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Introducción: Los implantes subperiósticos personalizados de titanio, diseñadosa partir de un software de planificación yfabricación, constituyen una alternativaen la rehabilitación de atrofias severasen los maxilares, evitando cirugías de reconstrucción óseas y el de partes blandasmás complejas y disminuyendo los tiempos de cicatrización. El objetivo de este trabajo es presentar la rehabilitación enun caso clínico con una atrofia severa enmaxilar superior, utilizando una estructuracon implantes subperiósticos, medianteun protocolo digital.Descripción del caso: Se diseñó unaestructura subperióstica de titanio sinterizada con seis conexiones transepitelialesque fueron rehabilitadas con una prótesisfija inmediata implantosoportada fabricada en PMMA. Dos meses después, serealizó una estructura sinterizada en cromo-cobalto con bases mecanizadas recubierta con dientes de resina acrílica comorestauración final. En el seguimiento a unaño, el caso permanece estable.Conclusiones: Hoy en día, la rehabilitación con implantes subperiósticos constituye una herramienta alternativa en casosde cirugías complejas con grandes atrofias con la posibilidad, además, de realizar una carga inmediata. (AU)
Introduction: Customized subperiosteal titanium implants, designed from planning and fabrication software, constitute analternative in the rehabilitation of severe maxillary atrophy, avoiding more complex bone and soft reconstruction surgeries and reducing healing times. The aim of this article is to present the rehabilitation in a clinical case with severe atrophy in the upper jaw, using a structure with subperiosteal implants, by means of a digital protocol.Clinical Case: A subperiosteal sintered titanium structure was fabricated with six transepithelial connections that were rehabilitated with an immediate implant-supported fixed prosthesis made of PMMA. Two months later, a sintered Chromium-Cobalt framework with machined bases covered with acrylic resin teeth was fabricated as the final restoration. At one year follow-up, the case remains stable. Conclusions: Nowadays, rehabilitatin with subperiosteal implants is an alternative tool in cases of complex surgeries with large atrophies with the possibility of immediate loading. (AU)
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Humanos , Masculino , Idoso , Implantes Dentários , Implantação Dentária/métodos , Reabilitação Bucal/métodos , Planejamento de Assistência ao Paciente , Retração Gengival/cirurgia , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Maxillectomies cause malocclusion, masticatory disorders, swallowing disorders and poor nasolabial projection, with consequent esthetic and functional sequelae. Reconstruction can be achieved with conventional approaches, such as closure of the maxillary defect by microvascular free flap surgery or prosthetic obturation. Four patients with segmental maxillary defects that had been reconstructed with customized subperiosteal titanium maxillary implants (CSTMI) through virtual surgical planning (VSP), STL models and CAD/CAM titanium mesh were included. The smallest maxillary defect was 4.1 cm and the largest defect was 9.6 cm, with an average of 7.1 cm. The reconstructed maxillary vertical dimension ranged from 9.3 mm to 17.4 mm, with a mean of 13.17 mm. The transverse dimension of the maxilla at the crestal level was attempted to be reconstructed based on the pre-excision CT scan, and these measurements ranged from 6.5 mm in the premaxilla area to 14.6 mm at the posterior level. All patients were rehabilitated with a fixed prosthesis on subperiosteal implants with good esthetic and functional results. In conclusion, we believe that customized subperiosteal titanium maxillary implants (CSTMI) are a safe alternative for maxillary defects reconstruction, allowing for simultaneous dental rehabilitation while restoring midface projection. Nonetheless, prospective and randomized trials are required with long-term follow-up, to assess its long-term performance and safety.
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Introduction: To describe a clinical case on cancer patient with ablative tumor surgery, from treatment planning, surgical resection and subsequent implantological rehabilitation. Case Report: A 61-year-old male, diagnosed with a squamous cell carcinoma in the maxilla, requires the removal of the lesion and corresponding oral rehabilitation. However, two surgeries were necessary to rehabilitate the upper jaw. A custom-made prosthesis was fabricated. It was made from sintered titanium using machined subperiosteal implants with a universal external connection. Finally, a milled cobalt- chrome structure was produced and a feldspar ceramic covering was subsequently applied. Conclusions: Rehabilitation using subperiosteal implants may be an alternative tool for complex surgery involving large atrophies or cancer patients who have undergone highly ablative surgery. Key words:Oral rehabilitation, oral cancer, subperiostal implants.
