Prevalencia de Complicaciones de Post Exodoncia de Terceros Molares / Prevalence of Post-Extraction Complications of Third Molars

El Centro de Salud Familiar (CESFAM) de San Pedro de Atacama, es el único establecimiento de Atención de salud en la comuna y alrededores, se hace imperativo para los Cirujanos Dentistas ser resolutivos y entregar una solución efectiva a la demanda local. El objetivo de este trabajo consistió en determinar prevalencia de complicaciones postexodoncia de terceros molares de pacientes atendidos en CESFAM San Pedro de Atacama entre enero y octubre de 2020. Estudio descriptivo de corte transversal entre enero y octubre 2020, se realizó revisión retrospectiva de fichas clínicas manuales y base de datos electrónica de atenciones odontológicas realizadas en CESFAM. Se incluyeron en el estudio pacientes mayores 18 años, sistémicamente sanos o ASA II compensados, que se hayan realizado exodoncia de tercer molar superior o inferior y que hayan asistido a control clínico a los 7 días. Se excluyeron fichas clínicas ilegibles o sin evolución, pacientes que tuvieran antecedentes de pericoronaritis hasta 7 días previos y pacientes inmunocomprometidos. La frecuencia de complicaciones postoperatorias se relacionó según dificultad de la intervención (leve/moderada/alta) y si el diente era maxilar o mandibular. Se realizó un análisis descriptivo y estadístico de los datos obtenidos mediante prueba exacta de Fisher para evaluar asociación entre las variables utilizando programa estadístico STATA v. 15. Entre enero y octubre de 2020 se realizaron 146 exodoncias de terceros molares; 61 fueron de dificultad leve (41,7 %), 58 dificultad moderada (39,8 %) y 21 dificultad alta (18,5 %). El total de complicaciones postexodoncia alcanza 5,4 % (n=8) donde la complicación más frecuente es alveolitis. Las complicaciones postexodoncia se relacionan significativamente con el nivel de dificultad leve (p0,05).

The Communnity Health Center (CESFAM) of San Pedro de Atacama, is the only establishment of health assistance in the community and surroundings, it is imperative for Dental Surgeons to be decisive and deliver an effective solution to local demand. Determinate the prevalence of post-extraction complications of third molars in patients treated at CESFAM San Pedro de Atacama between January and October 2020. Descriptive cross- sectional study between January and October 2020. It has been done a retrospective review of manual clinical records and electronic database of dental care performed at CESFAM. Patients over 18 years old, systemically healthy or compensated ASA II, who had extracted an upper or lower third molar and who had attended a 7-day clinical check-up were included in the study. Were excluded Illegible or no follow up clinical records, patients with a history of pericoronitis up to 7 days previously, and immunocompromised patients. The frequency of postoperative complications was related to the difficulty of the intervention (mild / moderate / high) and whether the tooth was maxillary or mandibular. A descriptive and statistical analysis of the data obtained by Fisher's exact test was carried out to evaluate the association between the variables using the statistical program STATA v. 15. Between January and October 2020, 146 third molar extractions were performed; 61 were of mild difficulty (41.7 %), 58 of moderate difficulty (39.8 %) and 21 of high difficulty (18.5 %). The result of post-extraction complications reached 5.4 % (n = 8), where the most frequent complication was alveolitis. Post-extraction complications are significantly related to the level of mild difficulty (p 0,05).

Resolución Quirúrgica para Un Caso de Polisinusitis de Origen Odontogénico / Surgical Resolution for A Case of Polysinusitis of Odontogenic Origin

La celulitis orbitaria es una patología grave que está asociada con sinusitis paranasal. Éstas suelen presentar edema periorbitario, dolor, y movimiento extraocular restringido. La mayoría de los casos presentan pronóstico favorable, asociado a terapia antibiótica o drenaje quirúrgico. Las celulitis de origen odontogénico representan 2 a 5 % de todos los casos; se caracterizan por una diseminación del proceso infeccioso desde los ápices de las raíces, infectando al seno maxilar, llegando a la órbita a través de la fisura orbitaria inferior o a través de un defecto en el piso de la órbita. En el presente estudio se reporta el caso de un paciente masculino de 28 años que consulta por aumento de volumen periorbitario izquierdo con 4 días de evolución, posterior a exodoncia de segundo molar superior izquierdo. Al examen extraoral presenta aumento de volumen izquierdo con eritema periorbitario, proptosis ocular ipsilateral con visión conservada, y salida de líquido purulento por fosa nasal izquierda. En los exámenes de laboratorio e imagenológicos se pesquisa compromiso de seno maxilar, etmoidal y esfenoidal, decidiendo su hospitalización y manejo quirúrgico en tres tiempos operatorios, los cuales permiten acceso a pared anterior del seno maxilar y a espacio pterigoideo. Dentro de los diagnósticos de celulitis orbitaria pueden incluir reacciones alérgicas, conjuntivitis o herpes. Se excluyeron los diagnósticos mencionados debido a que no se observaron alteraciones dermocutáneas periorbitarias. Por el contrario, el compromiso unilateral, movimiento ocular alterado y doloroso indica que el cuadro abarcaba espacios profundos. La infección de senos paranasales posterior a una exodoncia es una complicación poco frecuente. Un diagnóstico temprano adecuado disminuye la morbilidad y mortalidad de esta condición. Debemos estar alertas a complicaciones posteriores en procedimientos realizados, tener conocimiento en diagnóstico y manejo de posibles evoluciones tórpidas en pacientes.

