Patients with Thyroid Disorder, a Contraindication for Dental Implants? A Systematic Review.

The thyroid gland is composed of the thyroid follicles, considered to be the functional units of the thyroid gland. The synthesis of the thyroid hormones occurs in these follicles. Triiodothyronine (T3) and thyroxine (T4) are the thyroid hormones and affect metabolic processes all through the body. This systematic evaluation was performed to answer the following PICO question: "Can patients with thyroid disorders undergo dental implant rehabilitation with the same survival rate as patients without thyroid disorders?". A systematic review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements to gather available and current evidence of thyroid disorders and its relationship with dental implants. The electronic search, in the PubMed and Cochrane databases, yielded 22 articles. Out of the 22 articles, only 11 fulfilled the inclusion criteria. Manual research of the reference list yielded no additional papers. According to the SORT criteria and answering our PICO question, level B can be established to conclude that patients with thyroid disorders can be rehabilitated with dental implants, with similar survival rates as patients without thyroid disorders. Papers with higher scientific evidence and bigger sample size should be carried out.

The Application of Beta-Tricalcium Phosphate in Implant Dentistry: A Systematic Evaluation of Clinical Studies.

The demand for synthetic graft materials in implant dentistry is rising. This systematic review aims to evaluate the survival rate of dental implants placed simultaneously with bone regeneration procedures using the material ß-tricalcium phosphate, one of the most promising synthetic graft materials. The electronic search was conducted in PubMed, Scielo, and the Cochrane Central Register of Controlled Trials. Five randomized clinical trials, one non-randomized controlled clinical trial and four observational studies without control group were include. Implant survival rate and other clinical, radiographic, and histological parameters did not differ from those of implants placed simultaneously with another type of graft material, or placed in blood clots or natural alveolar ridges. Based on the available literature, ß-tricalcium phosphate seems to be a promising graft material in implant dentistry. Nevertheless, more randomized clinical trials, with long follow-up periods, preoperative and postoperative CBCT, and histological analysis, are necessary to assess its long-term behavior.

An analysis of the prevalence of peripheral giant cell granuloma and pyogenic granuloma in relation to a dental implant.

BACKGROUND: The aim of the present investigation was to evaluate the literature recurrence of peripheral giant cell granuloma and pyogenic granuloma associated with dental implants. It's important to know the characteristics present in these lesions and possible effects on the prognosis of dental implants. METHODS: An electronic search without time restrictions was done in the databases: PubMed/Medline. With the keywords "Granuloma" OR "Granuloma, Giant Cell" OR "peripheral giant cell" OR "Granuloma, Pyogenic" AND "Dental implants" OR "Oral implants". RESULTS: After applying the inclusion and exclusion criteria, a total of 20 articles were included, which reported 32 lesions (10 pyogenic granulomas, 21 peripheral giant cell granulomas and one peripheral giant cell granuloma combined with peripheral ossifying fibroma, all associated with implants). According to our review, these lesions are more frequent in males and in the posterior region of the mandible. Both excision and curettage of the lesion, compared to only excision, presented similar recurrences (40%). Explantation of the implant was performed in 41% of cases without additional recurrences. The results are not statistically significant when comparing one lesion to the other in terms of explantation (p = 0.97), recurrence (p = 0.57) or bone loss (p = 0.67). CONCLUSIONS: The main therapeutic approach is tissue excision. The lesions show a high recurrence rate (34.4%), which often requires explantation of the associated implant. This recurrence rate is not affected by curettage after excision.

Epstein-Barr Virus and Peri-Implantitis: A Systematic Review and Meta-Analysis.

The exponential growth in the use of dental implants in the last decades has been accompanied by an increase in the prevalence of peri-implant disease. It appears that viruses may have pathogenic potential for the development of this pathology. The objective of this systematic review is to study the possible association between the presence of Epstein-Barr virus and the development of peri-implantitis. An electronic search was conducted in PubMed/MEDLINE, Scielo and Embase databases for cross-sectional and case-control studies in humans published up to and including 4 January 2021. Five studies were included in the qualitative analysis. The meta-analysis did not show a statistically significant difference regarding the prevalence of Epstein-Barr virus in the peri-implant sulcus between implants with peri-implantitis and healthy implants. In conclusion, no association between the human herpesvirus 4 and peri-implantitis was found. Further research on this topic is essential to develop more effective treatments.

