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Background: Oral antiplatelet and anticoagulant drugs are widely used in a large number of patients visiting the dentist, and there has been much controversy over the years towards their clinical management. The aim to carry out a literature review in order to develop an update on dental management in anticoagulated and / or anti aggregated patients, focusing on oral surgery. Material and methods: A bibliographic search was carried out in PubMed on studies published between January 1, 2018, until December 10, 2020, using the keywords ('antiplatelet' OR 'antiplatelets') AND ('dentistry'), and ('anticoagulant' OR 'anticoagulants') AND ('dentistry'). Results: The number of studies included in this review was 13, and the number of patients among all of them was 3.497 patients under treatment with some type of antithrombotic drug, who underwent different oral surgery treatments. Conclusions: There is a low risk of peri- and postoperative bleeding events during basic oral surgery treatments in antiplatelet or anticoagulated patients, which can be easily managed through the use of local haemostatic measures. Keywords: Oral surgery, antiplatelet drugs, anticoagulant drugs, dental treatment.

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 root width, peripheral dentin thickness, and minimum dentin thickness were recorded. Root measurements, and the position (maxillary or mandibular) and type of tooth (roots of incisors, canines, premolars or molars) were further correlated to periapical surgery outcome. Results: A total of 51 patients, comprising 52 teeth and 62 roots, were included in the study. The mean measurements were: maximum root width (4.13 +/- 0.84 mm), minimum root width (2.46 +/- 0.72 mm), peripheral dentin thickness (0.77 +/- 0.2 mm) and minimum dentin thickness (0.4 +/- 0.2 mm). The success rate was 82.2%. Premolar roots showed a greater minimum dentin thickness (0.58 +/- 0.25 mm) ( p

Background Eruption disturbances of permanent molars are uncommon; however, it is important to treat them as soon as they are diagnosed. The main objective was to analyze the effectiveness of the “miniscrew-supported pole technique,” a surgically assisted orthodontic procedure to force the eruption of impacted/retained second molars (M2s) when there are indicators of complex molar inclusion. An observational prospective study was carried out during a 2-year period. Sociodemographic, clinical and low-dose scanner variables were taken at baseline (T0). Follow-up variables (T1) were the time between surgery and tooth eruption, radiographic measurements, debonding of buttons, failure rate of miniscrews and success rate of eruption. Results A total of 21 patients (mean age of 13.9 years) with 24 retained/impacted M2s were recruited; 13 molars were maxillary (54.2%) and 11 (45.8%) were mandibular. Six (25%) were impacted molars and 18 (75%) primarily retained. At T0, molar angulation was mesial in six molars (25%), distal in five molars (20.8%) and 13 molars were vertically positioned (54.2%). Infraocclusion degree was moderate in four (16.7%) molars and severe in 20 (83.3%). Only three (12.5%) third molars were removed due to lack of space. All M2s managed to erupt, achieving a success rate of 100%; however, two molars of the same patient did not achieve occlusion. The period of eruption after surgery was 126.8 (117.3) days. Anatomical radicular alteration was the only variable independently related to a longer time of treatment (p = 0.027). Conclusions The pole technique, using one mesial miniscrew and simple orthodontic mechanics, applies forces that succeed in erupting complicated retained/impacted M2s in a short period of time and with a low failure rate.

Background The aim of the present review was evaluate the utility and validity of the Bispectral Index (BIS) in dental treatment carried out under endovenous sedation, and compare its efficacy with clinical sedation scales. Material and Methods Electronic and manual literature searches were conducted by two independent reviewers for articles published up to April 2017 in several databases, including Medline and Cochrane Library. Results Sixteen articles met the inclusion criteria. A correlation was identified between BIS and clinical sedation scales. A BIS range between 75 and 84 showed a high probability of corresponding to an Observer’s Assessment of Alertness and Sedation Scale (OAA/S) value of 3; a scored 3 on the Ramsay scale corresponds around 85 on the BIS; while BIS values between 57 and 64 corresponded to a University of Michigan Sedation Scale value of 3. BIS monitoring provides continuous measurement of the patient’s hypnotic state or state of consciousness, awareness, and recall. It proved impossible to perform an analysis of statistical data drawn from the studies reviewed due to the disparity of inclusion criteria among the works. Conclusions BIS for sedation monitoring might make possible to evaluate sedation levels objectively in real time, reducing the dose of the sedative required, increasing safety, and minimizing secondary effects. Key words:Bispectral analysis, BIS monitoring, intravenous sedation, dental treatment, anesthetics.

Objectives: The aim of this research was to determine the osseointegration of two presentations of biphasic calcium phosphate (BCP) biomaterial&mdash, one untreated and another submitted to biofunctionalization with a TGF-&beta, 1 inhibitor peptide, P144, on dental alveolus. Materials and Methods: A synthetic bone graft was used, namely, (i) Maxresorb&reg, (Botiss Klockner) (n = 12), and (ii) Maxresorb&reg, (Botiss Klockner) biofunctionalized with P144 peptide (n = 12). Both bone grafts were implanted in the two hemimandibles of six beagle dogs in the same surgical time, immediately after tooth extraction. Two dogs were sacrificed 2, 4, and 8 weeks post implant insertion, respectively. The samples were submitted to histomorphometrical and histological analyses. For each sample, we quantified the new bone growth and the new bone formed around the biomaterial&rsquo, s granules. After optical microscopic histological evaluation, selected samples were studied using backscattered scanning electron microscopy (BS-SEM). Results: The biofunctionalization of the biomaterial&rsquo, s granules maintains a stable membranous bone formation throughout the experiment timeline, benefitting from the constant presence of vascular structures in the alveolar space, in a more active manner that in the control samples. Better results in the experimental groups were proven both by quantitative and qualitative analysis. Conclusions: Synthetic bone graft biofunctionalization results in slightly better quantitative parameters of the implant&rsquo, s osseointegration. The qualitative histological and ultramicroscopic analysis shows that biofunctionalization may shorten the healing period of dental biomaterials.

Ameloblastomas are benign but locally invasive odontogenic tumors most frequently located in the mandible. The gold standard of treatment is the surgical resection of the tumor with safety margins. Postsurgical defects generate a significant morbidity that needs reconstruction and oral rehabilitation to restore the oral functions. This case report describes the prosthetic rehabilitation of a 42-year-old male after resection of a mandibular ameloblastoma. Excision of the lesion by segmental mandibulectomy and mandibular reconstruction by microvascularized fibula flap was performed. After placement of 6 dental implants, the patient was rehabilitated with a lower hybrid prosthesis fabricated using computer-aided design-computer-aided manufacturing. During a 7-year and 5-month follow-up, some clinical complications were observed.

