Clinical practice guideline of the spanish society of oral surgery for oral surgery in patients with coagulation disorders / Guía de práctica clínica de la sociedad española de cirugía bucal para cirugía oral en pacientes con trastornos de la coagulación

Background: The number of patients treated with coagulation disorders, and more specifically with anticoagulanttherapy, has increased worldwide in recent years due to increased life expectancy in developed countries. Theprotocols for managing this type of patient in oral surgery has varied over recent years, especially after the appear-ance of new direct-acting oral anticoagulants (DOACs). The assessment of risk of bleeding in this type of patientwhen undergoing a surgical procedure continues to be a controversial issue for patients, dentists and general prac-titioners. The objective of this document is to offer recommendations, based on evidence, for decision making forpatients with coagulopathies who require dental surgical intervention. Material and Methods: Based on the indications of the “Preparation of Clinical Practice guidelines in the NationalHealth System. Methodological manual”, we gathered a group of experts who agreed on 15 PICO questions basedon managing patients with coagulation disorders in dental surgical procedures, such as fitting of implants or dentalextractions.Results: The 15 PICO questions were answered based on the available evidence, being limited in most cases due tothe lack of a control group. Two of the PICO questions were answered by the experts with a grade C recommendation,while the rest were answered with grade D.Conclusions: The results of this review highlight the need to undertake well designed clinical trials with controlgroups and with a representative sample size.(AU)

2-years retrospective observational case-control study on survival and marginal bone loss of implants in patients with hereditary coagulopathies

Background: Evaluating 2-years implant loss and marginal bone loss in patients with hereditary coagulopathies, comparing with a healthy control group. Material and Methods: 37 implants in 13 patients (17 haemophilia A, 20 Von-Willebrand disease) versus 26 implants in 13 healthy patients. Data measured through Lagervall-Jansson index (after surgery, at prosthetic loading, at 2 years). Statistics: Chi-square, Haberman’s, ANOVA, Mann-Whitney-U. Significance p<0.05. Results: Haemorrhagic accidents in 2 coagulopathies patients (non-statistical differences). Hereditary coagulopathies patients suffered more hepatitis (p<0.05), HIV (p<0.05) and less previous periodontitis (p<0.01). Non-statistical differences in marginal bone loss among groups. 2 implants were lost in the hereditary coagulopathies and none in the control group (non-statistical differences). Hereditary coagulopathies patients had longer (p<0.001), and narrower implants (p<0.05) placed. 43.2% external prosthetic connection in hereditary coagulopathies patients (p<0.001); change of prosthetic platform more frequent in control group (p<0.05). 2 implants lost: external connection (p<0.05). Survival rate 96.8% (hereditary coagulopathies 94.6%, control group 100%). Conclusions: Implant and marginal bone loss at 2 years is similar in patients with hereditary coagulopathies and control group. Precautions should be taken on the treatment for hereditary coagulopathies patients, through prior haematological protocol. Implant loss only occurred in in a patient with Von-Willebrand´s disease. (AU)

Retrospective Case-Control Study Genes Related to Bone Metabolism That Justify the Condition of Periodontal Disease and Failure of Dental Implants in Patients with down Syndrome.

Down syndrome patients show success rates in dental implants much lower than those observed in the general population. This retrospective case-control study aimed to identify possible genes that are related to the regulation of inflammatory responses and bone metabolism related to periimplantitis and implant loss, as well as genes related to bone quality. This process involved using the functional analysis of the gene expression software Transcriptome Analysis Console (TAC version 4.0 Applied BiosystemsTM, Thermo Fisher Scientific, Waltham, MA, USA) and a search for possible candidate genes involved. The focus was placed on the 93 genes related to periodontitis, periimplantitis, bone loss, implant loss, and genes related to bone quality and regulators underlying the establishment and maintenance of osseointegration. Five genes showed statistically significant results (p < 0.05) in our comparison. Four of them, IL1B (p = 0.023), IL1RN (p = 0.048), BGLAP (p = 0.0372) and PTK2 (p = 0.0075) were down-regulated in the periodontal disease and implant rejection group, and only one was overexpressed: FOXO1A (p = 0.0552). The genes with statistically significant alterations described in this article determine that the group of Down syndrome patients with periodontal disease and implant failure is a group of patients genetically susceptible to suffering from both conditions together.

