Consideraciones bucodentales en pacientes con Síndrome de Morquio / Dental considerations of the morquio síndrome

La mucopolisacaridosis tipo IV (MPS-IV) también conocida como enfermedad de Morquio en recuerdo del pediatra uruguayo Luis Morquio que la describió por primera vez, es una enfermedad congénita causada por la deficiencia de la enzima N-acetilgalactosamina 6 sulfatasa o de la enzima B-Galactosidasa. Estas anomalías enzimáticas tienen como consecuencia que se acumulen en diferentes tejidos del organismo cantidades elevadas de mucopolisacaridos. En la bibliografía se describe con detalle los defectos del esmalte que presentan los pacientes diagnosticados del síndrome de Morquio. Estos defectos son una característica aparentemente constante en la enfermedad y, por lo tanto, hace necesaria las visitas al odontólogo para su control evitándose problemas mayores. Dichos defectos consisten en un esmalte anormalmente delgado, que es áspero debido a los numerosos hoyos diminutos y a una superficie irregular. La delgadez del esmalte da como resultado una forma alterada y decoloración de los dientes que, añadido a los diastemas interdentales, provocan alteraciones en la oclusión. Aparte de estos defectos, el esmalte es histológicamente normal y tiene una du-reza y radiodensidad normales. El trata-miento odontológico de los pacientes con MPS-IV requiere colaboración multidisciplinar, debido a que las manifestaciones orales de la enfermedad pueden aparecer a cualquier edad, resultando en ocasiones tedioso para el paciente y complicado para el profesional. Especial mención merecen las terapias utilizadas como trata-miento sintomático de la enfermedad, así como el manejo de la vía aérea en el caso de intervenciones bajo anestesia general o sedación para tratar ciertas patologías del territorio bucomaxilodental

Mucopolysaccharidosis type IV (MPS-IV) also known as Morquio’s disease in memory of the Uruguayan pediatrician Luis Morquio who described it for the first time, is a congenital disease caused by the deficiency of the enzyme N-acetylgalactosamine 6 sulfatase or enzyme B -Galactosidase. These enzymatic anomalies result in high amounts of mucopolysaccharides accumulating in different tissues of the organism. The enamel defects presented by patients diagnosed with Morquio syndrome are described in detail in the bibliography. These defects are an apparently constant feature in the disease and, therefore, make visits to the dentist necessary for their control, avoiding major problems. These defects consist of an abnormally thin enamel that is rough due to numerous tiny holes and an irregular surface. The thinness of the enamel results in an altered form and discoloration of the teeth, which added to the interdental diastemas, cause alterations in the occlusion. Apart from these defects, the enamel is histologically normal and has a normal hardness and radiodensity.Dental treatment of patients with MPS-IV requires multidisciplinary collaboration, because the oral manifestations of the disease can appear at any age, being sometimes tedious for the patient and complicated for the professional. Special mention should be made of the therapies used as a symptomatic treatment of the disease, as well as the management of the airway in the case of interventions under general anesthesia or sedation to treat certain pathologies of the bucomaxillodental territory

Epidemiological Features and Clinical Repercussions of Supernumerary Teeth in a Multicenter Study: A Review of 518 Patients with Hyperdontia in Spanish Population.

OBJECTIVES: The aim of this study was to establish the prevalence of supernumerary teeth (ST) in a sector of the population of Madrid, as well as possible complications associated with the presence of these teeth. MATERIALS AND METHODS: The study investigated patients (n = 28,114) who sought dental care at the Oral Surgery Service of three different centers between May 2005 and April 2018. Cases that did not present this numeric dental developmental variation were discarded, registering only those presenting ST. STATISTICAL ANALYSIS: Statistical analysis consisted of univariate analysis (mean, standard deviation, median, etc.), bivariate analysis applying the chi-squared test, whereby statistical significance was established with a confidence interval (CI) of 95% (p < 0.05), and multivariate analysis by means of classification and decision trees. RESULTS: The study found ST in 518 patients, representing a prevalence of 1.84%. The 518 patients presented a total of 726 ST. Distomolars were the most common, representing 37.7% of the sample, followed by premolars (20.1%). About 70.5% of the sample were located in the maxilla and 78% of ST were impacted. Radiographs revealed that 39.7% of STs were associated with disorders. Supplementary morphology appeared in 52.1% of the sample. CONCLUSIONS: Although mesiodens is considered the most common ST, the present study found distomolars and supernumerary premolars to be the most frequently occurring. Pathology was associated with 39.7% of the ST sample. 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.