Survival of Dental Implants in Oncology Patients versus Non-Oncology Patients: A 5-Year Retrospective Study.

Patients with a history of cancer are increasingly common in the dental office. Treating cancer patients requires a multidisciplinary team, which should include the dentist, in order to control the complications that occur in the oral cavity and also to recover the patient undergoing treatment in any of its types: surgical, medical, radiotherapeutic, or its possible combinations. Dental implants can be a safe and predictable treatment option for prosthetic rehabilitation. The aim of this paper is to describe in retrospect the success rate of osseointegrated implants in oncology and non-oncology patients placed by the Master of Dentistry in Oncology and Immunocompromised Patients, as well as the Master of Medicine, Surgery and Oral Implantology of the University of Barcelona Dental Hospital, between July 2011 and March 2016. 466 patients were reviewed, with a total of 1405 implants placed, considering the oncological history of the patients and the implant success rate. The total success rate in the concerned period was 96.65%. When comparing cancer patients with healthy ones, the success rate has been 93.02% in the first case, and 97.16% in the latter. According to the literature review, our results encourage implant placement in cancer patients, it is important to recognize that this is an analysis of a complex care pathway with a large number of confounding variables. However, the findings should not be considered as generalizable.

Survival of dental implants in oncology patients versus non-oncology patients: a 5-year retrospective study

Abstract Patients with a history of cancer are increasingly common in the dental office. Treating cancer patients requires a multidisciplinary team, which should include the dentist, in order to control the complications that occur in the oral cavity and also to recover the patient undergoing treatment in any of its types: surgical, medical, radiotherapeutic, or its possible combinations. Dental implants can be a safe and predictable treatment option for prosthetic rehabilitation. The aim of this paper is to describe in retrospect the success rate of osseointegrated implants in oncology and non-oncology patients placed by the Master of Dentistry in Oncology and Immunocompromised Patients, as well as the Master of Medicine, Surgery and Oral Implantology of the University of Barcelona Dental Hospital, between July 2011 and March 2016. 466 patients were reviewed, with a total of 1405 implants placed, considering the oncological history of the patients and the implant success rate. The total success rate in the concerned period was 96.65%. When comparing cancer patients with healthy ones, the success rate has been 93.02% in the first case, and 97.16% in the latter. According to the literature review, our results encourage implant placement in cancer patients, it is important to recognize that this is an analysis of a complex care pathway with a large number of confounding variables. However, the findings should not be considered as generalizable.

Resumo Pacientes com histórico de câncer são cada vez mais comuns no consultório odontológico. O tratamento de pacientes com câncer requer uma equipe multidisciplinar, que deve incluir o dentista, a fim de controlar as complicações que ocorrem na cavidade oral e também para tratar o paciente com qualquer uma das modalidades de tratamento: cirúrgica, médica, radioterápica ou suas possíveis combinações. Os implantes dentários podem ser uma opção de tratamento segura e previsível para reabilitação protética. O objetivo deste artigo é propor um estudo retrospectivo sobre a taxa de sucesso de implantes osseointegrados em pacientes oncológicos e não oncológicos atendidos no Mestrado em Odontologia em Pacientes Oncológicos e Imunodeprimidos, bem como no Mestrado em Medicina, Cirurgia e Implantodontia Oral do Hospital Odontológico da Universidade de Barcelona, entre julho de 2011 e março de 2016. Foram revisados 466 pacientes, com um total de 1405 implantes instalados, considerando o histórico oncológico dos pacientes e a taxa de sucesso do implante. Resultados: A taxa de sucesso total no período em questão foi de 96,65%. Na comparação entre pacientes com câncer e saudáveis, a taxa de sucesso foi de 93,02% no primeiro caso e 97,16% no segundo. Conclusão: De acordo com a revisão da literatura, nossos resultados encorajam a colocação de implantes em pacientes com câncer, é importante reconhecer que esta é uma análise complexa que requer cuidado devido ao grande número de variáveis. No entanto, os resultados não devem ser considerados de forma generalizada.