Orbital cellulitis is a serious pathology that is associated with paranasal sinusitis. These medical conditions usually present with periorbital edema, pain, and restricted extraocular movement. Most cases have a favorable prognosis, associated with antibiotic therapy or surgical drainage. Cellulitis of odontogenic origin represents 2 to 5 % of all cases. They are characterized by a spread of the infectious process from the apices of the roots, infecting the maxillary sinus, reaching the orbit through the inferior orbital fissure or through a defect in the floor of the orbit. The present study reports the case of a 28-year-old male patient, who consulted for a volume increase in left periorbital volume with 4 days of evolution, after extraction of the upper left second molar. Extraoral examination showed left volume increase with periorbital erythema, ipsilateral ocular proptosis with preserved vision, and discharge of purulent fluid from the left nostril. The laboratory and imaging tests showed compromise of the maxillary, ethmoid and sphenoid sinus deciding on hospitalization and surgical management in three operative times, which allow access to the anterior wall of the maxillary sinus and the pterygoid space. Diagnoses of orbital cellulitis may include allergic reactions, conjunctivitis, or herpes. These diagnoses were excluded because no periorbital dermocutaneous alterations were observed. In contrast, unilateral involvement, impaired eye movement, and pain indicate that the condition involved deep spaces. Paranasal sinus infection after tooth extraction is a rare complication. An early diagnosis adequately decreases the morbidity and mortality of this condition. We must be alert to subsequent complications in procedures performed, have knowledge in diagnosis and management of possible torpid evolutions in patients.

Efectividad del uso transoperatorio de solución electrolizada de superoxidación para la prevención de infecciones postoperatorias en cirugía de terceros molares / Effectiveness of the trans-operative use of electrolyzed superoxidation solution for the prevention of post-operative infections in third molar surgery

La cirugía de terceros molares es uno de los procedimientos más realizados dentro de la práctica odontológica, generalmente conlleva la prescripción de fármacos, incluidos antibióticos indicados para prevenir la aparición de procesos infecciosos. La resistencia antimicrobiana es considerada como un problema de salud pública a nivel mundial, por lo que el uso de antibióticos debe ser cauteloso. La solución electrolizada de súperoxidación ha demostrado tener efectos bactericidas, virucidas y ha sido utilizada para la prevención y el tratamiento de procesos infecciosos. El objetivo del presente estudio fue demostrar la efectividad de dicha solución en la prevención de infecciones posteriores a la cirugía de terceros molares. Se realizó un estudio aleatorizado, ciego, prospectivo en 20 pacientes utilizando un diseño split mouth, en donde cada paciente fue sujeto control y experimental, en el grupo control se irrigó durante el procedimiento con solución de súperoxidación y no se prescribió antibiótico posterior, mientras que en el grupo control se irrigó con solución fisiológica y se prescribió antibiótico posterior. Se realizaron 40 cirugías en 20 pacientes utilizando en cada paciente ambas terapéuticas. Se analizó el dolor postoperatorio, inflamación y presencia de infección. El dolor y la inflamación fueron ligeramente superiores en el grupo experimental al tercer día; sin embargo, al séptimo día los resultados fueron similares. No se presentó ningún caso de infección postoperatoria. El uso de solución de súperoxidación transoperatoria puede ser una herramienta muy útil en la prevención de infecciones postoperatorias posterior a cirugía de terceros molares en pacientes sanos en cirugías con dificultad leve a moderada (AU)

Third molar surgery is one of the most performed procedures in dental practice, generally involving the prescription of drugs including antibiotics indicated to prevent the onset of infectious processes. Antimicrobial resistance is considered a public health problem worldwide, so the use of antibiotics should be cautious. The electrolyzed super oxidation solution has been shown to have bactericidal and virucidal effects and has been used for the prevention and treatment of infectious processes. The objective of the present study was to demonstrate the effectiveness of said solution in the prevention of infections after third molar surgery. A randomized, blind, prospective study was conducted in 20 patients using a split mouth design where each patient was a control and experimental subject, in the control group they were irrigated during the procedure with super oxidation solution and no subsequent antibiotic was prescribed. while the control group was irrigated with physiological solution and a subsequent antibiotic was prescribed. Forty surgeries were performed on 20 patients using both therapies in each patient. Postoperative pain, inflammation and presence of infection were analyzed. Pain and inflammation were slightly higher in the experimental group on third day, however on seventh day the results were similar. There were no cases of postoperative infection. The use of trans operative super oxidation solution can be a very useful tool in the prevention of postoperative infections after third molar surgery in healthy patients undergoing surgeries with mild to moderate difficulty.(AU)

Effects of early unilateral mandibular first molar extraction on condylar and ramal asymmetry / Efectos de la extracción temprana del primer molar mandibular unilateral sobre la asimetría condilar y ramal

SUMMARY: Craniofacial symmetry is an important factor in creating a harmonious facial appearance. Genetic and external factors may cause the formation of mandibular asymmetry. The aim of this study was to evaluate vertical mandibular asymmetries in adolescents who had unilateral mandibular first permanent molar (FPM) teeth extracted at an early age. The study group consisted of 60 subjects (30 females, 30 males with a mean age of 16.18±1.04 years) who had their mandibular permanent first molar tooth extracted before the age of 12, and the control group consisted of 60 healthy subjects (30 females, 30 males with a mean age of 16.23±0.92 years). Condylar asymmetry index (CAI), ramal asymmetry index (RAI), and condylar-ramal asymmetry index (CRAI) were calculated using panoramic radiographs of the subjects. Independent samples t-test was used to evaluate the differences between groups. CAI, RAI, and CRAI values were similar between male and female subjects in both control and study groups, and no statistically significant difference was found (p>0.05). No statistically significant difference was observed between the group who had their mandibular first permanent molar teeth extracted at an early age and the control group (p>0.05). CAI values were relatively higher in both groups, but there was no significant difference between the CAI, RAI, and CRAI values between the groups.