Metallothioneins in Dental Implant Treatment Failure and Periodontitis in Patients with Down's Syndrome: Validation of Results.

Metallothioneins (MTs) are low molecular weight cysteine-rich proteins that can bind up to seven zinc ions. Among their numerous functions, MTs appear to act as protectors against oxidative and inflammatory injury. In our first published study, we reported downregulation of the isoforms MT1B (fold distance (FD) -2. 95; p = 0.0024), MT1F (FD -1.72; p = 0.0276), MT1X (FD -3.09; p = 0.0021), MT1H (FD -2.39; p = 0.0018), MT1M (FD -2.37; p = 0.0092), MT1L (FD -2. 55; p = 0.0048), MT1E (FD -2.71; p = 0.0014), MT2A (FD -2.35; p = 0.0072), MT1G (FD -2.24; p = 0.0118), and MT1A (FD -2.82; p = 0.0023) by comparing Down's syndrome patients with periodontal disease and implant failure to those without periodontal disease and with a positive progression of their implants. In this gene validation study, we intended to verify the results of our first gene expression analysis. Materials and Methods: In our retrospective case-control study, we performed retrotranscription (RT-qPCR) of 11 RNA-to-cDNA samples using the SuperScript™ VILO™ kit (50; reference 1,176,605) from Thermo Fisher. We conducted the study using the real-time PCR technique on the q-PCR ViiA 7 platform from Thermo Fisher. We chose the format of the Taqman Array Plate 16 Plus (reference 4,413,261) from Thermo Fisher, which accommodates 12 genes plus four controls (GAPDH, 18S, ACTB, and HPRT1). We conducted the analysis of the plates using the Thermo Fisher Cloud Web Software. Results: The results obtained through gene validation analysis show that in PD+RI+ patients, the genes encoding the isoforms MT1F (FD 0.3; p = 0.039), MT1X (FD 338; p = 0.0078), MT1E (FD 307; p = 0.0358), and MT2A (FD 252; p = 0.0428) continue to show downregulation, whereas MT1B (FD 2.75; p = 0.580), MT1H (FD 281; p = 0.152), MT1L (FD 354; p = 0.0965), and MT1G (FD 336; p = 0.0749) no longer show statistically significant results.

An evaluation of peri-implant marginal bone loss according to implant type, surgical technique and prosthetic rehabilitation: a retrospective multicentre and cross-sectional cohort study.

To evaluate implant loss (IL) and marginal bone loss (MBL); follow-up period of up to 10 years after prosthetic loading. Retrospective multi-centre cross-sectional cohort study. Double analysis: (1) all the implants (n = 456) were analysed; (2) to allow for possible cluster error, one implant per patient (n = 143) was selected randomly. Statistical analysis: Spearman's correlation coefficient; Kruskal-Wallis (post-hoc U-Mann-Whitney); Chi-square (post-hoc Haberman). (1) Analysing all the implants (456): IL was observed in patients with past periodontitis (6 vs. 2.2%, p < 0.05), short implants (12 vs. 2.8%, p < 0.001) and when using regenerative surgery (11.3 vs. 2.9%, p < 0.001); greater MBL was observed among smokers (0.39 ± 0.52 vs. 0.2 ± 0.29, p < 0.01), maxillary implants (0.28 ± 0.37 vs. 0.1 ± 0.17, p < 0.0001), anterior region implants (0.32 ± 0.36 vs. 0.21 ± 0.33, p < 0.001), external connection implants (0.2 ± 0.29 vs. 0.63 ± 0.59, p < 0.0001), and 2-3 years after loading (p < 0.0001). (2) analysing the cluster (143): IL was observed in smokers (18.8 vs. 3.5%, p < 0.05), splinted fixed crowns (12.9%, p < 0.01), short implants (22.2 vs. 4.0%, p < 0.01) and when using regenerative surgery (19.2 vs. 3.4%, p < 0.01); greater MBL was observed in maxillary implants (0.25 ± 0.35 vs. 0.11 ± 0.18, p < 0.05), in the anterior region (p < 0.05), in the first 3 years (p < 0.01), in external connection implants (0.72 ± 0.71 vs. 0.19 ± 0.26, p < 0.01) and in short implants (0.38 ± 0.31 vs. 0.2 ± 0.32, p < 0.05). There is greater risk in smokers, patients with past periodontal disease, external connection implants, the use of short implants and when regenerative techniques are used. To prevent MBL and IL, implantologists should be very meticulous in indicating implants in patients affected by these host factors.