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Background: Oral mucositis (OM) is a painful lesion that takes place in the mucosa of the oral cavity, usually itsetiology is associated with drug therapies in cancer patients. It is presented as well-defined ulcers whose painfulsymptomatology sometimes implies the suspension of oncological treatment or parenteral feeding, being there-fore an important adverse effect, marking the evolution of these types of therapies against cancer. The presentwork aim is to know the prevalence of oral mucositis in oral cancer immunotherapy compared to its prevalencein standard therapy.Material and Methods: A protocol was developed for a systematic review following PRISMA® guidelines and afocused question (PICO) was constructed. A comprehensive literature search was conducted on electronic data-bases including PubMed, the SCOPUS database, the Cochrane library and the Web of Science (WOS).Results: Six clinical trials were included that met the different inclusion criteria. In these articles, a discrepancybetween the prevalence of OM in patients treated with chemotherapy and patients treated with immunotherapyrelated to the immune checkpoint PD-1/PD-L1 (Nivolumab and Pembrolizumab) was observed. Conclusions: The prevalence of oral mucositis is lower in new immunotherapy with monoclonal antibodies againstoral cancer than drugs used so far (chemotherapy drugs [methotrexate, cisplatin] as well as cetuximab). However,more studies should be carried out to confirm these data.(AU)
Assuntos
Humanos , Masculino , Feminino , Boca/lesões , Estomatite , Imunoterapia , Neoplasias Bucais/tratamento farmacológico , Estomatite/induzido quimicamente , Saúde Bucal , Patologia Bucal , Cirurgia Bucal , Medicina Bucal , PrevalênciaRESUMO
A 52-year-old female patient with a diagnostic of osteosarcoma in the mandible, in which it was necessary a reconstruction with a microvascularized osteomyocutaneous fibula bone. Coadjuvant chemotherapy was scheduled. Two years later, 4 osseointegrated implants (OII) were placed in the fibula a 2 OII in the right mandible, using a splint guided surgery. The final prosthodontic consisted in a metal ceramic restoration using CAD/ CAM technology. Key words:Oral rehabilitation, oral cancer, head and neck radiotherapy, oral oncology.
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El tratamiento de recesiones gingivales utilizando procedimientos de cirugía plástica periodontal es habitualmente requerido en la odontología moderna. El objetivo final de estos procedimientos es la cobertura completa de la raíz y los resultados estéticos agradables. La literatura muestra que el colgajo de avance coronal + injerto de tejido conectivo podría ser considerado como el "gold standard" para el tratamiento de recesiones gingivales unitarias. Sin embargo, en la arcada inferior podemos encontrarnos con limitaciones anatómicas que nos impidan realizar las técnicas convencionales de cirugía mucogingival. En este trabajo se presenta y describe el tratamiento de recesiones gingivales unitarias y múltiples que afectan a la zona anteroinferior, las cuales se trataron mediante la técnica de Edlan-Mejchar modificada. La utilización de la técnica de Edlan-Mejchar modificada muestra resultados positivos para tratar recesiones gingivales en el sector anteroinferior
Treatment of gingival recessions using periodontal plastic surgery procedures is routinely required in modern dentistry. The ultimate goal of these procedures is complete root coverage and pleasing aesthetic results. The literature shows that the coronal advancement flap + connective tissue graft could be considered as the "gold standard" for the treatment of single gingival recessions. However, in the lower arch we can find anatomical limitations that prevent us from performing conventional mucogingival surgery techniques. In this work we present and describe the treatment of single and multiple gingival recessions that affect the lower anterior zone, which were treated using the modified Edlan-Mejchar technique. The use of the modified Edlan-Mejchar technique shows positive results to treat gingival recessions in the mandibular anterior area
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Humanos , Feminino , Adulto Jovem , Adulto , Retração Gengival/cirurgia , Gengivoplastia/métodos , Tecido Conjuntivo/transplante , Retalhos Cirúrgicos/cirurgia , Resultado do Tratamento , Estética DentáriaRESUMO
