Oral Complications and Management Strategies for Cancer Patients: Principles of Supportive Oncology in Dentistry.

PURPOSE OF REVIEW: It is recognized that patients undergoing cancer treatment experience different adverse effects depending on the type of therapy they received. The objective of this work is to provide a scientific evidence-based protocol for oral care in cancer patients. Cancer resection surgery, chemotherapy, and radiotherapy can cause important complications that impact patients' quality of life. RECENT FINDINGS: Cancer patients, from the moment of diagnosis to the end of treatment and subsequent follow-up, have diverse care needs, both from a systemic and local point of view. The implementation of oral care protocols before, during, and after cancer therapy is essential because it helps to identify risk factors for the development of predictable oral complications. It is essential to establish that all cancer patients, before starting treatment, undergo a systematic dental check-up to avoid limitations during treatment and also alter their quality of life. Regular professional oral care maintenance and follow-up programs are essential to maintaining a patient's long-term oral health.

Experiences, perceptions, and decision-making capacity towards oral biopsy among dental students and dentists.

The dentist plays a crucial role in identifying oral lesions as it is their responsibility to conduct the clinical examination for diagnosing diseases in this anatomical region. Dentists should be able to perform simple oral biopsies when this procedure is necessary. However, several studies point out that dentists lack experience and perceive themselves incapable of performing biopsies. This analytical cross-sectional study aimed to assess participants' experiences and perceptions regarding a continuing education activity focused on the biopsy procedure. The secondary aim was to evaluate their ability to determine when a biopsy is indicated. The sample consisted of 228 individuals: 143 dentists and 85 undergraduate dental students who completed questionnaires related to a lecture held in May/2021, as part of the continuing educational activities of the "Red May" Project. Participants completed two questionnaires: the first assessed their experience and self-confidence in performing oral biopsies, whereas the second evaluated their capacity to define when the biopsy is indicated by means the evaluation of 10 clinical cases. The results reveal no significant difference in the percentage of correct answers between dental students and dentists. Regarding the frequency of performing the biopsy procedure, most respondents (69.7%) reported doing so rarely or never. Furthermore, while 31.6% of the participants stated that they perform biopsies depending on the case, 68.4% prefer to refer patients to specialists, such as professionals in Stomatology/Oral Medicine. These findings highlight limitations in the educational preparation of the study population concerning biopsy procedures, oral lesions, and their management. They also indicate a concerning tendency to overestimate knowledge in this area. Thus, this study emphasizes the importance of continuing education and underscores the need to revise academic curricula and provide complementary education for all dental professionals.

Oral Health and Pathologies in Migrants and Vulnerable Population and Their Social Impact: The Good Practices of the Intervention Model of a University Dental Clinic.

Numerous studies have shown the high incidence of diseases affecting oral health in vulnerable populations. The Canary Islands is a region particularly affected by the low income of its inhabitants and a high migration rate. Poor oral health habits and limited access to health care have turned these groups into risk groups. The role of the Fernando Pessoa Canarias University (CDUFPC) dental clinic in the health care of these groups has been an example of good professional practice and a fundamental resource in their health care. The present study aims to identify the profile of pathologies as well as the impact on the oral health of vulnerable population groups served by the CDUFPC. This study was developed between September 2019 and July 2022 with a sample of 878 patients, of whom 267 (30.4%) belonged to vulnerable groups referred by institutions and social organizations. The results identified the prevalence of dental caries as the main pathology and the lack of good oral habits and commitment to oral health and care.

Production of bone mineral material and BMP-2 in osteoblasts cultured on double acid-etched titanium

Background: The study of osteoblasts and their osteogenic functions is essential in order to understand them and their applications in implantology. In this sense, this study try to study BMP-2 production and bone matrix deposition, in addition to other biological variables, in osteoblasts cultured on a rough double acid-etched titanium surface (Osseotite®, Biomet 3i, Palm Beach Garden, Florida, USA) in comparison to a smooth titanium surface (machined) and a control Petri dish. Material and Methods: An in vitro prospective study. NHOst human osteoblasts from the femur were cultured on three different surfaces: Control group: 25-mm methacrylate dish (n = 6); Machined group: titanium discs with machined surface (n = 6) and Experimental group: titanium discs with a double acid-etched nitric and hydrofluoric Osseotite® acid surface (n = 6). A quantification of the mitochondrial membrane potential, and studies of apoptosis, mobility and adhesion, bone productivity (BMP-2) and cellular bone synthesis were carried out after culturing the three groups for forty-eight hours. Results: A statistically significant difference was observed in the production of BMP-2 between the experimental group and the other two groups (22.33% ± 11.06 vs. 13.10% ± 5.51 in the machined group and 3.88% ± 3.43 in the control group). Differences in cellular bone synthesis were also observed between the groups (28.34% ± 14.4% in the experimental group vs. 20.03% ± 6.79 in the machined group and 19.34% ± 15.93% in the control group). Conclusions: In comparison with machined surfaces, Osseotite® surfaces favor BMP-2 production and bone synthesis as a result of the osteoblasts in contact with it (AU)

No disponible

What Are the Histologic Effects of Surgical and Orthodontic Treatment on the Gingiva of Palatal Impacted Canines?

