Risk of bias in dentistry-related randomized controlled trials in spanish language journals

Objectives: To assess the risk of bias (RoB) of randomized controlled trials (RCTs) published in dental journals in the Spanish language. Methods: A systematic retrospective survey was conducted of all RCTs published from 1980 to 2019 in dentistry Spanish and Latin American journals. We extracted data and performed RoB assessments using the Cochrane Risk of Bias tool. Results: 292 RCTs published in 51 journals were included. The best-rated domains were incomplete outcome data, selective reporting, and other biases. The domains assessed with higher proportions of an unclear or high risk of bias were sequence generation, allocation concealment, and blinding of outcome assessment. There is a low proportion of RCTs published in Spanish language journals. However, the number has been increasing over the years, and the low risk of bias assessment rates across domains show an increasing trend. Conclusions: A low percentage of Spanish-language dental journals issue RCTs. Our assessment of these RCTs' RoB suggests higher difficulties in the design and conduction phase than in the posterior reporting stage.

Histological Evaluation of the Effect of Alendronate on the Maxillary Bone of Wistar Rats Combined with Orthodontic Movement of Intense Force / Evaluación Histológica del Efecto del Alendronate en el Hueso Maxilar de Ratas Wistar Combinado con Movimiento de Ortodoncia de Fuerzas Intensas

SUMMARY: To evaluate the histological adverse effects of alendronate administered systemically and topically in combination with orthodontic movement by intense force. Thirty-six 24-week-old female Wistar rats, ovariectomized, were used and divided into three groups (n = 12/group): control, locally treated with saline (0.07 ml/kg/week) (group 1) and experimental, treated with alendronic acid systemically (0.07 mg/kg/week) (group 2) and locally (7 mg/kg/week) (group 3). At 14 days, an orthodontic anchor was installed in the right first molar, and a force of 144 cN was applied for 28 days. The samples were processed for histological evaluation. Descriptive statistics, Shapiro-Wilk tests, one-way ANOVA with Bonferroni correction, one-way repeated measures ANOVA and chi-square tests were performed. All tests were statistically significant at p <0.05. The adverse events found in all groups were inflammation and osteoclastic activity. In the bisphosphonate-treated groups, there were statistically significant differences (p = 0.005) in the osteoclastic activity between the two hemiarcates. All rats in group 2 presented paralytic ileus. Compared to local administration, systemic treatment with alendronic acid produces more adverse effects, such as inflammation, fibrinoid necrosis, and osteoclastic activity. During the application of intense forces, it was not possible to show that there is necrosis associated with bisphosphonates.

Evaluar los efectos adversos histológicos del alendronato administrado sistémica y tópicamente en combinación con movimientos ortodóncicos de fuerza intensa. Treinta y seis ratas Wistar hembras de 24 semanas de edad, ovariectomizadas, fueron utilizadas y divididas en tres grupos (n = 12/grupo): control, tratado localmente con solución salina (0,07 ml/kg/semana) (grupo 1) y experimental, tratados con ácido alendrónico por vía sistémica (0,07 mg/kg/semana) (grupo 2) y local (7 mg/kg/semana) (grupo 3). A los 14 días se instaló un anclaje de ortodoncia en el primer molar derecho y se aplicó una fuerza de 144 cN durante 28 días. Las muestras fueron procesadas para evaluación histológica. Se realizó estadística descriptiva, pruebas de Shapiro-Wilk, ANOVA de una vía con corrección de Bonferroni, ANOVA de medidas repetidas de una vía y pruebas de chi-cuadrado. Todas las pruebas fueron estadísticamente significativas con un p <0,05. Los eventos adversos encontrados en todos los grupos fueron inflamación y actividad osteoclástica. En los grupos tratados con bisfosfonatos hubo diferencias estadísticamente significativas (p = 0,005) en la actividad osteoclástica entre los dos hemiarcados. Todas las ratas del grupo 2 presentaron íleo paralítico. En comparación con la administración local, el tratamiento sistémico con ácido alendrónico produce más efectos adversos, como inflamación, necrosis fibrinoide y actividad osteoclástica. Durante la aplicación de fuerzas intensas, no fue posible demostrar que existe necrosis asociada con los bisfosfonatos.

