Software applied to oral implantology : update

Software in combination with imaging techniques is used increasingly for diagnosis, planning and treatment in oral implantology. Computer-aided surgery allows a great accuracy in implant positioning to be obtained, taking advantage of the amount of bone available and facilitating minimally invasive surgery. It is a significant aid in determining implant number, location, angle and characteristics. A CT with a radiographic template positioned in the mouth is made for the patient. Data are stored on a CD in DICOM 3 format and then introduced in the computer where implant treatment will be planned, using the chosen software. Navigation improves surgical accuracy through the aid of software bas…

Periapical surgery of maxillary posterior teeth : A review of the literature

En los últimos años, la cirugía periapical ha evolucionado gracias a la incorporación de avances diagnósticos y técnicos. El objetivo del presente artículo es realizar una revisión bibliográfica de los trabajos publicados sobre cirugía periapical en los dientes antrales; hemos revisado el Medline y las revistas españolas de Odontología desde 1974 hasta el 2003. Comentamos la anatomía del seno maxilar, el diagnóstico de las lesiones periapicales y la relación del seno maxilar con los dientes antrales; también la técnica quirúrgica, sus consideraciones especiales, y el pronóstico de la cirugía periapical en estos dientes. Los trabajos recientes plantean que la proximidad de los dientes antral…

Soft tissue integration of different abutment surfaces: An experimental study with histological analysis

OBJECTIVE To evaluate whether abutment surface and surface bio-activation have an effect on soft tissue morphogenesis. MATERIALS AND METHODS 36 patients (36 implants) were included. Abutments were randomly divided into 4 groups (n = 9): Smooth Surface-MAChined (MAC), Ultrathin Threaded Microsurface (UTM), MAC Plasma of Argon activated (Plasma-MAC), and UTM Plasma of Argon activated (Plasma-UTM). After 2 months of healing, soft tissue samples were collected and prepared for histological analysis. The margin of the peri-implant mucosa (PM), the apical extension of the barrier epithelium (aJE), and the apical location of the abutment (AM) were identified. Significances of differences among gro…

The post-endodontic periapical lesion: Histologic and etiopathogenic aspects

Apical periodontitis is produced in the majority of cases by intraradicular infection. Treatment consists in the elimination of the infectious agents by endodontia. Even when carrying out a correct cleansing and filling of canals, it is possible that periapical periodontitis will persist in the form of an asymptomatic radiolucency, giving rise to the post-endodontic periapical lesion. The chronic inflammatory periapical lesion is the most common pathology found in relation to alveolar bone of the jaw. From the histological point of view, it can be classified as chronic periapical periodontitis (periapical granuloma), radicular cyst, and as scar tissue. The most frequent is the periapical gr…

Oral rehabilitation with dental implants in patients with recessive dystrophic epidermolysis bullosa : a retrospective study with 2-15 years of follow-up

Background Epidermolysis bullosa (EB) comprises a group of hereditary disorders characterized by mechanical fragility of the skin and mucous membranes, with the development of blisters and vesicles in response to minimum tissue friction. Recessive dystrophic epidermolysis bullosa (RDEB) with generalized involvement is the most common subtype in the oral cavity. The present study was carried out to investigate dental implant survival, peri-implant tissue condition, patient satisfaction, and the impact of treatment upon the quality of life of patients with RDEB rehabilitated with implants and full-arch implant-supported prostheses. Material and Methods Thirteen patients with RDEB underwent de…

Bisphosphonates and dental implants: current problems

Osteonecrosis of the jaw has been described in patients taking bisphosphonates after oral surgery procedures, including the placement of dental implants. This review is an update of the relationship between bisphosphonates and dental implants.Results obtained by different authors are compared, contrasting earlier studies where an improvement in implant osseointegration using bisphosphonates was observed, with ones where statistically significant differences were found, and more recent studies disagreeing with the use of bisphosphonates for causing necrosis of the jaw. The differing results obtained between animal studies and the situation observed in humans may be due to a short medication …

Malignant mental nerve neuropathy : systematic review

Malignant mental neuropathy (MMN) is a neurological manifestation of cancer, characterized by the presence of hypoesthesia or anesthesia restricted to the territory of the mental branch of the mandibular nerve. A systematic review of the literature has been made on MMN, analyzing the etiology, pathogeny, clinical characteristics, complementary tests and the prognosis. Sixteen studies, providing 136 cases were selected. Breast cancer and lymphomas were the most frequently associated malignant diseases. The most frequent pathogenic mechanisms producing neurological involvement were: peripherally, mandibular lesions; and centrally, tumors at the base of the cranium. Regarding clinical characte…