La simetría craneofacial es un factor importante para crear una apariencia facial armoniosa. Factores genéticos y externos pueden causar la formación de asimetría mandibular. El objetivo de este estudio fue evaluar las asimetrías mandibulares verticales en adolescentes a quienes se les extrajo el primer molar permanente (FPM) mandibular unilateral a una edad temprana. El grupo de estudio consistió en 60 sujetos (30 mujeres, 30 hombres con una edad media de 16,18±1,04 años) a quienes se les extrajo el primer molar mandibular permanente antes de los 12 años, y el grupo control consistió en 60 sujetos sanos (30 mujeres, 30 hombres con una edad media de 16,23±0,92 años). El índice de asimetría condilar (CAI), el índice de asimetría ramal (RAI) y el índice de asimetría condilar-ramal (CRAI) se calcularon utilizando radiografías panorámicas de los sujetos. Se utilizó la prueba t de muestras independientes para evaluar las diferencias entre los grupos. Los valores de CAI, RAI y CRAI fueron similares entre los hombres y las mujeres tanto en el grupo control como en el de estudio, y no se encontraron diferencias estadísticamente significativas (p>0.05). No se observaron diferencias estadísticamente significativas entre el grupo al que se le extrajo el primer molar permanente mandibular a una edad temprana y el grupo control (p>0,05). Los valores de CAI fueron relativamente más altos en ambos grupos, pero no hubo diferencias significativas entre los valores de CAI, RAI y CRAI entre los grupos.

A Comparison between Inferior Alveolar Nerve Block and Crestal Anesthesia in Children Undergoing Dental Extraction Procedure

ABSTRACT Objective: To evaluate the efficacy of crestal anesthesia compared to the inferior alveolar nerve block (IANB) in 6-9-year-old children undergoing tooth extraction. Material and Methods: This case-control study was conducted on 70 children who needed bilateral mandibular primary molar extractions. The Faces Pain Scale was used to determine the efficacy of the anesthetic technique. Demographic data, onset time of anesthesia, duration of anesthesia, and blood pressure were also recorded. The data were analyzed using SPSS 25 and analytical tests: t-test, chi-squared test, and one-way ANOVA. The level of significance was set at p<0.05. Results: The efficacy of the IANB was significantly higher than the crestal anesthesia (p<0.05). The duration of IANB anesthesia was significantly more than the crestal anesthesia (p<0.05). The two anesthetic techniques showed no significant differences in pediatric blood pressure as a determinant of the pain evoked in children during the injection (p>0.05). Conclusion: Crestal anesthesia proved an effective method to extract primary molars. However, further studies are necessary to confirm this.

Success and survival rates of immediate anatomic zirconia implants: a prospective clinical and radiographic evaluation

Modern immediate titanium implants have two major drawbacks which are the black metal appearance that might be seen through the mucosa and the gap between implant and extraction socket. Immediate anatomical zirconia implants were introduced to match the shape of the extracted root and fill the socket without gaps while still providing better metal-free appearance. Aim: This study aims to investigate success and survival rates of immediate anatomical zirconia implants. Methods: This prospective interventional study was held between 2017 and 2020 in the faculty of dental medicine, Damascus University, Syria. The sample consisted of 27 immediate anatomical zirconia implants in 21 patients from both genders. Implants were designed and manufactured starting from CBCT image and prior to extraction. Specialized software applications were used to modify implant design. Implants went through different processing procedures to make them ready for insertion immediately after tooth extraction. Restorations were made after a minimum period of 3 months, clinical and radiographic follow ups were performed after 10 - 13.5 months from restoring the implants in order to evaluate their success/ survival. Repeated measures ANOVA was used to assess marginal bone loss, t test for probing depth assessment. Results: Immediate anatomical zirconia implants showed success in (n=17) 63% of total cases, satisfactory survival (n=3) 11.1%, compromised survival (n=2) 7.4% and they failed in (n=5) 18.5%. Conclusions: Immediate anatomical zirconia implants had low success/survival rates when compared to conventional immediate implants. Therefore, they cannot be considered as a predictable alternative in their current form

Histopathological evaluation of the effect of Salvadoria persica and Nigella sativa on the healing of tooth extraction socket in animal

To assess the effects of Salvadoria persica and Nigella sativa combination in tooth socket healing after extraction that can be a novel remedy for tooth extraction socket. Methods: Forty rabbits were included in this study, divided into two groups (control and experimental) with 20 rabbits. Upper right central incisors were extracted for all animals, the tooth sockets of the experimental group were dressed using an admix of Salvadoria persica and Nigella sativa immediately after irrigation with normal saline. In contrast, the extraction sockets of the control group were left without dressing. Biopsies were taken after euthanizing the animals at 1, 3, 7, and 14 days after treatment, histological examination was done for the samples at the given periods respectively. Results: On day 1 post-treatment, histological examination of the experimental group sections showed less acute inflammatory reaction than the control group. This continued to be reduced until the seventh day. The amount of granulation tissue formation was more in the experimental group along the different periods of the study, while new bone formation was observed after 1 week as woven bone, increased after 2 weeks and appeared as woven and lamellar bone in both experimental and control groups. Conclusions: A mixture of Salvadoria persica and Nigella sativa has an anti-inflammatory effect and accelerate bone healing by stimulating bone formation in the tooth extraction socket

Combined micro-apical surgery and vital pulp therapy in mandibular second molars with external root resorption caused by impacted teeth / 华西口腔医学杂志

OBJECTIVES@#This study aimed to establish a new treatment of the mandibular second molars with external root resorption caused by impacted teeth to preserve the affected teeth and their vital pulps.@*METHODS@#For mandibular second molars clinically diagnosed as external root resorption caused by impacted teeth, debridement and removal of the root at the resorption site via micro-apical surgery and direct capping of the pulp with bioactive material on the surface of the root amputation via vital pulp therapy were performed immediately after the impacted teeth were extracted.@*RESULTS@#The external root resorption of the affected tooth was ceased. It was asymptomatic with intact crown, normal pulp, periapical alveolar bone reconstruction, normal periodontal ligament, continuous bone sclerosis, and no periapical translucency in radiographic examination at the 1-year postoperative follow-up, thus showing good prognosis.@*CONCLUSIONS@#Simultaneous combination of micro-apical surgery and vital pulp therapy after extraction of impacted teeth could successfully preserve mandibular second molars with ERR caused by impacted teeth and their vital pulps.

