Clinical effect of platelet rich fibrin in the treatment of periodontal intrabony defects. systematic review and meta-analysis

Background: There is currently no gold standard biomaterial for the treatment of periodontal intrabony defects (PIDs). One of the current options is the use of platelet-rich fibrin (PRF). Objective: To determine the clinical effect of PRF in the treatment of PID through a systematic review and meta-analysis. Materials and Methods: A literature search was conducted up to February 2017 in the following biomedical databases: Pubmed, Embase, Scielo, Science Direct, SIGLE, LILACS and in the Cochrane Central Register of Clinical Trials. The selection criteria included: randomized clinical trials published in the last 5 years, reporting clinical effects (probing depth, clinical insertion level or gingival recession), with a follow-up time equal to or greater than 6 months, and sample size larger than or equal to 10 patients reporting the use of PRF as a treatment for PID. The methodological quality of the studies was analyzed using the Cochrane Handbook of Systematic Reviews of Interventions as a reference. Results: The search strategy yielded 20 articles. A reduction in probing depth and an increase in clinical insertion level or a reduction in gingival recession is reported, when using PRF alone or in combination with another biomaterial or substance that stimulates tissue regeneration. Conclusion: The literature suggests that the use of PRF in the treatment of PIDs has a beneficial clinical effect when compared to control treatments.

Clinical effect of platelet rich plasma in the treatment of periodontal intrabony defects. systematic review and meta-analysis

Introduction: One of the consequences of periodontitis is periodontal intrabony defects (PID). Various biomaterials have been used for its treatment, but there is still no biomaterial considered as the gold standard. Current research is focused on the use of platelet-rich plasma (PRP) for the treatment of PID. Objective: To determine the clinical effect of PRP in the treatment of PID through a systematic review with meta-analysis. Materials and Methods: A literature search was conducted until February 2017 in the biomedical databases: Pubmed, Embase, Scielo, Science Direct, SIGLE, LILACS, IBECS, and the Cochrane Central Register of Clinical Trials. The criteria for the selection of the studies, which were randomized clinical trials, were the following: articles or papers published in the last 5 years, reporting clinical effects, with a follow-up time equal to or greater than 6 months, and a sample size equal to or greater than 10 patients reporting the use of PRP as a treatment for PID. The methodological quality of the studies was analyzed using the Cochrane Handbook of Systematic Reviews of Interventions as a reference. Results: The search strategy yielded nine articles reporting a reduction in probing depth and gingival recession, and an increase in clinical insertion level when using PRP alone or in combination with another biomaterial. Conclusion: The reviewed literature suggests that the use of PRP in the treatment of PID has a positive clinical effect.

Cotrimoxazol en infecciones óseas: toxicidad e impacto clínico y económico / Cotrimoxazole in bone-related infections: toxicity and clinical and economic impact

Background: Cotrimoxazole is a therapeutic option for bone-related infections but is associated to hyperkalemia and renal failure. Tolerance to this drug may reduce length of stay (LOS) and hospital charges. Aims: To evaluate renal, potassium toxicity, clinical outcome, and use of hospital resources in patients treated with cotrimoxazole for bone-related infections. Methods: Retrospective analysis of adult patients with bone-related infections confirmed by culture and treated with this drug. Serum potassium and creatinine levels were analyzed during follow-up and risk factors for hyperkalemia were searched. Length of stay (LOS) and hospital charges were compared. Clinical outcome was evaluated as a secondary endpoint. Results: From 2011 to 2014, 23 patients were identified (mean age 64.7 years). Diabetes mellitus, peripheral vascular disease, and previous amputations prevalence were high (82.6%, 47.8%, and 43.5%, respectively). Median serum potassium concentration increased significantly at first control (4.35 mEq/L to 4.9 mEq/L; p < 0.001), and also creatinine serum concentration (0.9 to 1.1 mg/dL; p < 0.05). Seven patients developed hyperkalemia. Cotrimoxazole was discontinued in 10 patients (43.5%), and in 6, discharge was postponed. Drugs active against the renin-angiotensin system (DAARAS) were associated with kyperkalemia (OR 10.8 IC95 1.37-85; p < 0.05). LOS was higher among patients with cotrimoxazole toxicity (median LOS 56 versus 30 days, p < 0.05). Patients with no cotrimoxazole interruption had less drug-related hospital charges (median values of 563 versus 2820 USD, respectively; p < 0.01). Conclusions: Cotrimoxazole use must be monitored in order to detect hyperkalemia or renal toxicity and suspend its prescription. Patients that use DAARAS have a higher risk of kyperkalemia. LOS and drug-related hospital charges are reduced when patients can tolerate cotrimoxazole.