An update in periapical surgery

Periapical surgery has largely improved at all levels due to new technologies provided by researchers throughout the last years. The aim of this article is to carry out a bibliographic revision of the last seven years. For this reason, we will analyse the studies published in Medline and the most important spanish dental magazines. The subjects to investigate are mainly based on the incorporation of ultrasonic root-end, which allow the performance of small and adjusted retrograde cavities; as well as the new filling materials. We also include magnifying glasses or surgical microscope to the work material, plus surgical laser and the application of guided tissue regeneration.

Quiste aneurismático mandibular

El quiste óseo aneurismático es una lesión intraósea quística, caracterizada por la presencia de espacios lagunares rellenos de sangre, asociados a una proliferación conectiva con células gigantes y tejido osteroide. Rara vez localizado en la región craneofacial y la mandíbula. Presentamos un quiste aneurismática en ángulo mandibular en un niño de 11 años. Se realizó una extirpación quirúrgica de la lesión y no hubo recurrencia en un periodo de seguimiento de tres años. Se evalúan y comparan con la literatura revisada la edad de aparición, las características clínicopatológicas, el tratamiento y los resultados quirúrgicos.

Prevalence, etiology, diagnosis, treatment and complications of supernumerary teeth

The aim of this article was to review the literature on supernumerary teeth, analyzing their prevalence, etiology, diagnosis, treatment and possible complications. An electronic search was made in the Pubmed-Medline database up to January 2014 using the key search terms "multiple supernumerary teeth" (n=279), "prevalence supernume rary teeth" (n=361), and "supernumerary teeth" (n=2412). In addition to the articles initially identified, others were included in the review proceeding from a manual search and from any references considered of relevance. Supernumerary teeth are those that exceed the normal dental formula. They are more common in men, more common in the upper maxilla, and more pr…

Actualización de la cirugía periapical en los implantes dentales

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…

Oral mucocele: review of the literature

Mucocele is a common lesion of the oral mucosa that results from an alteration of minor salivary glands due to a mucous accumulation. Mucocele involves mucin accumulation causing limited swelling. Two histological types exist - extravasation and retention. Mucoceles can appear at any site of the oral mucosa where minor salivary glands are present. Diagnosis is principally clinical; therefore, the anamnesis should be carried out correctly, looking for previous trauma. The most common location of the extravasation mucocele is the lower lip, while retention mu- coceles can be found at any other site. Mucoceles can affect the general population, but most commonly young patients (20-30 years old…

Fibromatosis paramandibular infantil. Presentación de dos casos clínicos.

Las fibromatosis de partes blandas constituyen a menudo un problema diagnóstico, especialmente dado en la edad infantil, debido al carácter celular de estos procesos, que pueden inducir a pensar en la existencia de un fibrosarcoma. Presentamos dos casos de fibromatosis orales de partes blandas paramandibulares, comentándose los hallazgos histopatológicos y los diagnósticos diferenciales planteados.

Implantes inmediatos a la exodoncia: situación actual

Los implantes inmediatos son insertados en el mismo acto quirúrgico en el cual se extrae el diente a sustituir. Su porcentaje de éxito varía según diferentes autores entre un 92,7 % y 98,0 %. Su principal indicación es la sustitución de dientes con patologías sin posibilidad de tratamiento. Entre sus ventajas, respecto a los implantes diferidos, están el disminuir la reabsorción ósea del alvéolo post-extracción, el acortar el tiempo de tratamiento rehabilitador y evitar una segunda cirugía de implantación. Como inconvenientes están el requerir, generalmente, técnicas de regeneración ósea guiada con membranas, con el riesgo de exposición e infección de la misma; y la necesidad de injertos mu…

Vestibular bone window for the extraction of impacted lower third molars : four case reports

Four patients attending for the extraction of an impacted lower third molar are reported. The aim of this paper is was to describe a technical approach, which facilitates impacted lower third molar extraction, minimizing the ostectomy, thus reducing secondary postoperative manifestations and avoiding possible periodontal defects on the distal side of the second mandibular molar. To facilitate the extraction of the crown, roots or the complete molar, a small ostectomy in the form of a window can be made in the vestibular cortical, approaching the extraction through the resultant mesial space.