Introduction: This study aimed to show the clinical outcomes of implants inserted by guided surgery supporting mandibular overdentures in edentulous patients. Patients and methods: Mandibular edentulous patients were diagnosed with an oral examination, cone-beam computerized tomography, and diagnostic casts for intermaxillary relations and treated with overdentures over two implants by guided surgery. After flapless surgery, implants were early loaded with an overdenture at 6 weeks. Results and discussion: Fourteen patients (nine females and five males) were treated with 28 implants. Four patients (28.6%) had a previous history of periodontitis. Five patients (35.7%) were smokers. Nine patients (64.3%) suffered from systemic diseases (i.e., diabetes, cardiovascular diseases). The clinical follow-up of the study was 44.7 ± 31.4 months. Clinical outcomes showed a global success of 100% of implants. Fourteen overdentures were placed in the patients over the implants. Mean marginal bone loss was 1.25 mm ± 0.95 mm. Four patients (28.6%) showed some kind of mechanical prosthodontic complications. Six implants (21.4%) were associated with peri-implantitis. Conclusions: This study indicates that treatment of mandibular edentulous patients with overdentures by guided surgery and early loading of implants placed appears to be a successful implant protocol.

Guided bone regeneration techniques are increasingly used to enable the subsequent placement of dental implants. This systematic review aims to analyze the success rate of these techniques in terms of bone gain and complications rate using titanium membranes as a barrier element. Electronic and hand searches were conducted in PubMed/Medline, Scielo, Scopus and Cochrane Library databases for case reports, case series, cohort studies and clinical trials in humans published up to and including 19 September 2020. Thirteen articles were included in the qualitative analysis. Bone gain both horizontally and vertically was comparable to that obtained with other types of membranes more commonly used. The postoperative complication rate was higher that of native collagen membranes and non-resorbable titanium-reinforced membranes, and similar that of crosslinked collagen membranes and titanium meshes. The survival rate of the implants was similar to that of implants placed in native bone. Due to the limited scientific literature published on this issue, more randomized clinical trials comparing occlusive titanium barriers and other types of membranes are necessary to reach more valid conclusions.

Background To assess if photobiostimulation (PBS) alleviates pain intensity/duration and swelling after implant surgery. Material and Methods Sixty subjects (27 male and 33 female, with a mean age of 47,13 8.05 years) were included and randomly assigned to experimental group (implant surgery and photobiostimulation), placebo group (implant surgery and simulated photobiostimulation) and control group (implant surgery only). Inclusion criteria: subjects older than 20 years, with a healthy oral mucosa and requiring implant surgery. Exclusion criteria: pregnancy, history of implant failure, light sensitivity, metabolic deseases, consumption of antibiotics or corticosteroids in the last two weeks, smokers and alcohol drinkers. Patients reported the pain experienced by using a numeric rating scale (NRS) at 2 hours, 6 hours, 12 hours, 24 hours and from day 2 to 7. Swelling score was assessed by linear measurements and type and number of analgesic drugs within each time-point were recorded on a spreadsheet. Data of pain and amount of swelling were compared among the three groups by using the Kruskal-Wallis H Test and post-hoc comparisons tests. Results Pain in the experimental group was less compared to controls and placebo group, at each time intervals (p < 0.001) as well as the maximum pain score (experimental group: median = 2, interquartile range 2-3; control group: median = 8, interquartile range 3,75-9; placebo group: median = 8, interquartile range 6,25-9). Swelling was almost insignificant in the experimental group (maximum value = 1, interquartile range 0-2,75, at 24 hours) compared with control (maximum value = 6, interquartile range 5-8,75, at 24 hours) and placebo (maximum value = 6, interquartile range 5-8, at 24 hours). Subjects in the experimental group assumed less analgesics compared to both controls and placebo groups. Conclusions Photobiostimulation is an effective method to reduce pain intensity/duration and swelling after implant surgery. Key words:LLLT, photobiostimulation, pain, implant surgery.

Background To assess the effect of implantoplasty and implant-abutment design on the fracture resistance and macroscopic morphology of narrow-diameter (3.5 mm) dental implants. Material and Methods Screw-shaped titanium dental implants (n = 48) were studied in vitro. Three groups (n = 16) were established, based on implant-abutment connection type: external hexagon, internal hexagon and conical. Eight implants from each group were subjected to an implantoplasty procedure; the remaining 8 implants served as controls. Implant wall thickness was recorded. All samples were subjected to a static strength test. Results The mean wall thickness reductions varied between 106.46 and 153.75 µm. The mean fracture strengths for the control and test groups were, respectively, 1211.90±89.95 N and 873.11±92.37 N in the external hexagon implants; 918.41±97.19 N and 661.29±58.03 N in the internal hexagon implants; and 1058.67±114.05 N and 747.32±90.05 N in the conical connection implants. Implant wall thickness and fracture resistance (P < 0.001) showed a positive correlation. Fracture strength was influenced by both implantoplasty (P < 0.001) and connection type (P < 0.001). Conclusions Implantoplasty in diameter-reduced implants decreases implant wall thickness and fracture resistance, and varies depending on the implant-abutment connection. Internal hexagon and conical connection implants seem to be more prone to fracture after implantoplasty. Key words:Dental implants, narrow diameter, implant connection, peri-implantitis, implantoplasty, fracture strength.

INTRODUCCIÓN: Cuando se coloca un implante, se asume que habrá una pérdida de hueso en la zona más coronal alrededor de este. La colocación del implante respecto al nivel de hueso ya sea crestal o subcrestal y el tipo de conexión elegida, ya sea conexión externa o interna, se han relacionado como algunos de los factores causantes de la pérdida de hueso alrededor de implantes. La preservación del hueso periimplante, es fundamental porque influye sobre la forma y el contorno de los tejidos blandos suprayacentes, que son importantes para el resultado estético del tratamiento y para el éxito de los mismos. El objetivo principal de esta tesis fue evaluar la pérdida de hueso marginal tanto en implantes de conexión externa e interna, como en implantes colocados a nivel crestal y subcrestal. Se ha sugerido que en la conexión externa y en la colocación subcrestal de los implantes existe mayor pérdida de hueso marginal, sin embargo, la literatura no es clara al respecto. Por este motivo se realizaron dos revisiones sistemáticas para responder a las siguientes preguntas: “En pacientes tratados con implantes dentales, ¿hay diferencia entre la conexión externa e interna en términos de pérdida ósea marginal alrededor de las conexiones? y ¿hay diferencias entre la colocación subcrestal y crestal en términos de pérdida ósea marginal? En la primera revisión se analizaron las conexiones. Se incluyeron 10 artículos que incluían 1.523 pacientes con 3.965 implantes. De acuerdo con esta revisión y considerando las limitaciones debidas a los grados de heterogeneidad entre los estudios incluidos, ambas conexiones presentaron altas tasas de supervivencia. Así todo y que la conexión interna es la que parece gozar de mayor reconocimiento en la actualidad; los estudios incluidos en esta revisión, caracterizados por un gran número de muestra y largos periodos de seguimiento demostraron que la conexión externa era una conexión fiable, avalada por estudios de longevidad. Respecto a la segunda revisión y metaanálisis, en la que se analizó la colocación a nivel crestal o subcrestal de los implantes, se obtuvieron resultados clínicos apropiados. Teniendo en cuenta la falta de evidencia científica en ambos aspectos y con la intención de poder aportar claridad a la hora de elegir la conexión del implante y su posicionamiento vertical respecto al hueso, planteamos la realización de un ensayo clínico aleatorio, con el objetivo de determinar si la pérdida de hueso difería significativamente entre las dos conexiones y las posiciones verticales del implante. MATERIAL Y MÉTODO : Los pacientes fueron reclutados del Máster de Medicina Cirugía e Implantología Oral. Facultat de Medicina i Ciencies de la Salut (Odontología). Y fueron atendidos en el Hospital Odontològic Universitat de Barcelona (HOUB). Se realizó un ensayo clínico aleatorizado, con un tamaño muestral de 93 implantes (31 de conexión externa y 62 de conexión interna: 33 con diseño para colocación infracrestal y 29 crestal) colocados en 27 pacientes. Se realizaron controles radiológicos el día de la colocación de implantes, al mes y durante la realización de las coronas, también se tuvo en cuenta el Análisis de Frecuencia de Resonancia (AFR) el día de la colocación del implante, cuando se colocó el pilar de cicatrización y durante la realización de la prótesis.