PURPOSE: To histologically evaluate changes in the marginal gingiva of palatal impacted maxillary canines after surgical exposure and orthodontic treatment. MATERIALS AND METHODS: A prospective case-and-control study was conducted of 10 patients presenting with bilateral palatal impaction of the maxillary canines. All patients underwent surgical exposure of the impacted canines with an open-window technique, which was followed by orthodontic treatment to achieve proper arch alignment. Once the treatment was finalized, 4 samples of marginal gingival tissue from each patient were taken for histologic study. The 4 samples consisted of 1 from each of the repositioned maxillary canines (case teeth) and 1 from each of their respective adjacent first premolars (control teeth). RESULTS: Histologic examination of the case teeth tissue samples showed microscopic changes mainly in the nonkeratinized epithelium and connective tissue, whereas changes in the keratinized epithelium remained minimal. The control teeth showed a greater inflammatory reaction in the nonkeratinized epithelium. CONCLUSION: Orthodontic treatment of impacted maxillary canines used in conjunction with an open-window surgical technique results in predictable orthodontic eruption with few periodontal discrepancies of the marginal gingiva compared with their adjacent first premolars.

Importance of Poly(lactic-co-glycolic acid) in Scaffolds for Guided Bone Regeneration: A Focused Review.

Total or partial tissue damage and loss of function in an organ are two of the most serious and costly issues in human health. Initially, these problems were approached through organ and allogenic tissue transplantation, but this option is limited by the scarce availability of donors. In this manner, new bone for restoring or replacing lost and damaged bone tissue is an important health and socioeconomic necessity. Tissue engineering has been used as a strategy during the 21st century for mitigating this need through the development of guided bone regeneration scaffold and composites. In this manner, compared with other traditional methods, bone tissue engineering offers a new and interesting approach to bone repair. The poly-α-hydroxy acids, which include the copolymers of lactic acid and glycolic acid, have been used commonly in the fabrication of these scaffolds. The objective of our article was to review the characteristics and functions of scaffold with biomedical applications, with special interest in scaffold construction using poly(lactic-co-glycolic acid) polymers, in order to update the current methods used for fabrication and to improve the quality of these scaffolds, integrating this information into the context of advancements made in tissue engineering based on these structures. In the future, research into bone regeneration should be oriented toward a fruitful exchange between disciplines involved in tissue engineering, which is coming very close to filling the gaps in our ability to provide implants and restoration of functionality in bone tissue. Overcoming this challenge will provide benefits to a major portion of the population and facilitate substantial improvements to quality of life.

Mechanical behavior of single-layer ceramized zirconia abutments for dental implant prosthetic rehabilitation.

OBJECTIVES: This study was undertaken to characterize the mechanical response of bare (as-received) and single-layer ceramized zirconia abutments with both internal and external connections that have been developed to enhanced aesthetic restorations. MATERIAL AND METHODS: Sixteen zirconia implant abutments (ZiReal Post®, Biomet 3i, USA) with internal and external connections have been analyzed. Half of the specimens were coated with a 0.5mm-thick layer of a low-fusing fluroapatite ceramic. Mechanical tests were carried out under static (constant cross-head speed of 1mm/min until fracture) and dynamic (between 100 and 400N at a frequency of 1Hz) loading conditions. The failure location was identified by electron microscopy. The removal torque of the retaining screws after testing was also evaluated. RESULTS: The average fracture strength was above 300N for all the abutments, regardless of connection geometry and coating. In most of the cases (94%), failure occurred by abutment fracture. No significant differences were observed either in fatigue behavior and removal torque between the different abutment groups. CONCLUSIONS: Mechanical behavior of Zireal zirconia abutments is independent of the type of internal/external connection and the presence/absence of ceramic coating. This may be clinically valuable in dental rehabilitation to improve the aesthetic outcome of zirconia-based dental implant systems. Key words:Dental implant, zirconia, ceramic structure, mechanical properties.

Zirconia implant abutments: microstructural analysis.