Assessment of Panoramic Radiographic Variables as Predictors of Inferior Alveolar Nerve Injury During Third Molar Extraction

ABSTRACT Objective: To assess the role of radiological predictive markers on orthopantomogram for inferior alveolar nerve (IAN) injury related to the removal of mandibular third molar surgery and the occurrence of post-operative IAN paresthesia. Material and Methods: This prospective observational study was conducted on 60 patients (aged 17-35 years) indicated for extraction and showed one or more of the seven previously known panoramic radiographic risk signs of IAN injury. Variables such as age, sex, tooth angulation, and relationship with the inferior alveolar canal (IAC) were assessed to see their outcome on IAN injury. Data analysis is presented through tables and descriptive methods. Results: Among patients, 26 were male and 34 were female, with a mean age of 26.17 years. Out of seven radiological predictive markers, only six were found in this study, whereas one marker, viz. interruption of white line of the canal was not found. After surgical removal of the lower third molar, only two patients with radiographic signs showing the deflection of roots and darkening of roots continued with sensory deficit 5 weeks post-operatively. Conclusion: The risk of inferior alveolar nerve injury during lower third molar surgery is very low, even in patients with radiological predictive markers.

Efficacy of Buccal Infiltration with or without Palatal Injection for Posterior Maxillary Teeth Extraction - A Split-Mouth Randomized Trial

ABSTRACT Objective: To evaluate the feasibility of posterior maxillary teeth extraction buccal infiltration with or without the use of palatal injection. Material and Methods: A total of 70 patients underwent extraction of bilateral maxillary posterior teeth under 2% lignocaine hydrochloride with 1:2,00000 adrenaline infiltration in this single-centric split-mouth randomized trial. The test side was administered with a buccal infiltration of 2 mL of anesthetic alone. An extended waiting period of 10 minutes was given before the commencement of the procedure. A standard protocol was followed for the control side. A single operator performed all extractions. Results: A total of 140 posterior maxillary teeth were extracted. Patients marked pain perception on a visual analogue scale in three different instances. During the administration of injections for the test side, the pain score was less than that of the control side and was statistically significant. The overall pain during the extraction procedure was comparable and statistically insignificant. The overall success of the method was 90%. Conclusion: Extraction of posterior maxillary teeth was feasible with a single buccal infiltration without palatal injection in most cases using an extended waiting period. Dentists can attempt extraction without palatal injections with optimal success. However, the alternate technique could be used when there is a necessity for rescue palatal anesthesia.

Soft tissue and incisor position changes in class I bimaxillary subjects after retraction using friction and frictionless mechanics

Aim: Bimaxillary protrusion is a common condition observed irrespective of race and ethnicity and is a chief concern for patients who seek orthodontic treatment. The aim of this study was to compare and evaluate changes in soft tissue structures and incisor positions in class I bimaxillary protrusion subjects undergoing orthodontic therapy when friction and frictionless mechanics were used. Methods: Two groups with a total of 40 patients aged 18­30 years diagnosed with class I bimaxillary protrusion treated by extracting first premolars were considered for this study. Patients treated with friction mechanics were included in Group 1 and those treated with frictionless mechanics in Group 2. The digital lateral cephalograms were calibrated and analyzed using Nemoceph software. Selected landmarks were marked on pre- and post-treatment cephalograms and assessed for intra- and inter-group soft tissue and incisor position changes. Student's t-test was used to analyze the collected data using SPSS 20 software. Result: Intragroup comparison revealed significant changes in both groups. Inter-group comparison of the selected parameters between groups 1 and 2 showed differences but without any statistical significance, except for the inter-incisal angle. Conclusion: Pre- and post-treatment comparison analysis revealed significant soft tissue changes in both groups. However, the comparison between friction and frictionless mechanics showed no statistically significant changes

Preparation of ICD and overdenture in patients with Cushing's Syndrome: five-year follow-up / Preparo de PTI e overdenture em pacientes com Síndrome de Cushing: cinco anos de acompanhamento

The aim of this study is to report a clinical case of a patient with Cushing's syndrome, low self-esteem and need for oral rehabilitation. A 50-year-old female patient with hypercortisolism sought care at School of Dentistry of the Federal University of Minas Gerais. During anamnesis, the patient reported painful symptoms and mobility of the upper and lower teeth. On clinical examination, absence of many teeth were observed, periodontal disease and caries lesions. After discussion of the case, the planning involved the extraction of all teeth, and the preparation of Maxillary Immediate Complete Dentures (ICD's) and Immediate Mandibular Implant-retained Overdenture (IMIO). The treatment proposed allowed the restored aesthetics, phonetics and chewing(AU)

O objetivo desse estudo é relatar um caso clínico de uma paciente com síndrome de Cushing, baixa autoestima e necessidade de reabilitação oral. Paciente do sexo feminino, 50 anos de idade e com hipercortisolismo, procurou atendimento na Faculdade de Odontologia da Universidade Federal de Minas Gerais. Durante a anamnese, a paciente relatou sintomas dolorosos e mobilidade dos dentes superiores e inferiores. No exame clínico, foi observada a ausência de muitos dentes, doença periodontal e lesões cariosas. Após a discussão do caso, o planejamento envolveu a extração de todos os dentes, e o preparo de Prótese Total Imediata maxilar (PTI), e Overdenture Implantorretida Imediata mandibular. O tratamento proposto permitiu que restaurasse a estética, fonética e mastigação(AU)