Effectiveness of salivary stimulation using xylitol-malic acid tablets as coadjuvant treatment in patients with gastro-oesophageal reflux disease: early findings

BACKGROUND: Besides dental erosion syndrome, other oral syndromes could benefit from the stimulation of salivary secretion, in patients with gastrooesophageal reflux disease (GORD). Our aims is evaluate the improvement of oral extraoesophageal manifestations in patients with GORD using xylitol–malic acid tablets to stimulate salivary secretion. Material and METHODS: The effectiveness of salivary stimulation using xylitol–malic acid tablets (as a supplement to omeprazole 40 mg/day) was assessed in a clinical trial (n = 14) lasting six months with patients with prior positive pH-metry, through GORD extra-oesophageal clinical signs, GerdQ and RDQ questionnaires, odontological variables, basal salivary secretion, stimulated salivary secretion, pH and buffer capacity, mucosal erythema index and dental wear. Statistics: chi-square (Haberman post-hoc), ANOVA, and Mann-Whitney U; variables between visits were evaluated with McNemar’s Student’s t and Wilcoxon tests; p < 0.05. RESULTS: 100% of patients not taking xylitol–malic acid presented xerostomia, but only 14.3% of patients taking xylitol–malic acid (p < 0.01) did. The mean saliva-buffer capacity at the last visit for patients not taking xylitol–malic acid was 2.14 ± 0.38, versus 2.71 ± 0.49 for patients taking xylitol–malic acid (p < 0.05). Retro-sternal burning (p < 0.05), heartburn (p < 0.05) and regurgitation (p < 0.05) were also reduced. CONCLUSIONS: Xylitol-malic acid tablets improve quality of life among patients with GORD, by reducing dry mouth, increasing saliva buffering and reducing heartburn, retro-sternal burning and regurgitation

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Using Genetics in Periodontal Disease to Justify Implant Failure in Down Syndrome Patients.

Peri-implant bone loss leading to dental implant failure does not develop in the same way across subjects who apparently present the same condition-specifically, in the case of Down syndrome patients with the same genetic disorder-given that they do not necessarily develop immune-inflammatory disorders to the same extent. METHODS: This retrospective case-control study was aimed at identifying the possible genes involved in implant failure in Down syndrome patients by matching the periodontal disease variable by means of a retrospective case-control study. This process involved using the functional analysis of gene expression software Transcriptome Analysis Console (TAC, Affymetrix, Thermo Fisher Scientific, Waltham, MA, USA) and a search for the possible candidate genes involved. Focus was placed on the 92 genes related to the inflammation identified from the TaqMan™ Array Plate Human Inflammation Kit (Thermo Fisher Scientific, Waltham, MA, USA). RESULTS: Six genes showed statistically significant results (p < 0.05) in our comparison. Three of them-PLCG2 (p = 0.0333), ALOX5 (p = 0.03) and LTAH4 (p = 0.0081)-were overexpressed in the implant reject group, and the following three were down-regulated: VCAM1 (p = 0.0182), PLA2G2A (p = 0.0034) and PLA2G10 (p = 0.047). CONCLUSION: Statistically significant differences exist in the gene expression involved in osteoclastogenesis, inflammatory response and host defensive response.

Bone loss around narrow implants versus standard diameter implants: Retrospective 2-years case-control study.

