Evaluation of healing criteria for success after periapical surgery
Introduction: In periapical surgery, the absence of standardization between different studies makes it difficult to compare the outcomes. Objective: To compare the healing classification of different authors and evaluate the prognostic criteria of periapical surgery at 12 months. Material and methods: 278 patients (101 men and 177 women) with a mean age of 38.1 years (range 11 to 77) treated with periapical surgery using the ultrasound technique and a 2.6x magnifying glass, and silver amalgam as root-end filling material were included in the study. Evolution was analyzed using the clinical criteria of Mikkonen et al., 1983; radiographic criteria of Rud et al., 1972; the overall combined cli…
Analysis of the use of expansion osteotomes for the creation of implant beds. Technical contributions and review of the literature.
La atrofia ósea severa del maxilar superior compromete e incluso, en ocasiones, impide la colocación de implantes. Con la expansión ósea mediante osteodilatadores se evita usar instrumentos rotatorios, no se produce calor ni se elimina hueso y se simplifica el tratamiento quirúrgico permitiendo la colocación de fijaciones sin recurrir a tratamientos más complejos. Presentamos una revisión de la técnica de expansión maxilar mediante osteodilatadores, describiendo las principales indicaciones, ventajas e inconvenientes de este procediminiento quirúrgico. Sometimes, the severe superior maxillary atrophy compromises and even impide oral implants treatment. The use of rotatory instruments (drill…
Update in dental implant periapical surgery
La lesión periapical implantaria es una patología infecciosa-inflamatoria localizada alrededor del ápice del implante. Puede ser provocada por diversas causas, entre ellas: la contaminación en el momento de la instrumentación, el sobrecalentamiento óseo y la presencia de una patología preexistente en el hueso. Su diagnóstico es sintomático y radiográfico, y puede observarse una imagen radiolúcida alrededor del periápice. Clasificamos las lesiones según el momento evolutivo en lesión aguda (no supurada y supurada) y crónica o absceso periapical. El tratamiento de esta patología es la cirugía periapical con legrado e irrigación en la fase aguda; y la extracción del implante cuando se involucr…
Non surgical predicting factors for patient satisfaction after third molar surgery
Background: In the third molar surgery, it is important to focus not only on surgical skills, but also on patient satisfaction. Classically studies have been focused on surgery and surgeon’s empathy, but there are non-surgical factors that may influence patient satisfaction. Material and Methods: A cross-sectional study was performed on 100 patients undergoing surgical extractions of impacted mandibular third molars treated from October 2013 to July 2014 in the Oral Surgery Unit of the University of Valencia. A questionnaire (20 questions) with a 10-point Likert scale was provided. The questionnaire assessed the ease to find the center, the ease to get oriented within the center, the burocr…
Rehabilitation of severely resorbed maxillae with zygomatic implants: An update
Studies highlight the zygomatic bone as a suitable anatomical structure for implant placements since they cross four corticals. Zygomatic implants were described by Branemark in 1998, since then zygomatic implants are indicated in maxillae with atrophy of the posterior area. They have been used in systemic diseases associated with bone loss in this area, and in patients who have suffered radical surgery for maxillofacial tumors. Computed tomography is recommended before placement in order to discount any pathology of the maxillary sinus. The surgical technique has been slightly modified since its description with procedures such as the sinus slot technique. The success rate obtained by diff…
Factors that influence the position of the peri-implant soft tissues: A review
Introduction: The implantological rehabilitation of the anterior sector is one of the most demanding and complex treatments due to the necessity of obtaining an optimum esthetic result. At the level of the soft tissues, it involves obtaining the complete formation of the papilla and creating a harmonic contour of the gingival margin.Objective: A bibliographical review has been carried out on the factors that influence the final position of the soft tissues.Material and methods: A search has been carried out in the Pubmed database of articles written in English and Spanish. Articles that presented a clinical series of less than five patients and a monitoring of less than one year were exclud…
Periapical implant lesion: A systematic review.