Análisis densitométrico comparativo entre un nuevo biomaterial compuesto por fosfato cálcico vs. Hidroxiapatita bovina en preservació alveolar. Estudio Piloto / Comparative densitometric analysis between a new bone graft material composed by calcium phosphate vs. Bovine hydroxyapatite in alveolar ridge preservation. Pilot study

Introducción: En el presente estudio se evalúa la densidad ósea alcanzada, mediante las unidades Hounsfield, por un nuevo biomaterial, compuesto por fosfato cálcico con agregado de silicio, en comparación con la hidroxiapatita de origen bovino en la preservación alveolar pos-textracción. La preservación alveolar pos-textracción se presenta como una técnica quirúrgica dirigida a reducir el colapso del reborde alveolar tras la extracción dental mediante la utilización de un biomaterial. La finalidad del tratamiento es facilitar la posterior rehabilitación implantológica. Material y método: Se llevó a cabo un estudio sobre 6 pacientes procedentes de la Facultad de Odontología de la Universidad Complutense de Madrid a los que se les realizó la técnica de preservación alveolar postextracción. Se establecieron dos grupos: un grupo test en el que el alveolo se rellenó con fosfato cálcico con agregado de silicio y un grupo control en el que se rellenó con hidroxiapatita de origen bovino. Transcurridos 3 meses, se realizó una tomografía computerizada de haz de cono para evaluar la densidad ósea alcanzada por los biomateriales. Resultados: La densidad mineral media alcanzada en el grupo tratado con fosfato cálcico con agregado de silicio fue de 1.100,40 ± 111,19 unidades Hounsfield, mientras que en el grupo que fue tratado con hidroxiapatita de origen bovino fue de 1.029,46 ± 95,16 unidades Hounsfield. Conclusiones: Ambos biomateriales parecen presentar un comportamiento similar en cuanto a los resultados densitométricos obteniendo una densidad superior a 1.000 unidades Hounsfield, siendo el fosfato cálcico con agregado de silicio el que mayor densidad presenta

Introduction: In the present study, bone density from the new biomaterial composed by calcium phosphate and added silica is compared with bovine hydroxyapatite by means of Hounsfield units in alveolar ridge preservation. Alveolar ridge preservation is a surgical technique proposed to reduce bone resorption caused by dental extraction, using a bone graft. This technique ́s final goal is to facilitate implant insertion and rehabilitation. Materials and methods: A study was carried out on 6 patients from the Faculty of Dentistry of the Complutense University of Madrid performing the technique of alveolar ridge preservation. Two groups were established, a test group in which the alveolar socket was filled with calcium phosphate and added silica and a control group where the socket was filled with bovine hydroxyapatite. After 3 months, a cone-beam computed tomography was performed to evaluate the bone density achieved by both biomaterials. Results: The average bone density achieved in the group treated with calcium phosphate and added silica was 1100,40 ± 111,19 Hounsfield units whereas in the group treated with bovine hydroxyapatite the average bone density was 1029,46 ± 95,16 Hounsfield units. Conclusions: Both biomaterials seem to present a similar behaviour in terms of densitometric results obtaining a density greater than 1000 Hounsfield units, having the calcium phosphate and added silica the highest density

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 explora-tion, 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

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Manejo quirúrgico de la transmigración bilateral de caninos mandibulares. Reporte de caso / Surgical management of bilateral transmigration of mandibular canines. Case report

La transmigración se define como el fenómeno en el cual un diente incluido no erupcionado, traspasa en más de la mitad de su longitud la línea media. Es una anomalía poco frecuente y es aún más raro que ocurra de forma bilateral. Se presenta con mayor incidencia en los caninos mandibulares, en el sexo femenino, de forma unilateral, y siendo el canino izquierdo el más comúnmente afectado. El objetivo de este trabajo es describir el manejo quirúrgico satisfactorio en un paciente varón de 16 años, asintomático, el cual presentaba a la exploración clínica intraoral ausencia de ambos caninos mandibulares permanentes y persistencia de canino temporal inferior izquierdo, acompañado de una ligera malposición dentaria. En la exploración radiográfica (panorámica), se observaron ambos caninos inferiores derecho e izquierdo, en posición horizontal, bajo los ápices de incisivos inferiores. Se procedió a la extracción quirúrgica de ambos caninos, transcurriendo el postoperatorio sin incidencias. Se realizaron controles periódicos y radiográficos satisfactorios a los seis meses. Palabras clave: Diente impactado; Migración del diente; Diente incluido; Canino (fuente: DeCS BIREME)