Initial monotherapy with eslicarbazepine acetate for the management of adult patients with focal epilepsy in clinical practice: a meta-analysis of observational studies.

AIM OF THE STUDY: To assess the effectiveness, overall tolerability of eslicarbazepine acetate (ESL) as an initial or early monotherapy treatment of adult patients with focal epilepsy under real-world practice conditions. MATERIALS AND METHODS: We focused on real-world longitudinal studies that included or separately reported the results of at least one of the efficacy outcomes of interest. A DerSimonian-Laird random effects model was used with the presentation of the 95% confidence intervals of the estimate. RESULTS: 5 studies met our selection criteria and were included in the quantitative synthesis. All studies were observational and uncontrolled studies, and all but one were retrospective studies. The pooled proportion of patients who were seizure-free for the entire study period was 64.6% (95% CI, 45.7 to 79.8) at month 6 and 56.6% (95% CI, 50.2 to 62.8) at month 12. Pooled retention rates were 95.0% (95% CI, 90.3 to 97.5) at 6 months and 83.6% (95% CI, 73.9 to 90.1) at 12 months. The pooled proportion of patients who reported at least one adverse event was 27.2% (95% CI, 21.7 to 33.6), and the pooled proportion of patients who discontinued ESL due to adverse events was 8.9% (95% CI 6.2 to 12.6). CONCLUSIONS: Our results suggest that initial or early monotherapy with ESL is effective and well-tolerated for the management of adult patients with focal epilepsy in clinical practice, with results that are at least similar to those reported in the pivotal randomized clinical trial of ESL monotherapy. No new safety signals with ESL have been identified in this systematic review.

Effect of the 2008 economic crisis on oral health in Spain: analysis of serial cross-sectional, population-based health surveys.

OBJECTIVES: To evaluate the impact of the economic crisis on the oral health of individuals in Spain based on variables including sex, unemployment, social class and educational level. DESIGN: This was an analysis of serial cross-sectional, population-based health surveys conducted before the crisis (2003 and 2006) and during the crisis (2011, 2014 and 2017). SETTING: National Health Surveys of Spain and the European Health Survey in Spain.ParticipantsA total of 189 543 participants were recruited. OUTCOME MEASURES: The independent variables were sex, employment, social class and educational level. The dependent variables were related to oral health. Descriptive statistics, χ2 tests and the Cochran-Mantel-Haenszel test were performed. RESULTS: The results showed that there were differences (p<0.001) in all oral health indicators before and after the crisis. Compared with the precrisis period, men had a higher probability of tooth extractions (OR 1.41, 95% CI 1.37 to 1.45), dental fillings (OR 1.30, 95% CI 1.27 to 1.34), prostheses (OR 1.04, 95% CI 1.01 to 1.07) and missing teeth (OR 1.35, 95% CI 1.31 to 1.39). Unemployed individuals were more likely to have dental caries (OR 1.08, 95% CI 1.00 to 1.16) and missing teeth (OR 1.36, 95% CI 1.27 to 1.46). Working class individuals had a higher probability of tooth extractions (OR 1.63, 95% CI 1.59 to 1.67), bleeding gums (OR 1.04, 95% CI 1.01 to 1.07), prostheses (OR 1.05, 95% CI 1.02 to 1.07) and missing teeth (OR 1.36, 95% CI 1.33 to 1.39). Participants with a basic or intermediate level of education had a higher probability of dental mobility (OR 1.13, 95% CI 1.07 to 1.19), prostheses (OR 1.11, 95% CI 1.08 to 1.14) and missing teeth (OR 1.42, 95% CI 1.38 to 1.46). CONCLUSIONS: The economic crisis affected the oral health of the Spanish population, with a more significant deterioration among men, working class individuals and unemployed individuals.

Seroprevalence of SARS-CoV-2 in a Fully Operative Dentistry Academic Center in Madrid (Spain) During the De-escalation Phase of the COVID-19 Pandemic. Are Our Dentists at Greater Risk?

