Tratamiento de las fracturas en mandíbulas atróficas: nuestra experiencia con la reducción abierta y fijación interna según el principio de carga soportada / Treatment of atrophic mandible fractures: our experience with open reduction and internal fixation according to the load-bearing principle

Objetivo: presentar los resultados terapéuticos obtenidos por medio de la reducción abierta y fijación interna, aplicando el principio de carga soportada, en el tratamiento de fracturas de mandíbulas atróficas. Casos clínicos: se llevaron a cabo tratamientos en 21 pacientes, con un total de 30 fracturas de mandíbula atrófica, sobre 410 pacientes ingresados por fracturas mandibulares, en un hospital municipal de tercer nivel y en la práctica privada, durante el período 1991-2014. Conclusión: la reducción abierta y fijación interna según el principio de carga soportada, es una terapéutica predecible y segura para el tratamiento de las fracturas en mandíbulas atróficas. La mayoría de las publicaciones recientes comparten resultados similares y lo consideran el procedimiento terapéutico de elección...

Evaluation and new classification of alveolar bone dehiscences using cone-beam computed tomography in vivo / Evaluación y nueva clasificación de las dehicencias del hueso alveolar mediante tomografía computadorizada de haz cónico in vivo

Alveolar bone dehiscences, which were "V" shaped defects related the margin of the alveolar bone, were common findings in different populations and decreased bony support of teeth. It was difficult to detect dehiscence during direct clinical examination. All of the previous studies on the prevalence of dehiscences were based on dry human skulls. In the current article, we evaluated the prevalence of dehiscences occurring naturally in a Chinese subpopulation, and prepared a classification of dehiscences using cone-beam computed tomography (CBCT). The high prevalence rate of dehiscences and different characteristics of each category suggest that it would be helpful for clinicians who perform periodontal surgery, endodontic surgery, implant surgery or orthodontic treatment to understand which teeth are most often associated with such bony defects, and to consider the effect of severe dehiscences on their diagnosis and treatment plan.

Las dehiscencias óseas alveolares, con forma de "V" en el margen del hueso alveolar, son hallazgos comunes en diferentes poblaciones y provocan una disminución del soporte óseo de los dientes. La dehiscencia fue difícil de identificar durante la exploración clínica directa. Todos los estudios anteriores sobre la prevalencia de dehiscencia se basaron en cráneos humanos secos. En el presente artículo, se evaluó la prevalencia de dehiscencia natural ocurrido en una subpoblación de China. Realizamos una clasificación de las dehiscencias mediante tomografía computarizada cone-beam (TCCB). La alta prevalencia de dehiscencias y las diferentes características de cada categoría sugieren que esta clasificación sería de gran ayuda para los médicos que realizan cirugía periodontal, endodóntica, cirugía de implantes o tratamiento de ortodoncia, permitiendo informar sobre que dientes están más frecuentemente asociados con tales defectos óseos, y poder considerar los efectos severos de las dehiscencias severas en el diagnóstico y el plan de tratamiento.

Nueva clasificación de rebordes atróficos en el sector posterior maxilar para el tratamiento con implantes dentales / A new classification of atrophic ridges in the posterior jaw for the treatment with dental implants

El edentulismo en el sector posterior maxilar es una de las condiciones más comunes que se presenta en la consulta odontológica9, 10, 12. La prevalencia del edentulismo difiere sustancialmente en la mayoría de los países del mundo (4). Algunos de los índices más altos son encontrados en el Reino Unido y Nueva Zelandia, y los más bajos en Estados Unidos.

Impaired neutrophil and monocyte chemotaxis in chronic and aggressive periodontitis and effects of periodontal therapy.