BACKGROUND: To describe a clinical case of a cancer patient who underwent ablative tumor surgery, including treatment planning, surgical resection and subsequent implant rehabilitation. CASE REPORT: A 61-year-old patient with a diagnosis of multicystic follicular ameloblastoma in the maxilla, in which it was necessary a multidisciplinary approach and two surgical steps. In the first surgical intervention osseointegrated implants (OII) were placed in the fibula, until their osseointegration period of 8 weeks was complete. Afterwards, in the second surgery, the micro-vascularized free fibular flap bearing the implants was transplanted into the oral cavity, in order to perform simultaneous reconstruction and early rehabilitation. The final prosthetic rehabilitation consisted in a hybrid prosthesis fabricated using CAD CAM technology. RESULTS: The latest advances in medical research have improved our understanding of the oral cavity's regenerative capacity after oncological treatment. This, aided by the advances in digital 3D technologies, has allowed meticulous treatment planning prior surgery. CONCLUSIONS: The functional and esthetic reconstructions described in these two case reports were made possible by coordinating multidisciplinary approaches involving dentists and oral and maxillofacial surgeons. Advances in medicine have improved understanding of the regenerative capacity of the oral region following oncologic treatment, facilitating meticulous advance planning, while advances in digital 3D technologies for planning make it possible to reduce the number of surgical sessions and the time taken for the patient to recover both the esthetics and function of the stomatognathic system. Key words:Oral rehabilitation, oral cancer, oral surgery.
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Background: The aim of the present study was to describe and compare the oral and dental health status of two groups, one diagnosed with eating disorders (EDs), and another group without this pathology, assessing the fol-lowing oral manifestations: dental alterations, periodontal disorders, soft tissue disorders, non-stimulated salivary flow, and oral pH. Material and Methods: This comparative transversal epidemiological study included 179 participants, of whom 59 were diagnosed with EDs (Eating Disorder Group: EDG) and 120 had no antecedents of EDs (No Eating Disor-der Group: NEDG). All patients fulfilled the following inclusion criteria: women aged over 18 years, diagnosed with an ED by a specialist, patients who had undergone at least 1 year monitoring by the Clinical Nutrition Unit, and had not received any periodontal treatment during the previous 6 months. Both groups were homogeneous in terms of sex, age, education, and socioeconomic level. Oral exploration was performed, registering clinical variables, as well as sociodemographic and socioeconomic data, oral hygiene habits, and smoking. Statistical significance was established as p<0.05 (confidence level > 95%).Results: The dental erosion (DE) was the most significative feature of dental alterations. The degree of DE was significantly greater in the EDG (p<0.001). A significant association between soft tissue lesions and EDs was found (p<0.001) A notable difference in non-stimulated salivary flow was found between the groups (p<0.001) No significant differences between the groups were found for periodontal status, dental caries, or oral hygiene prac-tices. Conclusions: On the basis of the results obtained, it is necessary to carry out oral/dental examination as soon as an ED is diagnosed with regular check-ups thereafter
No disponible
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Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Cárie Dentária , Transtornos da Alimentação e da Ingestão de Alimentos , Nível de Saúde , Saúde Bucal , EspanhaRESUMO
La recesión gingival compromete la estética, dificulta el control de placa, posee mayor susceptibilidad de desarrollo de caries radicular e hipersensibilidad. Se han propuesto diferentes procedimientos quirúrgicos y diseños de colgajo para abordar recesiones gingivales. Las opciones de tratamiento deben minimizar el riesgo de complicaciones, reducir la morbilidad y ser efectivas a largo plazo. Se presenta y describe un caso con múltiples recesiones gingivales empleando matriz de colágeno (Mucograft ®, Geistlich) con un seguimiento de 1 año. Conclusiones: Mucograft (MG) es una opción terapéutica alternativa al injerto de tejido conectivo (ITC) en determinadas situaciones clínicas (AU)
Gingival recessions are known to compromise esthetic appearance, hinder plaque control, have greater susceptibility of developing root caries and hypersensitivity. Different surgical procedures and flap designs have been proposed for the treatment of gingival recession. Treatment options should minimize the risk of complications, reduce morbidity and be effective in the long term. It presents and describes a case with multiple gingival recessions using collagen matrix (Mucograft ®, Geistlich) over the course of a one year follow-up. Conclusions: Mucograft (MG) is an alternative treatment option to connective tissue graft (ITC) in certain clinical situations (AU)