Transmigration is defined as the phenomenon in which an unerupted included tooth tran-scends the midline by more than half of its length. It is a rare anomaly and it is even more rare to occur bilaterally. It is presented with greater incidence in the mandibular canines, in the female sex, unilaterally, and the left canine being the most commonly affected. The objective of this study is to describe satisfactory surgical management in a 16-year-old asymptomatic male patient, which presented to the intraoral clinical examination absence of both permanent mandibular canines and temporary biscuspid persistence. Lower left, accompanied by a slight dental malposition. In the radiographic exploration (panoramic), both right and left lower canines were observed, in a horizontal position, under the lower incisor apexes. We proceeded to the surgical extraction of both canines, passing the post-operative period without incidents. Satisfactory periodic and radiographic controls were performed at six months. Keywords: Tooth, impacted; Tooth migration; Tooth, unerupted; Cuspid (source: MeSH NLM).

Abordaje quirúrgico combinado para la desinfección y regeneración de defectos periimplantarios. A propósito de tres casos / Combined surgical treatment for the decontamination and regeneration of peri-implant defects. A three cases series

Los implantes dentales sufren una alta incidencia de mucositis y periimplantitis, que pueden llevar a su fracaso. Existen múltiples abordajes terapéuticos no quirúrgicos y quirúrgicos para estas patologías, si bien en caso de periimplantitis deberá realizarse tratamiento quirúrgico. El tratamiento quirúrgico puede ser mediante cirugía de acceso, tratamiento resectivo o regenerativo. Para lograr la remoción del biofilm y la mejora de los tejidos periimplantarios, debe realizarse siempre la descontaminación previa del implante. Para ello pueden emplearse métodos mecánicos, químicos, antibióticos o láseres. En el presente artículo se presentan tres casos clínicos en los que se empleó un abordaje quirúrgico combinado de implantoplastia, descontaminación con clorhexidina y ácido ortofosfórico, aplicación de antibiótico local (piperacilina/tazobactam) y regeneración mediante hidroxiapatita sintética y membrana reabsorbible, que ha mostrado resultados favorables concordantes con la bibliografía

Dental implants suffer a high occurrence of mucositis and peri-implantitis, which may lead to implant failure. There are several therapeutical approaches both surgical and non-surgical for the treatment of these pathologies, though in peri-implantitis lesions a surgical procedure must be conducted. Surgical treatment can be trough: access surgery, resective or regenerative surgery. In order to remove the biofilm and to improve peri-implant tissues, decontamination of implant surface must be performed beforehand. For this, mechanical, chemical, antibiotics or lasers may be employed. In this article, we present three clinical cases of combined surgical treatment by implantoplasty, chemical decontamination with clorhexidine and orthophosphoric acid, local antibiotic (piperazilin/tazobactam) and regenerative treatment with synthetic hydroxyapatite and resorbable membrane. This treatment has shown favourable results, coinciding with the results found in the literature

Consideraciones en cirugía bucal de los pacientes con enfermedad e Crohn / Considerations in oral surgery of patients with Crohn's disease

La enfermedad de Crohn es una inflamación crónica transmural de etiología desconocida que puede afectar a cualquier parte del tracto digestivo, desde la cavidad oral hasta la región anal, aunque su localización más frecuente es el íleon. El tratamiento odontológico de los pacientes requiere colaboración multidisciplinar, debido a que las manifestaciones orales de la enfermedad pueden aparecer incluso antes de que los signos intestinales. Especial mención merecen las terapias biológicas de última generación así como la corticoterapia empleada y sus repercusiones frente a cicatrización e infecciones del territorio bucal. El propósito del presente artículo es revisar las manifestaciones orales que presentan los pacientes diagnosticados de enfermedad de Crohn, así como establecer unos protocolos de actuación en la práctica odontológica, mediante el adecuado conocimiento de los diversos tratamientos que estos pacientes necesitan

Crohn's disease (C.D) is a chronic transmural inflammation of unknown etiology that can affect any part of the digestive tract, from the oral cavity to the anus, although its most frequent location is the ileum. The dental treatment of patients with C.D requires multidisciplinary collaboration, because oral manifestations of the disease may appear even before the intestinal signs. Special mention should be made of the biological therapies of last generation as well as the corticotherapy used and their repercussions against healing and infections of the oral territory. The purpose of our article is to review the oral manifestations presented by patients diagnosed with C.D, as well as to establish protocols of action in dental practice, through adequate knowledge of the various treatments that these patients need

Comparison of peri-implant soft tissues in submerged versus transmucosal healing: A split mouth prospective immunohistochemical study.