Sangramiento posextracción dentaria y medidas para su control en pacientes tratados con antiagregantes plaquetarios / Bleeding after tooth extraction and measures for its control in patients treated with antiplatelet agents

Introducción: El desarrollo de las ciencias médicas trae consigo un incremento en la expectativa de vida, junto a la detección temprana de un gran número de enfermedades crónicas como las cerebrovasculares y cardiovasculares, que son tratadas rutinariamente con medicamentos antiagregantes plaquetarios. El conocimiento del manejo de estos pacientes ante los procedimientos quirúrgicos estomatológicos constituye un reto en la práctica diaria profesional. Objetivo: Determinar el nivel de sangramiento posextracción dentaria en pacientes con enfermedad cardiovascular y cerebrovascular, según el tipo de antiagregantes plaquetarios y grupo dentario, así como la frecuencia de utilización de las medidas para su control. Métodos: Se efectuó un estudio observacional, descriptivo, longitudinal y prospectivo con un universo de 136 pacientes de más de 20 años, remitidos por su cardiólogo y que necesitaban realizarse extracciones dentarias sin modificar su tratamiento con antiagregantes plaquetarios. Las variables estudiadas fueron la enfermedad sistémica, el tipo de antiagregante plaquetario, el nivel de sangramiento, grupo dentario intervenido y método hemostático utilizado. Resultados: La mitad de los pacientes estudiados no presentó sangramiento posextracción dentaria. En los pacientes tratados con aspirina o clopidogrel predominaron los sujetos sin sangramiento para un 84,3 por ciento y 62,5 por ciento, respectivamente. En los de doble antiagregación prevaleció el sangramiento moderado con un 46,3 por ciento. Los grupos dentarios incisivo, canino y premolar no presentaron episodios de sangramiento para un 64,1 por ciento, 51,6 por ciento y 53,3por ciento, respectivamente. El método hemostático más utilizado fue la compresión de las corticales y termoterapia fría (47,8 por ciento). Conclusiones: La mitad de los pacientes con enfermedades cardiovasculares y cerebrovasculares no presentaron sangramiento posextracción dentaria(AU)

Introduction: The development of medical sciences brings with it an increase in life expectancy, together with the early detection of a large number of chronic diseases such as cerebrovascular and cardiovascular diseases, which are routinely treated with antiplatelet aggregation drugs. Knowledge on the treatment of these patients before stomatological surgical procedures constitutes a challenge in daily professional practice. Objective: To determine the level of bleeding after tooth extraction in patients with cardiovascular and cerebrovascular disease, according to the type of antiplatelet agents and dental group, as well as the frequency of use of measures for their control. Methods: An observational, descriptive, longitudinal and prospective study was carried out with a universe of 136 patients over 20 years of age, referred by their cardiologist, who needed dental extractions without modifying their treatment with antiplatelet agents. The variables studied were systemic disease, type of antiplatelet agent, level of bleeding, dental group treated and hemostatic method used. Results: Half of the patients studied did not present bleeding after tooth extraction. In patients treated with aspirin or clopidogrel, 84.3 percent and 62.5por ciento, respectively, had no bleeding. In those with double antiplatelet therapy, modera te bleeding prevailed with 46.3 The incisor, canine and premolar tooth groups did not present bleeding episodes (64.1 percent, 51.6and 53.3 percent respectively). The most commonly used hemostatic method was cortical compression and cold thermotherapy (47.8%). Conclusions: Half of the patients with cardiovascular and cerebrovascular diseases did not present bleeding after tooth extraction(AU)

Influence of abutment angulation on implant failure in immediately placed and restored implants in the esthetic zone: a randomized clinical trial

Background: Tooth extraction socket in the aesthetic area is a major indication for immediate implant placement greatly improving patient satisfaction and preserving the alveolar ridge. However, the effect of non-axial force on the peri-implant bone with subsequent early implant failure remains unclear. Objective:Evaluate the prognosis of tilted implants immediately placed and restored with angled abutments in comparison to straight implants restored with straight abutments in the esthetic area (anterior or premolars) using computer-aided surgical guides. Material and methods: Badly decayed non-restorable teeth in the aesthetic zone (anterior or premolars) were extracted atraumatically. Immediately after guided implant insertion, the abutments were adjusted and placed according to the allocation group (0, 15, or 25-degree angle) then a temporary crown was performed out of occlusion in centric and eccentric relation. Early implant failure was assessed at three and six months. Results:There was no statistically significant difference between the two groups (P=0.305). Straight and angled abutment groups showed 6 (14.3%) and 8 (20%) failed cases, respectively. The post-hoc subgroup analysis showed no statistically significant difference between angle 15 and angle 25 degree groups where (P=0.686) or between Anterior and Premolar groups (P=0.853). Conclusion: There was no statistically significant difference in the failure rate when comparing angled to straight immediately placed & restored implants. This applies to both anterior and premolar implants

Diagnóstico clínico, radiográfico e histológico de un caso de fibrosis periapical posendodóntica / Clinical, radiographic, and histologic diagnosis of a postendodontic periapical fibrosis case

Objetivo: La fibrosis periapical posendodóntica es un proceso reparativo asintomático, radiolúcido y no progresivo que se interpreta con frecuencia como una lesión patológica persistente. El diagnóstico de esta entidad suele ser dudoso y sólo puede definirse mediante la correlación de las obser- vaciones clínicas, radiográficas e histológicas. El objetivo de este informe es describir el caso de un paciente que presenta un área radiolúcida periapical persistente y asintomática en un incisivo lateral superior. Caso clínico: Luego de cuatro años y dos meses de ha- ber recibido un tratamiento endodóntico el paciente concurre a la consulta para un examen de rutina. El examen radiográfico del diente revela un área radiolúcida persistente y bien defini- da. A causa de una fractura radicular irreparable, se indicó la extracción de la pieza dentaria. Esto permitió realizar el estu- dio histológico del tejido blando que permanecía adherido en el ápice de la raíz, lo que confirmó y completó el diagnóstico de fibrosis periapical posendodóntica.(AU)