Background and Objectives: Depressed chemotactic activity of polymorphoneutrophil (PMN) and monocyte (MN) appears to be one of the significant risk factors in the development of periodontal disease. Although bacteria are the primary etiologic factor in periodontal disease, the patient's host response is a determinant of disease susceptibility. Depressed chemotaxis of PMN and MN could lead to periodontal destruction by altering the host response i.e. impairment of the normal host response in neutralizing infection and alterations that result in destruction of the surrounding periodontal tissues. Materials and Methods: Thirty patients (10 healthy subjects, 10 chronic periodontitis, and 10 with aggressive periodontitis) participated in this study. Clinical parameters like plaque index, gingival index, probing pocket depth, and radiographic assessment were done. The peripheral blood PMNs and MNs were isolated from the patient and the chemotactic response was studied. Statistical analysis was performed using post-hoc Newman-Keul range test. Results: PMN and MN chemotaxis was found to be statistically significant (P<0.05) at baseline and three months after periodontal therapy in chronic and aggressive periodontitis group compared to healthy subjects. However on comparison between chronic and aggressive periodontitis group statistical significance was not found (P>0.05).Comparision between chronic periodontitis, aggressive periodontitis with healthy subjects, PMN and MN chemotaxis showed statistical significance (P<0.05) at baseline and three months after periodontal therapy, Whereas statistically there was no difference when chronic periodontitis was compared with aggressive periodontitis Interpretation and Conclusion: Depressed chemotaxis of PMN and MN results in increased periodontal destruction. In this study, depressed PMN and MN chemotaxis is seen in both aggressive periodontitis group and chronic periodontitis group and the response was altered although to a lesser degree after periodontal therapy in both groups indicating that effect of treatment does exist.

Allele, genotype, and composite genotype effects of IL-1A +4845 and IL-1B +3954 polymorphisms for chronic periodontitis in an Indian population.

Introduction: The pro-inflammatory cytokine interleukin-1 (IL-1) is a key modulator of host responses to microbial infection and a major modulator of extracellular matrix catabolism and bone resorption, and polymorphisms in the IL-1 gene cluster have been associated with an increased risk of developing severe adult periodontitis. A case control study was performed to determine the role of IL-1A+4845 and IL-1B+3954 polymorphisms in the predisposition to chronic periodontitis. Materials and Methods: The study was conducted with 103 unrelated participants recruited from Manipal College of Dental Sciences, Manipal, which included 51 chronic periodontitis patients and 52 normal periodontally healthy individuals. Extensive clinical data were collected, bone loss was the major outcome variable and smokers and diabetics were excluded from the study to eliminate the influence of these risk factors. Genomic DNA was isolated from the blood samples of participants for genotyping IL-1A+4845 and IL-1B+3954 polymorphisms by polymerase chain reaction-restriction fragment length polymorphism and the data statistically analyzed. Results: Allele 2 of the IL-1A+4845 polymorphism was carried by 38% of all participants; of these only 6 were homozygous for the allele. Allele 2 of the IL-1B+3954 was carried by 21% of the subjects; only 1 was homozygous for allele 2. The composite genotype was carried by 31% of the cases and by 38% of the controls. Overall, 35% participants carried the composite IL-1 genotype. No statistically significant association was found for the distributions. Conclusions: The distribution of the IL-1 positive composite genotype is in concordance with the frequencies reported in the Caucasians. Association was not found for the effect of allele, genotype, composite genotype, and haplotypes of IL-1A+4845 and IL-1B+3954 polymorphisms with periodontitis. Its utility as a risk marker in this population was not borne out by the study.

Treatment of human periodontal infrabony defects with hydroxyapatite+ β tricalcium phosphate bone graft alone and in combination with platelet rich plasma: A randomized clinical trial.

Background: The present study was aimed at comparing the clinical effectiveness of two regenerative techniques - platelet rich plasma (PRP) + bone graft (HA + β TCP) versus bone graft (HA + β TCP) + normal saline in the treatment of periodontal intrabony defects. Materials and Methods: Ten patients diagnosed with chronic periodontitis were enrolled in a randomized split mouth clinical trial. Following phase I therapy the sites were randomly assigned to the test group - PRP + bone graft (HA + β TCP) and control group - saline + bone graft (HA + β TCP). Clinical parameters recorded at baseline and 6 months included plaque index, probing pocket depth, relative attachment levels, and relative gingival margin levels. Hard tissue evaluation was done using digital radiography to evaluate the image intensity and therefore the radioopacity of a desired region of interest in the intrabony defect. Pre- and postoperative comparisons were made between the treatment groups at 6 months. Results: Test group sites showed a significantly higher reduction in pocket depth compared to control group sites. Test group sites showed a significantly higher amount of radioopacity in the regions of interest, indicative of better graft remodeling, compared to control group sites. Conclusion: (HA + β TCP) bone graft appears to be a beneficial material in the treatment of human periodontal intrabony defects. When combined with platelet-rich plasma there is a significantly higher reduction in probing pocket depth, higher gain in attachment levels and higher amount of radio-density seen in the intrabony defects.

