy to correct class III dentofacial deformities in patients with considered normal nasal morphology. MATERIAL AND METHODS: Fifteen patients (7 males, 8 females) requiring maxillary advancement to treat class III dentofacial deformities were studied prospectively between January 2004 and January 2011. All the patients had an adequate projection of the nasal tip preoperatively preventing a conventional Le Fort I osteotomy. Patients received preoperatively (T1), 6 months after surgery (T2), and 12 months after the initial surgical procedure (T3) lateral cephalograms, CT-3D studies and clinical nose analysis to measure different morphologic variables including: the alar/nose base width, nasal tip protrusion and nasal bridge length using a digital sliding caliper directly on the soft-tissue surface of the face. RESULTS: Mean age was 26.2 years, range 20-36 years. A significant advancement of the maxilla was noted postoperatively (mean 7.5 mm). After surgery the different anthropometric variables of the nasal region analysed had not suffered any significant variation. No significant differences were found when comparing T2 with T3 measures. No significant complications were found. CONCLUSION: The results indicated that maxillary advancement using a subnasal modified Le Fort I osteotomy can prevent undesirable soft tissue changes of the nose when anterior repositioning of the maxilla is indicated in patients with preoperatively normal nasal morphology.

Prosthodontic rehabilitation in patient with ectodermal dysplasia combining preprosthetic techniques: a case report.

Oral manifestations in ectodermal dysplasia include oligodontia, alveolar ridges hypoplasia, and others. Due to the special conditions in terms of unhealthy teeth and lack of bone, implant-supported rehabilitation seems to offer the most satisfactory outcome. A 27-year-old male diagnosed with ectodermal dysplasia was referred to our department for oral rehabilitation. Oral manifestations included oligodontia, maxillary and mandibular atrophy, mandibular alveolar ridge with knife-edge morphology, and conical teeth. Treatment planning consisted of a Le Fort I osteotomy with interpositional grafts, bilateral sinus lift, and placement of maxillary and mandibular inlay and onlay corticocancellous grafts, using autologous iliac crest bone. In the second surgery, all remaining teeth were removed and 11 endosteal implants were placed. Six months after implant placement, a bimaxillary fixed implant-supported prosthesis was delivered, maintaining a satisfactory esthetic and functional result after a 2-year follow-up. The use of combined preprosthetic techniques allows the placement of endosteal implants and a fixed implant-supported prosthesis in patients with oligodontia and ectodermal dysplasia, providing an esthetic and functional oral rehabilitation.

A sheep model for endoscopic treatment of mandible subcondylar fractures.

BACKGROUND: Mandible subcondylar fractures may be treated via a traditional visible access incision; however, with the advances in surgical endoscopy surgeons are transitioning to a minimally invasive approach in an effort to reduce surgical morbidity and external facial scarring. We sought to design a clinically applicable teaching tool in a large animal model that would allow the operator to gain experience treating mandible subcondylar fractures via an endoscopic approach. METHODS: A large animal model was developed using the Churra sheep. Subcondylar fractures were created, reduced, and internally plated in ten specimens via an extraoral, two-port endoscopic approach. Animals were monitored for surgical success during the intraoperative and immediate postoperative periods. RESULTS: Mandibles were reduced and fixated successfully in each of the animals. Operative time was reduced from 70 to 40 min as the surgeons became more familiar with the surgical procedure. Each of the ten Churra sheep used in the study tolerated the surgeries without postoperative complications. CONCLUSIONS: Capitalizing on a mandibular anatomy similar to humans, the Churra sheep successfully demonstrated utility for the extraoral, endoscopic approach in treating mandibular condyle fractures. This model offers surgeons the opportunity to gain surgical endoscopic experience before treating clinical patients.