PURPOSE: To determine the prevalence of COVID-19 infection among dental professionals at an Academic Center in Madrid (Spain) at the beginning of the pandemic's de-escalation phase. MATERIALS AND METHODS: A cross-sectional study was designed. COVID-19 infection was determined by membrane-based immunoassay qualitative detection of IgG and IgM antibodies in human whole blood. Age, sex, race and professional qualification were recorded, as were symptoms compatible with COVID-19 infection whenever present. Data collected were analysed by means of descriptive and qualitative (X2) statistical analyses. RESULTS: A total of 195 individuals were included (40 administrative professionals and 155 dentists). Seroprevalence at the end of the de-escalation phase was 20.0% among all the participants. The highest prevalence was found among the orthodontists (34.8%), followed by the paediatric dentists (28.6%) and oral surgeons (14.7%). Most subjects were positive for IgG and negative for IgM (79.5%). CONCLUSIONS: The seroprevalence of SARS-CoV-2 among dental professionals at the end of the de-escalation phase after the first wave of the pandemic was almost double the seroprevalence of the general population. Orthodontists had the highest rates of SARS-CoV-2 infection.

A retrospective study on the effect of the COVID-19 pandemic on dental treatments in adults.

BACKGROUND: The aim was to analyze the prevalence of dental treatments that were not performed in a dental care university referral center in the capital of Spain during the first wave of the COVID-19 pandemic. METHODS: This was a retrospective observational study based on the registry of medical records. Sex, age, nationality, and the type of treatment that was not performed in the service of the Integrated Adult Dental Clinic subject of the Dentistry degree at the Rey Juan Carlos University of Madrid were analyzed. RESULTS: A total of 392 medical records were analyzed. The prevalence of the treatments that were not performed was 58.67% (95% CI 53.74-63.44) of conservative treatments, 47.45% (95% CI 42.55-52.39) of periodontal treatments, 27.30% (95% CI 23.12-31.91) and 13.52% (95% CI 10.49-17.26) of clinical activities. The patients most affected by the absence of dental treatment ranged in age from 35 to 74 years. Age, sex, and nationality were not influential in not performing dental treatments. CONCLUSIONS: The COVID-19 pandemic could have negatively influenced treatments, such as conservative and periodontal treatments, that increasing the risk of tooth loss in adults.

Evaluation of the Efficacy of Lacer HaliTM Treatment on the Management of Halitosis: A Randomized Double-Blind Clinical Trial.

BACKGROUND: Halitosis of oral origin is very common in the general population. Due to their antimicrobial properties, chlorhexidine-based products are widely used in the management of this condition, but these are associated with reversible side effects. In this study we evaluated the efficacy of Lacer HaliTM mouthrinse and toothpaste in subjects with intraoral halitosis after several applications under normal conditions of use. METHODS: In this randomized clinical trial with mouth rinse and toothpaste, single-center, double-blinded, parallel participants were assigned to an experimental group (Lacer HaliTM,, n = 20), a positive control group (HalitaTM, n = 20), and a placebo group (n = 20). The active duration of the study was 18 days. The clinical follow-up evaluations were performed at five time points (T0, T1, T2, T3, and T4). The intensity of halitosis was evaluated by organoleptic measurement and the portable gas chromatograph OralChromaTM. The data were analyzed using generalized mixed linear models. RESULTS: Sixty patients completed the study. Lacer HaliTM, in comparison with HalitaTM, did not show statistically significant differences at any time during the study except for the levels of hydrogen sulfide and total volatile sulfur compounds at 15 days, where HalitaTM was better. Compared to the placebo treatment, Lacer HaliTM, was significantly more efficient, in terms of both the organoleptic evaluations at 8 days and the levels of hydrogen sulfide. CONCLUSIONS: Lacer HaliTM is an alternative to chlorhexidine-based toothpaste and mouthwashes in the management of halitosis.

Real-World Data on the Adverse Metabolic Effects of Second-Generation Antipsychotics and Their Potential Determinants in Adult Patients: A Systematic Review of Population-Based Studies.

