Quiste óseo solitario / No disponible

INTRODUCCIÓN: El quiste óseo solitario representa el 1% de todos los quistes maxilares. Es una lesión ósea benigna que aparece de forma fortuita en una radiografía de control en la primera/segunda década de la vida, aunque la lesión carezca de trascendencia en la vida del paciente requiere de abordaje quirúrgico para confirmar el diagnóstico. CASO CLÍNICO: Se presenta un caso clínico de una paciente mujer de 11 años de edad y raza negra, remitida al Servicio de Cirugía Bucal del Hospital Virgen de la Paloma tras observarse imagen radiotransparente apical a nivel de 43 y 44. Una vez realizada la exploración clínica y radiológica se propone cirugía exploratoria ante diagnóstico de presunción de quiste óseo solitario. Bajo anestesia local se procedió al abordaje quirúrgico observándose cavidad vacía en maxilar inferior sin contenido alguno, legrándose profusamente las paredes de la cavidad e introduciendo plasma rico en plaquetas obtenido previamente de la paciente. CONCLUSIONES: La cirugía exploratoria confirma el diagnóstico de presunción de quiste óseo solitario vacío al no poderse mandar a analizar a anatomía patológica

No disponible

Caso clínico. Diagnóstico precoz del carcinoma mucoepidermoide. A propósito de un caso clínico / Early diagnosis of mucoepidermoid carcinoma. Case report

El carcinoma mucoepidermoide (CME) se define como una neoplasia maligna epitelial de glándulas salivales, caracterizada histopatológicamente por la proliferación de células mucosecretoras, intermedias y epidermoides. Se presenta en glándulas salivales mayores como la parótida y cuando afecta a las glándulas salivales menores, el paladar es el sitio más comúnmente afectado, aunque también puede encontrarse a nivel del labio inferior, suelo de boca y trígono retromolar. El objetivo de este trabajo es describir el caso de un paciente varón de 67 años que acudió al Servicio de Cirugía del Hospital Virgen de la Paloma, presentando una lesión localizada en el trígono retromolar derecho de aproximadamente 7 meses de evolución. Su historial médico no refiere ningún antecedente personal ni familiar de especial importancia. En el examen clínico extraoral no se encontró ningún hallazgo patológico de interés, e intraoralmente presentaba una lesión tumoral con forma irregular y superficie lisa, localizada en el trígono retromolar derecho, de color rojo parduzco, de consistencia blanda y dolorosa a la palpación. Se solicitó radiografía panorámica en la cual no se observó ningún hallazgo patológico, por lo que se procedió a realizar una biopsia incisional para su estudio histopatológico. La histopatología reveló la presencia de fragmentos con una proliferación neoplásica maligna en la que se reconocen células claras de aspecto mucoso, estructuras glandulares y otras con cierta disposición quística, al igual que la presencia de placas epiteliales de aspectos epidermoides, con células intermedias y un epitelio mucoso superficial con paraqueratosis, obteniéndose finalmente un diagnóstico definitivo de CME. El CME se considera una neoplasia maligna agresiva, que obliga a dar seguimiento a cualquier lesión sospechosa para poder descartar o corroborar esta entidad

Mucoepidermoid carcinoma (MEC) is defined as a epithelial malignant neoplasm of the salivary glands, characterised histopathologically by the proliferation of mucus-secreting, intermediate and epidermoid cells.It appears in major salivary glandes such as the parotid gland and when it affects the minor salivary glands, the palate is the most commonly affected site, although it can also be found at the level of the lower lip, floor of the mouth and retromolar trigone. The objective of this paper is to describe the case of a male patient of 67 years of age who came to the surgical service, presenting a lesion located in the right retromolar trigone of approximately 7 months of evolution.His medical history does not report any personal or family background of special importance. During the extraoral clinical examination, no pathological finding of interest was found; intraorally he presented a tumoral lesion with an irregular shape and smooth surface, located in the right retromolar trigone, of a dark red colour, soft consistency and tender to touch. A panoramic x-ray was requested in which no pathological finding was observed, for which reason an incisional biopsy was performed for its histopathological study. The histology revealed the presence of fragments with a malignant neoplastic proliferation in which clear cells of a mucous appearance, glandular structures and others with a certain cystic arrangement were recognised, as well as the presence of epithelial plaques of an epidermoid appearance, with intermediate cells and superficial mucous epithelium with parakeratosis, finally obtaining a definitive diagnosis of Mucoepidermoid carcinoma MEC is considered an aggressive malignant neoplasm, which requires the monitoring of any suspicious lesion in order to be able to rule out or corroborate this entity

