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Background: Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse reaction experienced by some patients exposed to certain drugs (antiresorptives such as bisphosphonates or denosumab, and antiangiogenic drugs). From a review of the literature it appears that there is no uniform criterion when selecting preventive measures; these vary according to author. Likewise, the measures recommended are usually general, so that in few cases they result in specific actions to be applied depending on the different variables involved such as the type of drug used, the duration of its application, the underlying pathology, the presence or absence of risk factors, etc. The aim of this study has been to design a preventive protocol which can be easily applied in any clinic or by any dental care service. Material and Methods: We undertook an exhaustive literature review to find any articles related to the topic of study, namely, preventive measures for medication-related osteonecrosis of the jaw, on the one hand generically and on the other focusing on dental implant treatment. The most part the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. From 3946 items, we selected a total of 21 items. Results: From the analysis of the selected articles, several protocols have been developed that are easy to apply in a dental clinic.: Protocol 1. Before starting treatment with antiresorptives (Patients who are going to be treated for osteoporosis / Patients who are going to be treated for cancer). Protocol 2. Once treatment is initiated with antiresorptives (Patients being treated for osteoporosis / Patients being treated for cancer). Conclusions: The application of these protocols requires an interdisciplinary team which can handle the various treatments and apply the measures contained in them. Along with a team of well-educated and trained dentists, it is equally important to maintain contact with the med

Introduction Preserving peri-implant tissues after immediate implant placement (IIP), especially in aesthetic zones, is a topic of interest. Objectives This systematic review investigated the effects of currently available surgical procedures for preserving peri-implant tissue or ensuring dimensional stability following immediate implant placement. Materials and methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement’s guidelines were followed, and articles were sought on the PubMed and Cochrane databases with no date restrictions. Only randomised clinical trials that evaluated changes in soft and hard tissues around immediately placed implants were included. Statistical analyses were performed, and the studies´ quality was assessed using the Cochrane Collaboration tool. The agreement between reviewers was assessed based on Cohen’s kappa statistics. Results Of the 14 studies that met the inclusion criteria, 11 were analysed in the meta-analysis (kappa = 0.814; almost perfect agreement). The use of connective tissue grafts resulted in a significantly greater improvement of the facial gingival level (MD = −0.51; 95% CI: −0.76 to −0.31; p = < .001), and the placement of bone grafts significantly reduced the horizontal resorption of the buccal bone (MD = −0.59; 95% CI: −0.78 to −0.39; p < .001). Conclusion Connective tissue grafts and bone grafts positively influence tissue preservation around immediately placed implants. Neither the flapless technique nor palatal implant positioning resulted in significant improvements to any of the investigated parameters. Additional longitudinal studies are required. Clinical relevance This meta-analysis is useful for discerning the effects of soft tissue augmentation, bone grafting, the flapless technique, and palatal implant positioning on preserving peri-implant tissues after immediate implant placement.

Purpose: The objective of this study was to assess the influence of a novel surface of dental implants (ContacTi®) on the osseointegration process in a minipig model. The surface was compared with other existing surfaces on the market (SLA® and SLActive®) by employing bone implant contact analysis (BIC) and implant stability. Method: Twelve minipigs were used with prior authorisation from an ethics committee. Three types of surfaces were tested: SLA® (sand-blasted acid-etched titanium), SLActive® (same but hydrophilic, performed under a nitrogen atmosphere), and ContacTi® (alumina particle bombardment of titanium, bioactivated when treated thermochemically) in 4.1 mm × 8 mm implants with internal connection and a polished neck. Twelve implants of each surface type (N = 36) were placed, sacrificing 1/3 of the animals at 2 weeks of placement, 1/3 at 4 weeks and the remaining 1/3 at 8 weeks. Numerical variables were compared with Analysis of Variance, and the correlation between ISQ and BIC was established with the Spearman’s rank correlation coefficient. Results: SLActive® and ContacTi® surfaces showed elevated osteoconductivity at 4 weeks, maintaining a similar evolution at 8 weeks (large amount of mature lamellar tissue with high maturity and bone quality). The SLA® surface showed slower maturation. The ISQ values in surgery were elevated (above 65), higher at necropsy and higher at 4 and 8 weeks in the SLA® group than in the other two (SLActive® and ContacTi®). No significant correlation was found between ISQ and BIC for each implant surface and necropsy time. Conclusion: The three surfaces analysed showed high RFA and BIC values, which were more favourable for the SLActive® and ContacTi® surfaces. No statistical correlation was found between the RFA and BIC values in any of the three surfaces analysed.