INTRODUCTION: To assess the risk of occurrence and potential determinants of metabolic disorders in adult patients treated with second-generation antipsychotics (SGAs) under real-world practice conditions. METHODS: MEDLINE, EMBASE, and PsycInfo were searched in July 2019 from database inception. We included population-based, longitudinal, comparative studies that report the results of the outcomes of interest for adult participants, including diabetes, ketoacidosis, hyperosmolar hyperglycemic state, weight gain/obesity, dyslipidemia, hypertension, and metabolic syndrome. Two reviewers independently extracted data on the study design, study quality, and study outcomes. RESULTS: We included 40 studies. Most studies showed that clozapine and olanzapine were associated with an increased likelihood of developing diabetes, while the results for risperidone and quetiapine were mixed. Although less well studied, ziprasidone and aripiprazole appeared to not be associated with the occurrence of diabetes. Information on antipsychotic-induced weight gain/obesity is extremely scarce. Regarding dyslipidemia, aripiprazole was not associated with an increased likelihood of developing dyslipidemia, clozapine was associated with an increased likelihood of developing dyslipidemia, and risperidone, olanzapine, quetiapine, and ziprasidone showed mixed results. Two studies suggested an association between ziprasidone and the occurrence of hypertension. Several studies found that the occurrence of a metabolic disorder acted as a risk factor for the development of other metabolic disorders. We did not find information on brexpiprazole, cariprazine, or lurasidone, and data on any long-acting SGA were lacking. CONCLUSION: Although there are relevant differences among SGAs concerning the risk of metabolic disorders, it appears that none of the SGAs included in our review are fully devoid of these disturbances.

Patients with severe mental disorders often present metabolic disorders such as obesity, increased blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels. Treatment with antipsychotics may contribute to the occurrence of these disorders. Using a systematic review, we have evaluated the risk of occurrence of these metabolic disorders associated with the most frequently used antipsychotics­the so-called second-generation antipsychotics (SGAs)­and which factors increase the patient chances of presenting a metabolic disorder when they are treated with these drugs under routine clinical practice. After reviewing 40 studies, we found that, although there are relevant differences among SGAs concerning the risk of metabolic disorders, it appears that none of the drugs included in our review are fully free of these disturbances. Among the factors that increase the chances of these disturbances, we highlight that the presence of a particular metabolic disorder (e.g., increased blood pressure) acts as a risk factor for the occurrence of other metabolic disorders (e.g., high blood sugar), and that the duration of treatment could be a relevant factor for the occurrence of these disorders. Finally, we also found important gaps in our knowledge about this matter, mainly the limited information on the SGAs apparently associated with lower risk of metabolic disorders in experimental studies (that is, few studies evaluating ziprasidone and aripiprazole, and none evaluating brexpiprazole, cariprazine, or lurasidone) and the lack of information on long-acting injectable (that is, antipsychotics that are usually given every 2­4 weeks) SGAs.

Self-reported prevalence of periodontal disease among the Spanish population and immigrants: 2006, 2011/12 and 2017: a population-based study.

BACKGROUND: Periodontal disease is one of the most common pathologies in the population. Self-reporting has been used as a diagnostic tool in large populations, among other reasons, to detect the needs of potentially vulnerable groups. This study evaluated the prevalence of periodontal disease in people of Spanish nationality and immigrants in Spain. METHODS: This population-based, cross-sectional study was carried out using data obtained from National Health Interview Surveys (NHSs) carried out in 2006, 2011/2012 and 2017 in Spain. Subjects aged 16 years and older were included in the NHS-2006 and aged 15 years and older were included in the other NHSs. The following variables were self-reported by the participants: gum bleeding, tooth mobility, tooth extraction and missing teeth. Chi-square homogeneity tests were performed to assess the main associations between the independent variable (nationality) and the dependent variables (bleeding gums, tooth mobility, tooth extraction and missing teeth). Multinomial logistic regression models were constructed to evaluate the influences of the variables age and sex and their interactions on the main associations. RESULTS: A total of 115,123 participants were included in the NHS-2006 (n = 37,327, 11.38% immigrants), NHS-2011/12 (n = 38,727, 14.39% immigrants) and NHS-2017 (n = 39,069, 13.71% immigrants). The variables directly related to periodontal disease were gum bleeding and tooth mobility. These were significantly associated with nationality in the NHS-2006 and NHS-2017 cohorts. In the NHS-2011/12 cohort, only tooth mobility was associated with nationality. After adjustments for sex, age, and their interactions, immigrant status was associated with increased odds of bleeding in only the NHS-2006 cohort (RR = 1.65, 95% CI 1.38-1.99, p = 0.000). CONCLUSION: Immigrants in Spain have a lower probability of developing signs associated with periodontal disease than the Spanish population. Among the immigrant cohort, females and those in adult age groups had lower prevalence rates than their counterparts.