Quality and readability of the dental information obtained by patients on Internet : criteria for selecting medical consultation websites

Background The main objective of this study is to examine the quality of the information available for patients online with regards to the apicoectomy surgical procedure, both on general and critically selected websites. The hypothesis is that general websites has less quality than other that have been pre-selected. Material and Methods A search for the English term "apicoectomy” was performed online. The first 100 websites that appeared in both Google and Yahoo were analysed. Seven validated instruments were used for these two dimensions: quality (DISCERN, JAMA and EQIP), and readability (FRES, Fog Scale, FKRGL and SMOG). Results A total of 21 websites (10.5%) were selected. The readabilit…

Implantes en arbotantes anatómicos del maxilar superior

El cráneo posee una serie de arbotantes de hueso denso que forman un armazón protector en torno a las múltiples cavidades craneofaciales. El tercio medio posee dos arbotantes anteriores (frontomaxilar y frontocigomático) y uno posterior (pterigomaxilar). Estos permiten, en algunas situaciones, la rehabilitación de extremos libres superiores en maxilares atróficos mediante la colocación de implantes con una angulación parasinusal, evitando así la utilización de técnicas más complejas como la elevación sinusal o la reconstrucción mediante autoinjerto. En este trabajo se ha realizado una revisión bibliográfica sobre la inserción de implantes en arbotantes anatómicos en el maxilar superior. The…

Subcutaneous emphysema resulting from surgical extraction without elevation of a mucoperiosteal skin flap

Subcutaneous emphysema, is a rare occurrence in dental practice. It is usually benign and self-limiting; nevertheless, severe consequences can result from surgical treatment. Emphysema occurs when air is injected into the subcutaneous layer of the tissue, this may come from either an air turbine handpiece or air syringe. Due to the danger of developing emphysema, procedures using compressed air are not recommended in dental extractions involving the raising of a skin flap, bone sectioning or exeresis. Two determining factors are always involved with subcutaneous emphysema. On the one hand, a compressed air procedure (air turbine handpiece, air-water syringe), and on the other, a communicati…

Effect of Laser Radiation on Infected Sites for the Immediate Placement of Dental Implants.

Objective: The study aims to evaluate the feasibility of erbium-chromium: yttrium-scandium-gallium-garnet (ErCr:YSGG 2780 nm) laser irradiation on infected and/or inflamed post-extraction sites for...

Periimplantitis marginal por sobrecarga oclusal: A propósito de un caso

En la etiología de la periimplantitis marginal se describen un factor infeccioso y otro biomecánico, por sobrecarga oclusal. Los trabajos experimentales y clínicos orientados al factor biomecánico son escasos, al igual que los estudios sobre histopatología asociada a la periimplantitis. Presentamos un caso de periimplantitis marginal en un implante de zona molar mandibular, causado por sobrecarga oclusal, que provocó un defecto óseo en la cresta marginal. El tratamiento consistió en un ajuste oclusal, el retiro quirúrgico del tejido contaminado y un injerto de hueso autógeno, lo cual difiere del tratamiento habitual en la periimplantitis infecciosa. En el análisis histológico del tejido per…

Closure of oroantral communications with Bichat's buccal fat pad. Level of patient satisfaction

Purpose: To report the closure of oroantral communications with the pedicled buccal fat pad in a series of patients, and to determine the level of patient satisfaction after the surgery. Study Design: A prospective study of patients diagnosed of unilateral or bilateral oroantral communication (OAC) closed using the buccal fat pad between May 2012 and January 2013 was performed. Data analysis extended to: age, sex, and cause, location and size of oroantral communication. Complications and success related to buccal fat pad surgery were evaluated. Also, patient satisfaction was assessed after six months of surgery. Results: Nine patients (3 men and 6 women) with a mean age of 50.5 years and 11…

Análisis del uso de los osteodilatadores para la creación del lecho implantológico: aportaciones técnicas y revisión de la literatura

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…

Actualización en el tratamiento del dolor orofacial

En los últimos años se han desarrollado nuevos tratamientos en el dolor orofacial. En la cefalea en racimos se ha incorporado la administración de nuevos fármacos por vía intranasal. En el dolor masticatorio la aplicación tópica de capsaicina y el uso de férulas orales en combinación con ejercicios de movilización mandibular, son los tratamientos más utilizados. En el dolor neurógeno se han desarrollando nuevos fármacos anticonvulsivos con menos efectos secundarios que la carbamacepina. Los últimos avances farmacológicos se dirigen hacia el uso de AINES y opioides de forma tópica y hacia la combinación de distintos analgésicos. Comentamos en este trabajo de revisión los últimos avances en e…