Introduction: In the different branches of dentistry, the use of laser to solve different clinical situations is increasing due to numerous advantages that have been studied in literature since the 70s. Leucoplakia and hyperkeratosis can benefit from laser-assisted treatment. In most cases biopsy sampling, histological examination and, if no malignant cells are present, the follow-up is needed. However, even if the lesion is free of dysplasia patients often ask to eliminate these white spots that are always a cause of concern. Aim: From these numerous requests comes the idea of setting up a laser-assisted protocol as less invasive as possible to be offered to patients. The aim of the study is to find a laser-assisted protocol for the surgical excision of leucoplakia and hyperkeratosis that can both improve the clinical aspect of the lesion and be sustainable for patients. The null hypothesis has been identified in the following statement: the treatment is effective and efficient at the same time, where effectiveness was tested with the following criteria: size of the lesion, tactile perception, discomfort, pain, and efficiency with the following criteria: pain and discomfort perceived during the treatment. Materials and methods: To collect all data, a specially designed medical record was used. The diode laser was used with a pulsed mode and the maximum power corresponds to 1.8 W. No anaesthesia was used. Before laser-assisted treatment, the fibre was activated and was used with a contact overflowing. Results: Our results show a decrease in the size of the lesion statistically significant. No pain was referred during treatment, except for a slight burning sensation. Conclusion: In conclusion we can state that the treatment is both efficient and effective.

Treball Final de Grau d'Odontologia, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Curs: 2017-2018, Director: Rui Pedro Barbosa de Figueiredo, Background: The development of new imaging technologies like Cone-Beam Computer Tomography (CBCT) has allowed a great advance in the pre-surgical implant planning. Computer Assisted Surgery (CAS) in implantology has been described aiming to minimize the differences between the preoperative planning and the final treatment outcome. The dynamic CAS, also known as surgical navigation system, allows to determine the real position of the surgical drill on the reconstructed 3D image of the CBCT. It guides the surgeon, while performing the surgical procedure, to the preoperative planned position. Aim: To assess the accuracy and the role of the surgeon’s experience comparing the implant placement using both freehand and a dynamic navigation system. Materials and methods: A randomized in-vitro study was made. Six resin mandible models and 36 implants were used. Two investigators with different degrees of clinical experience placed implants using either the CAS Navident® system (Navident group) or the conventional freehand method (freehand group). Accuracy assessment was measured by overlapping the virtual presurgical placement of the implant in a CBCT and the real position in the postoperative CBCT. Descriptive and bivariate analysis of the data was made. Results: The Navident group had a significantly higher accuracy for all studied variables, except for the 3D entry and depth deviation. This system significantly enhanced the accuracy of the unexperienced professional in several outcome variables in comparison with the freehand implant placement method. On the other hand, when the implants were placed by the experienced clinician, the Navident® system only allowed to improve the angulation deviation. If both degrees of experiences are compared, significant differences were only found when the freehand method was employed. The implants placed with the Navident® system had similar deviations. Conclusion: The dynamic computer assisted surgery system Navident® allows a more accurate implant placement in comparison with the conventional freehand method, regardless of the surgeon’s experience. However, this system seems to offer important advantages to unexperienced professionals, since they can significantly reduce their deviations, achieving the same results of experienced clinicians.

Los implantes dentales cortos, aunque históricamente se han asociado a un mal pronóstico en las rehabilitaciones orales implantosoportadas, con el paso de los años y los avances en implantología, se han convertido en un tratamiento habitual en la práctica diaria de muchos clínicos, obteniendo tasas de éxito que se han incrementado recientemente hasta prácticamente igualarse a los implantes convencionales para muchos autores. La necesidad de reducir tiempos de trabajo, costes económicos y morbilidad intraoperatoria unida a la creciente demanda derehabilitaciones implanto soportadas en pacientes de un rango de edad cada vez mayor hace necesario añadirlos entre nuestras opciones rehabilitadoras implantológicas. Para ello es necesario conocer sus pros y contras y establecer unos protocolos quirúrgicos y de selección del paciente receptor.

Background: Scientific literature estimates that around 18 to 40 % of asymptomatic third molars are extracted. The aims of the present study were to determine the indications for extraction of asymptomatic lower third molars in a sample of Spanish and Portuguese dentists, and to relate these indications to the clinicians’ training and professional experience. Material and Methods: A survey consisting of 15 cases of asymptomatic lower third molars was emailed to Portuguese and Spanish dentists. The clinicians were asked to assess the level of difficulty of the extractions and to make a reasoned recommendation based on the panoramic radiographs, gender and age of the patients. Results: 381 clinicians filled in the questionnaires. Most of the professionals had over 13 years of clinical experience. The number of Spanish clinicians with postgraduate degrees in Oral Surgery was significantly higher. On average, 42% of respondents recommended extraction of asymptomatic third molars. The indication for extraction was significantly higher among Portuguese dentists. Clinical experience was negatively correlated with the perceived extraction difficulty (p

Background Several publications have measured the difficulty of third molar removal, trying to establish the main risk factors, however several important preoperative and intraoperative variables are overlooked. Material and Methods A prospective cohort study comprising a total of 130 consecutive lower third molar extractions was performed. The outcome variables used to measure the difficulty of the extraction were operation time and a 100mm visual analogue scale filled by the surgeon at the end of the surgical procedure. The predictors were divided into 4 different groups (demographic, anatomic, radiographic and operative variables). A descriptive, bivariate and multivariate analysis of the data was performed. Results Patients’ weight, the presence of bulbous roots, the need to perform crown and root sectioning of the lower third molar and Pell and Gregory 123 classification significantly influenced both outcome variables (p< 0.05). Conclusions Certain anatomical, radiological and operative variables appear to be important factors in the assessment of surgical difficulty in the extraction of lower third molars. Key words:Third molar, surgical extraction, surgical difficulty.

Background: To assess differences in marginal bone loss in implants placed at subcrestal versus crestal level. Methods: An electronic and a manual research of articles written in English from Jaunary 2010 to January 2018 was performed by two independent reviewers. Clinical trials comparing bone loss for implants placed at crestal and subcrestal level were included. Pooled estimates from comparable studies were analyzed using a continuous random-effects model meta-analysis with the objective of assessing differences in crestal bone loss between the two vertical positions. Results: 16 studies were included; 10 studies did not encounter statistically significant differences between the two groups with respect to bone loss. Three articles found greater bone loss in subcrestal implants; while 3 found more bone loss in crestal implants. A meta-analysis for randomized control trial (RCT) studies reported an average and non-statistically different crestal bone loss of 0.028 mm. Conclusions: A high survival rate and a comparable bone loss was obtained both for crestal and subcrestal implants’ placement. Quantitative analysis considering a homogenous sample confirms that both vertical positions are equally valid in terms of perimplant bone loss. However, with respect to soft tissue; in presence of a thin tissue; a subcrestal placement of the implant should be preferred as it may reduce the probability for the implant to become exposed in the future and thus avoid the risk of suffering from peri-implant pathologies.