Accuracy assessment of dental age estimation with the Willems, Demirjian and Nolla methods in Spanish children: Comparative cross-sectional study.

BACKGROUND: The objective of this study was to evaluate and compare the validity and accuracy of the Willems, Demirjian and Nolla methods in predicting chronological age in a Spanish ethnicity population. METHODS: A sample of 604 orthopantomographs of Spanish children aged 4 to 13 years was evaluated by two independent evaluators. Descriptive statistics were applied to calculate the chronological age and dental age, presenting the mean and standard deviation. The difference between dental age and chronological age was calculated for each method. A positive result indicated an overestimation and a negative figure indicated an underestimation. The Wilcoxon test for paired data and Spearman's correlation coefficient were applied by age groups and sex to compare the chronological age and dental age of each method (that of Willems, Demirjian and Nolla). Statistical tests were performed at a 95% confidence level. RESULTS: The interexaminer agreement was 0.98 (p = 0.00), and the intraexaminer agreement was 0.99 (p = 0.00). The Willems method significantly overestimated the age of boys (0.35 years (0.93)) and girls (0.17 years (0.88)). The Demirjian method significantly overestimated the age of boys (0.68 years (0.95)) and girls (0.73 years (0.94)). The Nolla method significantly underestimated age in boys (0.44 years (0.93)) and girls (0.82 years (0.98)). CONCLUSIONS: In the Spanish population, the use of the Demirjian method for legal and medical purposes is frequent. This study reveals that the Willems method is more appropriate due to its greater precision in estimating dental age.

Three-dimensional descriptive study of the pterygomaxillary region related to pterygoid implants: A retrospective study.

The objective of this study was to analyze three-dimensionally the morphological characteristics of the pterygomaxillary region related to pterygoid implants. Volume, height, width and bone density were studied in relation to age, sex and dental status. This retrospective observational study analyzed the CBCT of 52 hemi-maxillas three-dimensionally (females n = 28, males n = 24; dentate = 31, edentulous = 21). Patients were exposed between September 2009 and October 2014, and data collection was performed between November 2015 and May 2016. Bone density, volume, height and width were analyzed in various locations of the maxilla and pterygoid process, and the variables age, gender and dental status patients were compared. The results show that the mean width of the pterygomaxillary joint was 7.5 mm (SD 1.00 mm), mean height was 12.51 mm (SD 1,82 mm) and mean volume was 321.7 mm3 (SD 142.02 mm3). Statistically significant differences between dentate and edentulous patients were found, showing a higher osseous density in dentate patients in the pterygoid process (758.2, SD 106.8, 95% CI 729.2 to 787.3 GSD - Gray Scale Density - compared to 689.9, SD 107.3, 95% CI 660.8 to 719.1 GSD; P = 0.022). In the maxilla, density was statistically significant lower in female subjects (571.0, SD 74.1, 95% CI 594.9 to 645.4 GSD) than in male subjects (620.2, SD 93.8, 95% CI 594.4 to 645.4 GSD, P = 0.047). In conclusion, due to the significant variation in the morphological characteristics of the pterygomaxillary region among subjects, personalized pre-surgical radiological assessment should always be performed. Gender, age and dental status are critical factors as they significantly affect bone density in this region.

Evaluation of the accuracy of the Nolla method for the estimation of dental age of children between 4-14 years old in Spain: A radiographic study.

The aim of this study was to estimate the age of subjects from their dental age by showing the different stages of tooth development using the Nolla method in a Spanish population sample considering the gender, age group, and the development of the two dental arches. The sample consisted of 604 orthopantomographs corresponding to Spanish children (male: 302 and female: 302) aged from 4 to 14 years old. The resulting chronological and dental ages were compared using Student's t-test. We obtained a good index of agreement between the evaluators and good internal consistency in the evaluation of the ages of the teeth. In general, the dental age estimates were lower than the chronological ages, obtaining an underestimation with the application of the Nolla method. In the male group, the average dental age of the maxillary teeth was 8.36 years and that of the mandibular teeth was 8.40 years, compared to the chronological age of 8.84 years in both cases. In the female group, the average dental age of the maxillary teeth was 7.76 years and that of the mandibular teeth was 7.88 years, compared to the chronological age of 8.70 years in both cases. On applying the Nolla method to our sample, a significant overestimation was observed only in children aged between 4 and 6.9 years. The Nolla method can be used as a complementary tool for estimating age in children of Spanish origin. The application of this method is more favourable in the case of individuals evaluated under the law applied to minors. In general, with this method, age is underestimated, but the calculations involved are reliable, and greater precision has been observed in male than in female. The data from this study can be used as a reference to determine the dental maturity of Spanish children and to estimate their ages.