BACKGROUND: The objectives were to evaluate the bone loss (BL) around narrow diameter implants (3.3 mm) 2 years after implant loading and compare with the bone loss around conventional-diameter implants (4.1 mm), as well as with clinical and anatomical variables. 2-years follow-up. MATERIAL AND METHODS: Cases: 20 patients either gender-age, narrow implants (Straumann TM-SLA, diameter 3.3 mm); Control: 20 patients matching for gender-age, conventional implants (Straumann TM-SLA, diameter 4.1). Total 82 implants (31 narrow implants and 51 conventional implants) in 40 patients. To avoid statistical bias, a cluster of one implant per patient was randomly selected (20 narrow implants and 20 conventional implants). To evaluate changes resulting from bone loss around the implants, a total of 80 panoramic radiographs were taken of all 40 patients; the first panoramic image was taken at the time of implant loading and the second one 2 years later. Clinical and demographic variables were obtained from the patients' medical records. Statistical method: Spearman's correlation coefficient, chi-squared (Haberman's post hoc), Mann-Whitney U and Kruskal-Wallis tests. Statistical significance p< 0.05. RESULTS: No significant differences in bone loss around were found around narrow implants versus conventional implants. Differences linked to tobacco use were found after studying one implant per patient (p< 0.05). CONCLUSIONS: With the limitations of the present study, no significant differences in BL were found when comparing narrow implants with conventional implants after 2 years of implant loading. There were also no differences found when accounting for other demographic and clinical variables, with the exception of tobacco use. Key words:Lagervall & Jansson's index, bone loss, narrow implants, panoramic radiographs.

Clinical performance of titanium-zirconium implants with a hydrophilic surface in patients with controlled type 2 diabetes mellitus: 2-year results from a prospective case-control clinical study.

OBJECTIVE: Analyze the 2-year clinical performance of single-unit titanium-zirconium (TiZr) alloy narrow-diameter (3.3 mm) dental implants with a hydrophilic surface (Straumann® Roxolid®, SLActive®) in patients with controlled type 2 diabetes mellitus (T2DM), measured using the glycated hemoglobin A (HbA1c) concentration test, compared with results in individuals without T2DM. MATERIAL AND METHODS: The studied sample consisted of 28 patients, 14 with T2DM (study group) and 14 without (control group). The plaque index, bleeding on probing, probing depth, clinical attachment level, gingival biotype, and marginal bone loss (MBL) at the site of the implants were assessed. HbA1c levels were assessed in all patients during each checkup. RESULTS: Two years after implant placement and prosthetic restoration no implant failures were reported in either group, resulting in 100% survival and success rates in both groups. No statistically significant differences in MBL were found between the control and study groups (p > 0.05). CONCLUSIONS: Within the limitations of this study, it can be concluded that reduced-diameter TiZr alloy implants with a hydrophilic surface represent a safe and predictable treatment option for patients with well-controlled T2DM. The clinical performance was comparable with that observed in individuals without T2DM in the medium term. CLINICAL RELEVANCE: The narrow implants placed in patients with T2DM with well-controlled glycemia (HbA1c) showed a marginal bone loss and success and survival rates similar to those of the control group without DM2, in the medium term.

Influence of marginal bone loss on peri-implantitis: Systematic review of literature.

BACKGROUND: The marginal bone of dental implants is subjected to slight load modifications over time, conditioning implant survival. Objective: Perform a systematic review of the literature analyzing the factors that contribute to marginal bone loss (MBL) and the subsequent development of peri-implantitis. MATERIAL AND METHODS: Bibliographic research in the databases PubMed, Medline and Scopus between 2010 and 2018 was performed. The inclusion criteria were articles published in the last 10 years and that were in English or Spanish, that were carried out on humans, that were cohort studies, that included cases and controls or that used randomized clinical trials. Exclusion criteria removed articles that contained clinical cases, case series or systematic reviews. RESULTS: A total of 90 articles were analyzed that examined all the factors reported in the literature, such as idiosyncratic factors, toxic habits, systemic drugs and implant characteristics (diameter, length, type surface, implant connection, implant design and type of platform at the moment of the prosthetic load). Discussion: Patient characteristics and associated pathologies must be taken into account when assessing MBL. MBL in all dental implants can be considered independent of the type of prosthetic rehabilitation and the moment of load; this was emphasized. The MBL is smaller in dental implants with rough surfaces, switch platforms and infracrestal localization, as they are of multifactorial origin. CONCLUSIONS: All the reviewed articles maintain a common criterion regarding the concept and measurement of the MBL and highlighting the importance of radiodiagnosis for quantification. Longterm prospective studies with unified criteria are needed to reduce bias by identifying the most relevant factors in MBL. Key words:Marginal bone loss, dental implant, peri-implantitis.