Introduction: Chemotherapy-associated osteonecrosis of the jaw caused by bisphosphonates is an exposure of necrotic bone with more than eight weeks of evolution that is attributable to bisphosphonates and no prior radia tion therapy. Its etiopathogenesis remains unknown, although there are two hypotheses that may explain it: the drug’s mechanism of action, and the risk factors that can lead to osteonecrosis. There is a wide range of treatment options for managing chemotherapy-associated osteonecrosis of the jaw, from conservative treatments to surgical procedures of varying levels of invasiveness, which are sometimes supplemented with adjuvant therapies. Objectives: The objective of this article is to group the therapeutic options for osteonecrosis of the jaw (ONJ) into seven different protocols and to evaluate their effectiveness in relation to stage of ONJ. Material and Methods: A literature review was carried out in PubMed following the PRISMA criteria. A total of 47 were collected after compiling a series of variables that define ONJ, applied treatments, and the clinical results obtained. Results and Discussion: The 47 articles selected have a low to average estimated risk of bias and are of moderate to good quality. According to the data obtained, Protocol 3 (conservative treatment, clinical and radiological follow up, minimally invasive surgical treatment, and adjuvant therapies) is the most favorable approach for ONJ lesions caused by oral bisphosphonates. For lesions caused by intravenous bisphosphonates, Protocol 2 (conservative treatment, clinical and radiological follow-up, minimally invasive surgical treatment, and no adjuvant therapies) is the best approach. When comparing the different stages of ONJ, Protocol 1 (conservative treatment, clinical and radiological follow-up) promotes better healing of Stage 1 ONJ lesions caused by orally administered bisphos phonates, and Protocol 3 is recommended for Stage II. For ONJ lesions attributable to intravenous

Introduction: Osteonecrosis of the jaw (MRONJ) linked to bisphosphonate treatment has specific characteristics that render its therapeutic management challenging for clinicians. Poor response to standard treatment makes it essential to take special precautions when treating this type of disease; therefore, antibiotic prophylaxis and/or antibiotic therapy have been proposed as effective and helpful tools in these situations. Objectives: This article seeks to assess published evidence in order to evaluate the different protocols used for antibiotic prophylaxis and/or antibiotic therapy in the general context of patients treated with bisphosphonates. Material and Methods: A literature review of the last 10 years was carried out in PubMed using the following keywords: “antibiotic prophylaxis and osteonecrosis,” “bisphosphonates AND osteonecrosis AND dental management,” “bisphosphonate AND osteonecrosis AND antibiotic prophylaxis AND oral surgery.” A total of 188 articles were obtained, of which 18 were ultimately selected. Results and Discussion: In patients treated with oral and intravenous bisphosphonates without chemotherapy-associated osteonecrosis of the jaw, antibiotic prophylaxis prior to oral surgery is an important tool to avoid osteonecrosis and promote healing of the affected area. If the patient previously exhibited chemotherapy-associated osteonecrosis after tooth extraction, antibiotic prophylaxis is indicated to prevent recurrent osteonecrosis and promote healing of the extraction site. If chemotherapy-associated osteonecrosis is already present, antibiotic therapy is a vital part of conservative management to reduce the symptomatology of MRONJ and keep it from worsening. Finally, a lack of clinical data and randomized controlled trials makes it difficult to choose the most appropriate protocol for the various clinical situations studied.

The keratocystic odontogenic tumor is a benign odontogenic cystic neoplasia characterized by its thin, squamous epithelium with superficial parakeratosis. It has the potential for infiltration and local aggressiveness and has a high rate of recurrence. This neoplasia is predominantly found in males and people of white origin. The mandible is the most frequently involved site, in particular the third molar region, mandibular angle, and ramus. It has a mandible-maxilla ratio of 2:1. Only about twenty cases of peripheral keratocystic odontogenic tumors (PKCOT) have been reported in the international literature. This study presents a case of PKCOT localized in the anterior region of the maxilla, on the vestibular side of the upper left lateral incisor and the upper left canine. The diagnosis and treatment procedures, as based on the literature, are also discussed.