Correlation of periodontal status and bone mineral density in postmenopausal women: A digital radiographic and quantitative ultrasound study.

Background: Data suggest that postmenopausal women with osteoporosis are at an increased risk for periodontal attachment loss and tooth loss; however, the extent of relationship between these two diseases is still not clear. Aim: The aim of the study was to evaluate the correlation of periodontal status and bone mineral density (BMD) in postmenopausal women. Materials and Methods: The study population included 60 postmenopausal women aged 50-60 years (mean±SD: 55.5±3.4 years). Periodontal status was examined by plaque index, bleeding index, probing depth, and clinical attachment level (CAL). Digital panoramic radiograph was taken to measure the maxillary and mandibular alveolar bone density values. Skeletal (calcaneal) BMD was measured by quantitative ultrasound technique for T-score values. The recorded data for T-score, maxillary and mandibular alveolar bone densities, and periodontal status were subjected to statistical analysis for correlation and regression procedures. Results: The results showed that mandibular alveolar (r=0.907, P<0.001) and maxillary alveolar bone density (r=0.898, P<0.001) had significant positive correlation with calcaneal T-score. Probing depth (r=-0.316, P<0.05), bleeding index (r=-0.277, P<0.05), and plaque index (r=-0.285, P<0.05) showed weak but significant negative correlation with calcaneal T-score and alveolar bone density of both the jaws, whereas CAL showed weak correlation with T-score which could not reach to a statistically significance level (r=-0.221, P>0.05). Conclusion: Calcaneal BMD was related to alveolar bone loss and, to a lesser extent, to clinical attachment loss, implicating postmenopausal bone loss as a risk indicator for periodontal disease in postmenopausal women.

Evaluation of the C-reactive protein serum levels in periodontitis patients with or without atherosclerosis.

Background : Several studies suggested an association between periodontal disease and cardiovascular disease (CVD). C- reactive protein is elevated in periodontitis patients and has been found to be a predictor of increased risk for cardiovascular disease. Since, CRP is known to play a role in pathogenesis of atherosclerosis, the present study was undertaken to evaluate the serum levels of CRP in periodontitis patients with or without atherosclerosis. Materials and Methods : A total of 45 patients, 15 chronic periodontitis patients with atherosclerosis (Group A), 15 chronic periodontitis patients with no history of any systemic disease (Group B), and 15 clinically healthy individuals with no history of periodontal or systemic disease (Group C) within age range of 30 to 55 years were selected for the study. PI, PBI, PPD, CAL and radiographic marginal alveolar bone level were assessed in all the three groups. CRP levels were assessed with 'Turbi-latex' kit using turbidimetric analysis. Results : The mean CAL recorded was 4.9mm in group A, 4.6mm in group B and 1.9 mm in group C. The mean radiographic marginal bone level was 45 to 50% in group A, 45 to 50% in group B and 90 to 95% in group C. Mean serum C-reactive protein level was significantly higher in group A (8.9 mg/l), as compared to group B (4.9 mg/l) as well as group C (0.9 mg/l). Conclusion : Within the limits of this study it was concluded that periodontitis may add to the inflammatory burden of the individual and may result in increased risk of atherosclerosis based on serum C-reactive protein concentrations.

Clinical evaluation of guided tissue regeneration procedure in the treatment of grade II mandibular molar furcations.

The management of furcation defects remains a challenge in periodontal therapy, Traditionally, furcation therapy involved scaling, rootplaning, furcation plasty and resective techniques. The purpose of this study was to clinically evaluate the potential of guided tissue regeneration in the treatment of mandibular molar grade II furcations using a nonresorbable barrier, TefGen-GTR and compare it with open flap debridement alone. Ten patients with similar bilateral grade II furcation lesions participated in the study. TefGen-GTR was placed in the experimental sites while the contralateral sites served as controls. Treatment effects were evaluated at six months reentry. Both groups showed gain in vertical and horizontal open probing attachment and defect depth reduction when compared to baseline values, with experimental sites showing statistically significant improvement over the controls. The results suggest that the nonresorbable Teflon barrier, TefGen-GTR, may be used as an alternative for treatment of grade II furcation invasions.