Cirugía periapical y regeneración: revisión sistemática / Periapical surgery and regeneration: systematic review

Introducción: Tras un cirugía periapical, suele estar asociado un defecto óseo que puede ser regenerado o no según la literatura. El objetivo es analizar si la regeneración ósea asociada a la cirugía periapical tiene efectos beneficiosos en la curación de los diferentes defectos. Material y Mètodos: Revisión sistemática realizada en Medline-Pubmed, Scopus y Cochrane. Se consideraron criterios PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Ensayos clínicos aleatorizados, estudios de casos y controles, de cohortes y transversales publicados entre enero 2011 y abril 2022, que analizaran el èxito de la cirugía periapical combinada o no con diferentes tècnicas de regeneración ósea, idioma inglès o español, realizados en humanos y adultos (≥16años) fueron incluidos. Resultados: Se incluyeron un total de 8 artículos que analizaban una "n" total de 285 sujetos con 35 abandonos. Se analizan diferentes tipos de lesiones: lesiones transversales, defectos apicomarginales y lesiones periapicales, excepto un estudio que compara las tres. Se utilizan diferentes materiales de regeneración. Se obtuvo un rango de èxito de regeneración ósea entre 81,6% y 93,7%. Discusión: Los avances en equipos de magnificación visual aumento, instrumentos y materiales endodónticos son la razón de un mayor èxito de las cirugías periapicales. Las imágenes en 3D, son valiosas para obtener un mejor diagnóstico del tamaño y tipo de defecto, y planificar así el tratamiento considerando la necesidad de regenerar o no. Aunque los resultados siguen siendo inciertos parece ser que en los defectos transversales y apicomarginales es mejor regenerar, al contrario de los defectos periapicales. (AU)

Introduction: According to the literature, after a periapical surgery there usually remains a bone defect that may be regenerated or not. The aim of this review is to analyse whether bone regeneration associated with periapical surgery is favourable on the healing of different defects. Material and Methods: A systematic review was performed in Medline-Pubmed, Scopus and Cochrane. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria were considered. Randomized clinical trials, case-control, cohort and cross-sectional studies published between January 2011 and April 2022, that analyses the success of periapical surgery associated or not with different bone regeneration techniques, English or Spanish, humans and adults (≥ 16years) studies were included. Results: A total of eightreports were included. They evaluated 285 subjects, with 35 subjects that dropped out. Different types of lesions were analysed in each report: through-and-through lesions, apico-marginal lesions, and periapical lesions, except for one that compared all of them. Different kinds of bone regenerative materials were used. A range of success of between 81,6% and 93,7% of bone regeneration was achieved. Discussion: Improvements in augmentation equipment, instruments, and materials are the reason for the large success of periapical surgery. 3D images are useful to make a better diagnosis of the size and kind of the defect and, in this way, to plan the treatment considering the need to regenerate or not. Although the results remain uncertain, it seems that for through-and-thought and apico-marginal lesions, it is better to regenerate in contrast with periapical lesions. (AU)

Role of selected salivary inflammatory cytokines in the diagnosis and prognosis of oral squamous cell carcinoma. A Systematic Review and Meta-analysis.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is gradually increasing its incidence in our society. Unfortunately, this entity is diagnosed at an advanced stage in most patients, a fact that implies greater difficulty in its treatment and a worse prognosis. This systematic review aims to assess whether the cytokines IL-6, IL-8 and TNF-α are potential salivary biomarkers that allow early diagnosis of cancer. MATERIAL AND METHODS: An electronic search was performed in three databases (Pubmed, Scopus and Web of Science). We used the following keywords: "salivary cytokines", "saliva cytokines", "salivary interleukins", "biomarkers", "oral squamous cell carcinoma" and "diagnosis", combined with the Boolean operators "AND" and "OR". RESULTS: 128 publications were found and finally 23 articles were included in the review and 15 in the meta-analysis. It has been observed that the majority of OSCC patients express higher salivary concentrations of IL-6, IL-8 and TNF-α compared to the control (CL) and premalignant lesion (OPML) groups. It has also been observed that the different premalignant lesions do not have statistically significant differences in the salivary concentration of the cytokines, and on the other hand, differences have been observed between the different TNM stages. The meta-analysis has shown that the difference in concentration of IL-6, IL-8 and TNF-α is statistically significant between the CL group and the OSCC, and also between the CL group and OPML. CONCLUSIONS: There is sufficient evidence to affirm that IL-6, IL-8 and TNF-α are useful salivary cytokines in the early diagnosis and prognosis of OSCC. Although future studies are necessary to establish greater reliability of these biomarkers and thus be able to develop a valid diagnostic test.