Since the 1970s, modern Implantology is based on a concept of surgery with flap elevation. Gradually, several clinical trials demonstrated that a mid-crestal incision gives similar success rates compared to those obtained using the classical protocol. However, over the past decade in medicine it has been established the concept of minimally invasive surgery, consisting in taking advantage of advancements experienced in diagnostic techniques and specific surgical instruments, to perform surgical procedures infringing as less damage as possible to the patient The present work aims to produce a thorough review of the literature published on the field of Implantology with flapless surgery, to determine the current scientific evidence of the technique, along with illustrating the results with different clinical cases. After presenting the clinical cases, and the review of literature, we can say that flapless surgeries should be restricted to well-selected cases in which a proper clinical and radiological planning has been made. Patients treated with anticoagulant drugs or medically compromised equally can get benefitted by this minimal invasion technique.

Resonance frequency analysis (RFA) allows assess implant stability by measuring implant oscillation frequency on the bone. RFA is an objective and non-invasive method for implant stability measurement, although scarce evidence has been provided so far on its reliability. Objectives: Assess the Osstell ISQ system’s reliability (i.e., its measurement reproducibility and repeatability) by means of the intraclass correlation coefficient (ICC) as statistical method. Study Desing: Implants stability registers were completed by means of Osstell ISQ on 85 implants on 23 patients. Six measurements were completed on each implant by means of two different SmartPegs (types I and II); that is, three consecutive measurements with each transducer. Results: Average ISQ was 72.40, 72.22 and 72.79, and 72.06, 72.59 and 72.82 in the first, second, and third meas urements with SmartPegs I and II, respectively. Equal values or differences below three ISQ points were observed in 52.9% and 62.4% of the cases with SmartPegs I and II, respectively. The intraclass correlation coefficient was 0.97 for both SmartPegs, and repeatability and reproducibility also reached 0.97 for both SmartPegs. Conclusions: The RFA system Osstell ISQ presents almost perfect repeatability and reproducibility after intra class correlation coefficient analysis. Osstell ISQ measurements are highly reliable regarding reproducibility. Therefore, one measurement proves enough.

Objetivos: La rehabilitación implantológica del sector maxilar posterior se caracteriza, en un importante porcentaje de casos, por presentar un hueso de poca calidad y escaso. Estos aspectos han hecho que se desarrollen numerosas técnicas avanzadas de cirugía para evitar las dificultades asociadas a estas limitaciones. Tras la descripción de la elevación del seno maxilar mediante abordaje lateral, vino la descripción de técnicas de abordaje crestal, menos agresivas, pero que precisaban de una cantidad mínima de hueso para que se llevaran a cabo, y más sensibles a la técnica del operador, pues el control de la integridad de la membrana sinusal se hacía de forma indirecta. El objetivo del presente artículo es revisar la literatura relativa a técnicas de elevación sinusal mínimamente invasivas y comparar sus ventajas respecto a una nueva técnica, Intralift. Diseño del estudio: En el actual trabajo realizamos una revisión bibliográfica de las técnicas de elevación de seno mínima mente invasivas en Cochrane, Embase y Medline, durante los últimos diez años y presentamos una técnica de elevación de seno crestal mínimamente invasiva basada en la piezocirugía, ilustrada con un caso clínico. Resultados: Tan sólo se han encontrado ocho artículos centrados en técnicas de elevación de seno mínimamente inva sivas. Las principales ventajas de esta nueva técnica, Intralift, es que no precisa una cantidad mínima de hueso crestal (es más, cuanto menor es el ancho del hueso crestal, mejor funciona la técnica) y minimiza la posibilidad de dañar de la membrana sinusal al utilizarse la presión hidrodinámica de los ultrasonidos para elevarla; y conservando, por supuesto, un abordaje crestal poco agresivo. Conclusiones: Por todo lo anterior pensamos que esta técnica avanza en la búsqueda de técnicas menos traumáticas y agresivas que caracteriza a la cirugía actual.