Aim: The postendodontic periapical fibrosis is an asymp- tomatic radiolucent and non-progressive healing process that is often interpreted as a persistent pathological lesion. The diagnosis of this entity is usually uncertain, and it is only de- fined by the correlation of clinical, radiographic and histo- logical observations.The aim of this report is to describe the case of a patient with a long-term persisting asymptomatic and radiolucent area in a upper lateral incisor. Clinical case: Four years and two months after receiv- ing an endodontic treatment the patient comes to our office for a routine control. Radiographic examination revealed the presence of a persistent well defined radiolucent area. Sur- gical tooth extraction was required due to the presence of a complicated root fracture.This allowed to perform a histolog- ical study of the soft tissue attached to the apex of the ex- tracted root, which confirmed and completed the diagnosis of postendodontic periapical fibrosis (AU)

Lingual supplementation may not be required after articaine buccal infiltration anesthesia for lower molar extraction: a clinical comparative study / La suplementación lingual opcional después de la anestesia por infiltración bucal con articaína para la extracción de molares inferiores: un estudio clínico comparativo

Purpose: To investigate the anesthetic effectiveness of buccal infiltration (BI) versus buccal plus lingual infiltration (BI+LI) of 4% articaine for intra-alveolar extraction of erupted mandibular molar teeth. Material and Methods: Eighty patients were included in this prospective clinical study. They were randomly divided into 1 of 2 equal groups: the 1st group received BI of 4% articaine 1.8 ml and LI of 0.5 ml, while the 2nd group received 4% articaine 1.8 ml BI plus 0.5 ml LI of normal saline. Another 1.8 ml articaine BI was given if initial anesthesia was inadequate. Outcome variables included pain, which was rated by patients at 3 intervals using visual analogue scale, and lingual anesthesia and patients' satisfaction which were measured using 5-score verbal rating scale. Data analyses used were descriptive statistics, t test, χ2 test, and Pearson's correlation coefficient. P-value value less than 0.05 was considered significant. Results: There were 46 females and 34 males and the mean age was 35.3 years. All outcome variables were comparable between the two study groups (p˃0.05). Anesthesia was successful in 78% and 88% of cases in the (BI) and (BI+LI) groups respectively with no significant difference (p=0.2392). The mean articaine volume used was 2.5 ml and 2.87 ml respectively without significant difference (p=0.090). Conclusion: The anesthetic efficacy of (BI) alone and (BI+LI) of 4% articaine was comparable. When given in an adequate dose, articaine (BI) alone could be justified as an anesthetic option for the intra-alveolar extraction of mandibular molar teeth.

Objetivo: Investigar la efectividad anestésica de la infiltración bucal (BI) versus la infiltración bucal más lingual (BI+LI) de articaína al 4% para la extracción intraalveolar de molares mandibulares erupcionados. Material y Métodos: Ochenta pacientes fueron incluidos en este estudio clínico prospectivo. Se dividieron aleatoriamente en 1 de 2 grupos iguales: el primer grupo recibió BI de articaína al 4% 1,8 ml y LI de 0,5 ml, mientras que el segundo grupo recibió articaína al 4% 1,8 ml BI más 0,5 ml LI de solución salina normal. Se administró otro BI de articaína de 1,8 ml si la anestesia inicial era inadecuada. Las variables de resultado incluyeron el dolor, que los pacientes calificaron en 3 intervalos mediante una escala analógica visual, y la anestesia lingual y la satisfacción de los pacientes, que se midieron mediante una escala de calificación verbal de 5 puntos. Los análisis de datos utilizados fueron estadística descriptiva, prueba t, prueba χ2 y coeficiente de correlación de Pearson. Se consideró significativo el valor del valor de pinferior a 0,05. Resultados: Hubo 46 mujeres y 34 hombres y la edad media fue de 35,3 años. Todas las variables de resultado fueron comparables entre los dos grupos de estudio (p=0,05). La anestesia fue exitosa en el 78% y 88% de los casos en los grupos (BI) y (BI+LI) respectivamente sin diferencia significativa (p=0,2392). El volumen medio de articaína utilizado fue de 2,5 ml y 2,87 ml respectivamente sin diferencia significativa (p=0,090). Conclusión: La eficacia anestésica de (BI) solo y (BI+LI) de articaína al 4% fue comparable. Cuando se administra en una dosis adecuada, la articaína (BI) sola podría estar justificada para la extracción intraalveolar de molares mandibulares.

The effect of scaffold hydroxyapatite derived from portunus pelagicus shell on the expression of fibroblast growth factor-2 (fgf-2) and bone morphogenetic proteins-2 (bmp -2) in the extraction sockets of cavia cobaya / El efecto del scaffold de hidroxiapatita derivada de portunus pelagicus sobre la expresión del factor de crecimiento de fibroblastos-2 (FGF-2) y las proteínas morfogenéticas óseas-2 (BMP-2) en los alvéolos dentarios de cavia cobaya

Objetive: To determine the expression of Fibroblast Growth Factor (FGF)-2 and Bone Morphogenetic Protein (BMP)-2 after application of scaffold hydroxyapatite from Rajungan crab shell (Portunus pelagicus) in the tooth extraction socket of Cavia cobaya. Material and Methods: This study used a post-test only control group design with 28 Cavia cobaya separated into two groups, control and treatment group. The left mandibular incisor was extracted, and socket preservation was conducted. A hydroxyapatite graft derived from crab shells was mixed with gelatin and eventually turned into a scaffold, which was afterward put into the extraction socket. After 7 days and 14 days, each group was terminated and examined using immunohistochemical staining to observe the expression of FGF-2 and BMP-2. One-Way Anova and Tukey HSD were used to examine the research data. Results: FGF-2 and BMP-2 expressions were observed higher in the group that received hydroxyapatite scaffold at the post-extraction socket than those in the group that did not receive hydroxyapatite scaffold. Conclusion: The application of a hydroxyapatite scaffold from Rajungan crab shell (Portunus pelagicus) to the tooth extraction socket can increase FGF-2 and BMP-2 expression.