Abordaje intraoral en el síndrome de Eagle. Presentación de un caso clínico / Intraoral approach in Eagle syndrome. A case report

El síndrome de Eagle es una patología infrecuente secundaria a la elongación de la apófisis estiloides y/o calcificación del ligamento estilo-hioideo. La mayoría de pacientes afectados no presentan sintomatología, aunque la presión ejercida por esta estructura morfológicamente alterada contra estructuras vecinas puede desencadenar una gran variedad de síntomas, incluyendo dolor cervicofacial, sensación de cuerpo extraño en la orofaringe, aumento en la secreción salival, cefalea y dificultad para la deglución, el habla o los movimientos de la lengua. Presentamos el caso de una paciente de 50 años de edad con el síndrome de Eagle. La tomografía computerizada en haz de cono confirmó la sospecha clínica. Como tratamiento se realizó la resección parcial de ambas apófisis estiloides mediante un abordaje intraoral. La presentación clínica, el diagnóstico diferencial y el tratamiento se describen en este artículo(AU)

Eagle syndrome is a rare condition resulting from either the elongation of the temporal styloid process or calcification of the stylohyoid ligament. Most patients are asymptomatic, but when this structure presses against other parts of the head and neck it can originate a wide range of symptoms, including cervico-facial pain, foreign body sensation in oropharynx, increased saliva secretion, headache and difficulty with swallowing, speaking and neck or tongue movements. The case of a 50-year-old woman with Eagle syndrome is reported. Cone-beam computed tomography (CBCT) confirmed the clinical suspicion. The intraoral approach was used for the partial resection of both styloid processes. The clinical presentation, diagnosis, management and differential diagnosis are described(AU)

Is PRP useful in alveolar cleft reconstruction? Platelet-rich plasma in secondary alveoloplasty

Objective: Cleft lip and palate is a congenital facial malformation with an established treatment protocol. Mixed dentition period is the best moment for correct maxillary bone defect with an alveoloplasty. The aim of this surgical procedure is to facilitate dental eruption, re-establish maxillary arch, close any oro-nasal communication, give support to nasal ala, and in some cases allow dental rehabilitation with osteointegrated implants.Study design: Twenty cleft patients who underwent secondary alveoloplasty were included. In 10 of them autogenous bone graft were used and in other 10 autogenous bone and platelet-rich plasma (PRP) obtained from autogenous blood. Bone formation was compared by digital orthopantomography made on immediate post-operatory and 3 and 6 months after the surgery.Results: No significant differences were found between both therapeutic groups on bone regeneration.Conclusion: We do not find justified the use of PRP for alveoloplasty in cleft patients’ treatment protocol (AU)

Efficacy and safety comparison of two amoxicillin administration schedules afterthird molar removal. A randomized, double-blind and controlled clinical trial

Objective: The aim of this comparative double-blind, prospective, randomized, clinical trial was to evaluate two amoxicillin administration patterns. The first was a short prophylactic therapy and the second a long postoperative regimen.Study Design: The study population consisted of 160 patients who under went mandibular third molar extraction.Patients were randomized into two equal groups. In group 1, 2 grams of amoxicillin were administered 1 hour before the procedure and 1 gram 6 hours after surgery. In group 2, patients received 1 gram of amoxicillin 6 hours after surgery followed by 1 gram every 8 hour for 4 days. All patients received the same number of tablets thanks to the use of placebo pills. A total of 25 variables were evaluated, such as alveolitis, surgical infection, number of analgesic needed, subjective pain scale, post-surgical inflammation, consistency of the diet, axillary temperature and millimetres of mouth opening loss after the surgery.Results: No statistically significant post-operative differences were found within the recorded parameters between the groups.Conclusions: Postoperative 4-days amoxicillin therapy is not justified (AU)

A comparative study of platelet-rich plasma, hydroxyapatite, demineralizedbone matrix and autologous bone to promote bone regeneration after mandibularimpacted third molar extraction

Objectives: 1) to compare mandibular bone regeneration by applying autologous bone, platelet-rich plasma andtwo biomaterials (synthetic calcium hydroxyapatite, and demineralized bone matrix), and thus establish the potentialbenefits of these biomaterials in the regeneration of postextraction alveolar bone, 2) to identify wich of themaccelerates more bone regeneration and 3) to determine whether there are differences in the postoperative period(pain, swelling, trismus, infection) depending on the material used.Study Design: It consists in a prospective, controlled (with a split- mouth design) and double blinded study. We useas a model an easily reproducible non-critical bone defect: the defect that remains after extraction of mandibularimpacted third molar. The study design is based on the extraction of two mandibular impacted third molars ina patient during the same surgical procedure by the same surgeon. We assessed postoperative clinical data, andshort, medium and long term neoformation of alveolar bone after extraction. We compared the two sockets (rightand left), which had been grafted in a different way with the various elements mentioned above. In addition, wecompared the postoperative inflammatory symptoms between groups.Results: The highest acceleration in bone formation was observed in groups in which we used autologous boneand demineralized bone matrix. There were no statistically significant differences between groups regarding pain,swelling, trismus and infection throughout the postoperative period.Conclusions: According to the results of our study, autologous bone persists as the gold standard material for boneregeneration. Among the assessed biomaterials, demineralized bone matrix has yielded the best results obtained.No significant differences in the postoperative (pain, swelling, trismus and infectious events) were observed, dependingon the type of material used as a graft (AU)

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Efficacy and safety comparison of two amoxicillin administration schedules after third molar removal. A randomized, double-blind and controlled clinical trial.