Objectives: Placing implants in the posterior maxillary area has the drawback of working with scarce, poor quality bone in a significant percentage of cases. Numerous advanced surgical techniques have been developed to overcome the difficulties associated with these limitations. Subsequent to reports on the elevation of the maxillary sinus through the lateral approach, there were reports on the use of the crestal approach, which is less aggressive but requires a minimal amount of bone. Furthermore, it is more sensitive to operator technique, as the integrity of the sinus membrane is checked indirectly. The aim of this paper is to review the technical literature on minimally invasive sinus lift and compare the advantages of different techniques with Intralift™, a new technique. Study design: The present study is a review of techniques used to perform minimally invasive sinus lift published in Cochrane, Embase and Medline over the past ten years and the description of the crestal sinus lift technique based on minimally invasive piezosurgery, with the example of a case report. Results: Only eight articles were found on minimally invasive techniques for sinus lift. The main advantage of this new technique, Intralift, is that it does not require a minimum amount of crestal bone (indeed, the smaller the width of the crestal bone, the better this technique is performed). The possibility of damage to the sinus membrane is minimised by using ultrasound based hydrodynamic pressure to lift it, while applying a very non-aggressive crestal approach. Conclusions: We believe that this technique is an advance in the search for less traumatic and aggressive techniques, which is the hallmark of current surgery.

La Odontología está experimentando un desarrollo científico vertiginoso: entrevista a los Dres.: Manuel María Romero Ruíz, José Luis Gutiérrez Pérez, Daniel Torres-Lagares, autores de la segunda edición del libro "El tercer molar incluido".

The aim of this study is to analyse the current situation in dental autotransplantations within the different therapeutic alternatives that the dentist has available to replace a tooth in the dental arcade.For some authors this is an option headed for failure, whereas for others, it is an alternative to keep in mind. In this study we analyse the factors related to the predictability of the technique, based on an analysis of research work published in the scientific literature up to date. We also present two clinical cases performed by our team and their subsequent evaluation. In spite of the satisfactory results seen when reviewing the existing literature, we cannot say that dental autotransplantation is currently the technique of choice when a tooth is lost, given the predictability of osteointegrated implants.

Purpose: Chlorhexidine is a good prophylactic agent for post-extraction dry socket alveolitis. The bio-adhesive 0.2% chlorhexidine gel could improve this action since its intra-alveolar positioning would allow a more direct action on the alveolus and more prolonged action of the medication. Materials and Method: We present a single blind, randomised study on 30 patients to evaluate the efficacy of the bio-adhesive 0.2% chlorhexidine gel, placed only once within the alveolus, on the reduction of the incidence of impacted third molar postextraction dry socket alveolitis and its post-operative effects on patients. Results. A reduction of 42.65% in the occurrence of alveolitis and a more favourable post-operative period in the experimental group was observed. In the control group, the appearance of alveolitis was 30.76% opposite to 17.64 % in the experimental group. Conclusions: The bio-adhesive 0.2% chlorhexidine gel, applied only once after the extraction of impacted third molars, seems to be an appropriate option for the reduction of alveolitis. It improves the buccal aperture and oedema in the post-operative period, although further double blind studies with larger samples are necessary., Introducción: La clorhexidina es un buen agente profiláctico de la alveolitis post-extracción. La aparición del gel bioadhesivo conteniendo clorhexidina al 0,2% podría mejorar esta acción. Su colocación intraalveolar permitiría una actuación más directa sobre el alveolo y una actuación más prolongada del fármaco. Pacientes y método: Presentamos un estudio a simple ciego, randomizado, sobre 30 pacientes, valorando la influencia de la colocación en una sola vez y de forma intraalveolar gel bioadhesivo conteniendo clorhexidina al 0,2% tras la extracción de terceros molares incluidos, en la aparición de alveolitis y en el postoperatorio de los pacientes. Resultados: Encontramos una reducción del 42,65% en la tasa de alveolitis y un postoperatorio más favorable en el grupo experimental. En el grupo control, la alveolitis apareció en un 30,76% frente a un 17,64 % en el grupo experimental. Discusión y conclusiones: Tras comparar nuestros datos con otros estudio, pensamos que el gel bioadhesivo de clorhexidina al 0,2%, aplicado en una sola vez de forma intraalveolar parece ser una opción adecuada para la prevención de la alveolitis. Esta actuación mejora la apertura bucal y el edema en el postoperatorio, aunque son necesarios nuevos estudios realizados a doble ciego y con muestras más amplias para confirmar nuestros datos.