Modificaciones en la microbiota y los factores inflamatorios después de la utilización de un dentífrico con aceite de oliva virgen, betaina y xilitol, desarrollado para el cuidado del microbioma oral: estudio clínico piloto / Modifications in the microbiota and inflammatory factors with the use of a toothpaste with virgin olive oil, betaine and xylitol, developed for the care of the oral microbiome: pilot clinical study

Introducción: La correcta homeostasis oral, asociada a una buena higiene oral, es necesaria para disminuir la de patógenos cariogénicos y la inhibición de patógenos periodontales, así como modular la respuesta inflamatoria. El objetivo de este estudio es evaluar los efectos de un dentífrico para la protección del microbioma oral, en pacientes atendidos en el Hospital Odontológico Universidad de Barcelona (HOUB). Material y métodos: Ensayo Clínico Randomizado doble ciego y placebo en pacientes atendidos en el HOUB. En el Grupo estudio [GE] se utiliza una pasta dentífrica específica [PDE], que contiene como ingredientes activos aceite de oliva virgen extra, betaina y xilitol además de monofluorofosfato de sodio (1,450 ppm F-) + Excipientes. Y en el Grupo control [GC] se utiliza una pasta placebo sin ingredientes activos. A todos los pacientes se les realiza una exploración oral con parámetros clínicos periodontales, medición de pH, flujo salival (no estimulado y estimulado), recuento de citoquinas (TNF, IL-1 e IL-4.) y de carga total bacteriana, mediante PCR cuantitativa, al inicio y al mes del tratamiento. Resultados: Se incluyen un total de 26 pacientes, 17 mujeres y 9 hombres con una edad media de 48,76 años. El nivel de pH se mantuvo estable entre el inicio y final del estudio en ambos grupos, sin diferencias entre ellos. 11 pacientes indicaron la sensación subjetiva de encontrar la boca mejor, 7 eran test y 4 control (p=0.1); 10 pacientes encontraron la boca igual y solo uno (placebo) la encontró peor. En el análisis de la carga bacteriana mediante determinación de PCR cuantitativa de gen16S solo se analizaron 10 pacientes: 5 GE y 5 GC. En el grupo test bajó en todos los casos la carga de patógenos periodontales y en el grupo control, disminuyó en 4 aumentando en 1. En los 16 pacientes que se analizaron las citoquinas no se observaron diferencias estadísticamente significativas. (AU)

Introduction: Correct oral homeostasis, associated with good oral hygiene, is necessary to decrease the bacterial load of cariogenic pathogens and the inhibition of periodontal pathogens, as well as to modulate inflammatory response. The objective of this study is to evaluate the effects of a toothpaste for the protection of the oral microbiome, in patients treated at the Hospital Odontológico Universidad de Barcelona (HOUB).Material and methods: Randomized double-blind clinical trial with placebo in patients treated at HOUB. In the Study Group [SG] a specific toothpaste [PDE] is used, which contains as active ingredients extra virgin olive oil, betaine and xylitol, as well as sodium monofluorophosphate (1,450 ppm F-) + Excipients. In the control group [CG] a placebo paste without active ingredients is used. All patients underwent an oral examination with periodontal clinical parameters, pH measurement, salivary flow (stimulated and unstimulated), cytokine count (TNF, IL-1 and IL-4.) and total bacterial load by qPCR16S at the beginning and one month after treatment.Results: A total of 26 patients were included, 17 women and 9 men, with a mean age of 48.76 years. The pH level remained stable between the beginning and the end of the study in both groups, with no differences between them. 11 patients felt their mouth was in a better state, 7 of which were test and 4 control (p=0.1); 10 patients felt their mouth was in the same as before the treatment; and only one (placebo) felt it was worse. For the 16S analysis, only 10 patients were analyzed: 5 SG and 5 CG. In the test group, the total bacterial load decreased in all cases, and in the control group, it decreased in 4 and increased in 1. Among the 16 patients whose cytokines were analyzed, no statistically significant differences were observed. (AU)

Role of thyroid hormones in burning mouth syndrome. Systematic review.

BACKGROUND: Burning mouth syndrome is an idiopathic condition characterized by burning pain in a normal-appearing oral mucosa lasting at least four to six months. In the case of secondary burning mouth syndrome is associated with local or systemic factors (such as thyroid disorders) that can cause these symptoms. The aim of this review was to study the relationship between thyroid disorders and burning mouth syndrome. MATERIAL AND METHODS: The present study followed the PRISMA guidelines. An electronic search strategy was developed for PubMed/Medline, Scopus and Cochrane. The following combination of keywords and Boolean operators were used: Thyroid AND burning mouth; Thyroid AND burning mouth syndrome; Hypothyroidism AND burning mouth; Hypothyroidism AND burning mouth syndrome; Hyperthyroidism AND burning mouth; Hyperthyroidism AND burning mouth syndrome. The results were processed by existing free software in https://www.graphpad.com/. To evaluate the association of the categorical variables we used the Fisher test at a level of significance of p-value ≤ 0,05. As a primary summary measure the Odds Ratio (OR) has been used. To analyze the risk of bias the guidelines of the GRADE guide were used and the grade of evidence was analyzed by the guide of Joanna Briggs Institute: Levels of Evidence and Grades of Recommendations. RESULTS: After applying the inclusion and exclusion criteria, 5 studies were selected for review. The Chi-square was 10.92 and the Odds Ratio was 3.31 with respect to TSH values with p <0.0001 (Fisher's test). The population of patients with TSH alterations is increased in 80.49% and decreased in 19.51%. CONCLUSIONS: It can be concluded that thyroid hormone abnormalities are a factor in secondary burning mouth syndrome; specially in patients with hypothyroidism.