Objetivo: Determinar la expresión del factor de crecimiento de fibroblastos (FGF)-2 y la proteína morfogenética ósea (BMP)-2 después de la aplicación de hidroxiapatita de andamio de caparazón de cangrejo Rajungan (Portunus pelagicus) en el alvéolo de extracción dental de Cavia cobaya. Material y Métodos: Este estudio utilizó un diseño de grupo de control solo posterior a la prueba con 28 Cavia cobaya separados en dos grupos, grupo de control y grupo de tratamiento. Se extrajo el incisivo mandibular izquierdo y se realizó la preservación del alvéolo. Un injerto de hidroxiapatita derivado de caparazones de cangrejo se mezcló con gelatina y se convirtió en un andamio, que luego se colocó en el alvéolo de extracción. Después de 7 días y 14 días, se terminó cada grupo y se examinó mediante tinción inmunohistoquímica para observar la expresión de FGF-2 y BMP-2. Se utilizaron One-Way Anova y Tukey HSD para examinar los datos de la investigación. Resultados: Las expresiones de FGF-2 y BMP-2 se observaron más altas en el grupo que recibió la estructura de hidroxiapatita en el alvéolo posterior a la extracción que en el grupo que no recibió la estructura de hidroxiapatita. Conclusión: La aplicación de un andamio de hidroxiapatita de caparazón de cangrejo Rajungan (Portunus pelagicus) al alvéolo de extracción dental puede aumentar la expresión de FGF-2 y BMP-2.

Preservação alveolar e instalação tardia de implante dentário: relato de caso / Alveolar preservation and late dental implant installation: case report / Preservación alveolar e instalación tardía de implante dental: reporte de caso

Introdução. Decorrente do trauma local, durante a exodontia, ou pela falta de estímulos mastigatórios, a ausência dentária promove respostas biológicas que desencadeiam um processo de reabsorção óssea. A preservação óssea alveolar propõe minimizar a reabsorção óssea alveolar, promovendo maior biodisponibilidade óssea para a reabilitação por implantes dentários. Os implantes dentários são uma modalidade terapêutica eficaz para a reabilitação de ausências dentárias. Objetivo. relatar um caso de reabilitação por implante em alvéolo cicatrizado, após preservação alveolar. Relato de caso. Paciente A.L.L., sexo masculino, 23 anos, compareceu à clínica odontológica da UNIBRA. Ao exame físico observou-se ampla destruição coronária do elemento 25 e, ao exame radiográfico notou-se tratamento endodôntico. O tratamento proposto foi a exodontia minimamente traumática, preservação alveolar com matriz de colágeno e instalação de implante dentário em alvéolo cicatrizado. Discussão. Em desdentados, a falta de estímulos mastigatórios, promove um desequilíbrio no turnover ósseo, desencadeando um processo de reabsorção. A preservação alveolar por matriz de colágeno visa minimizar a reabsorção e fornecer maior biodisponibilidade óssea para a reabilitação por implantes. Conclusão. A preservação alveolar com a matriz de colágeno cumpriu com seu objetivo e, a reabilitação por implante dentário em alvéolo cicatrizado é uma modalidade eficaz na reabilitação de pacientes desdentados... (AU)

Introduction. Due to local trauma, during tooth extraction, or the lack of masticatory stimuli, the absence of teeth promotes biological responses that trigger a process of bone resorption. Alveolar bone promotion minimizes alveolar bone resorption, promoting high bone bioavailability for rehabilitation with dental implants. Dental implants are a treatment modality to edentulous. Objective. Report a case of implant rehabilitation in a healed socket after alveolar preservation. Case report. Patient A.L.L., male, 23 years old, attended the UNIBRA dental clinic. On physical examination, a wide coronary destruction of element 25 was observed and, on radiographic examination, endodontic treatment was noted. The proposed treatment was a minimally traumatic tooth extraction, alveolar preservation with collagen matrix and implant placement in healed sockets. Discussion. In edentulous patients, the lack of masticatory stimuli promotes an imbalance in bone turnover, triggering a resorption process. Alveolar preservation by collagen matrix aims to minimize resorption and provide greater bone bioavailability for implant rehabilitation. Conclusion. Alveolar preservation with collagen matrix fulfilled its objective, and rehabilitation by dental implant in a healed socket is an effective modality in the rehabilitation of edentulous patients... (AU)

Introducción. Por traumatismo local, durante la extracción dentaria, o por falta de estímulos masticatorios, la ausencia de dientes promueve respuestas biológicas que desencadenan un proceso de reabsorción ósea. La preservación ósea alveolar propone minimizar la reabsorción ósea alveolar, promoviendo una mayor biodisponibilidad ósea para la rehabilitación mediante implantes dentales. Los implantes dentales son una modalidad terapéutica eficaz para la rehabilitación de dientes perdidos. Objetivo. reportar un caso de rehabilitación con implantes en un alvéolo cicatrizado después de preservación alveolar. Reporte de un caso. Paciente A.L.L., masculino, 23 años, acudió a la clínica odontológica de la UNIBRA. El examen físico reveló destrucción coronaria extensa del elemento 25 y el examen radiográfico reveló tratamiento endodóntico. El tratamiento propuesto fue extracción dental mínimamente traumática, preservación alveolar con matriz de colágeno y colocación de implante dental en alvéolo cicatrizado. Discusión. En pacientes edéntulos, la falta de estímulos masticatorios promueve un desequilibrio en el recambio óseo, desencadenando un proceso de reabsorción. La preservación alveolar mediante matriz de colágeno tiene como objetivo minimizar la reabsorción y proporcionar una mayor biodisponibilidad ósea para la rehabilitación con implantes. Conclusión. La preservación alveolar con matriz de colágeno cumplió su objetivo, y la rehabilitación mediante implante dental en un alvéolo cicatrizado es una modalidad eficaz en la rehabilitación de pacientes edéntulos... (AU)