Manejo terapéutico de la celulitis crónica circunscrita: a propósito de un caso clínico / Therapeutic Management Of Circunscribed Chronic Cellulitis: A Case Report

La celulitis crónica circunscrita es resulta-do de la persistencia de una lesión dentaria, bacterias de baja virulencia o una antibioterapia mal planteada. Se caracteriza por la presencia de un cordón fibroso, signo patognomónico, que debe ser elimina-do junto al foco causal. La clínica es poco llamativa y puede pasar desapercibida al paciente. Sin embargo, no está exenta de un posible proceso de agudización que dificulten su posterior tratamiento o que actúen como un foco infeccioso a distancia. Se presenta un caso de un paciente de 51 años que acude a consulta exudado de contenido purulento a través de una fistula extra-oral de un año de evolución. Se realizó la extracción de los dientes involucrados y se eliminó el cordón fibroso asociado. Se plantea junto al abordaje quirúrgico una pauta antibiótica de corta duración para prevenir la aparición de resistencias basado en la evidencia científica actual

Circumscribed chronic cellulitis is the result of the persistence of a dental lesion, bacteria of low virulence or poorly raised antibiotic therapy. It has been defined by the presence of a fibrous cord, a pathognomonic sign, which must be eliminated together with the causal focus.The clinic is inconspicuous and can go unnoticed to the patient. However, it is not exempt from a possible process of exacerbation that hinders its subsequent treatment or that acts as an infectious focus at a distance. We present a case of a 51-year-old patient who included an exudate consultation of purulent content through an extra oral fistula that had been one year old. The extraction of the involved teeth was performed and the associated fibrous cord was removed. It is presented with the surgical approach, a short-term medical practice to prevent the emergence of resistance based on current scientific evidence

Clinical repercussions and epidemiological considerations of supernumerary canines: A 26 case series.

BACKGROUND: To establish the prevalence of supernumerary canines (SNC) in a sector of the population of Madrid (Spain), as well possible complications associated with this unusual developmental variation. STUDY DESIGN: This observational study was performed between 2005 and 2017, among 21,615 patients seeking dental treatment at the Faculty of Dentistry, Complutense University of Madrid (Spain), and at the Virgen de la Paloma Hospital, Madrid (Spain); 22 patients with 26 SNCs were diagnosed. These 22 patients underwent clinical and radiological exploration, registering patient data. RESULTS: SNCs presented a prevalence of 0.10% of the study population. The supernumerary teeth (SNT) were located in the upper maxilla more frequently (61.54%) than the mandible (38.46%). 69.23% were found to be impacted, also causing the impaction of the permanent canine in 53.85% of these cases. In 15.38%, follicular expansion > 3mm was observed. SNCs were associated with other SNT in only four patients. CONCLUSIONS: Despite of the fact that the SNCs are usually diagnosed casually in the course of radiological exploration, in the present study over half of them (53.85%) caused impaction of the permanent canine. Early diagnosis allows optimal patient management and treatment planning, with intervention at an appropriate time to prevent complications in development and so reduce later treatment need.

Hiloterapia como tratamiento coadyuvante en la extracción quirúrgica de terceros molares. A propósito de un caso clínico / Hilotherapy as a coadyuvant treatment in the third molar surgical extraction. A clinical case report

Introducción: La extracción de los terceros molares es una práctica habitual en la consulta odontológica. Es muy común la aparición postoperatoria de respuestas fisiológicas como el dolor, inflamación, hematomas y trismo, y cuyo tratamiento de elección sigue siendo la farmacología. La hiloterapia es un tratamiento alternativo complementario que forma parte de la medicina física terapéutica. Se trata de una unidad conectada a una máscara preformada de contorno facial que, mediante la reducción de la termperatura tisular de manera constante, persigue conseguir la disminución del flujo sanguíneo, la inflamación, el dolor y el edema. Caso clínico: Se presenta el caso clínico de una mujer de 22 años de edad, sin antecedentes médicos de interés, que acudió al Hospital Virgen de la Paloma por presentar dolor en el tercer molar inferior izquierdo. Una vez realizada la exploración clínica y radiológica de la paciente, se propuso como plan de tratamiento la extracción de los cuatro cordales, bajo anestesia general. Inmediatamente después de la cirugía se colocó a la paciente la máscara facial de Hilotherm(R), programada a una temperatura constante de 15ºC. Se revisó a las 24h y a los 8 días tras la intervención. Conclusiones: La terapia con la máscara facial Hilotherm(R) ha demostrado ser de utilidad en la disminución del dolor y la inflamación postoperatorios derivados de la extracción quirúrgica de los terceros molares, probablemente debido a la posibilidad de un control constante de la temperatura y a la mayor colaboración del paciente. No hay evidencia científica suficiente que respalde su posible participación en la reducción de hematomas. Asimismo, este sistema sugiere un aumento significativo de la calidad de vida de los pacientes, así como una buena aceptación por parte de éstos otorgando más comodidad y satisfacción