Antecedentes: Cotrimoxazol es una alternativa en infecciones óseas pero se ha asociado al desarrollo de falla renal e hiperkalemia. Objetivo: Evaluar toxicidad renal, hiperkalemia, estadía y gastos hospitalarios y evolución clínica en un grupo de pacientes con infecciones óseas tratados con este compuesto. Pacientes y Métodos: Estudio retrospectivo-descriptivo de pacientes adultos con infecciones óseas confirmadas con cultivos y tratados con este compuesto. Seguimiento de creatinina y kalemia y búsqueda de factores de riesgo para hiperkalemia, comparación de gastos y estadía hospitalaria y análisis de eficacia clínica. Resultados: Desde el año 2011 al 2014 se identificaron 23 pacientes (promedio de edad 64,7 años). La prevalencia de diabetes mellitus tipo 2 (82,6%), enfermedad vascular periférica (47,8%) y amputaciones previas (43,5%) fue elevada. La mediana de la kalemia basal aumentó significativamente al primer control (4,35 a 4,9 mEq/L) al igual que la creatinina plasmática (0,9 a 1,1 mg/dL). Siete pacientes desarrollaron hiperkalemia (30,4%). Se suspendió cotrimoxazol en 10 casos (43,5%) y en 6 casos se postergó el alta. El uso de fármacos activos contra el sistema renina-angiotensina (FASRA) se asoció a hiperkalemia (OR 10,8 IC95 1,37-85; p < 0,05). La estadía hospitalaria fue mayor en el grupo con toxicidad a cotrimoxazol (mediana de 56 versus 30 días; p < 0,05) y los pacientes sin suspensión de terapia tuvieron menos gastos por fármacos (medianas de 563 vs 2.820 USD, p < 0,01). Conclusiones: El uso de cotrimoxazol debe ser monitorizado para detectar hiperkalemia o toxicidad renal y suspender su prescripción. Los pacientes que usan FASRA tienen mayor riesgo de hiperkalemia. La estadía y gastos hospitalarios por fármacos son menores en pacientes que toleran el cotrimoxazol.

Dental implant survival rate in well controlled diabetic patients: a systematic review / Tasa de supervivencia de implantes dentales en pacientes diabéticos controlados: una revisión sistemática

Abstract: Background: dental implants have now become one of the most popular options for replacing a missing tooth. On the other hand, diabetes mellitus is a systemic disease that affects a large part of the population and is generally considered an absolute or relative contraindication to implant therapy. Aim: To determine the survival rate of dental implants in controlled diabetic patients through a systematic review. Material and methods: A systematic search in Pubmed, SciELO and RedALyC databases was performed. The selection criteria were: studies published in the last 10 years, with at least 20 controlled diabetic patients, reporting survival rate and number of implants placed, with follow-up periods equal to or longer than 1 year, including a control group of healthy patients. Methodological quality was analyzed with the follwing scales: Jadad and Downs & Black’s CMQ. Results: Three articles with a follow-up period between 1 and 12 years were analyzed. The overall survival rate of dental implants in diabetic controlled patients was 97.43 percent. Conclusion: The reviewed literature suggests that survival rate of dental implants in well-controlled diabetic patients is similar to non diabetic patients.

Resumen: Antecedentes: los implantes dentales se han convertido actualmente en una de las opciones más populares para sustituir un diente perdido. Por otro lado, la diabetes mellitus es una enfermedad sistémica que afecta a gran parte de la población y es considerada generalmente una contraindicación absoluta o relativa en la terapia con implantes. Objetivo: Determinar mediante una revisión sistemática la tasa de supervivencia de implantes dentales en pacientes diabéticos controlados. Materiales y métodos: Búsqueda sistemática en las bases de datos biomédicas Pubmed, SciELO y RedALyC. Los criterios de selección fueron: estudios publicados en los últimos 10 años, con al menos 20 pacientes diabéticos controlados, que reporten tasa de supervivencia y número de implantes colocados, con un seguimiento igual o superior a 1 año, con un grupo control de pacientes sanos. Se analizó la calidad metodológica de los estudios con las escalas Jadad y CMQ de Downs y Black. Resultados: Se analizaron tres artículos con un seguimiento de entre 1 y 12 años. La tasa de supervivencia global de los implantes dentales en los pacientes diabéticos controlados fue de un 97.43 por ciento. Conclusión: La literatura revisada sugiere que la supervivencia de los implantes dentales en pacientes diabéticos bien controlados es similar a pacientes no diabéticos.

Aclareamiento dental en tinciones por tetraciclina: caso clínico / Staining in dental bleaching by tetracyclines: case report

El manejo de los pacientes con tinciones por tetraciclinas es un manejo complejo, según el grado de tinción que presenta cada paciente. En la atención clínica, se pueden presentar este tipo de situación y está en el profesional preparado para manejar adecuadamente estos casos. Se han descrito en la literatura varios tipos de alternativas de tratamiento, según la complejidad del caso. En el presente artículo se presenta una alternativa de tratamiento en la resolución de un caso clínico. El objetivo fue mejorar la estética de las piezas dentarias, realizando un procedimiento de blanqueamiento dental con cubetas. Los resultados fueron satisfactorios para el paciente, ya que en general se puede atenuar bastante las tinciones, volviendo al paciente la estética en su sonrisa. Se puede concluir que el manejo adecuado de los geles de blanqueamiento ofrece una alternativa eficaz en la resolución de este tipo de casos.

The management of patients with stains by tetracycline is complicated depending on the degree of stain that each patient presents when attending These situations may occur and the professional should be properly prepared to handle these cases. Several kinds of alternatives of treatment depending on the complexity of the case have been described in the literature. This article presents an option to treatment in a clinical case. The objective was to improve the teeth esthetic performing about a procedure of dental bleaching with buckets. The results were satisfactory for the patient because the stains were quite mitigated and this gave the patient an esthetic smile. It can be concluded that the proper handling of whitening or bleaching gels offer an effective alternative in the resolution of such cases.