Estudio del dolor e inflamación en 41 pacientes tras la colocación de 131 implantes dentales

Objetivos: Estudiar el dolor y la inflamación durante la primera semana del postoperatorio tras la colocación de implantes dentales. Material y métodos: En 41 pacientes (17 hombres y 24 mujeres) se colocaron 131 implantes con anestesia local. El dolor fue valorado mediante una escala analógica-visual y verbal, y la inflamación con una escala verbal. Resultados: En la mayoría de los pacientes que tuvieron dolor, éste fue leve, y el pico mayor fue a las 6 horas de la intervención en un 41.5% de los pacientes. Existió una relación significativa entre el dolor y el número de implantes colocados. La inflamación fue moderada en la mayoría de los pacientes que tuvieron dolor, y el momento de mayor…

Immediately restored dental implants for partial-arch applications : a literature update

This article carries out a literature update on immediately restored dental implants in partially edentulous patients. A search was made in Medline of all articles published between the year 2000 and February 2007, including all articles published in both English and Spanish, in which immediate restoration of implants was made of partially edentulous areas with a minimum of 12 implants and six months follow-up. Certain decisive factors exist for the success of this technique in partially edentulous patients, such as primary stability, a roughened implant surface, and the absence of parafunctional habits in patients acceptable for this type of treatment. Following the analysis of these studi…

Dental extraction in patients rece iving dual antiplatelet therapy

Background: Dual antiplatelet therapy consists of administering antiplatelet (antiaggregant) drugs (clopidogrel and aspirin) to prevent thrombotic processes, as a preventative measure in patients with acute coronary disease, or in patients subjected to percutaneous coronary intervention. Objective: The purpose of this study was to evaluate the efficacy of a protocol for performing dental extraction in patients receiving dual antiplatelet therapy. Material and Methods: Thirty-two patients undergoing dental extractions were included in the study. The variables evaluated were: collagen-epinephrine fraction, collagen- adenosine diphosphate fraction, surgical surface, post-surgical measures, and…

Transcrestal sinus lift and implant placement using the sinus balloon technique

Objective: A description is made of transcrestal sinus lift using the sinus balloon technique, evaluating the bone height achieved and implant success one year after prosthetic loading. Material and method: Between January and July 2007, transcrestal sinus lift using the sinus balloon technique for dental implant placement was carried out in 6 patients. A panoramic X-ray study and maxillary computed tomography scan were carried out before the operation, in order to discard possible sinus pathology. During the intervention, the integrity of the sinus membrane was evaluated using a Medi Pack Pal endoscope (Farol Store and Co., Tuttlingen, Germany), and the intraoperative complications were an…

Fixed Implant-Supported Full-Arch Prosthesis in Epidermolysis Bullosa With Severe Symptoms

Tilted implants for the restoration of posterior mandibles with horizontal atrophy: An alternative treatment

Purpose Horizontal atrophy in the posterior mandible presents serious limitations on conventional implant placement. The purpose of this study was to evaluate the use of tilted implants angled in a buccolingual direction for restoring atrophic posterior mandibular sectors. Materials and Methods A cohort study was performed of 25 patients who had partial prostheses supported by more than 1 implant (≥1 tilted and 1 axial implant) to restore molar areas in the mandible. When the bone thickness was at least 5 mm, axial implants were placed; when the alveolar ridge was narrower, the implant was placed with tilted angulation. The beds for these tilted implants were prepared using a lingual approa…

Estudio del análisis de frecuencia de resonancia tras la colocación de 133 implantes dentales

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…

Injerto óseo simultáneo a la colocación de implantes: a propósito de un caso

Los defectos óseos a nivel de la cresta alveolar mandibular dificultan la colocación de los implantes dentales en el lugar idóneo. La reconstrucción quirúrgica mediante injertos de hueso autólogo es una opción que permite la fijación de los implantes de manera estética y funcional. Presentamos un paciente con grandes pérdidas óseas mandibulares, secundarias a procesos inflamatorios periodontales. Se realizó la reconstrucción del proceso alveolar mandibular, empleando injertos en bloque, tipo onlay, tomados de la mandíbula. Los injertos fueron estabilizados al colocar los implantes a través de ellos, consiguiéndose además una buena fijación primaria de los mismos. Tras dos años de seguimient…