Introduction: The extraction of third molars is common practice in the dental practice. The postoperative appearance of physiological responses such as pain, inflammation, bruising and trismus is very common, for which the treatment of choice is still pharmacology. The hilotherapy is a complementary alternative treatment that is part of the therapeutic physical medicine which consists on a unit connected to a preformed face contour mask that, by constantly reducing tissue temperature, aims to achieve decreased blood flow, inflammation, pain and edema. Clinical case: A clinical case of a 22-year-old woman is presented, with no interesting medical record, who went to the Virgen de la Paloma Hospital with pain in the left lower third molar. Once the clinical and radiological examination of the patient had been carried out, a treatment plan for the extraction of the four wisdom teeth, under general anesthesia, was proposed. Immediately after the surgery, the patient was placed the facial mask of Hilotherm(R) on, programmed at a constant temperature of 15ºC. It was reviewed twice, 24h and 8 days after the intervention. Conclusions: Hilotherm(R) facial mask therapy has been shown to be useful in the reduction of postoperative pain and inflammation derived from the surgical extraction of third molars, probably due to the possibility of constant temperature control and greater patient collaboration. There is not enough scientific evidence to support its possible participation in the reduction of bruising. Likewise, this system suggests a significant increase in the quality of life of patients, as well as a good acceptance from patients, providing them with more comfort and satisfaction

Sialolitiasis Parotídea. Dificultades en el diagnóstico. Presentación de un caso clínico y revisión de la literatura / Parotid Sialolithiasis. Diagnosing complexities. Case report and literature review

Introducción: La sialolitiasis parotídea es una patología común de las glándulas salivales y puede dar lugar a atrofia glandular. Los sialolitos parotídeos son más raros que los submandibulares y su diagnóstico y tratamiento es más complejo, debido a la superposición de estructuras y a las dificultades de acceso. Caso clínico: Mujer, de 68 años, que acude con episodios inflamatorios recurrentes en la región geniana izquierda, coincidente con las comidas, y que, tras su paso por varios especialistas, acude a nuestro Servicio, en el que tras prescribir un CBCT con reconstrucción tridimensional se halla una pequeña estructura calcificada próxima a la parótida izquierda. Discusión: Los métodos de diagnóstico son variados y su utilización depende de la indicación. Entre las distintas pruebas figuran la resonancia magnética (RM), laa Tomografía Computerizada de Haz de Cono (CBCT) y la sialografía, siendo el método más eficaz de diagnóstico la combinación de estas. Los abordajes terapéuticos son diversos y dependen de multitud de factores, siendo los más utilizados la sialoendoscopia y el abordaje quirúrgico transoral. Conclusión: La sialolitiasis parotídea supone un reto, tanto diagnóstico como terapéutico, y es una situación clínica común por lo que en su tratamiento deben tenerse en cuenta muchos factores para elegir la alternativa que suponga una remoción completa del cálculo y pocas complicaciones a largo plazo

Introduction: Parotid stones are a common finding in salivary gland disorders and can lead to destruction of salivary tissue. Parotid calculi are rarer than submandibular calculi and their diagnosis and treatment are more challenging due to superimposition of hard structures and limited access. Clinical case: A female patient, 68 years old, is referred to our Service, after seeing different specialists, due to repeated inflammatory episodes of her left cheek area, which usually appear at mealtimes. After prescribing a CBCT with 3D reconstruction, a calcified structure can be seen next to the left parotid gland. Discussion: Diagnostic means are varied, and their use depends on their indication. Among diagnostic test, MRI, CBCT and sialography can be found, and usually combining them provides a more precise diagnosis. There are many therapeutical approaches, being sialoendoscopy and transoral approach the most common ones. Conclusion: Parotid sialolithiasis poses a diagnostic and therapeutic challenge, and it is a relatively common clinical situation, thus, treatment must be tailored to obtain complete stone removal and a minimum of long-term complications

Rehabilitación de atrofia posterior del maxilar con injerto de calota craneal. A propósito de un caso / Rehabilitation of posterior maxillary atrophy with calvarial graft. Case report