Descriptive retrospective study analyzing relevant factors related to dental implant failure

BACKGROUND: The objective of this retrospective descriptive study was to analyze the characteristics of incident reports provided by dentists while using a specific brand of dental implants. MATERIAL AND METHODS: The study was carried out in collaboration with Oxtein Iberia S.L.(R), with the company providing access to the incident database in order to evaluate the characteristics of incidents from January 2014 to December 2017 (a total of 917 over four years). The data sheet recorded different variables during each of the stages of implant treatment, from initial implant placement to subsequent prosthetic rehabilitation. These variables included age, sex, systemic pathologies, smoking habits, bone quality, implant type, prosthesis type, and type of load applied, among others. SPSS Statistics was used to perform statistical analysis of the qualitative variables (univariate logistic regressions, χ2 test, Haberman's adjusted standardized residuals). RESULTS: The total study sample consisted of 44,415 implants shipped from Oxtein (R) warehouses on the dates indicated, of which 917 implants (2.1%) were flagged due to reports of lack of primary stability, failed osseointegration, or implant failure within one year of placement. When analyzing incident reports, it was observed that 61.6% of incidents occurred in male patients, compared to 38.4% in female patients. The average age of patients in the reported cases was 56.12 ± 12.15 years. A statistically significant correlation was discovered between incidents of implant failure and tobacco use, diabetes, heart disease, poor oral hygiene, previous infection, poor bone quality, and bruxism (p < 0.05). A (statistically significant) higher rate of incidents was also observed in tapered, internal connection, Grade IV titanium, narrow, and short implants. CONCLUSIONS: Analysis of these implants reveals a higher rate of complication in short, tapered, internal connection and narrow-diameter implants. These data can help and encourage clinicians to use the utmost surgical precautions when placing these implants

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Metallothioneins in Failure of Dental Implants and Periodontitis Down Syndrome Patients.

BACKGROUND: Sometimes dental implants seem to be the only therapeutic alternative for the oral rehabilitation of patients with Down syndrome, given that they usually lose all their teeth early due to suffering aggressive periodontitis and they do not usually have the skills required to wear removable prostheses. However, the evolution of dental implants in these patients shows very adverse results. It is possible that basal genetic alterations, or at least some characteristics of these, may underlie these clinical results. The metabolic pathway of metallothioneins, molecules with an important influence on bone metabolism, could be one of the said alterations. AIMS: To determine whether the expression of metallothioneins (MTs) and their metabolic pathway may be identified and related to the periodontitis and lack of osseointegration of dental implants in Down syndrome patients. MATERIALS AND METHODS: Retrospective study of cases and controls by comparing patients with Down syndrome, periodontal disease, and implant failure (four patients, test group) with patients with Down syndrome, without periodontal disease, and without implant failure after two years of following (seven patients, control group), by extracting peripheral blood at the time of the dental examination to extract RNA and its subsequent processing in relation to gene expression of the metabolic pathway of metallothioneins. RESULTS: The results identified low expression in the group of patients with periodontal disease and implant failure of genes MT1E, MT1H, MT1X, MT1A, MT1B, MT1C, MT1L, MT2A, MT1M, and MT1G. CONCLUSIONS: The low MT1 and MT2 gene expression seems to be related to the onset of periodontal disease and implant rejection in Down syndrome patients, although more data are required to confirm whether this relationship is due to one of the two conditions, to both independently, or to the two jointly-this last option being indicated by our current study.

A Prospective Case-Control Clinical Study of Titanium-Zirconium Alloy Implants with a Hydrophilic Surface in Patients with Type 2 Diabetes Mellitus.