PURPOSE: Yttria-stabilized zirconia (ZrO2-Y2O3) ceramics have received increasing attention in recent years because of their stress-induced tetragonal-to-monoclinic (martensitic) transformation. This unique process acts as a toughening mechanism, imparting strength and toughness to the ceramic alloy. This property, along with well-documented biocompatibility, is now being exploited in an increasing number of medical applications, including implant dentistry. To prevent clinical problems and predict their behavior and physical limitations, a characterization of the ceramic elements used in dental restorations is essential. The aim of the present study is to characterize the crystal structure, elemental composition, and micr ostructure of asreceived ZiReal Post (Biomet 3i) zirconium oxide abutments, as well as specimens coated with a first layer of a low-fusing fluoroapatite ceramic. MATERIALS AND METHODS: Zirconium oxide abutments, both as-received and porcelain-coated, were studied using the following techniques: x-ray diffraction, x-ray fluorescence, energy dispersive x-ray spectroscopy, optical microscopy, and scanning and transmission electron microscopy. RESULTS: X-ray analyses detected only the presence of Zr, O, Y, and hafnium (Hf), in an amount of 3% to 4% molecular weight Y2O3-ZrO2. X-ray diffraction measurements showed that the ceramic abutment crystallizes mainly in the tetragonal phase, with some residual monoclinic phase. The microstructure is characterized by a rather homogenous grain distribution, formed by equiaxed and fine grains with a mean size of 0.30 Μm. CONCLUSIONS: Compositional and diffraction results are consistent with polycrystalline yttria-stabilized tetragonal zirconia. The material is susceptible to undergoing the stress-induced transformation toughening mechanism because of the very fine grain size. Except for machining ring marks, the surfaces exhibit an excellent finishing quality. No structural modifications were observed in the fluoroapatite ceramic-coated abutments because of the relatively low temperatures used for ceramization compared with the phase transformation temperatures used for zirconia.

Dental impactions related to pseudoxanthoma elasticum.

Pseudoxanthoma elasticum is a rare genetic disorder causing degeneration and calcification of elastic fibers, leading to injuries in the skin, retina, and cardiovascular system. This report describes a case of a 30-year-old woman whose diagnosis of pseudoxanthoma elasticum was confirmed after a skin biopsy. The patient presented at the Clinical Management Unit of the Department of Oral and Maxillofacial Surgery, Virgen del Rocio Hospital (Seville, Spain) with pain related to a semi-erupted lower first molar. Radiologic examination disclosed multiple dental impactions. Cases of oligodontia, amelogenesis imperfecta, and mucosal lesions related to pseudoxanthoma elasticum were found in the current literature, but there were no reports of multiple dental impactions.

Mechanical resistance of zirconium implant abutments: A review of the literature

The increase of aesthetic demands, together with the successful outcome of current implants, has renewed interestin the search for new materials with enough mechanical properties and better aesthetic qualities than the materials customarily used in implanto-prosthetic rehabilitation. Among these materials, zirconium has been used indifferent types of implants, including prosthetic abutments. The aim of the present review is to analyse current scientific evidence supporting the use of this material for the above mentioned purposes. We carried out the review of the literature published in the last ten years (2000 through 2010) of in vitro trials of dynamic and static loading of zirconium abutments found in the databases of Medline and Cochrane using the keywords zirconium abutment, fracture resistance, fracture strength, cyclic loading. Although we have found a wide variability of values among the different studies, abutments show favourable clinical behaviour for the rehabilitation of single implants in the anterior area. Such variability may be explained by the difficulty to simulate daily mastication under in vitro conditions. The clinical evidence, as found in our study, does not recommend the use of implanto-prosthetic zirconium abutments in the molar area (AU)

Use of anesthetics associated to vasoconstrictors for dentistry in patients with cardiopathies. Review of the literature published in the last decade.

OBJECTIVE: The use of local anesthetics associated to vasoconstrictor agents in dentistry is thoroughly justified and is widely extended, but we cannot ignore the fact that anesthetic infiltration poses risk of complications throughout the dental treatment period. The objective of the present review is to document the reported effects the use of the local anesthetics most widely employed in dentistry, with or without association to vasoconstrictor agents may have in patients with any sort of cardiopathy. STUDY DESIGN: We have searched for randomized clinical trials on the assessment of the cardiovascular effects of local anesthetics used in dentistry, without limits as regards age or sex, conducted in patients with any type of cardiopathy which were published during the last decade and were index-linked in Cochrane, Embase and Medline. RESULTS: We have found six randomized clinical trials index-linked in Medline and Cochrane in the past ten years. These trials compare different types of anesthetics: lidocaine 2%, mepivacaine 2%, prilocaine 2% , associated or not to different vasoconstrictor concentrations such as adrenaline or felypressin. The cardiopathies affecting the patients included in the different trials range from hypertension, ischemic heart disease, arrythmias, chronic coronary disease to heart transplantation. CONCLUSIONS: The use of anesthetics associated to vasoconstrictor agents is justified in the case of patients with cardiopathies (once we get over the period in which any type of dental manipulation is contraindicated) and in controlled hypertensive patients. In any case, we must be very careful with the choice and execution of the anesthetic technique, being it possible to use a dose between 1.8 and 3.6 ml, on a general basis. Further studies are necessary to establish the effects of these drugs on severe hypertensive patients or in patients with other more advanced cardiopathies. Key words:Vasoconstrictor agents, epinephrine/adverse effects, local anesthetics, dental restoration, oral surgery, cardiovascular diseases, coronary arteriosclerosis, heart disease, hypertension, arrhythmias, coronariopathy.