Introducción: La falta de volumen óseo en el maxilar es un hallazgo habitual en los pacientes que presentan pérdidas dentarias de larga duración. En la actualidad el uso de implantes es la opción más demandada para su rehabilitación, pero para ello son necesarias unas magnitudes mínimas y en los casos que no se presenten, habrá que realizar técnicas de regeneración ósea para que el tratamiento sea viable. Caso clínico: Paciente varón de 58 años de edad que acudió a Servicio de Cirugía Bucal e Implantología del Hospital Virgen de la Paloma de Madrid. Fue diagnosticado hace 7 años de enfermedad periodontal crónica del adulto; tras un periodo de abandono, regresó para la valoración de una rehabilitación completa superior. Se realizó una minuciosa exploración intraoral. Como pruebas complementarias se realizaron una radiografía panorámica y, posteriormente, un estudio tomográfico, donde se observó un insuficiente volumen óseo para el tratamiento implantológico, por lo que se planificó realizar una elevación sinusal bilateral mediante ventana con un injerto autógeno de calota combinado con plasma rico en plaquetas. Conclusiones: El tratamiento de elevación sinusal mediante ventana con injerto de calota es una opción a tener en cuenta para la rehabilitación impantológica de la arcada superior

Introduction: The lack of maxilla bone volume makes the implant treatment difficult. In order to make the implant rehabilitation possible a certain hight is required, which is not enough in this particular case. Therefore a regular sinus lift with lateral approach. Currently, the use of implants is the most demanded option for rehabilitation, but for this minimum magnitudes are necessary and in cases that do not occur, bone regeneration techniques must be performed in order for the treatment to be viable. Clinical case: Male 65 years old patient, arrived at the Oral Surgery service at the Virgen de la Paloma Hospital. No medical or family record of interest. Diagnosed seven years ago with a periodontal chronic disease. After a period of not taking care of it, he returned a few months ago with severe tooth mobility and bone loss, for a full rehabilitation valuation.A meticulous oral inspection was performed. As additional tests, a panoramic radiograph was performed as well as a tomographic test. As a result it was confirmed that the maxilla bone volume was not enough to develop any implant treatment. Therefore it was decided to perform a bilateral sinus lift via a calvarial graft mixed with plateletrich plasma at in hospital environment. Conclusion: The sinus lift treatment via craneal calvarial graft combined with platelet-rich plasma is an option to keep in mind for the full implant rehabilitation of the upper dental arch

Use of autologous tooth-derived graft material in the post-extraction dental socket. Pilot study.

BACKGROUND: The objectives of the present pilot study are to compare via CBCT the alveolar contraction suffered both vertically and horizontally between the control group and the group using autologous dental material (ADM), as well as to study the densitometric differences between both post-extraction sockets. MATERIAL AND METHODS: A split-mouth study was performed in n = 9 patients who required two extraction of single-rooted teeth deemed suitable for deferred rehabilitation with osseointegrated implants. Two groups were formed - a control group, in which the post-extraction socket was not filled, and an ADM group, in which the alveolar defect was filled with freshly processed autogenous dental material. Both dimensional and densitometric analyses of the alveoli were performed in both groups immediately after surgery (baseline), as well as 8 weeks and 16 weeks later. RESULTS: The mean height of alveolar bone loss was: VL (Control 1.77 mm, loss of 16.87% of initial alveolar height; ADM 0.42 mm, loss of 4.2% of initial alveolar height), HL-BCB (Control 2.22 mm, ADM 0.16 mm, p= 0.067 at 16 weeks). The mean bone loss of the vestibular width (VL-BCB) was much higher in the control group (1.91 mm at 1 mm, 1.3 mm at 3 mm, and 0.89 mm at 5 mm) than in the ADM group (0.46 mm at 1 mm, 0.21 mm at 3 mm, 0.01 at 5 mm, p=0.098 at 16 weeks). At 16 weeks, densitometric analysis of the coronal alveolar area revealed a bone density of 564.35 ± 288.73 HU in the control group and 922.68 ± 250.82 HU in the ADM group (p=0.045 ). CONCLUSIONS: In light of these preliminary results, autologous dentine may be considered a promising material for use in socket preservation techniques.

Masseter and temporalis muscle electromyography findings after lower third molar extraction.