PURPOSE: To evaluate prospectively the behavior of narrow-diameter (3.3-mm) titanium-zirconium alloy implants with a hydrophilic surface (Straumann Roxolid SLActive) in patients with type 2 diabetes mellitus in single-unit restorations, compared with a healthy control group (assessed using the glycosylated hemoglobin HbA1c test). MATERIALS AND METHODS: The patients evaluated in this study required single-unit implant treatment; 15 patients had type 2 diabetes mellitus, and 14 patients were healthy (control group [CG]). Marginal bone level (MBL) change around the implants was evaluated using conventional, sequential periapical digital radiographs. Patient HbA1c was assessed in each check-up. Normality test (Kolmogorov-Smirnov), univariate and multivariate logistic regression, analysis of variance (ANOVA), and Mann-Whitney U test were used for statistical analysis. RESULTS: No differences in MBL change and implant survival and success rates were found between the diabetes mellitus group (DMG) versus the control group, either during the initial recording (DMG, 0.99 ± 0.56 vs CG, 0.68 ± 0.54; P > .05) or 6 months after restoration (DMG, 1.28 ± 0.38 vs CG, 1.11 ± 0.59; P > .05). No significant correlation between HbA1c levels and MBL change was detected in these patients (P > .05). CONCLUSION: Patients with glycemic control exhibit similar outcomes to healthy individuals with regard to the investigated parameters. In light of these findings, the titanium-zirconium alloy small-diameter implants can be used in the anterior region of the mouth in type 2 diabetic patients.

Implante dental inmediato en paciente diabético / Immediate dental implant post-extraction on systemically compromised patient

RESUMEN: Actualmente el implante dental se considera una buena alternativa para reemplazar los órganos dentarios faltantes. Sin embargo, existen ciertos requerimientos necesarios para la colocación de este y obtener una buena resolución. Estudios actuales demuestran que la colocación inmediata del implante dental posterior a la extracción dental obtiene mejores resultados a largo plazo y preserva el espacio alveolo dental natural por lo cual facilita la inserción y correcto ajuste del implante dental, siempre y cuando la extracción sea atraumática y sin complicaciones. Por ende, en el presente caso se reporta paciente masculino de 73 años con antecedentes de hipertensión arterial y diabetes mellitus tipo II, controlado con su médico especialista, al cual se le realizó extracción dentaría atraumática de OD#46 con inmediata colocación de implante dental NORMON HI e inserción de xenoinjerto óseo BIO-GEN para asegurar correcta oseointegración, cuyo procedimiento se realizó sin complicaciones y con correcta posición y paralelismo.

ABSTRACT: Nowadays, a dental implant is considered a good alternative to replace the missing teeth. However, there are several requirements needed for the implant placements and for a good resolution. Present studies demonstrate that the immediate implant placement posterior to the extraction of the tooth obtains better long-term results and also preserves the natural alveolar socket. This facilitates the placement and correct adjustment of the dental implant, only if the extraction is done atraumatically and without complications. Therefore, the present case reports a 73-year-old male patient with arterial hypertension and type II diabetes mellitus background, controlled by his medical doctor. An atraumatic tooth extraction of OD#46 was carried out on this patient, with immediate dental implant NORMON HI placement and insertion of xenograft bone BIO-GEN in order to ensure correct osseointegration. This procedure was done without complications and with correct position and parallelism.

Analysis of different therapeutic protocols for osteonecrosis of the jaw associated with oral and intravenous bisphosphonates

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 radiation 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 followup, 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 bisphosphonates, and Protocol 3 is recommended for Stage II. For ONJ lesions attributable to intravenous bisphosphonates, Protocol 7 (conservative treatment, clinical and radiological follow-up, and adjuvant therapies) provides the best results in Stage 0; in Stages I, II, and III, Protocol 1 gives better results

Dental implants placement in paranoid squizofrenic patient with obsessive-compulsive disorder: A case report.