Objectives: The purpose of this study was to analyze how anti-infectious periodontal treatment affects C reactive protein (CRP) values in patients with type 1 diabetes, and correlate baseline CRP levels with periodontal disease severity. Study Design: A cohort of fifty three subjects with type 1 diabetes and moderate to severe periodontitis were recruited. Periodontal parameters were measured, and blood samples were obtained to evaluate high-sensitivity C-reactive protein (hs-CRP). Group 1 was treated with scaling, root planning, and systemic administration of doxycycline. Group 2 received only scaling and root planning. Results: Hs-CRP was reduced after periodontal treatment in group 1 (-0.22 mg/l) and 2 (-0.21 mg/l ) but this reduction was not statistically significant, even in the patients with the best response to periodontal treatment. However, significant correlation appeared between hs-CRP and mean probing pocket depth (PPD) (p=0, 01) and mean clinical attachment level (CAL) (p=0,03). Conclusions: Non-surgical periodontal treatment couldn’t reduce hs-CRP values, however, it was found an association between advanced periodontitis and elevated blood hs-CRP levels in patients with type 1 diabetes. It can be speculated that periodontal disease increases production of pro-inflammatory mediators in patients with type 1 diabetes, but other producing sources of these pro-inflammatory substances may exist. Key words:Periodontal disease, periodontitis, diabetes mellitus type 1, periodontal therapy, C reactive protein.

Background The aim of this study was to evaluate the clinical and microbiological impact of an antibacterial suture (Monocryl® Plus) in the surgical removal of I3M. Material and Methods A “split-mouth”, prospective pilot clinical study was designed involving 20 patients programmed for the surgical removal of I3M. Each side was randomly sutured with Monocryl® Plus or silk suture and removed for microbiological study 72 hours and 7 days after surgery. Presence of SSI, wound bleeding and the degree of discomfort associated with each type of suture material (scored by means of a visual analog scale) were evaluated. The level of contamination of each material was observed under the scanning electron microscope. Results Wound bleeding upon suture removing was slightly greater after 72 hours and 7 days with black silk suture, though the differences were not statistically significant (p=0.752 and p=0.113, respectively). Patient discomfort was very similar with both types of suture material (p=0.861). Only one case of SSI was recorded with black silk suture after 72 hours. Microbiologically, the antibacterial suture showed a lesser presence of microorganisms (p

Background: Breakage of surgical instruments is a rare complication. A mistake in operator technique or sub-standard/aged tools could lead to this type of accident. A tooth elevator is an instrument used in minor oral surgical procedures to luxate the tooth or fractured root from its socket. The authors have not found any previously published cases reporting the breakage of a tooth elevator tip which then remained as a foreign body in a hidden caries cavity. Case presentation: A 28-year-old African black male was referred to a hospital in Tanzania for an intraoral radiography. The patient explained that six months previously his mandibular left third molar had been extracted. Whilst the healing process had been satisfactory, he had recently experienced acute oral pain in this region. The dental X-ray showed an image consistent with a piece of broken metal embedded in a distal subgingival caries at the mandibular left second molar. Conclusion: Oral and dental surgeons should take particular care when employing metal instruments with strong force in poorly visible areas. A radiographic study should be carried out when instrument breakage occurs. If an unexpected accident takes place during a surgical procedure, the patient must be informed in accordance with ethical codes, and suitable measures adopted to resolve the issue.

espanolEl objetivo de este trabajo es realizar una revision bibliografica de los ultimos 5 anos (2006-2011), sobre la situacion actual de los caninos incluidos y su tratamiento. Se ha analizado la incidencia, etiologia, diagnostico y factores pronosticos de su alineamiento, asi como las terapeuticas de los mismos. Su manejo es de especial importancia, ya que estos dientes tienen un papel fundamental en la apariencia facial, estetica dental, desarrollo del arco dental y la oclusion funcional. Se deben diagnosticar mediante una evaluacion clinica y radiologica minuciosa ademas de un examen radiografico; determinando las posibles complicaciones asociadas y las opciones de tratamiento individualizandolas en cada caso. Se han planteado diferentes formas de manejarlos que van desde los controles periodicos, la prevencion de la inclusion con el tratamiento interceptivo, el tratamiento ortodoncico-quirurgico o la extraccion. Antes de iniciar cualquier procedimiento debemos valorar las caracteristicas individuales de cada paciente, asi como la situacion y la inclinacion del diente para lograr nuestro objetivo. EnglishThe aim of this article is to make a bibliographical review, from studies performed in the last 5 years (2006-2011), to analyse the current trends of the unerupted canines in its epidemiology, aetiology, diagnostic methods, prognostic factors in their alignment; and the various treatment options available. It is especially important because of its relevance in the facial appearance, dental aesthetics and functional occlusion. The diagnosis of the unerupted canine should be made through a thorough clinical and radiographic examination, because it helps in determining the best treatment plan and prevention and/or evaluation of possible complications. Different ways to manage such cases have been suggested from periodic controls, preventing the impaction using interceptive treatment, surgical and orthodontic techniques, and lastly, extraction. Thus, before commencing with any treatment, a proper evaluation of the patient characteristics and the characteristics of the canine should be evaluated to achieve the best possible outcome.

espanolUno de los factores clave del exito a largo plazo de los implantes dentales es el mantenimiento de la salud de los tejidos entorno a estos. El biofilm bacteriano es capaz de inducir alteraciones inflamatorias en los tejidos blandos periimplantarios, lo que puede llevar a la destruccion de los mismos, produciendo finalmente el fracaso del implante. Para la prevencion de esta patologia se han propuesto multiples estrategias terapeuticas, aunque no se ha evidenciado cual es la mas efectiva. Objetivos: Identificar el protocolo terapeutico mas efectivo para el tratamiento de la patologia periimplantaria en implantes osteointegrados. Conclusion: La cirugia de acceso ha demostrado resolver un 58% de los casos de periimplantitis. Ninguno de los metodos de descontaminacion de superficies ha demostrado ser superior a las demas. EnglishOne of the key factors for the long-term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (perimplantitis) and ultimately to implant failure. Different treatment strategies for perimplantitis have been suggested, however it is unclear which are the most effective. Objectives: To identify the most effective interventions for treating perimplantitis around osseointegrated dental implants. Conclusion: Access surgery has demonstrate that resolution occurred in 58% of the lesions. No single method of surface decontamination was found to be superior.