BACKGROUND: The main clinical application of electromyography is to detect abnormalities in muscle function, to assess muscle activity for purposes of recruitment, and in the biomechanics of movement. OBJECTIVES: To analyze electromyography (EMG) findings for masticatory muscles during chewing following surgical extraction of lower third molars, and to determine any correlation between pain, inflammation, trismus, and the EMG data registered. MATERIAL AND METHODS: This prospective study included 31 patients. Surface EMG was used to study masseter and temporalis muscle function before lower third molar extraction and 72 hours and seven days after surgery. Clinical variables, pain, inflammation, and trismus were registered before and after surgery. RESULTS: Studying the area and size of the masticatory muscles, higher values were found for temporalis than masseter muscles, regardless of the surgical side, which points to the greater involvement of the temporalis muscle in mastication. Comparing the side where surgery had been performed with the non-surgical side, a sharp and statistically significant reduction in amplitude and area were noted on the surgical side reflecting major functional affectation. One week after surgery, amplitude and area had almost returned to base-line values, indicating almost complete recovery. While pain decreased progressively after surgery, inflammation peaked at 72 hours, while mouth opening reached a minimum at this time, returning to normality within the week. CONCLUSIONS: Surgical extraction of lower third molars produces changes to electromyography activity that are more evident during the first hours after surgery and closely related to the intensity of pain suffered and the patient's inflammatory responses, although they are not related to mouth opening capacity.

Tratamiento quirúrgico de quistes dentígeros asociados a terceros molares: presentación de dos casos clínicos y revisión de la literatura / Surgical treatment of dentigerous cysts associated to third molars: two case reports and a literature review

Introducción. El quiste dentígero es un quiste odontógeno del desarrollo de origen epitelial, siendo el más común después del radicular. Generalmente se asocia con la corona de dientes permanentes impactados o no erupcionados y su aparición es más frecuente en varones durante la segunda década de la vida. Los dientes que suelen verse más afectados son los terceros molares mandibulares, seguido de los caninos maxilares. A causa de su curso asintomático, el diagnóstico suele realizarse por hallazgo casual en radiografías panorámicas rutinarias. Para el diagnóstico definitivo es indispensable la realización de la anatomía patológica. Caso clínico. Se presenta el caso clínico de dos mujeres de 60 y 42 años de edad, sin antecedentes médicos de interés, remitidas al servicio de Cirugía Bucal del hospital Virgen de la Paloma, presentando una imagen radiográfica radiotransparente asociada a la corona del tercer molar inferior izquierdo sin sintomatología asociada. Tras realizar la extracción quirúrgica de los cordales afectados y la lesión quística asociada, se obtiene el diagnóstico definitivo mediante la anatomía patológica, posteriormente se realizan controles clínicos y radiográficos de la zona. Conclusiones. El quiste dentígero representa el segundo quiste odontógeno más frecuente después del quiste radicular en terceros molares retenidos. Es importante el examen radiográfico periódico de terceros molares incluidos para el diagnóstico y tratamiento de esta entidad patológica (AU)

Introduction. A dentigerous cyst or follicular cyst is defined as a developmental odontogenic cyst of an epitelial origin which represents the second most common entity after the radicular cyst. Generally it is associated with the crown of a permanent unerupted tooth (or semi-erupted) and it tends to be more frequent in males during the second decade of life. The most common location of dentigerous cyst are mandibular third molars followed by the maxillary canines. Due to its asymptomatic behaviour, the diagnosis is reached by routine panoramic radiography, however, the anatomopathologic analysis will define its nature. Case Report. A case report of a 42 and 60 year old females with no medical history of interest, referred to the Oral Surgery Service of the hospital Virgen de la Paloma with a radiotransparent images surrounding the crown of the lower left third molar without associated symptoms. After the extraction of the teeth, cystic lessions are sent for anatomopathological study, which confirm the presumption diagnosis, dentigerous cyst. Patients carried out posterior follow ups sho-wing a positive healing of the bone around the surgical area. Conclusions. Dentigerous cyst represents the second most frequent odontogenic cyst after the radicular cyst at mandibular third lower molars. It is essential to monitor retained mandibular lower third molars for the incipient approach of the pathology (AU)

Exodoncia en pacientes geriátricos con bifosfonatos / Extraction in geriatric patients with phosphonates

En el paciente geriátrico, resulta común la presencia de enfermedades sistémicas, lo que conlleva a un consumo de diferentes fármacos para el tratamiento de las mismas. Uno de los más frecuentes son los bifosfonatos. Por lo general, los bifosfonatos son fármacos bien tolerados si se administran correctamente, aunque en los últimos años también se han descrito diferentes efectos adversos asociados a su consumo, siendo la osteonecrosis maxilar uno de los más importantes. Desde entonces son numerosos los casos publicados en los cuales se afirma que los procedimientos quirúrgicos menores como las exodoncias podrían ser uno de los factores desencadenantes. En el caso de los bifosfonatos intravenosos, dado que el riesgo es mucho mayor, se sugiere evitar en lo posible los tratamientos quirúrgicos orales como las extracciones mientras que en los tratamientos con bifosfonatos orales no se puede contraindicar dichos tratamientos de esa manera tan categórica Ante esta situación resulta evidente la necesidad de establecer unos protocolos definitivos encaminados a la prevención y tratamiento de esta posible complicación que pudiese acontecer (AU)