OBJECTIVE: The present split-mouth prospective study involves an immunohistochemical evaluation of peri-implant soft tissue healing after the osseointegration period, comparing submerged and transmucosal approaches using two-piece implant systems. The null hypothesis was that both surgical procedures elicit a similar immune response of the peri-implant soft tissues. DESIGN: Thirty-one healthy patients were included in this study, in which two implants were placed in the right and left maxillary pre-molar regions. A total of 62 dental implants were analyzed, establishing a control side with 31 submerged implants, and a study side with 31 exposed implants bearing healing abutments. After a three-month healing period, a soft tissue biopsy was collected and prepared for immunohistochemical analysis of the proportions of different lymphocyte subpopulations. RESULTS: The comparative analysis between the submerged and transmucosal approaches failed to identify statistically significant differences in CD19+ B cells, CD4+ T cells, CD8+ T cells, CD25+ T cells or γd T cells. However, significant differences in NK lymphocytes (p = 0.012) were recorded with the submerged surgical procedure. CONCLUSIONS: Peri-implant soft tissue immune response with submerged or transmucosal healing protocols demonstrated comparable outcomes after the osseointegration period. There is sufficient evidence that the null hypothesis of no difference cannot be rejected. To the best of our knowledge, this is the first study of its kind. Further research is therefore needed to further clarify the role of these lymphocyte subpopulations in peri-implant soft tissues.

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 (AU)

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Dental considerations in diagnosis of maxillary sinus carcinoma: A patient series of 24 cases.

BACKGROUND: Maxillary sinus carcinoma is a rare entity with an incidence of 0.2% and a low patient survival rate due to the frequency of late diagnosis. METHODS: In this multicenter, transversal, retrospective, observational study, the authors analyzed patients who had received a diagnosis of maxillary sinus carcinoma, registering their oral symptoms, histologic type, treatment efficacy, and survival rate. RESULTS: Maxillary sinus carcinoma was diagnosed in 24 patients (15 men and 9 women), of which 75% were squamous cell carcinomas. All patients had dental mobility, and some had swelling, orosinus fistula, or some dental loss. Mean patient survival rate was 38.83 months. CONCLUSIONS: A history of pain or swelling of unknown origin, an unexplained widening of periodontal ligament space, or mobility of the teeth should be considered warning signs of maxillary sinus carcinoma. PRACTICAL IMPLICATIONS: Recognition of oral symptoms by the dentist would help in making an early diagnosis of maxillary sinus carcinoma, improving the patient's chances of survival and quality of life.

Does the postoperative administration of antibiotics reduce the symptoms of lower third molar removal? A randomized double blind clinical study.

BACKGROUND: To date there is little scientific evidence that clarifies the therapeutic effect of antibiotics for managing the postoperative symptoms of impacted third molar surgery. The aim of this study was to evaluate the efficacy of antibiotic treatment for reducing non-infectious clinical symptoms. MATERIAL AND METHODS: Patient data was collected from the patients´ medical records and the results were statistically evaluated with SPSS versión 21.0; SPSS, IBM; Chicago, IL, USA). This longitudinal prospective study consisted of a randomized simple-blind clinical assay of 293 patients attending the Department of Oral Medicine and Surgery, Faculty of Dentistry at the Complutense University of Madrid (Spain). The predictive variable evaluated was the effect of antibiotic treatment on non-infectious symptoms after third molar extraction. The variables evaluated were pain, swelling, and oral aperture. RESULTS: The 293 patients were divided into 2 groups: a control group of 147 patients treated with analgesics and anti-inflammatories after surgery and a study group of 146 patients, who were also administered antibiotics. Better outcomes were observed in the study group treated with antibiotics. Pain, swelling and oral aperture variables presented better results in the antibiotic group with statistically significant difference. CONCLUSIONS: The results suggest that antibiotic administration decreases the post-operative non-infectious clinical symptoms of impacted third molar surgery. However, the prolonged administration of antibiotics had no real medical indications to justify their use and can cause serious health problems in the long term. Key words:Antibiotic, post-operative, impacted lower third molar.