Papel de la histamina en el Liquen Plano Oral, Leucoplasia y en el Carcinoma Oral de Células Escamosas. Revisión sistemática / Role of histamine in Oral Lichen Planus, Leukoplakia and in Squamous-Cell Oral Carcinoma. Systematic review

Introducción: Los queratinocitos presentes en las células epiteliales del cuerpo humano producen, de manera continuada, pequeñas cantidades de histamina que se mantienen en equilibrio en el epitelio oral. Cuando este equilibro se ve alterado, se produce un aumento de histamina en el tejido oral pudiendo provocar lesiones. Objetivo: En este trabajo de revisión se estudia la relación del exceso de histamina en el Liquen Plano Oral, la Leucoplasia oral y en el Carcinoma Oral de Células Escamosas. Material y método: Búsqueda bibliográfica en la literatura de estudios caso control y retrospectivos acerca del papel de la histamina en el Liquen Plano Oral, la Leucoplasia Oral y el Carcinoma Oral de Células Escamosas. Resultados: Se ha observado un aumento del número de mastocitos y de histamina en los tejidos orales con patología comparado con los tejidos sanos. Conclusión: Este aumento del número de mastocitos y de histamina en los tejidos orales con patología, provocan una desorganización en los precursores de la inflamaciónpudiendo así dañar el epitelio oral. (AU)

Introduction: Keratinocytes present in the epithelial cells of the human body produced, continuously, small amounts of histamine that are kept in balance in the oral epithelium. When this balance is disturbed, there is an increase in histamine in the oral tissue and it can cause injuries. Objective: In this review work we studied the relationship of excess histamine in Oral Lichen Planus, oral Leukoplakia and Oral Squamous Cell Carcinoma. Material and Method: Bibliographic search of the literature of case control and retrospective studies about the role of histamine in Oral Lichen Planus, Oral Leukoplakia and Oral Squamous Cell Carcinoma. Results: An increase in the number of mast cells and histamine has been observed in oral tissues with pathology compared to healthy tissues. Conclusion: This increase in the number of mast cells and histamine in oral tissues with pathology can cause disorganization in the precursors of inflammation and thus can further damage the oral tissue. (AU)

Implantes dentales en pacientes con liquen plano oral. Revisión sistemática / Dental implants in patients with lichen planus. Systematic review

Introducción: El liquen plano se considera una enfermedad muco-cutánea crónica, en la que la etiopatogenia se considera una alteración autoinmune mediada por células, con una prevalencia entre 0.5 y 2%. La colocación de implantes dentales en pacientes con dicha enfermedad puede hacer cambiar el éxito del tratamiento. Material y Método: se realizó una búsqueda en la base de datos Pub Med y Med line, utilizándose como palabras clave: “lichen planus” y "dental implant". El criterio de inclusión fue de estudios en humanos con liquen plano oral a los que se les había tratado con implantes dentales osteointegrados publicados en lengua inglesa que sean observacionales, experimentales y series de casos publicados entre 1990 y 2020. Resultados: Se selecciona un total de 13 artículos, la N total de implantes fue de 362 implantes colocados en 148 pacientes. El seguimiento de los implantes es de 2 a 10 años. Hay un fracaso de 45 (12,43%) implantes, de los cuales 42 sucede en pacientes con liquen plano activo y 3 en cuadros de liquen erosivo sin especificar si está en fase activa o no. La tasa de fracaso fue mayor en las mujeres (61%) en comparación con los hombres (44%). En uno de los casos, se diagnostica carcinoma oral de células escamosas [COCE] 3 años después de la colocación del implante, lo que corresponde al 0,2% de los casos. Conclusión: el liquen plano oral es una enfermedad autoinmune que debemos tener en cuenta cuando colocamos implantes y controlar periódicamente. (AU)

Introduction: Lichenplanus is considered a chronic mucocutaneous disease, in which etiopathogenesisis considered a autoimmune disorder, with a prevalence between 0.5 and 2%. Placing dental implants in patients with this disease can change the success of the treatment. Material and Method: A search was made in the Pub Med and Med line database, using as keywords: "lichen planus" and "dental implant". The inclusion criteria was studies in humans with oral lichen planus who had been treated with osseo integrated dental implants published in English, which are observational, experimental or clinical cases published between 1990 and 2020. Results: A total of 13 articles are selected, the N of implants was 362 implants placed in 148 patients. The follow-up of the implants is from 2 to 10 years. There is a failure of 45 (12,43%) implants, of which 42 occurs in patients with active lichen planus and 3 in a erosive lichen without specifying if they are in the active phase or not. The failure rate was higher in women (61%) compared to men (44%). In one case, oral squamous cell carcinoma [OSCC] is diagnosed 3 years after implant placement, which corresponds to 0.2% of cases. Conclusion: oral lichen planus is an auto immune disease that we must take into account when we place implants and control periodically. (AU)

Incidence rate of metastases in the oral cavity: a review of all metastatic lesions in the oral cavity.