La alveolitis seca es una complicación postoperatoria que acontece tras la extracción dental, quedando definida como una inflamación del alveolo. En el caso que esta inflamación sobrepase las paredes alveolares, estaríamos ante una osteítis localizada. La frecuencia de aparición de la alveolitis se ha referido en un margen muy amplio, desde el 1 % hasta el 70 %.Generalmente se acepta que la mayor incidencia de alveolitis acontece tras laextracción de terceros molares retenidos, en los que la aparición de esta complicación se tasa en un 20-30 % de las extracciones, diez veces más que en el resto de extracciones dentales. En el presente artículo se revisan la forma de aparición clínica, los factores de riesgo relacionados con el cuadro y las teorías etiopatogénicas que intentan explicar su aparición. También se examinan las pautas utilizadas actualmente en su tratamiento. Acorde con las teorías patogénicas de la alveolitis seca, para su prevención se han estudiado agentes fibrinolíticos, lavados, antisépticos y antibióticos. Analizamos los distintos fármacos utilizados, criticando los resultados obtenidos. Como conclusión, y a partir de los datos revisados, pensamos, sin abandonar el territorio de la hipótesis, que es posible defender un modelo patogénico en el que los mecanismos fibrinolíticos bacterianos y del propio organismo colaboren para producir la alveolitis seca, Dry socket is a postoperative complication that occurs after a dental extraction and has been defined as an inflammation of the alveolus. If this inflammation should surpass the alveolar walls, it would result in a located osteitis. The frequency of appearance of dry socket has been reported in a very wide margin, from 1% until 70%. It is generally accepted that most dry sockets appear after extraction of third retained molars, in which the occurrence of this complication is about 20-30% of dental extractions, tentimes more than in the rest of dental extractions. In this work we review the forms of clinical appearance, the risk factors related to this affection and the etiopathogenic theories that try to explain its appearance. The treatment management is also examined. Fibrinolitic agents, laundries, antiseptic, and antibiotics have been studied for its prevention, according to the pathogenic theories of dry socket. We analyze and critize the different drugs and their results. In conclusion from the revised data, we think it is possible to defend a pathogenic model in which the bacterial fibrinolytic mechanisms and the microorganism of the own patient may contribute to produce the dry socket.

El diagnóstico y enfoque terapéutico de los quistes radiculares supone una cuestión extremadamente controvertida para el odontólogo. Teniendo en cuenta que representa la lesión quística más frecuente de los maxilares, y que su diagnóstico diferencial con la periodontitis apical crónica presenta una especial dificultad, la cuestión adquiere una mayor trascendencia. El objetivo del presente artículo es valorar la validez de las distintas técnicas diagnósticas que nos permiten diferenciar ambas patologías y analizar críticamente la controversia sobre el enfoque terapéutico de los supuestos quistes radiculares hacia una actuación no quirúrgica y de seguimiento, o bien hacia la enucleación quirúrgica y análisis histopatológico de los mismos., The diagnosis and therapeutic approach to periapical cysts is an extremely controversial concern for dentists. Furthermore, as this complaint represents the most frequent cystic lesion of the maxilla, together with the fact that its differential diagnosis with chronic apical periodontitis presents special difficulty, the question takes on even greater importance. The purpose of this article is to assess the validity of the various diagnostic techniques used to differentiate between both pathologies and make a critical analysis of the controversy surrounding the therapeutic approach to suspected periapical cysts through non-surgical and follow-up treatment, or surgical enucleation and histopathological analysis.

Los antiinflamatorios son los fármacos más utilizados en la actualidad para el control de las secuelas postoperatorias de la extracción quirúrgica de los cordales incluidos. Vamos a distinguir por un lado los no esteroideos (AINE) y por otra parte los glucocorticoides.

En 1992, Kramer, Pindborg y Shear publicaron para la O.M.S. una clasificación de los tumores odontogénicos que fue aceptada por la comunidad internacional. Sin embargo, esta clasificación no incorpora como uno de sus criterios la inducción dentaria y su influencia en la génesis tumoral. Hemos realizado un estudio de la literatura con el objetivo de fundamentar una propuesta de enriquecimiento de esta clasificación que resultara de aunar los criterios utilizados por la O.M.S. y el efecto inductor, incorporando los últimos conocimientos publicados acerca de cada tipo de tumor odontogénico., In 1992, Kramer, Pindborg and Shearpublished a classification ofodontogenic tumors that was accepted by intemational community. Therefore this classífication does not add like one ofits criterious the dental induction and its influence in tumoral genesis. We have done a study o/ literature in order to lay thefoundations ora proposal ofenrichment of this classification which results ofuniting the criterious used by WHO nd inductor effect, adding the lastpublished knowledges about each type of odontogenic tumors