Finite element analysis comparing WaveOne, WaveOne Gold, Reciproc and Reciproc Blue responses with bending and torsion tests.

To evaluate the bending and torsional properties of four nickel-titanium endodontic files, we simulated and compared WaveOne® primary size 25 with 0.07 taper, WaveOne Gold® primary size 25 with 0.07 taper, Reciproc® primary size 25 with 0.08 taper, and Reciproc Blue® primary size 25 with 0.08 taper. Three-dimensional models were created using computer-aided design software and numerically analyzed in ANSYS® Workbench. Boundary conditions for the numerical analyses were based on the ISO 3630-1 specifications. The highest stress levels were recorded for WaveOne® and Reciproc®. Numerical results of the bending test showed that WaveOne Gold® is 86% more flexible than WaveOne® with a deflection of 3 mm. Reciproc Blue® was 42.31% more flexible than Reciproc® file with a deflection of 3 mm. The WaveOne® instrument withstood the highest stress under the torsion test, followed by Reciproc®, then Reciproc Blue® files. The stress under torsion in the WaveOne® and WaveOne Gold® files is reduced in a 51%. Regarding Reciproc® and Reciproc Blue® files, the stress under torsional moments remains very similar. Our results exposed a considerable difference in terms of stress tolerance between WaveOne® and WaveOne Gold®. However, Reciproc® files demonstrated a similar stress distribution. The results obtained through finite element analysis suggest that thermal treatment of files might improve their flexibility, increasing resistance during the preparation of highly curved canals. Also, the values obtained regarding the improvement of flexibility were in accordance with the manufacturer claims.

Probability of Failure of Internal Hexagon and Morse Taper Implants with Different Bone Levels: A Mechanical Test and Probabilistic Fatigue.

PURPOSE: The goal of this study was to foresee the fatigue life of two implant connections, evaluate the failure probability with several bone levels, and compare the in vitro test results with finite element results. MATERIALS AND METHODS: Mechanical tests were done with 60 implants (Ø3.50 mm), and abutments were used. These implants were divided into two groups with 30 implants each: internal hexagon and Morse taper. Three bone levels and 10 implants for each level were analyzed. The first level was considered at the platform level, the second at 3 mm, and the last level at 5 mm above the platform resin. A quasi-static loading at 30 degrees was applied to the axis of the implant in a universal machine. Six models were created and assembled to reproduce the conditions used in the laboratory testing. All models had restricted all displacement at the bone (bottom and lateral). Loads employed in the numerical test were obtained experimentally. Loads and material properties were supposed to be random. Then, failure probability was calculated by the probabilistic methodology. RESULTS: The internal hexagon group obtained the following mean fracture strengths: 2,092 N at the first level, 1,041 N at the second level, and 898 N at the third level. The mean fracture strengths for the Morse taper group were as follows: 1,687 N at the first level, 1,644 N at the second level, and 1,159 N at the third level. Results obtained by the finite element analysis are in accordance with the in vitro mechanical test results. The Morse taper group obtained a better behavior at bone levels 2 and 3 than the internal hexagon group. An important dependency between failure probability and bone level was found in the internal hexagon group. However, a similar behavior in levels 2 and 3 was obtained for the Morse taper group. CONCLUSION: In view of the mechanical results, the Morse taper group has a better behavior in bone levels 2 and 3 than the internal hexagon group. This is also in accordance with the probabilistic fatigue outcomes.