BACKGROUND: Metastases in the oral cavity are rare and account for only 1 to 3% of all malignant lesions in this area. The primary location from which most metastases have been described in the oral cavity in adult patients include lungs, breasts, kidneys and colon. MATERIAL AND METHODS: A systematic search of the literature was carried out following the PRISMA statement in PubMed database. Clinical trials and case series published in the last 10 years [2010-2020] were eligible to be selected. The headings and keywords used in the searches were "cancer" AND "oral metastases", "incidence" AND "oral metastases", "oral metastases" AND "jaw bone", "oral metastases" AND "soft tissue". RESULTS: For the study of the incidence of metastases in the oral cavity, 9 reports of clinical trials and 7 retrospective studies of case series have been included in this article. The primary locations from which more metastases have been described in the oral cavity are lungs (30.6% or 183 cases), breasts (22.2% or 133 cases), liver (15.5% or 93 cases), prostate (9 % or 54 cases), thyroid glands (8.1% or 49 cases), kidneys (7.3% or 44 cases), skin (2.3% or 14 cases), soft tissues (2% or 12 cases), colon (2% or 12 cases) and gastrointestinal (0.6% or 4 cases). These metastases have a predilection for hard tissues. The clinical presentation of these lesions varies from painless granulomatous lesions to lytic areas in the jaws. CONCLUSIONS: Although metastases in the oral cavity is an uncommon pathology, early diagnosis is needed so that in the event that it is the first manifestation, it allows the primary tumor to be diagnosed as soon as possible.

Postsurgical Prosthetic Rehabilitation after Mandibular Ameloblastoma Resection: A 7-Year Follow-Up Case Report.

Ameloblastomas are benign but locally invasive odontogenic tumors most frequently located in the mandible. The gold standard of treatment is the surgical resection of the tumor with safety margins. Postsurgical defects generate a significant morbidity that needs reconstruction and oral rehabilitation to restore the oral functions. This case report describes the prosthetic rehabilitation of a 42-year-old male after resection of a mandibular ameloblastoma. Excision of the lesion by segmental mandibulectomy and mandibular reconstruction by microvascularized fibula flap was performed. After placement of 6 dental implants, the patient was rehabilitated with a lower hybrid prosthesis fabricated using computer-aided design-computer-aided manufacturing. During a 7-year and 5-month follow-up, some clinical complications were observed.

Sífilis: manifestaciones orales, revisión sistemática / Syphilis: oral manifestations, systematic review

INTRODUCCIÓN: la sífilis es una infección bacteriana, que se puede transmitir por contacto sexual o de forma congénita. Esta enfermedad consta de tres estadios, en los cuales se pueden dar diferentes manifestaciones orales. MATERIAL Y MÉTODO: se realizó una búsqueda en la base de datos PubMed, utilizándose como palabras clave: "sexually transmitted diseases", "venereal diseases", "syphilis", "primary syphilis", "secondary syphilis", "tertiary syphilis", "oral manifestations", "oral lesions". Como criterios de inclusión se emplearon: series de casos, estudios en los que el tema principal fueran las manifestaciones orales de la sífilis y trabajos en inglés y español. No hubo restricción por fecha. RESULTADOS: se seleccionaron un total de 18 artículos, la N total de pacientes fue de 201. El 10,05% padecía sífilis primaria, el 52,76% sífilis secundaria y el 36, 68% sífilis terciaria. Las lesiones orales predominantes de la sífilis primaria fueron úlceras, inflamación, chancro sifilítico; en la sífilis secundaria se apreciaban placas mucosas, lesiones eritematosas, inflamación, lesiones papulares, lesiones maculares, lesiones erosivas; en la sífilis terciaria aparecen gomas sifilíticos, lesiones leucoplásicas y atrofia lingual. DISCUSIÓN: la sífilis es una infección bacteriana que puede simular diversas enfermedades, es muy importante tenerla en cuenta a la hora de realizar el diagnóstico diferencial de diversas lesiones orales, sobre todo aquellas que se presentan de forma ulcerosa, indurada y asintomática