espanolEl fibroma osificante periferico (FOP) es una entidad benigna que se incluye en el grupo de las lesiones gingivales reactivas, denominadas con el termino generico de epulis, y se origina, segun la teoria mas aceptada, en las celulas del ligamento periodontal. Se manifiesta en forma de tumoracion de consistencia firme, bien circunscrita, de color rosado o rojizo y esta situada normalmente en la zona incisivo-canina del maxilar superior, siendo rara su aparicion en crestas edentulas. Aparece a cualquier edad, con una mayor incidencia entre la segunda y tercera decadas de la vida, con una ligera predileccion por el sexo femenino. Es una lesion de partes blandas, que en ocasiones puede estar asociada a una ligera erosion superficial del hueso subyacente. Se han revisado 3 casos de FOP que afectaban a 2 hombres y 1 mujer de edades comprendidas entre los 39 y los 73 anos, presentandose uno de ellos en una cresta alveolar edentula. En dos casos se observaba radiograficamente una ligera erosion del hueso subyacente y el tercer caso presentaba puntos radioopacos difusos intralesionales. El tratamiento consistio en realizar la exeresis-biopsia de las lesiones, efectuandose dos casos mediante bisturi frio y uno con laser de CO2. Uno de los casos presento tres episodios de recidiva en el seguimiento postoperatorio. EnglishThe peripheral ossifying fibroma (POF) is a reactive gingival disorder known under the generic term of epulis and is widely considered to originate from the cells of the periodontal ligament. It manifests as a tumor of firm consistency, well circumscribed, pink or red and is usually located in the incisorcanine area of the maxilla, being uncommon occurrence in edentulous alveolar ridges. Appears without ages difference, with a higher incidence between the second and third decades of life, with a slight predilection for females. It is a soft tissue injury, which can sometimes be associated with a slight erosion traof the underlying bone surface. We have reviewed 3 cases of POF involving 2 men and 1 woman aged between 39 and 73 years, presenting one of them in edentulous alveolar ridge. In two cases showed radiological slight erosion of the underlying bone and the third case showed diffuse intralesional radiopaque points. Treatment consisted on resection of the lesions and biopsy of them, two cases to be carried out by cold scalpel and a CO2 laser. One case presented three episodes of recurrence in the postoperative follow.

Trata-se de estudo corte transversal, descritivo com componente analítico, com o objetivo de avaliar a ansiedade dos pacientes no período que precede o procedimento, as alterações hemodinâmicas, respiratórias e dor no intra-operatório em pacientes submetidos à extração de terceiros molares retidos sob anestesia local. Foram incluídos no estudo 42 sujeitos do sexo masculino, hígidos, com idade compreendida entre 18 e 34 anos. A anestesia foi feita com cloridrato de lidocaína a 2% com adrenalina 1:50.000, na dose que variou de 72 a 144mg. Com auxilio de monitor multiparamétrico não-invasivo avaliaram-se os parâmetros: pressão arterial média, freqüência cardíaca, saturação periférica de O2 e frequência respiratória; o grau de ansiedade (escala de ansiedade para cirurgia odontológica) e dor (escala analógica visual). A análise estatística foi realizada por meio dos testes t de Student e Wilcoxon pareado. O nível de significância foi fixado em 5%. O tempo médio máximo de cirurgia foi 60 minutos, período considerado para análise dos resultados. Neste estudo, vinte pacientes apresentavam algum grau de ansiedade. Dor intensa foi referida por sete pacientes nos momentos da osteotomia, odontosecção e luxação que necessitaram de complementação com anestésico local. A análise individual dos parâmetros hemodinâmicos e respiratórios mostrou alterações consideradas clinicamente significativas. Os resultados deste estudo permitem concluir que alterações hemodinâmicas e respiratórias podem ocorrer durante extrações de terceiros molares retidos, especialmente em pacientes ansiosos e com dor. A monitorização é importante na detecção e conseqüentemente prevenção dessas intercorrências, sendo particularmente útil em pacientes em que essas repercussões devam ser evitadas., A transversal, descriptive study with an analytical component was conducted, aimed at evaluating anxiety during the period preceding the procedure, as well as hemodynamic and respiratory alterations and pain during the intraoperative period in patients undergoing the extraction of retained third molars under local anesthesia. Forty-two healthy male subjects, ranging in age from 18 to 34 years were included in the study. Anesthesia was performed with lidocaine hydrochloride 2% with epinephrine 1:50.000, at a dose ranging from 72 to 144mg. A non-invasive multiparametric monitor was used to monitor the following parameters: mean arterial blood pressure, heart rate, peripheral O2 saturation, respiratory rate; level of anxiety (anxiety scale for dental surgery) and pain (visual analog scale). Statistical analysis was performed with a paired Student’s t and Wilcoxon’s test. The significance level was set at 5%. In this study, twenty patients had some level of anxiety. Severe pain was reported in seven patients who required supplementation with local anesthesia during osteotomy, tooth sectioning and luxation. Individual analysis of hemodynamic and respiratory parameters showed alterations that were considered significant. The results of this study enabled us to conclude that hemodynamic and respiratory alterations may occur during the extraction of retained third molars. Monitoring is important for the detection and thus prevention of these complications. Furthermore, it is particularly useful in patients in whom these repercussions must be avoided.

Objectives: This study evaluates the periodontal health status and the esthetic results of teeth subjected to orthodontic traction, after their exposure by an apically positioned flap. Study design: Fifteen patients were included in the study, ages between 11 and 28 years old. The fenestrated teeth and their homologous contralateral normally erupted teeth, used as control, were evaluated. Results: Statistically significant differences were found in the position of the gingival margin (p = 0.005), with an average distance between cemento-enamel junction (CEJ) and gingival margin of 2.47 mm (SD 1.19) in control teeth and of 1 mm (SD 1.31) in the operated teeth, and in the depth of palatal probing (p = 0.031), with 2.1 mm (SD 0.9) for the experimental teeth and 1.7 mm (SD 0.8) for the control teeth. The gingival index, the bleeding during probing and the probing depth did not show statistically significant differences. The patient?s subjective esthetic evaluation was more favorable for the control teeth in most of the cases. Conclusions: The surgical approach for the impacted teeth by means of the apically positioned flap resulted to be a predictable technique allowing the maintenance of the periodontal health on a long-term basis.

Objectives: The growing interest in minimally invasive surgery, together with the possibility of fitting prostheses with immediate function, have led to the development of software capable of planning and manufacturing a surgical guide and prosthesis that can be placed upon conclusion of the implant surgery step. The present study evaluates the surgical and prosthetic complications of implant treatment with the guided surgery technique, together with patient comfort during and after treatment. Patients and methods: A retrospective observational study was made of 19 patients with partially or totally edentulous upper and/or lower maxillae, involving the placement of a total of 122 implants. All cases were planned and operated upon with the guided surgery technique. Results: A total of 122 implants were placed in 14 males and 5 females. The intraoperative surgical complications comprised a lack of primary stability, while the postoperative complications consisted of infections and a lack of implant osteointegration. Ten implants failed. The prosthetic complications in turn comprised loosening of the provisional prosthesis screws, prosthesis tooth fracture, and a lack of passive fit of the immediate prosthesis. The degree of patient satisfaction was evaluated using a verbal scale. Conclusions: Implant restoration with the guided surgery technique and immediate functional loading is a predictable procedure, provided patient selection and the surgical technique are adequate, affording lesser postoperative morbidity and increased patient satisfaction thanks to the immediate restoration of esthetics and function.