Transoral robotic surgery vs open surgery in head and neck cancer. A systematic review of the literature

BACKGROUND: TORS has become one of the latest surgical alternatives in the treatment of oropharynx squamous cell carcinomas (OPSCC) and has become increasingly accepted by surgeons as a treatment option. Surgical robots were designed for various purposes, such as allowing remote telesurgery, and eliminating human factors like trembling. The study aimed to compare systematic review of the available literature in order to evaluate the safety and efficacy of Transoral Robotic Surgery (TORS) compared with open surgery. MATERIAL AND METHODS: We performed a systematic review of the available literature in order to evaluate the safety and effectiveness of TORS compared with open surgery. We compared TORS and open surgery based on 16 outcomes divided in to 3 groups: intraoperative complications, post-operative complications, and functional and oncologic outcomes. An electronic search of observational studies was carried out using the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Oral Health Group Trials Register, and Scielo. Data analysis was carried out in accordance to Preferred Reporting Items for Systematic Reviews and Metanalysis (PRISMA) and the quality of the studies were evaluated using the Newcastle-Ottawa Scale. No language restrictions were imposed. RESULTS: From the 4 studies identified (Newcastle-Ottawa Scale mean score 6.5), 371 patients were revised (186 patients were treated with TORS and 185 with conventional surgery). Overall, TORS, when compared with open surgery, appears to have better functional results (less hospital time, decannulation) and fewer intraoperative and post-operative complications. There is no significant difference when assessing the oncological outcomes (positive margins, survival rate) when comparing both techniques. CONCLUSIONS: TORS has an overall better functional outcome, and less intraoperative and postoperative complications with no difference in positive margins and survival rate when compared with conventional therapy

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Corticotomy in orthodontic treatment: systematic review.

OBJECTIVE: The aim of this study is to evaluate corticotomies effects to accelerate or facilitate dental movements in different kind of orthodontic treatments. DATA: This report followed the PRISMA Statement. A total of 9 articles were included in review. SOURCES: Two reviewers performed a literature search up to December 2018 in four databases: PubMed, Web of Science, Scopus and SciELO. STUDY SELECTION: Controlled clinical trials and randomized controlled clinical trials conducted in human patients and published during the last 10 years in English were eligible to be selected. The articles should give detailed information about the results and treatment parameters. There were no limitations established in terms of the type of malocclusion to be corrected or the type of orthodontic treatment performed. RESULTS: The methodological quality and evidence of the selected studies was low. Most of the studies observed a statistically significant increase in the rate of dental movement, when performing alveolar corticotomies as coadjuvants of orthodontic treatment; either with the conventional technique or with piezocision. The effect of combining corticotomy with bone grafts was assessed. CONCLUSIONS: High heterogeneity among studies made it difficult to draw clear conclusions. However, within the limitations of this review, the corticotomy procedures were able to statistically and clinically produce significant temporary decrease in orthodontic tooth movement rate. This technique does not seem to involve major complications compared to conventional orthodontic treatments. CLINICAL RELEVANCE: The use of this technique can reduce treatment time and therefore the undesirable effects associated with prolonged treatments.

Implant insertion torque and marginal bone loss: A systematic review and meta-analysis.

Purpose: The purpose of this study was to examine the possible association between implant insertion torque and marginal bone resorption. Materials and methods: Electronic and manual searches were conducted for articles published up to and including March 2020. The databases consulted were MEDLINE (PubMed), Embase, Scielo and Cochrane Library. Meta-analyses were performed to evaluate the marginal bone resorption around dental implants placed with high insertion torque values (≥ 50 Ncm) compared to marginal bone resorption around dental implants placed with low to moderate (< 50 Ncm) insertion torque values. Results: A total of five prospective studies and two randomised clinical trials were included in the qualitative analysis. Three of them were analysed quantitatively. The meta-analyses did not show a statistically significant difference between the groups at 3, 6 or 12 to 15 months. Conclusions: No association between insertion torque value and peri-implant marginal bone resorption was found. Further studies of higher methodological quality are necessary to evaluate the possible correlation.