INTRODUCTION: syphilis is a bacterial infection, which is transmitted by sexual contact or congenitally. This disease develops in three stages, in which different oral manifestations can occur. MATERIAL AND METHOD: a search was made in the PubMed database, using as keywords: "sexually transmitted diseases", "venereal diseases", "syphilis", "primary syphilis", "secondary syphilis", "tertiary syphilis", "Oral manifestations", "oral lesions". The inclusion criteria were: case series, studies in which the main theme was the oral manifestations of syphilis and works in English and Spanish. There was no restriction by date. RESULTS: a total of 18 articles were selected, the total sample of patients was 201. 10.05% had primary syphilis, 52.76% secondary syphilis and 36, 68% tertiary syphilis. The predominant oral lesions of primary syphilis were ulcers, inflammation, syphilitic chancre; in secondary syphilis there were mucous patches, erythematous lesions, inflammation, papular lesions, macular lesions, erosive lesions; in tertiary syphilis, syphilitic gums, leukoplastic lesions and lingual atrophy. DISCUSSION: Syphilis is a bacterial infection that can simulate various diseases, it is very important to take it into account when making the differential diagnosis of various oral lesions, especially those that occur in an ulcerative, indurated and asymptomatic form

Adherencia bacteriana en los materiales de sutura de uso habitual en cirugía bucal. Revision sistemática / Bacterial aggregation in the suture materials usually used in oral surgery. Systematic review

OBJETIVO: Demostrar la existencia de agregación bacteriana a los materiales de sutura que suelen emplearse en la práctica odontológica, comprobar si dicha agregación está relacionada con la inflamación que sucede al acto quirúrgico y por último dar recomendaciones sobre què tipo de sutura se adapta mejor para la prevención de la adherencia bacteriana. MATERIAL Y MÈTODO: Búsqueda bibliográfica a travès de las bases de datos PubMed, Cochrane y Scielo empleando las palabras clave: surgical sutures, bacterial adherence. Como criterios de inclusión se aceptaron los estudios publicados en los últimos 15 años, in vivo o in vitro en relación con la cirugía oral y con un nivel de evidencia científico superior a 3 según los criterios de evidencia científica. Fueron excluidas todas aquellas publicaciones que no tenían como objeto de estudio las sutura seda, Nylon™, Supramid™, Monocryl™, Vicryl™ o Vicryl Plus™. Tambièn se excluyeron todas aquellas publicaciones que no relacionaban los materiales de sutura a la agregación bacteriana. RESULTADOS: Un total de 9 publicaciones se organizaron en función del tipo de sutura empleada, si eran estudios in vivo o in vitro, el número de pacientes/muestras, tiempo transcurrido hasta la remoción de las suturas, si se realizaron controles, si existió algún tipo de reacción inflamatoria, que tipo de bacterias se agregaron y que material obtuvo mayor agregación. DISCUSIÓN: Los materiales de sutura que mayor acúmulo de placa bacteriana presentan bajo las mismas condiciones de tiempo de exposición a bacterias, son los de tipo multifilamento reabsorbible no tratados con antimicrobianos

OBJECTIVE: To demonstrate the existence of bacterial aggregation to the suture materials that are usually used in dental practice, to verify if aggregation is related to the inflammation that occurs after the surgical act and finally give recommendations on what type of suture is best suited for the prevention of bacterial adhesion. MATERIAL AND METHOD: Bibliographic search through PubMed, Cochrane and Scielo databases using the keywords: surgical sutures, bacterial adherence. Inclusion criteria were accepted studies published in the last 15 years, in vivo or in vitro in relation to oral surgery and with a level of scientific evidence of more than 3 according to the criteria of scientific evidence. All those publications that did not have the suture subject Silk, Nylon™, Supramid™, Monocryl™, Vicryl™ or Vicryl Plus™ were excluded. All publications that did not relate suture materials to bacterial aggregation were also excluded. RESULTS: A total of 9 publications were organized according to the type of suture used, whether they were in vivo or in vitro studies, the number of patients/samples, time elapsed until removal of the sutures, controls if they were performed, any type of inflammatory reaction, which type of bacteria were added and which material obtained greater aggregation. DISCUSSION: The suture materials with the greatest accumulation of bacterial plaque present under the same conditions of exposure to bacteria, are the reabsorbable multifilament type not treated with antimicrobials

Fractura mandibular tardía post exodoncia de molares inferiores. Caso clínico / Late mandibular fracture after lower third molar extraction: a case report

La extracción del tercer molar es un procedimiento común en cirugía oral. Una de las complicaciones es la fractura mandibular. Con una incidencia postoperatoria menor a un 0.005%. Los factores que contribuyen al riesgo de fractura del ángulo mandibular después de una extracción del tercer molar incluyen el nivel de impactación, la anatomía del diente, infecciones locales previas, edad, sexo, presencia de formaciones quísticas y bruxismo entre otras. Presentamos un caso clínico de fractura mandibular postoperatoria a las cinco semanas tras la exodoncia del 47 y 48 incluidos en posición horizontal. El objetivo final del tratamiento de una fractura mandibular es la consolidación ósea manteniendo la oclusión dental. En nuestro caso, al no tratarse de una fractura que sobrepasaba las corticales y sin desplazamiento mandibular, no fue subsidiaria de un tratamiento quirúrgico y se resolvió con reposo funcional