In geriatric patients is common the presence of systemic diseases, leading to a use of various drugs for the treatment thereof. One of the most common are the bisphosphonates. In general, bisphosphonates are well tolerated drugs if properly managed, although in recent years have also been described different adverse effects associated with its consumption, with the maxillary osteonecrosis one of the most important. Since then are numerous reported cases in which it is stated that minor surgical procedures such as extractions could be one of the triggers. In the case of intravenous bisphosphonates, since the risk is much higher, it is suggested to avoid possible oral surgical treatments like extractions while on treatment with oral bisphosphonates may not contraindicate such treatments that so categorically. In this situation the need to establish a definitive protocols aimed at the prevention and treatment of this possible complication that could happen is obvious (AU)

Protocolos de actuación con la exodoncia en pacientes geriátricos antiagregados y anticoagulados / Clinical protocols for tooth extraction in geriatric patients treated with anticoagulants and antiplatelet drugs

El paciente geriátrico presenta un mayor riesgo cardiovascular, siendo la cardiopatía isquémica la causa más frecuente de muerte en los ancianos. Con la edad se producen ciertos cambios en la homeostasis, con un aumento de la coagulabilidad, disminución de la fibrinólisis y un aumento de la agregabilidad plaquetaria. Estos factores unidos a las alteraciones endoteliales y un mayor estasis sanguíneo, conllevan un aumento del riesgo trombótico, y la posibilidad de padecer con mayor frecuencia enfermedades cardiovasculares. El empleo de antiagregantes plaquetarios y anticoagulantes orales ha demostrado ser una terapéutica efectiva tanto en la prevención primaria como secundaria de estos accidentes trombóticos. Los procedimientos quirúrgicos, como son las extracción dentales, en pacientes con tratamiento antitrombóticos, pueden conllevar un aumento del riesgo de sangrado tanto durante su realización como en el periodo postoperatorio. Por otro lado, la supresión de la terapia antitrombótica para reducir este sangrado, puede aumentar el riesgo de desarrollar un accidente tromboembólico, con unas consecuencias fatales para la salud del paciente. La finalidad de este trabajo es revisar los principales fármacos antitrombóticos usados en el momento actual, y dar a conocer las pautas actuales a seguir en el manejo de estos pacientes cuando van a ser sometidos a una extracción dental (AU)

Geriatric patient have an increased cardiovascular risk, and ischemic heart disease is the most common cause of death in the ederly. Age results in changes in the homeostasis as increased coagulability, decreased fibrinolysis and increased platelet agreeability. These factors together with endothelial dysfunction and increased blood stasis, involve an increased thrombotic risk and the possibility of having a cardiovascular event. The use of oralanticoagulants and antiplatelet drugs has amply demonstrated its effectiveness in both primary and secondary prevention of thrombotic events. Surgical procedures, such as dental extraction, in patients with antithrombotictherapy may entail to an increased risk of bleeding during the procedure and in the postoperative period. On the other hand, the removal of these drugs in order to reduce bledeing may increase the risk of developing a thromboembolic event with fatal consequences for the patient´s health. The purpose of this paper is to review antithrombotic drugs currently used and protocols for patients on anticoagulation/antiplatelet therapy who need a dental extraction (AU)

Efficacy of platelet-rich plasma applied to post-extraction retained lower third molar alveoli. A systematic review.

UNLABELLED: Dental retentions have a high prevalence among the general population and their removal can involve multiple complications. The use of platelet rich plasma has been proposed in an attempt to avoid these complications, as it contains high growth factors and stimulates diverse biological functions that facilitate the healing of soft and hard tissues. OBJECTIVES: To evaluate the available scientific evidence related to the application of platelet-rich plasma in the post-extraction alveoli of a retained lower third molars. MATERIAL AND METHODS: A systematic review of published literature registered in the Medline, EMBASE, Cochrane and NIH databases. The following categories were included: human randomized clinical studies. Key search words were: platelet rich plasma; platelet rich plasma and oral surgery; platelet rich in growth factors and third molar. RESULTS: Of 101 potentially valid articles, seven were selected, of which four were rejected as they failed to meet quality criteria. Three studies fulfilled all selection and quality criteria: Ogundipe et al.; Rutkowski et al.; Haraji et al. The studies all measured osteoblast activity by means of sintigraphy, and also registered pain, bleeding, inflammation, temperature, numbness as perceived by the patients, radiological bone density and the incidence of alveolar osteitis. CONCLUSIONS: Scientific evidence for the use of PRP in retained third molar surgery is poor. For this reason randomized clinical trials are needed before recommendations for the clinical application of PRP can be made.