Manejo odontológico del paciente con Miastenia Gravis / Dental treatment in patients with myasthenia gravis

La miastenia gravis es el trastorno neuromuscular más frecuente caracterizado por una afectación en la transmisión del impulso nervioso que repercutirá directamente en el tratamiento odontológico del paciente. Tiene gran importancia en odontología por su clínica, ya que afecta a la musculatura facial y masticatoria por lo que se deberá seguir un protocolo de actuación. El odontólogo deberá tener conocimiento de las interacciones y efectos secundarios medicamentosos para poder evitarlos durante el procedimiento, ya que estos pueden dar lugar a una crisis miasténica que acabe con la vida del paciente (AU)

Myasthenia gravis is the most common neuromuscular disorder characterized by an affection in the transmission of the nerve impulse that will directly affect the dental treatment of the patient. It is of great importance in dentistry because of its clinical manifestations, as it affects the facial and masticatory musculature, so a protocol of action should be followed. The dentist must be aware of the interactions and side effects of the medication in order to avoid them during the procedure, as these can lead to a myasthenic crisis that could kill the patient (AU)

Consideraciones odontológicas en los pacientes con Púrpura Trombocitopénica Idiopática / Dental considerations in patients with idiopathic thrombocytopenic purpura

Los trastornos de coagulación constituyen un gran inconveniente en la práctica odontológica diaria, especialmente en los cada vez más frecuentes tratamientos quirúrgicos implantológicos, por el riesgo de hemorragia. La púrpura trombocitopénica idiopática (PTI) o púrpura inmune primaria forma parte del grupo heterogéneo de enfermedades denominadas ‘raras’ y está caracterizada por una disminución temporal o persistente del recuento plaquetario. A un mayor número de sucesos hemorrágicos derivados de la PTI se añade el empleo de fármacos con una gran e importante repercusión odontológica como la ciclosporina, los anticuerpos monoclonales o los corticoides. El objetivo de este trabajo es facilitar al odontólogo las principales características de la enfermedad y las implicaciones farmacológicas relacionadas con su tratamiento a fin de dispensar una atención correcta e individualizada a cada paciente (AU)

Coagulation disorders are a major drawback in daily dental practice, more so in the increasingly frequent implant surgical treatments, because of the risk of bleeding. Idiopathic thrombocytopenic purpura (ITP) or primary immune purpura is part of the heterogeneous group of so-called ‘rare’ diseases and is characterized by a temporary or persistent decrease in platelet counts. A greater number of hemorrhagic events derived from ITP are added the use of drugs with a large and important dental impact, such as cyclosporine, monoclonal antibodies or corticosteroids. The objective of this work is to provide the dentist the main characteristics of the disease and the pharmacological implications related to its treatment in order to provide a correct and individualized care to each patient (AU)

Hemofilia y sus repercusiones en los tratamientos odontológicos de la cavidad bucal / Hemophilia and its repercussions on dental treatment of the oral cavity

La Hemofilia A y B es un trastorno congénito de la coagulación catalogada como enfermedad rara debido a su baja prevalencia. El déficit de factor VIII y IX, que caracteriza a esta patología, constituye un factor de riesgo de hemorragia en los tratamientos odontológicos, especialmente en los quirúrgicos, que es necesario prevenir y manejar por el odontólogo responsable del paciente. Sin embargo las medidas a adoptar frente a un paciente hemofílico suelen ser desconocidas por la mayoría de profesionales, lo que conlleva una atención odontológica deficiente y por ende un detrimento de la salud oral de estos pacientes. El objetivo de este trabajo es exponer de forma sintetizada y actualizada las medidas locales y generales a adoptar en el tratamiento odontológico de los pacientes hemofílicos, sin olvidar la imprescindible colaboración con el hematólogo del paciente (AU)

Hemophilia A and B is a congenital coagulation disorder classified as a rare disease due to its low prevalence. The factor VIII and IX deficiency, which characterizes this pathology, is a risk factor for excesive bleeding in dental treatments, especially in surgical procedures, which are necessary to prevent and manage by the dentist. However the measures to be taken in front of a hemophilic patient are usually unknown by most professionals, which implies poor dental care and therefore a detriment to the oral health of these patients. The aim of this paper is to present in a synthesized and updated way, local and general measures to be adopted in the dental treatment of hemophiliac patients, not forgetting the essential collaboration with the patient's hematologist (AU)