The lower third molar extraction is a common procedure in oral surgery. One of its complications, although uncommon, is the mandibular fracture. Postoperatively, it has an incidence lower than 0.005%. The factors that may contribute to the risk of the mandibular angle fracture after an extraction of the third molar include the level of impaction are the anatomy of the tooth, previous local infections, age, sex, cysts and bruxism among others. We present a clinical case of postoperative mandibular fracture at five weeks after the extraction of 47 and 48 included in horizontal position. The ultimate treatment goal of a mandibular fracture is to reach a bone consolidation with the premorbid dental occlusion. In our case, as it was not a fracture that surpassed the cortical and there was not a mandibular displacement, it was not need a surgical treatment so it was resolved with functional rest

Factores asociados a la malignización del liquen plano oral. Revisión de la literatura / Factors associated with the malignization of oral lichen planus. Review of the literatura

Introducción: El liquen plano (LP) es una enfermedad sistémica autoinmune de etiología desconocida y curso crónico que puede resultar en el desarrollo de carcinoma oral de células escamosas (COCE). Objetivo: Evaluar la evidencia relacionada con la malignización del LPO, así como las características clínicas y la incidencia de las lesiones que pueden desarrollan un COCE. Material y métodos: Se revisa la base de datos MEDLINE PubMed de los últimos 5 años (2013-2018) utilizando las siguientes palabras clave: "malignant transformation of oral lichen planus" and "squamous cell oral carcinoma". Resultados: Se obtuvieron 48 artículos de los cuales tras la lectura resúmenes y la aplicación de nuestros criterios de inclusión y exclusión obtuvimos un total de 19 artículos, además de los 4 artículos añadidos mediante búsqueda manual. La revisión se basa en la comparación de 9 estudios de cohortes para analizar la incidencia de la progresión de LPO a COCE. Conclusiones: Debemos considerar el LPO como una enfermedad potencialmente maligna (0.5-1%) siendo el sexo femenino, el tipo erosivo y la localización en la lengua factores de riesgo para la transformación a COCE. Teniendo en cuenta el riesgo de malignización es esencial el control de las lesiones para poder realizar un diagnóstico precoz

Introduction: Lichen planus (LP) is a systemic autoimmune disease of unknown etiology and chronic course that can result in the development of oral squamous cell carcinoma (OECD). Objective: To evaluate the evidence related to the malignization of the LPO as well as the clinical characteristics and the incidence of the lesions that can develop a COCE. Material and methods: The MEDLINE PubMed database of the last 5 years (2013-2018) was reviewed using the following keywords: "malignant transformation of oral lichen planus" and "squamous cell oral carcinoma". Results: 48 articles were obtained, after reading the summaries and applying our inclusion and exclusion criteria, we obtained a total of 19 articles, in addition to the 4 articles added by manual search. The review is based on the comparison of 9 cohort studies to analyze the incidence of progression from LPO to COCE. Conclusions: We should consider the LPO as a potentially malignant disease (0.5-1%), being the female sex, the erosive type and the localization in the tongue as a risk factors for the transformation to COCE. Taking into account the risk of malignancy, it is essential to control the lesions in order to make an early diagnosis

Medication-related osteonecrosis of the jaw associated with implant and regenerative treatments: Systematic review.

BACKGROUND: The aim of this study was to determine if the treatment with bisphosphonates other anti-resorptive and antiangiogenic agents influences the success of regenerative and / or implant treatments. MATERIAL AND METHODS: We reviewed the literature from the last 5 years in the PubMed database, using the following words: "Sinus Floor Augmentation"[Mesh] OR "Dental Implants"[Mesh]) OR "Guided Tissue Regeneration"[Mesh]) AND "Osteonecrosis"[Mesh]. The articles were selected following the inclusion and exclusion criteria and were evaluated using the 22 items of the STROBE declaration. The following PICO clinical question was applied: Does the treatment with agents associated with drug osteonecrosis influence the success of regenerative and implant treatments? RESULTS: The initial search resulted in a total of 27 articles. After eliminating those that did not refer to the topic, were duplicated or did not meet the inclusion / exclusion criteria, a full reading of the articles was made evaluating their methodological quality, obtaining six studies with high methodological quality and two with moderate. CONCLUSIONS: The literature regarding this topic is scarce, randomized clinical trials would be necessary to establish protocols relative to implant treatment in patients on antiresorptive treatments. The risk of developing an osteonecrosis associated with the regeneration / implant placement in patients with benign bone diseases is scarce, but it exists and it should not be underestimated. Especially, in the posterior areas of the jaw, if the duration of treatment with BP is greater than 3 years, and if the patient is under therapy with systemic corticosteroids.