Evaluation of the anaesthetic properties and tolerance of 1:100,000 articaine versus 1:100,000 lidocaine. A comparative study in surgery of the lower third molar.

OBJECTIVES: To evaluate the anaesthetic properties and tolerance of articaine versus lidocaine at equal vasoconstrictor concentration. STUDY DESIGN: A total of 96 male and female patients who underwent surgical treatment of the lower third molar participated. Patients were randomly assigned to articaine hydrochloride with epinephrine 1:100,000 and lidocaine hydrochloride with epinephrine 1:100,000. The variables analysed were latency period, duration of anaesthetic effect, tolerance and adverse reactions. RESULTS: Both the latency period and the duration of anaesthetic effect were greater for articaine, although the differences were not statistically significant. Latency: mean difference of 2.70 ± 2.12 minutes (95%CI of -1.51 minutes - 6.92 minutes). DURATION: mean difference of -33 minutes 5 seconds ± 31 minutes (95% CI -1 hour 35 minutes - 29 minutes). There were 4 adverse events that did not require the patients to be withdrawn from the study. CONCLUSIONS: The anaesthetics in this study have very similar properties for use in surgery and have demonstrated a good safety and tolerability profile.

Immediate post-extraction implants subject to immediate loading: a meta-analytic study.

UNLABELLED: Since Brånemark first started developing its implant system, there has been a continuous and significant evolution in oral implantology through experimental and clinical research, and many of the concepts that were once considered valid have now become the subject of debate. The insertion of the implant immediately after extraction of the tooth to be substituted has now become the implant treatment of choice and is associated with preserving the bone structure and the gingival architecture, as well as with reducing the treatment time, which ultimately benefits the patient. OBJECTIVE: To evaluate the success rate of the immediate post-extraction implants (IPI) subject to immediate loading. STUDY DESIGN: A meta-analytic study was carried out on 659 immediate post-extraction implants obtained from a bibliographic review of 25 articles published within the last 9 years. RESULTS: We obtained a sample of 322 patients who had been treated with a total of 659 implants placed immediately following extraction. The mean age of the patients was 51 years old. A total of 441 implants were inserted in the maxilla, 152 in the mandible and 64 were placed in an unspecified location. The survival rate ranged between 85% and 100%. CONCLUSIONS: Immediate post-extraction implant treatment is an implant alternative with a survival rate similar to that of the conventional technique for implant placement and enables preserving both the bone structure and gingival architecture, as well as providing immediate functional loading, thus improving the quality of the treatment as far as the patient is concerned.

Occular complications following dental local anesthesia.

OBJECTIVE: To determine the frequency of appearance and the factors most commonly associated with ocular complications following dental local anesthesia, also establishing the location and type of anesthesia used. STUDY DESIGN: An indexed search in the Pubmed and Compludoc databases was carried out with the keywords "oral anesthesia", "ocular", "ophthalmologic", "damage", "complications", "injection". We established a limitation that the literature had to have been published after the year 1970. A total of 19 articles were obtained, forming a total sample of 37 patients. The patient's sex, age, nerve anesthetized, type of anesthetic used, ophthalmological complication present, recovery time, treatment and side effects were analyzed. RESULTS: There is a higher involvement of females (77%). The average age was 34.2 years. There was no preference for an anesthetic technique. Diplopia was the most common complication (65%), which coincides with the data from other authors. Almost all of the complications were of a temporary nature, with an average recovery time of 68 minutes. CONCLUSIONS: This is one of the few studies of its kind in dental literature, it thus being difficult to make precise conclusions. Ophthalmological complications are seldom a problem, diplopia being the most common among them. The authors appear to indicate an intravascular injection of the anesthetic as the cause of the problem, and therefore, it should be avoided in order to prevent accidents at the ocular level.

Meta-analytic study on the frequency and treatment of oral antral communications.

OBJECTIVE: To determine the optimum surgical treatment for oral antral communications (OAC) and to understand the main post-operative complications. STUDY DESIGN: Meta-analytical, observational and retrospective study of 1.072 cases of OAC obtained from a literature review of 15 articles. RESULTS: OAC occur slightly more often in men and during the fourth decade of life. Its primary etiological factor is dental extraction, most often affecting the third molar. The most common treatment has been the use of Bichat's fat pad grafts, whereas the technique with the highest percentage of complications has been the use of the palatal rotation flap. The most frequent complication has been the fistulization of the OAC. CONCLUSIONS: Early diagnosis of OAC and its treatment within 48 hours of evolution are fundamental in order to properly resolve this pathology. The use of Bichat's fat pad grafts is a simple technique that offers excellent vascularization and results.