Neuropatías trigeminales tumorales: presentación de 7 casos

Las neuropatías del trigémino de origen tumoral suponen un bajo porcentaje de las neuropatías trigeminales, pero pueden tener muy mal pronóstico. Es importante descartar una neoplasia en los pacientes con adormecimiento en el territorio del trigémino. Presentamos 7 casos de neuropatías trigeminales secundarias a tumores; en 4 existían antecedentes de neoplasias sistémicas previas y en 3 la neuropatía fue el primer signo de la enfermedad tumoral. En tres ocasiones la lesión se localizó en mandíbula, una en base de cráneo, una en troncoencéfalo, una a nivel cerebral y en una no se encontró el nivel lesional. La evolución fue muy mala en 5 pacientes; sólo se recuperó un caso en el que tras la …

Intraoral onlay block bone grafts versus cortical tenting technique on alveolar ridge augmentations: a systematic review

To review systematically the bone gain and superficial resorption rate of the onlay block bone grafts versus the cortical tenting technique, as well as secondarily study the postoperative complications, implant survival and success rates, and peri-implant marginal bone loss. Following the recommended methods for systematic reviews and meta-analyses (PRISMA), an electronic search was performed in the PubMed (MEDLINE), EMBASE and the Cochrane Library of the Cochrane Collaboration (CENTRAL) databases to identify all relevant articles published up to March 2021 on onlay block bone grafts and cortical tenting technique. Eighteen papers complied with the inclusion criteria. In onlay grafts, the v…

Influence of root width and dentin wall thickness evaluated by endoscopy upon the outcome of periapical surgery. A cohort study.

Background: An analysis was made of the correlation between root width, the thickness of the remaining dentinal wall as determined by endoscopy, and the outcome of periapical surgery. Material and Methods: A retrospective cohort study was carried out involving patients subjected to periapical surgery between 2017 and 2019 at the University of Valencia (Valencia, Spain). One year after surgery, cone-beam computed tomography (CBCT) was used to evaluate healing against the preoperative volumes. The maximum root width was measured on the postoperative CBCT scan at the apical section of the treated root. This measurement was transferred to the intraoperative endoscopic image, where the minimum r…

Bone necrosis around dental implants: a patient treated with oral bisphosphonates, drug holiday and no risk according to serum CTX

Osteonecrosis of the jaw (ONJ) may appear following certain oral surgery procedures in patients treated with oral bisphosphonates (OB). Guidelines for the treatment of these patients were set out in the American Association of Oral and Maxillofacial Surgeons (AAOMS) Position Paper on Bisphosphonate-Related Osteonecrosis of The Jaws (Position Paper) and Approved by the Board of Trustees in September 2006. For the AAOMS the placement of implants in these patients is not contraindicated. In addition, the serum C-terminal telopeptide bone suppressor marker (CTX) test is available to determine the risk of ONJ. A case is presented of ONJ in a patient with 6 months of OB discontinuation ('drug hol…

Clinical practice guidelines: Oral health care for children and adults living with epidermolysis bullosa.

Background Inherited epidermolysis bullosa (EB) is a genetic disorder characterized by skin fragility and unique oral features. Aims To provide (a) a complete review of the oral manifestations in those living with each type of inherited EB, (b) the current best practices for managing oral health care of people living with EB, (c) the current best practices on dental implant-based oral rehabilitation for patients with recessive dystrophic EB (RDEB), and (d) the current best practice for managing local anesthesia, principles of sedation, and general anesthesia for children and adults with EB undergoing dental treatment. Methods Systematic literature search, panel discussion including clinical…

Single-blind randomized clinical trial to evaluate clinical and radiological outcomes after one year of immediate versus delayed implant placement support

Purpose: To evaluate and compare peri-implant health, marginal bone loss and success of immediate and delayed implant placement for rehabilitation with full-arch fixed prostheses. Material and Methods: The present study was a prospective, randomized, single-blind, clinical preliminary trial. Patients were randomized into two treatment groups. In Group A implants were placed immediately post-extrac - tion and in Group B six months after extraction. The following control time-points were established: one week, six months and twelve months after loading. Measurements were taken of peri-implant crevicular fluid volume, plaque index, gingival retraction, keratinized mucosa, probing depth, modifi…

Cirugía Bucal, 013, implantes grandes atrofias

Se presenta una guía simplificada del tratamiento con implantes dentales en pacientes con grandes atrofias.Producción: CIRUBUCA;

Guía de los implantes dentales

Se presenta una guía simplificada de la planificación en el tratamiento con implantes dentales.Producción: CIRUBUCA;