Cutaneous, genital and oral lichen planus: A descriptive study of 274 patients.

BACKGROUND: Lichen planus (LP) is a chronic autoimmune disease that affects the oral mucosa as well as the skin, genital mucosa and other sites. OBJECTIVE: to evaluate the correlation between oral, genital and cutaneous lichen planus, in a sample of LP patients. MATERIAL AND METHODS: This descriptive study reviewed 274 clinical histories of patients, who all presented histological confirmation of lichen planus verified by a pathologist, attending research centers in Barcelona. RESULTS: A total of 40 LP patients (14.59%) presented genital lesions. Of 131 patients with cutaneous LP (47.8%), the most commonly affected zones were the body's flexor surfaces, representing 60.1% of cases. 24% of patients (n=55) related the start of the lesions with previous stress events. Of the 131 subjects with cutaneous lesions, 19% (n=25) also presented oral lichen planus (OLP). Of the total sample, 53.6% (n=147) of patients presented oral lesions. The systemic diseases most commonly associated with this patient sample were psychological problems such as stress, anxiety and depression (48%), hypertension (27%), gastric problems (12%), and diabetes (9.7%). A family history of lichen planus was found in only 2 cases (0,72%) out of the total of 274. CONCLUSIONS: Any patient with OLP should undergo a thorough history and examination to investigate potential extraoral manifestations. The fact that 37 patients with OLP in this patient series were identified with simultaneous involvement at more than one site highlights the need for thorough evaluation and multidisciplinary approaches to this disease.

Periodontal treatment on patients with cardiovascular disease: Systematic review and meta-analysis.

BACKGROUND: Atherosclerotic cardiovascular disease is the main cause of mortality in developed countries. It is a chronic and systemic inflammatory disease with a multifactorial etiology. Periodontal disease is one of the many factors that contribute to its development. OBJECTIVE: To analyze the effects of periodontal treatment on cardiovascular risk parameters in patients with atherosclerotic cardiovascular disease. METHODS: A systematic research was conducted in the Pubmed/Medline databases for clinical trials published up to and including the year 2017. RESULTS: Ten articles were included for analysis. Periodontal treatment reduced C-reactive protein levels (77.8% of clinical trials), tumor necrosis factor-alpha (66.7%), interleukin-6 (100%) and leukocytes (50%). Fibrinogen levels also improved considerably (66.7%). Effects on lipid parameters were more limited, whereby only oxidized low density lipoprotein and very low density lipoprotein cholesterol decreased significantly. Meta-analysis showed a statistically significant decreased in C-reactive protein and leukocytes values when patients were submitted to non-surgical periodontal treatment in contrast to receiving no treatment at all (mean difference 1.199 mg/L, 95% confidence interval: 1.100-1.299, p<0.001; and mean difference 0,79 g/L, 95% confidence interval: 0.717-0.879, p<0.001, respectively). CONCLUSIONS: Periodontal treatment has a beneficial effect on some of the biochemical parameters considered to represent cardiovascular risk. Further randomized clinical trials are necessary, with longer follow-up periods including regular periodic monitoring, in order to determine the extent of the impact of periodontal treatment.

Oral manifestations of Diabetes Mellitus. A systematic review.

BACKGROUND: Diabetes Mellitus has become a global epidemic and presents many complications, usually proportional to the degree and duration of hyperglycemia. The aim of this systematic review was to investigate the different oral manifestations associated with Diabetes Mellitus. MATERIAL AND METHODS: A MEDLINE search for "Diabetes Mellitus and oral manifestations" was performed. A further search was conducted for "diabetes" and its individual oral manifestation. Inclusion criteria were as follows: human clinical studies with a minimum of 30 patients; studies published in relevant scientific journals between January 1998 and January 2016. Nineteen studies fulfilled the inclusion criteria and were analyzed, assessing the strength of scientific evidence according to recommendations made by the Centre for Evidence-Based Medicine, Oxford (OCEBM), which permits adequate assessment of prevalence studies. RESULTS: A total 3,712 patients (2,084 diabetics) were included in the studies reviewed. Of the 19 studies analyzed, 4 were longitudinal studies and 15 cross-sectional studies. Periodontal disease, periapical lesions, xerostomia and taste disturbance were more prevalent among diabetic patients. An association between diabetes and caries and mucosal lesions proved positive in 5 out of 10 studies. CONCLUSIONS: Despite multiple oral manifestations associated with DM, awareness of the associations between diabetes, oral health, and general health is inadequate. It is necessary for doctors and dentists to be aware of the various oral manifestations of diabetes in order to make an early diagnosis.

Osteomyelitis of the jaw (with pathological fracture) following extraction of an impacted wisdom tooth. A case report.