Riesgo de hemorragia postquirúrgica en pacientes bajo tratamiento antitrombótico sometidos a cirugía oral: Revisión Sistemática y Metaanálisis / Risk of postsurgical hemorrhage in patients with antitrombotic treatment undergoing oral surgery: A systematic review and Metanalysis

RESUMEN: Introducción: el objetivo de esta revisión fue determinar el riesgo de hemorragia postoperatoria en pacientes con tratamiento anticoagulante oral (TACO) sometidos a cirugía oral que no suspenden su tratamiento comparado con quienes lo modifican o suspenden. Materiales y métodos: se realizó una búsqueda en CENTRAL, Medline y EMBASE, junto con una revisión manual de revistas especializadas y resúmenes de la IADR. Dos revisores realizaron la selección de estudios, evaluación de riesgo de sesgo y extracción de datos de forma independiente. Se seleccionaron los ensayos clínicos aleatorizados que miden la aparición de hemorragias en pacientes sometidos a procedimientos quirúrgicos orales con TACO en comparación con un grupo que interrumpió o modificó su terapia. Resultados: Solo 5 estudios cumplieron los criterios de inclusión (549 pacientes). El metanálisis mostró que el mantenimiento de la TACO no aumenta el riesgo de hemorragia postoperatoria (riesgo relativo: 1,41 [0,93 - 2,16], IC del 95% p = 0,11) en comparación con la interrupción del tratamiento. Conclusión: Aunque se encontró una mayor cantidad de hemorragia postoperatoria en pacientes con TACO comparado con quienes lo interrumpieron o modificaron, esta diferencia no fue estadística ni clínicamente significativa. Por lo tanto, TACO no debe suspenderse en pacientes sometidos a cirugía oral.

ABSTRACT: Introduction: This systematic review aims to determine the postoperative bleeding risk in patients on oral anticoagulant therapy (OAT) undergoing oral surgical procedures when continuing with the treatment, compared with those modifying or discontinuing the treatment. Materials and methods: A search was performed using CENTRAL, Medline and EMBASE, in conjunction with a manual review of indexes of specialized journals and abstracts of the IADR. Study selection, assessments of risk of bias and data extraction were performed independently by 2 reviewers. Randomized clinical trials measuring the occurrence of bleeding in patients on OAT undergoing oral surgical procedures compared with a group discontinuing or modifying their therapy were selected. Results: A total of 5 studies were included based on inclusion criteria (549 patients). The meta-analysis showed that the maintenance of OAT does not increases the risk of postoperative bleeding (relative risk [RR] 1.41 [0.93 - 2.16]; 95% CI p= 0,11) compared with the discontinuation of therapy. Conclusion: Although a larger quantity of oral postoperative bleeding episodes were found in patients continuing with OAT compared with patients discontinuing or modifying their therapy, this difference was neither statistically nor clinically significant. Therefore, OAT should not be discontinued in patients undergoing oral surgery.

Complete mechanical characterization of an external hexagonal implant connection: in vitro study, 3D FEM, and probabilistic fatigue.

The aim of this study was to fully characterize the mechanical behavior of an external hexagonal implant connection (ø3.5 mm, 10-mm length) with an in vitro study, a three-dimensional finite element analysis, and a probabilistic fatigue study. Ten implant-abutment assemblies were randomly divided into two groups, five were subjected to a fracture test to obtain the maximum fracture load, and the remaining were exposed to a fatigue test with 360,000 cycles of 150 ± 10 N. After mechanical cycling, all samples were attached to the torque-testing machine and the removal torque was measured in Newton centimeters. A finite element analysis (FEA) was then executed in ANSYS® to verify all results obtained in the mechanical tests. Finally, due to the randomness of the fatigue phenomenon, a probabilistic fatigue model was computed to obtain the probability of failure associated with each cycle load. FEA demonstrated that the fracture corresponded with a maximum stress of 2454 MPa obtained in the in vitro fracture test. Mean life was verified by the three methods. Results obtained by the FEA, the in vitro test, and the probabilistic approaches were in accordance. Under these conditions, no mechanical etiology failure is expected to occur up to 100,000 cycles. Graphical abstract ᅟ.

A New Model to Study Fatigue in Dental Implants Based on Probabilistic Finite Elements and Cumulative Damage Model.