The Application of Statins in the Regeneration of Bone Defects. Systematic Review and Meta-Analysis.

This systematic review aims to analyze the effect of the local application of statins in the regeneration of non-periodontal bone defects. A systematic study was conducted with the Pubmed/Medline, Embase, Cochrane Library and Scielo databases for in vivo animal studies published up to and including February 2019. Fifteen articles were included in the analysis. The local application of the drug increased the percentage of new bone formation, bone density, bone healing, bone morphogenetic protein 2, vascular endothelial growth factor, progenitor endothelial cells and osteocalcin. Meta-analyses showed a statistically significant increase in the percentage of new bone formation when animals were treated with local statins, in contrast to the no introduction of filling material or the introduction of polylactic acid, both in an early (4-6 weeks) and in a late period (12 weeks) (mean difference 39.5%, 95% confidence interval: 22.2-56.9, p <0.001; and mean difference 43.3%, 95% confidence interval: 33.6-52.9, p < 0.001, respectively). Basing on the animal model, the local application of statins promotes the healing of critical bone size defects due to its apparent osteogenic and angiogenic effects. However, given the few studies and their heterogenicity, the results should be taken cautiously, and further pilot studies are necessary, with radiological and histological evaluations to translate these results to humans and establish statins' effect.

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. MATERIAL AND 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

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¿Cuál es su diagnóstico? / What is your diagnosis?

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Sarcoma de Kaposi de diagnóstico intraoral / Kaposi's sarcoma intraoral diagnosis

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Inflammatory Papillary Hyperplasia in a Non-Denture-Wearing Patient: A Case History Report.

Inflammatory papillary hyperplasia (IPH) is a benign lesion of the palatal mucosa. It is usually found in denture wearers but has also been reported in dentate patients with no history of wearing maxillary prostheses. This case history report describes an example of the latter and highlights the importance of professional awareness to diagnose IPH among non-denture-wearing patients.

Intraoral lipomas: Review of literature and report of two clinical cases.

BACKGROUND: Lipomas are benign mesenchymal tumors composed of mature adipocytes. They are classified according to their histological pattern and their etiology remains unclear. Objectives: To present two cases and review the literature. MATERIAL AND METHODS: A search was conducted in the Medline / PubMed and Scielo data bases of the last 10 years (2004-2014) with the keywords " intraoral lipoma OR oral cavity lipoma". RESULTS: 46 articles with 95 cases (56 women and 39 men) were reviewed. The average age was found to be 52.28 years (52.28 ± 18.55); and most of them occurred between the 4th and 6th decade of life. Lipomas occur mostly in the buccal mucosa (n = 36, 37.9%), followed by the tongue (n = 23, 24.2%) and other locations (n = 36, 37.9%). The most common histologic pattern was simple lipomas (n = 40, 42%), followed by fibrolipomas (n = 18, 18.9%) and other types (n = 37, 39.1%). The average tumor size was 19.77 ± 16.26mm. CONCLUSIONS: Lipomas are a relatively rare finding in the oral cavity. Surgical excision is the treatment of choice and recurrence is not expected. Key words:Benign oral tumor, oral lipoma, lipoma, oral cavity.

A literature review and case report of hand, foot and mouth disease in an immunocompetent adult.