Osteomyelitis is an infection and inflammation associated with the bone structures: bone marrow, cortical bone, periosteum, blood vessels and nerves. Although it does not have a frequent presentation, it can sometimes lead to complications such as pathological fractures or even septicemia. We present a clinical case study, to assess the relationship between osteomyelitis of the jaw and pathological fractures, after the extraction of an impacted wisdom tooth. This case highlights a rare complication following the surgical removal of mandibular third molar; a slow evolution of the pathology following an extraction should lead to close monitoring of the patient both clinically and radiographically, albeit osteomyelitis is a rare complication, it should be included as one of the differential diagnosis of persistent post-extraction pain.

Probiotics and oral health: A systematic review.

BACKGROUND: Probiotics are microorganisms, mainly bacteria, which benefit the host's health. Many studies support the role of probiotics as a contributor to gastrointestinal health, and nowadays many authors are trying to prove its influence in oral health maintenance. OBJECTIVES: To review the published literature with the purpose of knowing the importance of using probiotics as a preventive and therapeutic method for oral infectious diseases management. MATERIAL AND METHODS: An electronic search in PubMed database with the keywords "oral health AND probiotics AND dentistry" was conducted. The inclusion criteria were: randomized clinical trials (RCTs) that assess the action of any probiotic strain in the treatment and / or prevention of an infectious oral disease, RCTs that assess the action of any probiotic strain on counting colony forming units (CFU) of oral pathogens, systematic reviews and meta-analysis. The Jadad scale was used to assess the high quality of RCTs. RESULTS: Fifteen articles were considered for this review. Of which, 12 were RCTs of good / high quality (Jadad scale), two meta-analysis and one systematic review. CONCLUSIONS: The literature reviewed suggests probiotics usage could be beneficial for the maintenance of oral health, due to its ability to decrease the colony forming units (CFU) counts of the oral pathogens. However, randomized clinical trials with long-term follow-up periods are needed to confirm their efficacy in reducing the prevalence/incidence of oral infectious diseases. Furthermore, the recognition of specific strains with probiotic activity for each infectious oral disease is required, in order to determine exact dose, treatment time and ideal vehicles.

Inflammatory papillary hyperplasia: A systematic review.

INTRODUCTION: Inflammatory papillary hyperplasia (IPH) is a benign lesion of the palatal mucosa. It is usually found in denture-wearers but also has been reported in patients without a history of use of a maxillary prosthesis use. OBJECTIVES: The aim of this study is to review the literature to assess the prevalence of denture stomatitis and inflammatory papillary hyperplasia and the etiological factors associated. MATERIAL AND METHODS: A search was carried out in PubMed (January 2005 to October 2015) with the key words "inflammatory papillary hyperplasia", "denture stomatitis", "granular stomatitis" and "Newton's type III" The inclusion criteria were studies including at least a sample of 50 apparently healthy patients, articles published from 2005 to 2015 written in English. The exclusion criteria were reviews and non-human studies. RESULTS: Out of the 190 studies obtained initially from the search 16 articles were selected to be included in our systematic review. The prevalence of denture stomatitis was 29.56% and 4.44% for IPH. We found 5 cases of denture stomatitis among non-denture-wearer individuals. All IPH cases were associated with the use of prosthesis. Smoking and continued use of ill-fitting dentures turned out to be the most frequent risk factors for developing IPH. CONCLUSIONS: IPH is a rare oral lesion and its pathogenesis still remains unclear. Its presentation among non-denture-wearers is extremely unusual.

Correlation between periodontal disease management and metabolic control of type 2 diabetes mellitus. A systematic literature review.

BACKGROUND: Diabetes and periodontal disease share common features in terms of inflammatory responses. Current scientific evidence suggests that treatment of periodontal disease might contribute to glycemic control. The objective of the study is a review of the last three years. MATERIAL AND METHODS: A literature search was performed in the MEDLINE (PubMed), Cochrane, and Scopus databases, for articles published between 01-01-2013 and 30-06-2015, applying the key terms "periodontal disease" AND "diabetes mellitus". The review analyzed clinical trials of humans published in English and Spanish. RESULTS: Thirteen clinical trials were reviewed, representing a total of 1,912 patients. Three of them had samples of <40 patients, making a total of 108 patients and the remaining ten samples had >40 patients, representing a total of 1,804. Only one article achieved a Jadad score of five. Seven articles (998 patients, 52.3% total), presented a statistically significant decrease in HbA1c (p<0.05) as a result of periodontal treatment. In the six remaining articles (representing 914 patients, 47.8% of the total), the decrease in HbA1c was not significant. Patient follow-up varied between 3 to 12 months. In three articles, the follow-up was of 3, 4, and 9 months, in two 6 and 12 months. CONCLUSIONS: The majority of clinical trials showed that radicular curettage and smoothing, whether associated with antibiotics or not, can improve periodontal conditions in patients with diabetes mellitus. However, few studies suggest that this periodontal treatment improves metabolic control. However, there is no clear evidence of a relation between periodontal treatment and improved glycemic control in patients with type 2 diabetes mellitus.