El empleo de antibióticos como tratamiento de las infecciones establecidas o como profilaxis de infecciones a distancia en pacientes de riesgo es un procedimiento ampliamente instaurado y de reconocida eficacia. No obstante, el uso sistemático de profilaxis antibiótica ante procedimientos quirúrgicos en pacientes sin factores individuales de riesgo infeccioso es un tema controvertido por no estar científicamente justificado. El objetivo de este artículo es reflexionar acerca de la justificación de la profilaxis antibiótica y razonar la pauta antibiótica más adecuada según los datos científicos y los estudios realizados a este efecto por otros autores. Así, son numerosos los ensayos clínicos que cuestionan el valor de la profilaxis antibiótica. Mientras que algunos trabajos defienden que los antibióticos pueden reducir la incidencia de infecciones postoperatorias, otros equiparan su eficacia a la del placebo. De todo ello se desprende que no todas las intervenciones de Cirugía Bucal son tributarias de profilaxis antibiótica. Deberían valorarse los factores de riesgo intrínsecos de cada tipo de intervención quirúrgica así como las variables particulares de cada paciente. La combinación amoxicilina-ácido clavulánico cubre teóricamente todo el espectro bacteriano de la infección odontogénica en España. Sin embargo, el desconocimiento de las interrelaciones bacteriológicas presentes en la patogénesis de la infección local postexodoncia no permite descartar la utilidad de otros antibióticos. En caso de estar indicada la profilaxis antibiótica, ésta debe pautarse a altas dosis, de forma preoperatoria y su duración no debe superar las 24 horas. Debe prestarse especial atención a otras medidas antiinfecciosas locales que minimicen el riesgo de infección de la herida quirúrgica mientras dure su cicatrización.

Objetivo: estudio comparativo de los efectos histológicos de la amalgama de plata versus el compómero (Dyract®) a los 90 días de su colocación como materiales de obturación retrógrada en animales de experimentación. Método: se usaron seis perros Beaggle a los que se realizaron las pulpectomías totales y relleno de material ortrógrado, seguidas de la cirugía periapical de los seis incisivos del maxilar superior y de los seis incisivos de la mandíbula (un total de 72 dientes). 36 dientes correspondieron al lado derecho, obturados con el material control (amalgama de plata), mientras que los 36 dientes correspondientes al lado izquierdo fueron obturados con el material estudio (compómero). A los 3 meses los animales fueron sacrificados y se llevó a cabo el estudio histológico, con la evaluación de la formación de hueso, el grado de inflamación y el análisis del tejido en contacto con el material de obturación retrógrada. Con los datos se realizó un análisis estadístico descriptivo y comparativo (chi-cuadrado). Resultados: las muestras obturadas retrógradamente con compómero reflejaron un mayor porcentaje de inflamación (76,19% frente a 26,66%). Por otro lado, una gran proporción de muestras con crecimiento del cemento radicular fueron encontradas en el grupo del compómero. La expulsión del material de obturación fue también significativamente más frecuente cuando se usaba el compómero. Conclusiones: el análisis comparativo de los hallazgos histológicos reflejó una mayor reacción inflamatoria pero al mismo tiempo un mayor crecimiento del cemento radicular en el grupo del compómero.

Introducción: En cirugía periapical, la ausencia de estandarización entre los distintos estudios, dificulta la comparación de sus resultados. Objetivo: Comparar las escalas de curación para evaluar los criterios de pronóstico en cirugía periapical a los 12 meses. Material y método: se incluyeron 278 pacientes (101 hombres y 177 mujeres) con una edad media de 38.1 (rango entre 11 y 77) a los que se les realizó cirugía periapical con ultrasonidos y lupas de 2.6 aumentos; utilizando como material de obturación retrógrada la amalgama de plata. Se analizó la evolución con los criterios clínicos según Mikkonen y cols. 1983; la valoración radiográfica siguiendo a Rud y cols., 1972; los criterios globales, clínicos y radiográficos, de von Arx y Kurt, 1999, y el concepto de diente funcional de Friedman del 2005, a los 12 meses de realizar la cirugía. Resultados: a los 12 meses se obtuvo un 87.2% de éxito clínico según los criterios de Mikkonen y cols.; un 73.9% de curación radiográfica total según Rud y cols.; un 62.1% de éxito en la evolución global, considerando los parámetros clínicos y radiográficos, de von Arx y Kurt; y el 91,9% de los dientes eran funcionales. La escala que más se relacionó con el resto fue la de von Arx y Kurt. Conclusión: la evolución global según von Arx y Kurt era la más concordante con todas las demás escalas.

Introduction. Third molar extraction is the most frequent procedure in oral surgery. The present study evaluates the indication of third molar extraction as established by the primary care dentist (PCD) and the oral surgeon, and compares the justification for extraction with the principal reason for patient consultation. Patients and method. A descriptive study was made of 319 patients subjected to surgical removal of a third molar in the context of the Master of Oral Surgery and Implantology (Barcelona University Dental School, Barcelona, Spain) between July 2004 and March 2005. The following parameters were evaluated: sex, age, molar, type of impaction, position according to the classifications of Pell and Gregory and of Winter, and the reasons justifying extraction. Results. The lower third molars were the most commonly extracted molars (73.7%). A total of 69.6% of the teeth were covered by soft tissues only. Fifty-six percent of the lower molars corresponded to Pell and Gregory Class IIB, while 42.1% were in the vertical position. The most common reason for patient reference to our Service of Oral Surgery on the part of the PCD was prophylactic removal (51.0% versus 46.1% in the case of the oral surgeon). Discussion and conclusions. Our results show prophylaxis to be the principal indication of third molar extraction, followed by orthodontic reasons. Regarding third molars with associated clinical symptoms or signs, infectious disease ? including pericoronitis ? was the pathology most often observed by the oral surgeon, followed by caries. This order of frequency was seen to invert in the case of third molars referred for extraction by the PCD. A vertical position predominated among the third molars with associated pathology.

Swine is widely used as an experimental model in several areas of medicine based on its anatomical and physiological similarities to humans. In this report, we describe an external surgical approach on the mandible of the swine as a suitable experimental model in dentistry. Several biomaterials were implanted by using this technique in order to evaluate the degree of bone regeneration as well as the suitable sites to accomplish perforation.

Introducción: la extracción de los terceros molares es el procedimiento más frecuente en Cirugía Bucal. El objetivo de este estudio fue valorar la indicación de la extracción de los terceros molares por parte del odontólogo de atención primaria (OAP) y del cirujano bucal así como comparar dichas justificaciones con el motivo principal de consulta que tenía el paciente. Pacientes y Método: se realizó un estudio descriptivo simple de 319 pacientes a los que se había efectuado la extracción quirúrgica de un tercer molar en el Máster de Cirugía Bucal e Implantología Bucofacial de la Universidad de Barcelona entre julio de 2004 y marzo de 2005. Se valoraron los siguientes parámetros: sexo, edad, cordal, tipo de inclusión, posición según las clasificaciones de Pell y Gregory y de Winter así como los motivos que justificaron su exodoncia. Resultados: los terceros molares inferiores fueron extraídos en mayor proporción (73,7%). Un 69,6% de los dientes estaban cubiertos únicamente por tejidos blandos. La clase IIB de Pell y Gregory representó el 56% de los cordales inferiores, mientras que la posición vertical supuso un 42,1% de los casos. El motivo más frecuente de remisión a nuestro Servicio de Cirugía Bucal por parte del OAP fue la extracción profiláctica (51,0%) de manera muy similar a la que indicó el cirujano bucal (46,1%). Discusión y Conclusiones: la extracción de los terceros molares por motivos profilácticos fue la que se indicó con mayor frecuencia, seguida por la indicación ortodóncica. Con respecto a los terceros molares con signos patológicos o síntomas clínicos asociados, la patología infecciosa incluyendo la pericoronaritis fue la más frecuentemente observada por el cirujano bucal, seguida de la caries. Este orden de frecuencia se invirtió para los terceros molares remitidos para extracción por el OAP. La posición vertical predominó entre los terceros molares con patología asociada.