BACKGROUND: To report an uncommon case of hand, foot and mouth disease, (HFMD) in an immunocompetent adult; a highly infectious disease, characterized by the appearance of vesicles on the mouth, hands and feet, associated with coxsackieviruses and enteroviruses; including a literature review. CASE REPORT: A 23 year Caucasian male with no medical or surgical history, no allergies, was not taking any medication and smoked ten cigarettes a day, suffering from discomfort in the oral cavity; itching, burning and pain when swallowing associated with small erythematous lesions located on the hard palate, and small ulcers in tonsillar pillars and right buccal mucosa. Mild fever of 37.8 °C and general malaise. The patient reported he had had contact with a child diagnosed with HFMD. From his background and symptoms, the patient was diagnosed with HFMD. Following symptomatic treatment, the symptoms remitted in 7 days. METHODS: A literature review in MEDLINE (PubMed). The inclusion criteria were for studies on humans over the last 5 years, using the keywords HFMD. RESULTS: We found 925 articles, which were subsequently reduced to 52 documents after applying the inclusion criteria. Maculopapular lesions were found on hands and feet. CONCLUSIONS: Dentists may have a key role diagnosing the disease. A surveillance system to predict future outbreaks, encourage early diagnosis, put appropriate public health measures in place and research vaccine development is vitally important in order to control the disease.

Oral tongue squamous cell carcinoma (OTSCC): alcohol and tobacco consumption versus non-consumption. A study in a Portuguese population.

There has been an increase in the incidence of carcinoma of the tongue, particularly among alcohol and tobacco non-users. However, the number of studies that would allow a better understanding of etiological factors and clinical features, particularly in the Portuguese population, is very limited. This study was based on patients with squamous cell carcinoma of the anterior two thirds of the tongue that were treated at the Department of Head and Neck Surgery of the "Instituto Portugues de Oncologia de Lisboa - Francisco Gentil" (IPOLFG) in Lisbon, Portugal, between January 1, 2001 and December 31, 2009. The patients were divided in alcohol and tobacco users and non-users in order to evaluate the differences between these 2 groups based on gender, age, tumor location, denture use, and tumor size, metastasis and stage. Of the 354 cases, 208 were users and 146 were non-users. The main location in both groups was the lateral border of the tongue. Denture use showed no significant effect in both study groups. It was possible to conclude that patients who did not drink or smoke were older and presented with smaller tumor size, lower incidence of ganglion metastasis and lower tumor stage compared with alcohol and tobacco users.

Relationship between squamous cell carcinoma of the anterior two thirds of the tongue and removable denture use: a pioneer study in a Portuguese population.

The aim of the study was to determine whether there is any relationship between the presence of removable dentures and squamous cell carcinoma of the anterior two thirds of the tongue in a Portuguese population. A retrospective cross-sectional study was conducted on patients with a biopsy-proven diagnosis of squamous cell carcinoma of the tongue, who were seen and treated at the Department of Head and Neck Surgery of the Portuguese Institute of Oncology 'Francisco Gentil', Lisbon, Portugal, during a 3-year period. Several factors were examined: gender, use of removable dentures, age, location of the lesion, and alcohol and tobacco consumption. One hundred and six cases were selected from the initial 151 cases, with a male:female ratio of 3:1 and the lateral borders being the most commonly affected site. The prevalence in both genders was between the sixth and seventh decade of life. Men were more likely to consume alcohol and tobacco than women, and no relationship was observed between denture use and presence of carcinoma of the tongue. In light of the data obtained, it may be considered that female use of a denture plays an important role, but it cannot be identified as a remarkable etiologic factor.

Oral tongue squamous cell carcinoma (OTSCC): alcohol and tobacco consumption versus non-consumption. A study in a Portuguese population

There has been an increase in the incidence of carcinoma of the tongue, particularly among alcohol and tobacco non-users. However, the number of studies that would allow a better understanding of etiological factors and clinical features, particularly in the Portuguese population, is very limited. This study was based on patients with squamous cell carcinoma of the anterior two thirds of the tongue that were treated at the Department of Head and Neck Surgery of the “Instituto Portugues de Oncologia de Lisboa - Francisco Gentil” (IPOLFG) in Lisbon, Portugal, between January 1, 2001 and December 31, 2009. The patients were divided in alcohol and tobacco users and non-users in order to evaluate the differences between these 2 groups based on gender, age, tumor location, denture use, and tumor size, metastasis and stage. Of the 354 cases, 208 were users and 146 were non-users. The main location in both groups was the lateral border of the tongue. Denture use showed no significant effect in both study groups. It was possible to conclude that patients who did not drink or smoke were older and presented with smaller tumor size, lower incidence of ganglion metastasis and lower tumor stage compared with alcohol and tobacco users.