Injertos sustitutos no óseos. Aportaciones del ácidopoliláctico y poliglicólico / Synthetic grafts materials. Polylactide and poliglycolide acid effects in bone regeneration

En el presente trabajo se realiza una revisión bibliográfica de los sustitutos no óseos disponibles en el mercado para mejorar y acelerar la regeneración ósea centrándonos en los polímeros de ácido poliláctico y poliglicólico por su relativa novedad para dicha aplicación. Los resultados obtenidos permiten confirmar la capacidad osteoconductora de dichos sustitutos en los procesos reparativos óseos pero a menudo también pueden actuar como barrera del proceso fisiológico de autor remodelación ósea al requerir un tiempo de reabsorción demasiado largo (AU)

The goal of the present study is to describe the non-bony sustitutes available to improve and to accelerate the bone regeneration pointing us polilactide and poliglycolide acid polymers by its relative newness for this application. The results confirm the osteoconductive capacity of this sustitutes in the bone regeneration even thought they can also be a barrier on the osseous autoremodelation of the physiological process as they need long time to be reabsorbed (AU)

Consideraciones farmacodinámicas y farmacocinéticas en los tratamientos habituales del paciente gerodontológico / Farmacocinetic and farmacodinamic considerations in habitual

En los últimos años se está produciendo un aumento progresivo de la proporción y el número de personas mayores de 65 años. La gran mayoría de estas personas padecen a menudo algún tipo de enfermedad crónica y a menudo consumen uno o varios fármacos para tratarlas o disminuir sus síntomas. Por tanto debemos estudiar los cambios que se producen en el organismo durante la edad anciana y de que manera afectan a la farmacocinética y farmacodinamia de los medicamentos más utilizados en las consultas (..) (AU)

In the last years a progressive increase of the proportion and the number of greater people of 65 years is taking place. The great majority of these people often suffers some type of chronic disease and often they consume one or several drugs to treat them or to diminish its symptoms. Therefore we must study the changes that take place in the organism during the old age and how they affect the farmacocinétic and farmacodinamic of medicines more used in our clinics (AU)

Influencia de los terceros molares retenidos en pacientes con trastornos de la articulación temporomandibular en el hospital de Madrid / Influence of the third retdined molars in patients with problems in the temporomandibular joint in the Madrid hospital

El objetivo general del presente trabajo ha sido analizar una muestra de pacientes que acudieron al Hospital de Madrid, con trastornos de la articulación temporomandibular, que presentaron inclusión de los terceros molares, comparándolas con otro grupo poblacional con trastornos de la articulación temporomandibular sin la presencia de los mismos. Materiales y Metodología: el estudio se basó en la recolección y análisis de datos de 60 historias clínicas, de pacientes con diagnóstico de trastornos de la articulación temporomandibular atendidos en el Hospital de Madrid divididos en dos grupos con presencia o no de terceros molares incluidos. A dichos grupos se les realizó un estudio comparativo de las variables utilizadas en el estudio: edad, sexo, presencia o no de dolor en la ATM, ruidos en la ATM y disminución de la máxima apertura bucal (MAB).Resultados: se realizó un estudio descriptivo y comparativo de las variables sexo, edad, presencia o ausencia de dolor en ATM, ruidos en ATM y máxima apertura oral encontrando mayor número de casos en el sexo femenino, la media de las edades oscilan entre los 40 años, en cuanto a la variable dolor en la ATM se encontró aumentada en los pacientes del grupo A, con (43,33%), con respecto a los del grupo B, (38,33%) y las variables ruidos en ATM y máxima apertura bucal se encontraron ligeramente superiores en los pacientes del grupo A (AU)

Materials and Methodology: Our study was based on the compilation and analysis of information of 60 case histories, of patients with diagnosis temporomandibular joint disorders attended in the Hospital of Madrid divided into two groups with presence or not of third included molars, to the above mentioned groups realized them a comparative study of the variables used in the study: page, sex, presence or not of pain in the TMJ, noises in the TMJ and decrease of the maximum mouth opening. Results: there was realized a descriptive and comparative study of the variables sex, age, Presence or absence of pain in ATM, Noises in ATM and Maximum oral opening finding major number of cases in the feminine sex, the average of the ages they range between 40 years, as for variable pain in the ATM was increased in the patients of the group A, with (43.33%)with regard to those of the group B, (38.33%) and variables noises in ATM and Maximum mouth opening were lightly in the patients of the group A (AU)