BACKGROUND: Paranoid schizophrenia is a mental illness that involves no observable anatomical alteration. Main characteristic affects the personality of the individual, as well as areas of his own psychology. CASE REPORT: A 33-year-old man with paranoid schizophrenia and obsessive-compulsive disorder in treatment with Haloperidol, Oxcarbazepine, Olanzapine and Seroquel is presented. Dental exploration showed widespread decay mostly cervical with numerous root fragments, agenesis of lateral incisors, impacted wisdom teeth, missing teeth and malocclusion. Treatment plan included restoration of teeth decay, extractions of root fragments and implant-supported prostheses in bilateral upper lateral incisors for aesthetics reason. A previous consultation with a psychiatric specialist was performed and no contraindication were observed. A preliminary radiological examination was performed previous dental treatment and implant placement. Due to patient refusal to replace dental abscenses with implants, inform consent was signed up from his parents. After local anesthesia, first implant was placed at upper right lateral positions (Straumann Bone Level Ø 3.3 mm, length 10 mm). Two weeks later a second implant was placed at upper left lateral position (Straumann Bone Level Ø 3.3 mm, length 12 mm). The patient showed no postoperative complications. After implant placement, the patient attended scheduled review appointments. The prosthesis was placed after a 3-month period of osseointegration. CONCLUSIONS: Implant placement can be considered a suitable option for people with mental disorders. A previous consultation with psychiatric specialists for conducting a good patient management is necessaire. Key words:Paranoid schizophrenia, obsessive-compulsive disorder, dental implants.

Four years survival and marginal bone loss of implants in patients with Down syndrome and cerebral palsy.

OBJECTIVES: To evaluate implant survival rate and marginal bone loss (MBL) after 4 years in patients with Down syndrome and cerebral palsy, compared with a healthy control group. MATERIAL AND METHODS: The case group comprises 102 implants in 19 patients (71 cerebral palsy, 21 Down syndrome), and the control group comprises 70 implants in 22 healthy patients. One implant per patient was selected (n = 41 implants) to take clustering effects into account. MBL was measured using two panoramic radiographs (after surgery and 4 years later). Lagervall-Jansson's Index was used. Statistics used are chi-squared test and Haberman's post hoc test. p Value is significant at <0.05. RESULTS: MBL was significantly higher in the cases in all samples (p < 0.001) and when one implant was selected per patient (p < 0.05). More implants were lost in the cases (p < 0.01), especially those with a higher MBL (p < 0.01). MBL (p < 0.05) and implant loss (p < 0.01) increased with age in the cases. The three-unit fixed dental prosthesis (FDP) showed higher MBL (p < 0.05). Down syndrome had a higher MBL than cerebral palsy (entire sample p < 0.0001, one implant per patient p < 0.05). All patients with Down syndrome saw some damage to bone support (entire sample p < 0.0001; one implant per patient p < 0.05). Implant loss occurred only in Down syndrome (p < 0.00001). CONCLUSIONS: MBL and implant loss 4 years after placement are higher in neuropsychiatric disabilities. Down syndrome has a higher risk of MBL and implant loss; therefore, special precautions should be taken when deciding on treatment for these patients. CLINICAL RELEVANCE: As a consequence of this pilot study, professionals should be very cautious in placing implants in patients with Down syndrome.

Calidad del tratamiento endodóncico en pacientes con diabetes mellitus tipo II / Quality of root canal treatment in type II diabetic patients

Objetivo: Evaluar la calidad de tratamiento de conductos radiculares (TCR) en una muestra de pacientes con diabetes mellitus tipo 2 y diferente grado de control de la glucemia. Material y Método: Se examinaron las radiografías panorámicas de 106 pacientes con diabetes mellitus tipo 2. El control glucémico se realizó midiendo los valores de hemoglobina glicosilada (HbA1c). La periodontitis apical (PA) fue diagnosticada como lesión radiolúcida periapical (LRP), mediante la utilización del índice periapical (PAI). Entre los análisis estadísticos realizados se encuentra el cálculo de la t-student y regresiones logísticas uni/ multivariantes. Resultados: Entre los pacientes con diabetes mellitus el 39% fueron pacientes con buen control glucémico (HbA1c < 6,5%) y el 61% fueron pacientes con peor control glucémico (HbA1c ≥ 6,5%). El 32% de los pacientes tuvieron al menos un diente con TCR y el 24% un TCR con LRP. En la muestra total el 3.2% de los dientes presentaban un TCR, de los cuales el 12% estaba asociado a una LRP (p > 0,5). Las LRP estuvieron presentes en el 25% de los TCR con inadecuada obturación tridimensional de los conductos radiculares (p > 0,05), en el 16% de los TCR con inadecuada obturación de la longitud radicular (p > 0,05), en el 27% de los TCR con inadecuada restauración coronal (p = 0,056), y en el 14% de los pacientes con peor control glucémico (p > 0,05). Conclusiones: Considerando la calidad del TCR y la restauración coronal como covariables, no se encontró una asociación significativa entre el estado periapical de los dientes con TCR y el control glucémico