Um aumento do carcinoma da língua, particularmente entre os não consumidores de álcool e tabaco tem se verificado recentemente. No entanto, o número de estudos que permitam uma melhor compreensão dos fatores etiológicos e características clínicas, particularmente na população Portuguesa, é muito limitado. Este estudo foi baseado em pacientes com carcinoma de dois terços anteriores da lingual que foram atendidos e tratados no Departamento de Cabeça e Pescoço do “Instituto Portugues de Oncologia de Lisboa, Francisco Gentil” (IPOLFG), Portugal, entre 1 de janeiro de 2001 e 31 de dezembro de 2009. Eles foram divididos em usuários de álcool e tabaco e não usuários, a fim de avaliar as diferenças entre estes 2 grupos com base no sexo, idade, localização do tumor, o uso de prótese dentária, tamanho do tumor, metástase e estágio. Dos 354 casos estudados, 208 eram usuários de álcool e tabaco e 146 eram não-usuários. A localização principal, em ambos os grupos, foram a bordos laterais da língua. O uso de prótese dentária mostrou não ter um efeito significativo em ambos os grupos de estudo. Pode-se concluir que os não-usuários de álcool e tabaco eram mais velhos e apresentaram carcinoma de menores dimensões, menor incidência de metástases ganglionares e um estágio mais inicial da doença do que os etilistas e fumantes.

Relationship between squamous cell carcinoma of the anterior two thirds of the tongue and removable denture use: a pioneer study in a Portuguese population

The aim of the study was to determine whether there is any relationship between the presence of removable dentures and squamous cell carcinoma of the anterior two thirds of the tongue in a Portuguese population. A retrospective cross-sectional study was conducted on patients with a biopsy-proven diagnosis of squamous cell carcinoma of the tongue, who were seen and treated at the Department of Head and Neck Surgery of the Portuguese Institute of Oncology 'Francisco Gentil', Lisbon, Portugal, during a 3-year period. Several factors were examined: gender, use of removable dentures, age, location of the lesion, and alcohol and tobacco consumption. One hundred and six cases were selected from the initial 151 cases, with a male:female ratio of 3:1 and the lateral borders being the most commonly affected site. The prevalence in both genders was between the sixth and seventh decade of life. Men were more likely to consume alcohol and tobacco than women, and no relationship was observed between denture use and presence of carcinoma of the tongue. In light of the data obtained, it may be considered that female use of a denture plays an important role, but it cannot be identified as a remarkable etiologic factor.

O objetivo deste estudo foi determinar se existe alguma relação entre o uso de prótese removível e o carcinoma escamoso dos dois terços anteriores na população portuguesa estudada. Um estudo retrospectivo foi conduzido em paciente com diagnóstico anatomopatologico de carcinoma escamoso dos dois terços anteriores, diagnosticados no Instituto Português de Oncologia, Francisco Gentil, Lisboa desde 1 de Janeiro de 2001 até 31 de Dezembro de 2003. Diferentes fatores foram analisados: o gênero, uso de prótese removível, idade, localização, álcool e tabaco. Dos 151 casos iniciais de carcinoma, foram selecionados 106 casos mostrando numa proporção de 3:1 (masculino/feminino). Os bordos laterais foram a localização mais comum e a prevalência em ambos os sexos sitou-se entre a sexta e a sétima década. A presença de álcool e tabaco foi significativamente mais comum nos homens não se observando relação entre o uso de prótese e a presença do carcinoma na língua. Não se observou relação estatística entre o uso de prótese removível e o carcinoma escomoso dos dois terços anteriores da língua. Face aos resultados, o uso de prótese no sexo feminino desempenha um papel importante ainda que não possa ser considerado um fator etiológico significativo.