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Humanos , Feminino , Adulto Jovem , Retração Gengival/terapia , Colágeno/uso terapêutico , Adesivos Dentinários/uso terapêutico , Materiais Revestidos Biocompatíveis/uso terapêutico , Resultado do TratamentoRESUMO
La recesión gingival se define como la exposición parcial de la superficie radicular debido al desplazamiento del margen gingival a una posición apical a la línea amelocementaria. Se han propuesto diferentes procedimientos quirúrgicos y diseños de colgajos para abordar recesiones localizadas en la región anterior mandibular. Se presentan y describen tres técnicas quirúrgicas mediante el uso de injerto de tejido conectivo (ITC) e injerto gingival libre(IGL) con el objetivo de resolver recesiones producidas en incisivos mandibulares. La primera técnica quirúrgica llevada a cabo fue un IGL mediante la técnica descrita por holbrook y Ochsenbein, la segunda de ellas se abordó mediante la técnica de Edlan-Mejchar modificada y la tercera mediante un ITC mas un colgajo desplazado en sentido lateral. Conclusiones: Tanto el uso del ITC como el IGL son un componente valioso en cirugía mucogingival, y contribuyen, a solucionar situaciones antiestéticas y funcionalmente problemáticas (AU)
Gingival recession is defined as apical displacement of the gingival margin from de cementoenamel junction with oral exposure of the root surface. Different surgical procedures and flap designs have been proposed for the treatment of gingival recession in the mandibular anterior region. Presents and describes three surgical techniques using subepithelial connective tissue graft (SCTG) and free gingival graft (FGG) in order to solve recessions produced mandibular incisors. The first surgical procedure was carried out using the technique described by holbrook and Ochsenbein, the second of which was addressed by modified Edlan-Mejchar technique and the third by a laterally positioned flap. Conclusion: Both the use of SCTG as the FGG are a valuable component in mucogingival surgery, and contribute to solving unsightly and functionally problematic situations (AU)
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Adulto , Feminino , Humanos , Masculino , Retração Gengival/cirurgia , Gengivoplastia/métodos , Tecido Conjuntivo/transplante , Procedimentos de Cirurgia Plástica/métodos , Retalhos CirúrgicosRESUMO
Introducción: Reabsorción cervical invasiva(RCI) es un tipo de reabsorción radicular externa. Se caracteriza por la pérdida de tejidos duros dentales por la acción de los odontoclastos. Aparece con mayor frecuencia en la región cervical de la superficie radicular de los dientes. Objetivos: Presentar un caso clínico describiendo el protocolo de actuación ante una reabsorción cervical invasiva y revisión bibliográfica de su etiología, diagnóstico y tratamiento. Caso clínico: Paciente mujer de 19 años de edad, sin antecedentes médicos relevantes, acude a nuestra consulta debido a una coloración rosácea en la superficie cervico-vestibular del incisivo central superior derecho. El diente presentaba ausencia de dolor a la percusión y palpación. La vitalidad del diente fue negativa. Tras riguroso análisis, se procedió a realizar el tratamiento que constó de2 fases, una primera fase no quirúrgica seguida de una fase quirúrgica. La reconstrucción del defecto se llevo a cabo usando un cemento de ionómero de vidrio. Conclusiones: Es importante para el endodoncista comprender y manejar aspectos periodontales y restaurativos para tratar la RCI. Tras el tratamiento, la paciente quedó satisfecha del resultado estético
Introduction: Invasive cervical resorption (ICR) is a type of external resorption. ICR is the loss of dental hard tissue as a result of odontoclastic action. It usually begins on the cervical region of the root surface of the teeth. Objetive: To present a clinical case describing the protocol to an invasive cervical resorption and literature review of etiology, diagnosis and treatment. Clinical case: Female patient of 19 years of age, without medical history of interest, who went to the consultation due to presenting a pink coronal discoloration at the labial surface in the cervical region of the right central upper incisor. There was no pain on percussion and palpation. The tooth reacted negative to pulp sensitivity testing. After rigorous analysis, the treatment took place in two phases, nonsurgical therapy followed by surgical treatment. Reconstruction of the defect was achieved using resin ionomer cement. Conclusion: It is important for endodontists to understand the periodontal and restorative aspects to treating ICR. After the treatment, the patient was satisfied with the esthetic result