The aim of this study was to predict the fatigue life of two different connections of a dental implant as in load transfer to bone. Two three-dimensional models were created and assembled. All models were subjected to a natural masticatory force of 118 N in the angle of 75° to the occlusal plane. All degrees of freedom in the inferior border of the cortical bone were restrained, and the mesial and distal borders of the end of the bone section were constrained. Fatigue material data and loads were assumed as random variables. Maximum principal stresses on bone were evaluated. Then, the probability of failure was obtained by the probabilistic approach. The maximum principal stress distribution predicted in the cortical and trabecular bone is 32 MPa for external connection and 39 MPa for internal connection. A mean life of 103 and 210 million cycles were obtained for external and internal connection, respectively. Probability cumulative function was also evaluated for both connection types. This stochastic model employs a cumulative damage model and probabilistic finite element method. This methodology allows the possibility of measured uncertainties and has a good precision on the results.

Antibiotic Release from Calcium Phosphate Materials in Oral and Maxillofacial Surgery. Molecular, Cellular and Pharmaceutical Aspects.

Calcium phosphate materials (CPM) are widely used in dentistry and maxillofacial surgery. The presence of microbial biofilms and external infections is responsible for the failure of many procedures of dental implants and bone grafts. In an attempt to reduce the percentage of these infectious processes antibiotics have been associated with CPM improving certain conditions. For instance, antibiotics administered orally or intravenously have less effect and the blood flow in relation to this is poor near implants and grafts. Tissue engineering (TE) has employed CPM as a local drug delivery vehicle to be more effective and efficient in bone infections. This review is presented to describe current antibiotics used and the physical and chemical properties of scaffolds.

Anterior loop of the mental nerve, mental foramen and incisive nerve emergency: tridimensional assessment and surgical applications.

PURPOSE: The aim of this study was to investigate the prevalence and length of the anterior loop (AL), the distance from this landmark to the alveolar crest and its relation with the shape of the foramen and emergency pattern in the Spanish population on helical computed tomography scan (helical CT scan) through tridimensional reconstructions. METHODS: Helical CT scan images of 41 patients aged 65 or older were analyzed. A total of 82 human hemi-mandibles were examined in this study. A tridimensional reconstruction of each mandible and Inferior Alveolar Nerve canal was created in AMIRA® software (AMIRA, Mercury Computer Systems, Berlin, Germany). Prevalence, length and distance between the AL, mental foramen and alveolar ridge were measured. This retrospective observational study was performed according to the STROBE guidelines. RESULTS: Prevalence of the AL was 53.7 % (n = 44) and the mean length was 1.3 ± 0.64 mm. The mean distance from the highest point of the loop to the alveolar ridge was 13.4 ± 2.8 mm. The mean diameter of the mental foramen was 3.5 ± 0.65 mm and the proportion of the oval-shaped was 62.2 % (n = 51) and round-shaped was 37.8 % (n = 31). The study found that patients with type 1 pattern emergency pattern had a higher prevalence of the AL (p = 0.03). CONCLUSIONS: Prevalence, location and length of the anterior loop can be overlooked if only two-dimensional pre-surgical studies are performed. Therefore, three-dimensional imaging and modeling of anatomic structures should be used for the pre-operative examination of the interforaminal area. Given the wide variability of the emergency pattern of the mental nerve and the prevalence and location of the anterior loop, it should be studied in every patient individually.

Soft Tissue Augmentation Techniques in Implants Placed and Provisionalized Immediately: A Systematic Review.

The aim of this study was to evaluate the effectiveness of techniques for soft tissue augmentation in the placement of immediate implants with and without provisionalization and to assess the quality of the reports in the literature. Randomized clinical trials, prospective clinical trials, and case series were included in this review. Clinical questions were formulated and organised according to the PICOS strategy. An electronic search was performed in PubMed, Cochrane Central Register of Controlled Trials, Scopus, and ISI Web up until June 2016. Interexaminer agreement on eligibility (k = 0.842; p = 0.103) and quality (k = 0.933; p < 0.001) was high. Methodological approaches were assessed using criteria based on design related forms designed by the Dutch Cochrane Collaboration. Finally, 14 papers were identified. In two studies, the implant survival was 90%; for the rest of the studies it was 100%. All studies reported favourable aesthetic, biological, and radiographic outcomes. Surgical and biomechanical complications of this technique were not relevant. This technique effectively compensates for the expected loss of volume of the oral soft tissues and maintains high success rates with good aesthetic results over time.