El cerdo es un animal muy utilizado en estudios experimentales, como trasplantes de corazón y cirugía abdominal, entre otros campos. En el ámbito odontológico también se emplea; en implantología y cirugía reparadora; en el campo de los biomateriales, la regeneración periodontal e incluso la odontología restauradora.

Podeu consultar la versió en castellà a http://hdl.handle.net/2445/117329, Introduction. The incidence of oral sinus communications (OSC) following the extraction of an upper third molar remains uncertain. Objectives. The purpose of this study was to determine the incidence of OSC following the extraction of 389 consecutive upper third molars during 2003 in the Master of Oral Surgery and Orofacial Implantology (Barcelona University, Spain). Patients and method. Different variables were recorded, including patient age, sex, molar angulation, surgical technique and radiological sinus proximity, to determine the relation between third molar extraction and the incidence of OSC. Results. Only 5.1% (95% CI: 2.2-7.3%) of the upper molar surgical extractions produced OSC, the risk of which was found to be similar in all age groups and increased with the depth of third molar inclusion, the complexity of the surgical technique and the performance of an ostectomy.

Podeu consultar la versió en anglès a http://hdl.handle.net/2445/48495, Objetivo: El presente estudio retrospectivo pretende describir la distribución de los dientes supernumerarios en una población de pacientes que acuden a una Unidad ambulatoria de Cirugía Bucal. Introducción: Los dientes supernumerarios y la hiperodoncia múltiple se asocian normalmente con diferentes síndromes como el de Gardner o con fisuras faciales; sin embargo, pueden aparecer en pacientes sin ningún tipo de patología. Su prevalencia oscila entre el 0,5 y el 3,8% en la dentición permanente y entre el 0,35 y el 0,6% en la decidua. Pacientes y método: Para ello, se revisaron 36.057 historias clínicas de pacientes que acudieron a nuestro Servicio entre septiembre de 1991 y marzo de 2003. Se recogieron los siguientes datos: edad, sexo, número de dientes supernumerarios extraídos, localización, morfología y tipo de diente supernumerario. El número de pacientes incluidos en el estudio fue de 102. Resultados: De los 147 dientes supernumerarios descubiertos en la cavidad bucal, se extrajeron un total de 145. El grupo más frecuente fue el de los mesiodens (46,9%), seguido por los premolares supernumerarios (24,1%) y los cuartos molares supernumerarios o distomolares (18%). El 74,5% de los dientes supernumerarios se localizaban en el maxilar superior y un 46,9% de los dientes supernumerarios se localizaban en palatino/lingual. La morfología heteromórfica aparecía en dos tercios de los dientes supernumerarios, siendo la más frecuente la conoide. El 29,7% de los dientes supernumerarios producían la inclusión de los dientes permanentes, siendo el mesiodens el que la producía con mayor frecuencia. Conclusiones: Los mesiodens producen con elevada frecuencia la retención de los incisivos permanentes, que erupcionan espontáneamente después de la extracción de los dientes supernumerarios, si tienen espacio suficiente en la arcada y conservan la fuerza eruptiva. Los premolares supernumerarios tienen normalmente morfología eumórfica y son un hallazgo radiológico casual, al no producir ningún tipo de sintomatología.

Podeu consultar la versió en anglès a http://hdl.handle.net/2445/117330, Introducción. La incidencia de las comunicaciones bucosinusales (CBS) tras la extracción del tercer molar superior no se conoce con exactitud. Objetivos. El objetivo de este estudio fue identificar la incidencia de las CBS tras la extracción de 389 cordales superiores realizadas durante el año 2003 en el Máster de Cirugía Bucal e Implantología Bucofacial de la Universidad de Barcelona. Material y método. Se registraron diversas variables con el fin de determinar la relación de la extracción del tercer molar con la incidencia de las CBS: la edad y el sexo del paciente, la angulación del cordal, la técnica quirúrgica y la sospecha radiológica de proximidad con el seno maxilar. Resultados. Únicamente el 5.1% (IC 95%: 2.2-7.3%) de las extracciones quirúrgicas de los cordales superiores provocaron una CBS. El riesgo de producir una CBS fue similar en todos los grupos de edad, y aumentó con la profundidad de inclusión del tercer molar, la complejidad de la técnica quirúrgica y al efectuar ostectomía.

El surco de desarrollo radicular es una anomalía dentaria de origen embriológico presente en el 8,5% de la población que se localiza principalmente en la cara palatina de los incisivos laterales superiores. Este surco se origina en la fosa central y atravesando el cíngulo se dirige hacia el ápice, siendo su longitud variable. A través de él, los microorganismos penetran en el ligamento periodontal, causando una destrucción ósea localizada. Clínicamente los dientes afectados por esta anomalía pueden ser asintomáticos o bien presentar patología periodontal, pulpitis o necrosis pulpar por afectación secundaria de la pulpa. Presentamos el caso de una paciente que acudió a nuestro Servicio para realizarse la cirugía periapical del 1.2.

Objetivos: Este trabajo pretende demostrar que se pueden realizar la mayoría de las intervenciones quirúrgicas de la cavidad bucal en la población pediátrica en un medio ambulatorio, así como valorar y mostrar la actividad realizada en el Máster de Cirugía e Implantología Bucal de la Facultad de Odontología de la Universidad de Barcelona durante el año 2000. Diseño del estudio: Para la realización de este trabajo se ha contabilizado la actividad quirúrgica de las unidades de cirugía bucal y cirugía con láser en la población pediátrica en el Máster de Cirugía e Implantología Bucal de la Universidad de Barcelona. Resultados: De las 3187 intervenciones quirúrgicas realizadas en nuestro servicio, 489 fueron en pacientes menores de 18 años. La exodoncia quirúrgica de terceros molares inferiores fue la más frecuente (55Ê6%), seguida de otras extracciones dentarias (33Ê6%), quirúrgicas o no, y del resto de intervenciones (10Ê6%) que incluyeron: fenestraciones de caninos u otros dientes incluidos, exéresis de frenillos, de mucoceles y reubicaciones dentarias. Se presentaron complicaciones tras la extracción quirúrgica de los terceros molares en un 15Ê93% de los casos, siendo las más frecuentes el dolor (4Ê35%) y la tumefacción (4Ê35%), signos propios de la inflamación postoperatoria. Conclusiones: Nuestra experiencia muestra que la cirugía bucal ambulatoria puede practicarse de forma segura en la población pediátrica siempre y cuando se disponga de los medios y del personal sanitario adecuados. Aim: A study is made to show that most pediatric oral surgical interventions can be performed on a day case surgery or ambulatory basis, and to describe the activity of the Master of Oral Surgery and Implantology (Barcelona University Dental School, Spain) in the year 2000. Design: The study documents the surgical activity of the Units of Oral Surgery and Laser Surgery in pediatric patients, in the context of the Master of Oral Surgery and Implantology (Barcelona University Dental School, Spain). Results: Of the 3187 operations carried out in our Service in this period, 489 involved patients under 18 years of age. The surgical removal of third molars was the most common intervention (55.6%), followed by other surgical or non-surgical tooth extractions (33.6%) and other interventions (10.6%) comprising fenestration of impacted canines or other teeth, frenectomies, the removal of mucoceles, and tooth relocations. Complications after surgical third molar extraction were recorded in 15.93% of cases the most frequent problem being the pain and swelling (4.35% each) characteristic of postoperative inflammation. Conclusions: Our experience shows that day case oral surgery can be safely performed in pediatric patients, provided the required means and health care personnel resources are available.