OBJECTIVE: The aim of this comparative double-blind, prospective, randomized, clinical trial was to evaluate two amoxicillin administration patterns. The first was a short prophylactic therapy and the second a long postoperative regimen. STUDY DESIGN: The study population consisted of 160 patients who underwent mandibular third molar extraction. Patients were randomized into two equal groups. In group 1, 2 grams of amoxicillin were administered 1 hour before the procedure and 1 gram 6 hours after surgery. In group 2, patients received 1 gram of amoxicillin 6 hours after surgery followed by 1 gram every 8 hour for 4 days. All patients received the same number of tablets thanks to the use of placebo pills. A total of 25 variables were evaluated, such as alveolitis, surgical infection, number of analgesic needed, subjective pain scale, post-surgical inflammation, consistency of the diet, axillary temperature and millimeters of mouth opening loss after the surgery. RESULTS: No statistically significant post-operative differences were found within the recorded parameters between the groups. CONCLUSIONS: Postoperative 4-days amoxicillin therapy is not justified.

Is PRP useful in alveolar cleft reconstruction? Platelet-rich plasma in secondary alveoloplasty.

OBJECTIVE: Cleft lip and palate is a congenital facial malformation with an established treatment protocol. Mixed dentition period is the best moment for correct maxillary bone defect with an alveoloplasty. The aim of this surgical procedure is to facilitate dental eruption, re-establish maxillary arch, close any oro-nasal communication, give support to nasal ala, and in some cases allow dental rehabilitation with osteointegrated implants. STUDY DESIGN: Twenty cleft patients who underwent secondary alveoloplasty were included. In 10 of them autogenous bone graft were used and in other 10 autogenous bone and platelet-rich plasma (PRP) obtained from autogenous blood. Bone formation was compared by digital orthopantomography made on immediate post-operatory and 3 and 6 months after the surgery. RESULTS: No significant differences were found between both therapeutic groups on bone regeneration. CONCLUSION: We do not find justified the use of PRP for alveoloplasty in cleft patients' treatment protocol.

A comparative study of platelet-rich plasma, hydroxyapatite, demineralized bone matrix and autologous bone to promote bone regeneration after mandibular impacted third molar extraction.

OBJECTIVES: 1) to compare mandibular bone regeneration by applying autologous bone, platelet-rich plasma and two biomaterials (synthetic calcium hydroxyapatite, and demineralized bone matrix), and thus establish the potential benefits of these biomaterials in the regeneration of postextraction alveolar bone, 2) to identify which of them accelerates more bone regeneration and 3) to determine whether there are differences in the postoperative period (pain, swelling, trismus, infection) depending on the material used. STUDY DESIGN: It consists in a prospective, controlled (with a split- mouth design) and double blinded study. We use as a model an easily reproducible non-critical bone defect: the defect that remains after extraction of mandibular impacted third molar. The study design is based on the extraction of two mandibular impacted third molars in a patient during the same surgical procedure by the same surgeon. We assessed postoperative clinical data, and short, medium and long term neoformation of alveolar bone after extraction. We compared the two sockets (right and left), which had been grafted in a different way with the various elements mentioned above. In addition, we compared the postoperative inflammatory symptoms between groups. RESULTS: The highest acceleration in bone formation was observed in groups in which we used autologous bone and demineralized bone matrix. There were no statistically significant differences between groups regarding pain, swelling, trismus and infection throughout the postoperative period. CONCLUSIONS: According to the results of our study, autologous bone persists as the gold standard material for bone regeneration. Among the assessed biomaterials, demineralized bone matrix has yielded the best results obtained. No significant differences in the postoperative (pain, swelling, trismus and infectious events) were observed, depending on the type of material used as a graft.