Objectives: To evaluate the quality of root canal treatments (RCT) in a sample of type 2 diabetic patients with different grades of glycaemic control. Methods: The radiographic records of 106 type 2 diabetic patients were examined. Glycaemic control was assessed by mean of glycated haemoglobin (HbA1c) levels. AP was diagnosed as radiolucent periapical lesions (RPL) using the periapical index score (PAI). Statistical analysis were carried out using the Student t test, χ square test, and logistic regression analysis. Results: Amongst diabetic patients, 39% were well-controlled (HbA1c <6.5%) and 61% were poor-controlled. Thirty-two percent of patients had at least one root filled tooth (RFT), and 24% had at least one RFT with RPL. In the total sample, 3.2% of teeth were RFT, being 12% associated to RPLs (p > 0.5). RPLs were present in 25% of RFT with inadequate adaptation of root filling (p > 0.05), in 16% of RFT with inadequate length of root filling (p > 0.05), in 27% of RFT with inadequate coronal restoration (p = 0.056), and in 14% of poor-controlled diabetics (p > 0.05). Conclusions: Considering the quality of RCT and coronal restoration as covariates, no significant association between periapical status of RFT and glycaemic control has been found

Impact of rare diseases in oral health

BACKGROUND: Rare diseases (RD) are those that present a lower prevalence than 5 cases per 10.000 population. The main objective of this review was to study the effect on oral health in rare diseases, while the secondary objective of the study is theme upgrade. MATERIAL AND METHODS: Comparative observational case-control studies were analysed and a systematic review was conducted in PubMed. Each rare disease listed on the statistical data record of the Health Portal of the Ministry of Equality, Health and Social Policies Board of Andalusia was associated with 'oral health'. The variables studied included dental, oral mucosa and occlusion alterations, oral pathologies (caries, periodontal disease) and other alterations (mouth breathing, parafunctional habits, etc). A bias analysis of the variable caries was conducted. RESULTS: Six RD were selected through our inclusion and exclusion criteria (hypogammaglobulinemia, Rett syndrome, Marfan syndrome, Prader-Willi syndrome, cystic fibrosis and Cri du chat syndrome) in a total of 8 publications, of which four trials were classified as high risk of bias and one of them as medium risk. There were not trials with low risk of bias. CONCLUSIONS: The main statistically significant differences found by Syndrome compared to a control group were in Hypogammaglobulinemia with a greater tendency to enamel hypoplasia and dry mouth. The Rett syndrome had, as well, a greater tendency to an anterior open bite, ogival palate, bruxism, mouth breathing and tongue thrusting. Prader-Willi syndrome had a tendency of dental erosion, and Cri du chat syndrome showed a higher association to Tannerella forsythia

A systematic review of the oral and craniofacial manifestations of cri du chat syndrome.

Cri du chat syndrome is an autosomal disorder. Because it affects few people in the population it is considered a rare disease, yet it is one of the most common autosomal chromosomal syndromes in humans. It entails pathognomonic alterations that affect the craniofacial and oral anatomy of patients. The aim of this study is to review these craniofacial and oral abnormalities in patients with Cri du chat syndrome. The PubMed Medline database was searched using two different strategies. First, we used "Dentistry" and "Cri du chat" as keywords; second, we used "Cri du chat" and "craniofacial." Seven articles in which the main orofacial and cranio-skeletal characteristics of patients with Cri du chat syndrome were described were selected according to the inclusion and exclusion criteria. Cri du Chat syndrome entails pathognomonic characteristics in the craniofacial area (epicanthus, short philtrum, and wide nasal bridge), the oral area (mandibular retrognathism and anterior open bite) and the cranial region (alterations at the cranial base angle and a small upper airway). However, more studies on larger samples are needed to specify the orofacial and craniofacial characteristics of patients with Cri du chat syndrome more accurately. Clin. Anat. 29:555-560, 2016. © 2015 Wiley Periodicals, Inc.