Efficacy of Chlorhexidine after Oral Surgery Procedures on Wound Healing: Systematic Review and Meta-Analysis.

Our objective was to evaluate qualitatively and quantitatively, through a systematic review and meta-analysis, available evidence on the efficacy of chlorhexidine (CHX) when applied after oral surgery on wound healing and related clinical parameters. MEDLINE/PubMed, Embase, CENTRAL, Web of Science, and Scopus were searched for studies published before January 2023. The quality of the methodology used in primary-level studies was assessed using the RoB2 tool; meta-analyses were performed jointly with heterogeneity and small-study effect analyses. Thirty-three studies and 4766 cases were included. The results point out that the application of CHX was significantly more effective, compared to controls where CHX was not employed, providing better wound healing after oral surgery (RR = 0.66, 95% CI = 0.55-0.80, p < 0.001). Stratified meta-analyses confirmed the higher efficacy of 0.20% CHX gel vs. other vehicles and concentrations (p < 0.001, respectively). Likewise, the addition of chitosan to CHX significantly increased the efficacy of surgical wound healing (p < 0.001). The use of CHX has also been significantly beneficial in the prevention of alveolar osteitis after any type of dental extraction (RR = 0.46, 95% CI = 0.39-0.53, p < 0.001) and has also been effective when applied as a gel for a reduction in pain after the surgical extraction of third molars (MD = -0.97, 95% CI = -1.26 to -0.68, p < 0.001). In conclusion, this systematic review and meta-analysis demonstrate on the basis of evidence that the application of CHX exerts a beneficial effect on wound healing after oral surgical procedures, significantly decreasing the patient's risk of developing surgical complications and/or poor wound healing. This benefit was greater when CHX was used at 0.20% in gel form with the addition of chitosan.

Cylindrical dental implants with hydroxyapatite- and titanium plasma spray-coated surfaces: 5-year results.

Clinical follow-up was conducted on 127 cylindrical implants placed in 21 patients after 5 years of function: 75 implants were coated with titanium plasma spray (TPS) and 52 implants were coated with hydroxyapatite (HA). The aim of the study was to assess possible differences in clinical function and success rates for each implant type. Clinical and radiographic evaluations were conducted, and the periodontal indices of gingival bleeding, plaque, and calculus were measured. Cumulative data were analyzed for differences by implant type and jaw location. No significant differences were found between the 2 implant systems according to the periodontal parameters studied; however, 5-year success rates were 86.7% for TPS-coated implants and 94.3% for HA-coated implants. The periodontal probe index presented abnormal values in the patients with systemic disease and those who were provisionally restored with single-tooth restorations, complete screw-retained dentures, and fixed partial dentures. There were no differences regarding implant placement when mandibles and maxillae were compared. Long-term success rates were outstanding for HA-coated implants and acceptable for TPS-coated implants after 5 years of function. No significant differences were found between the 2 surfaces.

A pilot study in the development of indices for predicting the clinical outcome of oral bone grafts.

PURPOSE: Bone grafting to repair osseous defects is widely used in dentistry, but little information on how to predict the clinical survival of grafted bone is currently available. As an initial step toward the establishment of formal criteria for predicting the clinical outcome of oral bone grafts, this pilot study sought to determine the relevance of adverse clinical and radiographic parameters as predictor variables for graft survival. MATERIALS AND METHODS: Eighty patients presenting with a variety of clinical conditions were treated with 83 oral bone grafts. Alloplastic, allogenic, and/or autogenous materials were used with or without barrier membranes. During follow-up appointments at 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years after grafting, a series of clinical and radiographic parameters were used to evaluate the degree of graft integration. The data were then analyzed to determine the prediction accuracy of each variable in relation to the results of the graft. RESULTS: The findings of this clinical study suggest that the variables of (1) graft type, (2) inflammation, (3) infection, (4) fistula, (5) graft exposure, (6) pain, and (7) radiolucency were good indices for predicting graft survival, especially with cumulative data. DISCUSSION: The quality of the prognostic indices appeared to be good and should be further investigated for future applications. CONCLUSIONS: The cumulative index, with a sensitivity of 88.9% and a specificity of 93.8%, was the best predictor of clinical outcome. The 1-month and 3-month indices were similar.

Cinco casos de elevación del seno maxilar con autoinjertos. Estudio clínico, radiológico y análisis con MEB / Five clinical cases of augmentation of the maxillary sinus with autogenous bone graft. A clinical, radiological study and analysis with SEM

Introducción: Realizamos una evaluación clínica, radiológica y análisis con microscopio electrónico de barrido (MEB) de 5 casos de elevación del seno maxilar (unilateral y bilateral) con injerto autógeno procedente de la cresta ilíaca y de la sínfisis mentoniana. Pacientes y método: Se realizó un estudio observacional de seguimiento en 5 pacientes (2 hombres y 3 mujeres) al primer mes, sexto mes y al primer año de la colocación del injerto, en el cual se midieron una serie de parámetros clínicos y radiológicos. Este estudio se completó con el análisis del injerto mediante MEB. Resultados: El injerto ha sido viable, permitiendo la realización del tratamiento implantológico. Sin embargo ha habido sintomatología que ha variado según el paciente, siendo la inflamación y el dolor los síntomas más frecuentes. La reabsorción del injerto se ha mantenido con niveles inferiores al 30 por ciento, siendo menor en el injerto procedente de la sínfisis mentoniana. Histológicamente los mecanismos de formación y de remodelación del nuevo hueso se han producido satisfactoriamente. Conclusión: La elevación del seno maxilar con autoinjertos es un tratamiento factible que posibilita la colocación de implantes en pacientes con atrofia posterior del maxilar superior (AU)