Relación entre la presión arterial y el control de la hemorragia post-exodoncia en pacientes bajo tratamiento con warfarina / Relationship between blood pressure and hemorrhage control post exodontia in patients under warfarin treatment

Objetivo: Determinar la relación entre el nivel de pre- sión arterial (PA) y la hemorragia post-exodoncia aplicando medidas de hemostasia local en pacientes bajo tratamiento con warfarina. Materiales y métodos: Este estudio se realizó sobre 30 pacientes (15 hombres y 15 mujeres) bajo tratamiento anti- coagulante oral (TACO) con warfarina. Los pacientes concu- rrían al programa de TACO del Hospital y Centro de Referen- cia de Salud El Pino (HEP y CRS). Se les realizaron una o dos extracciones dentales (n=38) sin suspensión del anticoagulan- te oral a pacientes que tuvieran un coeficiente internacional normalizado (INR) del día menor o igual a 3. Se aplicaron medidas de hemostasia local con gasa compresiva y/o sutura en 30 de las extracciones dentales. Los procedimientos quirúr- gicos fueron llevados a cabo en el Servicio Dental del CRS y HEP. Se registraron las siguientes variables: 1) PA previa a la exodoncia, 2) PA a los 30 minutos, 3) Presencia o ausencia de hemorragia a los 30 minutos post-exodoncia y 4) PA y presen- cia o ausencia de hemorragia a las 24 horas post-exodoncia. Se estudió la relación entre el nivel de PA y la hemorragia post-exodoncia. Resultados: De todos los pacientes evaluados, ninguno presentó hemorragia post-exodoncia en los distintos momen- tos de evaluación, independientemente de cuál fuera su PA. No se encontraron efectos de la variable PA ­considerando valores de PA sistólica (PAS) por debajo de 140 mmHg y de PA diastólica (PAD) menores a 90 mmHg- en relación con la hemorragia post-exodoncia. Conclusión: De acuerdo con los resultados obtenidos en este estudio, la presión arterial con PAS <140 mmHg y PAD <90 mmHg no es un factor que influya en el sangrado post-exodoncia en pacientes bajo tratamiento con warfarina con ≤3 (AU)

Aim: To establish the relationship between blood pres- sure (BP) level and post-exodontic hemorrhage by applying local hemostasis measures in patients under warfarin treat- ment. Materials and methods: This study was conducted in 30 patients (15 men and 15 women) under oral anticoagu- lant (OAC) treatment with warfarin. The patients attended the TACO program of the "Hospital y Centro de Referencia de Salud el Pino (HEP y CRS)". One or two dental extractions (n=38) were performed in the patients that had an INR low- er or equal to 3, without suspending the oral anticoagulant treatment, applying local hemostasis measures with compres- sive gauze and/or suture in 30 of the extractions. The surgical procedure was carried out in the Dental Department of the CRS and HEP. The following variables were registered: 1) BP prior to extraction, 2) BP after 30 minutes, 3) presence or absence of hemorrhage after 30 minutes post-exodontia and 4) BP and presence or absence of hemorrhage 24 hours post-exodontia. The relation between BP level and post-exo- dontic bleeding was studied. Results: Considering all the examined patients, none of them presented post-exodontic hemorrhage at any of the dif- ferent moments of evaluation, regardless of their BP level. No effect of the BP variable ­considering a range of systolic BP SBP) below 140 mmHg and a diastolic BP (DBP) under 90 mmHg- was found in relation to post-exodontic hemorrhage. Conclusion: According to the results obtained in this study, blood pressure with SBP <140 mmHg and DBP <90 mmHg is not an influential factor in post-exodontic bleeding in patients under warfarin treatment with ≤3 (AU)

Osteonecrosis mandibular: hallazgos clínicos e imagenológicos en un paciente tratado con denosumab / Mandibular osteonecrosis: clinical and imaging findings in a patient treated with denosumab

Introducción: La administración de bifosfonatos y medicamentos antiangiogénicos en pacientes con cáncer es un esquema terapéutico usual en oncología. Existen reportes de osteonecrosis de los maxilares en pacientes sometidos a este esquema de tratamiento, luego de realizar un procedimiento dental invasivo. Objetivo: A partir de las características clínicas e imagenológicas de la patología, ilustrar al odontólogo sobre los medicamentos para el tratamiento del cáncer, susceptibles de generar osteonecrosis de los maxilares. Presentación de caso: Paciente masculino de 89 años, con cáncer de próstata tratado con denosumab, que desarrolló osteonecrosis del maxilar inferior posterior a una extracción dental. Es de vital importancia que el odontólogo identifique los medicamentos, factores de riesgo y las medidas para minimizar el riesgo de osteonecrosis de los maxilares en pacientes susceptibles(AU)

Introduction: The administration of bisphosphonates and antiangiogenic drugs in cancer patients is a usual therapeutic scheme in oncology. There are reports of osteonecrosis of the jaws in patients undergoing this treatment scheme, after performing an invasive dental procedure. Objective: Show the dentist from the clinical and imaging characteristics of the pathology on the drugs for the treatment of cancer sensitivity to generate osteonecrosis of the jaws. Case presentation: An 89-year-old male patient with prostate cancer treated with denosumab developed osteonecrosis of the lower jaw after tooth extraction. It is vitally important that the dentist identifies medications, risk factors and measures to minimize the risk of osteonecrosis of the jaws in sensitivy patients(AU)