Introducción: El objetivo de este estudio es determinar ·in vitro· si la aparición de las fisuras en la superficie apical se deben a la realización de la apicectomía o a la confección de una caja para obturación retrógrada mediante ultrasonidos o material rotatorio convencional. También se estudian otros factores determinantes en la formación de fisuras apicales. Material y métodos: Se emplearon 81 dientes, 41 de los cuales se conservaron en seco y 40 en hidratación con suero. Se realizó la apicectomía en todas las muestras. En la serie conservada en seco e 41) y en 20 de los dientes hidratados se realizaron las cajas de obturación retrógrada con ultrasonidos y en los restantes con instrumental rotatorio. Se tiñeron las muestras con azul de metileno (0,004%) y se analizaron visualmente las superficies apicales con una lupa óptica. Resultados: Se evidencian 9 fisuras nuevas tras la realización de la caja de obturación, perteneciendo la mayoría (7 de ellas) al grupo de los dientes no hidratados tratados con ultrasonidos. Conclusiones: El uso de ultrasonidos con abundante irrigación y un tiempo máximo de aplicación de 30', permiten realizar adecuadas cajas de obturación sin riesgo de generar fisuras .

El objetivo de este estudio fue determinar, in vitro, si la aparición de fisuras en la superficie apical se debía a la preparación de una caja para obturación retrógrada mediante ultrasonidos en dientes apicectomizados. Se consideró la no hidratación del diente como un factor predisponente para la aparición de este tipo de fisuras. Se emplearon 41 dientes unirradiculares conservados en seco. Utilizando una fresa de diamante se realizaron las apicectomías. Las cajas de obturación apical se hicieron con una punta ultrasónica diamantada. Se tiñeron las muestras con azul de metileno al 0,004%, se analizaron y fotografiaron las superficies apicales con la ayuda de una lupa óptica y transiluminación oblicua. Los resultados mostraron un solo caso, entre 41, interpretable como fisura debido a los efectos de los ultrasonidos, presentándose una mayor incidencia de fisuras intradentinarias y cementarias respecto a las que parten del conducto radicular. La escasa cantidad de fisuras encontradas en nuestro estudio parece justificar solo parcialmente la hipótesis que considera la no hidratación como factor predisponente a la aparición de una fisura.

La cirugía periapical ha cambiado, en los últimos años, con la realización de la cavidad retrógrada con instrumental ultrasónico, hacia una cirugía más minuciosa, conservadora y limpia. Todo esto gracias a que se efectúa una menor ostectomía, menor resección apical y además a la posibilidad de limpiar el material blando retrorradicular con las puntas de ultrasonidos. Estudiamos 122 casos de cirugía periapical (155 dientes tratados), realizados con la técnica de ultrasonidos, y relleno con amalgama de planta. Fueron 66 dientes anteriores (incisivos y caninos) y 89 premolares y molares. En todos se realizó el estudio histopatológico del tejido periapicallegrado, obtuvimos 19 quistes radiculares y 103 periodontitis periapicales crónicas. El tiempo de evolución media fue de 3,5 años. Según criterios clínicos, fracasaron 7 casos (5,7 %), y·según criterios radiológicos tuvimos éxito total en 107 casos (87,7 %), parcial en 8 (6,6 %) y fracaso en 7 (5,7 %).

En muchas ocasiones la cirugía periapical se considera un tratamiento radical asociado al fracaso del tratamiento endodóncico.

La historia clínica completa y detallada es un elemento imprescindible para llegar a un diagnóstico correcto, y establecer un pronóstico y realizar un plan de tratamiento adecuado en cualquier tipo de paciente.

La presencia de dientes supernumerarios en la línea mediadel maxilar superior, conocidos con el término de mesiodens, puede causar diferentes alteraciones, tales como la malposición de los dientes vecinos, la erupción anómala o el retraso de la erupción de los incisivos centrales superiores permanentes, un diastema interincisal y la formación de quistes, entre otros. El objetivo de este trabajo es realizar un estudio retrospectivo de una serie de 44 pacientes, con un total de 64 mesiodens tratados quiriirgicamente en nuestra clínica. Los métodos quirúrgicos utilizados se basaron en la localización del mesiodens, de forma que en los de situación vestibular se realizó el abordaje quirúrgico por esta vía. Los mesiodens de situación palatina fueron extraídos mediante la realización de un colgajo palatino envolvente. En cuanto a los resultados, del total de mesiodens, 62 eran palatinos y 2 vestibulares respecto al incisivo central permanente. De los 62 mesiodens situados en palatino, en 56 fue suficiente su extracción quirúrgica por vía palatina; en los seis casos restantes fue necesario, además, realizar un colgajo vestibular de reposición apical para exponer quirúrgicamente el incisivo central permanente y facilitar de esta manera su erupción. En los dos casos incluidos en vestibular se realizó la extracción quirúrgica del mesiodens por vía vestibular, y la exposición quirúrgica del incisivo central permanente mediante un colgajo de reposición apical. Presentamos, asimismo, una exhaustiva revisión bibliográfica y evaluamos los aspectos clínico, etiológico y diagnóstico, y las diferentes alternativas de tratamiento. Como conclusiones, diremos que la extracción del mesiodens es una técnica sencilla y frecuente, debido a la alta incidencia con que se presentan este tipo de supernumerarios, siempre que el abordaje quirúrgico se apoye en un correcto diagnóstico.

La que veurem és l'odontologia que es feia durant el segle XVIII a l'Europa del sud, i quina influència van tenir països com França i Itàlia en el nostre país. Aquesta influència tindrà uns antecedents que es remunten a l'Edat Mitjana.

Presentamos un estudio de las complicaciones surgidas en la extracción quirúrgica de 190 terceros molares inferiores incluidos. No se produjeron complicaciones intraoperatorias. Encontramos en 25 casos complicaciones postoperatorias (13%), las más frecuentes fueron edema persistente en 17 casos (9%) y alveolitis seca en 4 casos (2%). Otras complicaciones recogidas fueron 2 pacientes con parestesia del nervio dentario inferior, 1 con parestesia del nervio lingual y 1 caso de hemorragia postoperatoria. Todas las complicaciones remitieron favorablemente en el postoperatorio sin ningún tipo de secuela.