Background The aim of this study was to systematically review the evidence for periapical implant lesion, which makes a patient more susceptible to the periapical lesion, frequency, symptoms, signs (including radiological findings) and possible treatment options. Material and Methods A systematic literature review and analysis of publications included in PubMed, Embase and Cochrane; articles published until March 2016; with a populations, exposures and outcomes (PEO) search strategy was performed, focused on the issue: “In patients with periapical lesion to the implant during the osseointegration, what symptoms, signs, and changes in complementary examination manifested, for according to th…
Failure of locoregional anesthesia in dental practice : review of the literature
Correct identification of the causes of dental anesthetic failure is essential in order to adopt the required measures for successful anesthesia. A review is made of the factors implicated in locoregional anesthesia failure, such as a bifid inferior alveolar nerve, retromolar foramen associated to accessory innervation, double or accessory mental foramen, the relation between the infiltration technique and bone density, accessory innervation in the case of the mylohyoid nerve and first cervical branches, cross innervation of the incisors, inactivity in the presence of tissue inflammation, inactive anesthetic solutions, an incorrect technique, and subjective perception on the part of particu…
Resonance frequency analysis after the placement of 133 dental implants
Introducción: La estabilidad primaria del implante dental está relacionada con el hueso que se encuentra en contacto con él y se puede medir mediante el análisis de frecuencia de resonancia. Material y métodos: En 133 implantes (62 en maxilar y 71 en mandíbula) se midió la frecuencia de resonancia y la fuerza de inserción para conocer la estabilidad de los implantes el día de la cirugía, y estudiar su relación con distintas variables. Resultados: El cociente de estabilidad del implante obtenido el día de la cirugía fue de 62’1 y el de la fuerza de inserción fue de 35’7 Nw. La fuerza de inserción fue proporcional al análisis de la frecuencia de resonancia, a mayor fuerza de inserción mayor c…
Flap repositioning versus conventional suturing in third molar surgery
Objectives: A comparative study is made of two types of flaps in semi-impacted third molar surgery and their relation to the postoperative period (pain, swelling and trismus). Material and methods: Twenty-five healthy patients were subjected to surgical extraction of both semi-impacted lower third molars, located in a similar clinical and radiographic position. In 25 cases the wound was sutured using a reflection flap (healing by first intention), while in the 25 contralateral cases the conventional technique was used (simple approximation of the wound margins). Pain, swelling and trismus were evaluated, during the first week of the postoperative period. Results: There was lesser pain, swel…
Maxillary sinus lift performed using ultrasound. Evaluation of 21 patients.
Purpose: The aim of the present study was to evaluate the sinus membrane perforations that occurred during a sinus lift procedure using the ultrasound technique, and to evaluate the bone gain obtained. Materials and methods: In 21 patients, 26 sinus lifts were performed using ultrasound and filled with bone graft material. The bone height and the bone gain obtained were observed in postoperative orthopantomographs, correcting for previous distortion. Results: Of the 26 maxillary sinus lifts, 4 Schneiderian membrane perforations were observed. The average bone height prior to the intervention was 3.5 mm (scale 0.6- 8.7 mm ) and the average postsurgical bone height was 10.8 mm (scale 7.5- 15.…
Augmentation procedures for deficient edentulous ridges, using onlay autologous grafts: an update.
The purpose of this review was to analyze publications related to augmentation procedures using autologous onlay grafts and to evaluate the survival/success rates of implants placed in the augmented areas. An automated search was made in Medline, of clinical publications from 2002 to 2007, including at least 5 patients and with a minimum follow-up of 6 months. Ten papers were included. These suggested that grafts are indicated when the height of the alveolar crest is less than 5mm, or the width less than 4mm. The surface resorption of grafts protected by guided bone regeneration membranes was less than for unprotected grafts. Calvarial grafts suffered less resorption than did iliac grafts. …
Ostectomy versus osteotomy with repositioning of the vestibular cortical in periapical surgery of mandibular molars : a preliminary study
Introduction: Accessing the tooth roots in periapical surgery (PS) requires the elimination of periapical bone. Objective: To compare the postoperative morbidity and prognosis following PS on mandibular molars by ostectomy, or by osteotomy with repositioning of the vestibular cortical. Material and Methods: A retrospective clinical study of mandibular molars subjected to PS with ultrasound. Two groups were considered according to the surgical procedure used to access the roots: Group 1 (G1) with ostectomy and Group 2 (G2) with osteotomy and repositioning of the vestibular cortical. Only patients who had properly followed the post-operative instructions, adequately completed the post-operati…