Diagnosis and indications for the extraction of third molars - The SECIB clinical practice guideline.

BACKGROUND: The removal of third molars (3Ms) is the most frequent surgical procedure in the field of Oral Surgery. As a result, the Spanish Society of Oral Surgery (SECIB) aims to create a Clinical Practice Guideline (CPG) that offers evidence-based recommendations for optimal clinical practice. Specifically, the CPG will focus on providing guidance regarding the indications and criteria for clinical and radiological diagnosis of patients with 3Ms. MATERIAL AND METHODS: This CPG was developed by the SECIB, following the methodological guidelines described in the methodological manual for the "Development of Clinical Practice Guidelines in the National Health System". Several PICO questions related to the diagnosis and indications for the extraction of 3Ms were formulated. The leading experts carried out the evaluation of the evidence and the formulation of specific recommendations. RESULTS: A total of 17 PICO questions were evaluated, addressing the indications, prognosis, diagnosis, and cost-benefit relationship of 3M extraction. CONCLUSIONS: The present Clinical Practice Guideline provides evidence-based recommendations on the diagnosis and indications for 3M extraction. These evidence-based recommendations can assist healthcare professionals and the general population in making informed decisions regarding the management of 3Ms.

Evaluation of the efficacy of hydroxyl radical (OH˙) release for disinfection of the air and surfaces in the dental clinic: an in vitro study.

BACKGROUND: Concerning about the quality of room air has increased exponentially. Specially in dental clinics where diary practice is characterized by the important generation of aerosols. MATERIAL AND METHODS: An in vitro model was used in which samples were collected from the surfaces and room air of a dental clinic before and after the use of an OH˙ radical generator. RESULTS: A total of 1260 samples were collected for bacteriological analysis and 14 samples for the detection of SARS-CoV-2. Following OH˙ treatment, the tested surface samples showed a decrease in the number of colony forming units (CFUs) of 76.9% in TSA culture medium. The circulating room air samples in turn showed a decrease in CFUs of 66.7% in Sabouraud medium and 71.4% in Mannitol agar medium. No presence of SARS-CoV-2 was observed on the surface of the face shield. CONCLUSIONS: The disinfectant technology based on the use of hydroxyl radicals (OH˙) is effective in reducing the presence of moulds and yeasts and Staphylococcus in the air, and in reducing total aerobic bacteria on the tested surfaces.

Clinical effect of vitamin C supplementation on bone healing: A systematic review.

BACKGROUND: The aim of the present systematic review was to evaluate the clinical effect of vitamin C on bone healing after bone fracture or bone reconstruction procedures. MATERIAL AND METHODS: In October 2020, Cochrane Library, Scopus and PubMed-Medline databases were searched without restrictions to identify animal and human studies that fulfilled the eligibility criteria. Outcome measures were bone healing time, bone gain (mm), bone density and adverse events. The risk of bias assessment of the selected studies was evaluated by means of Cochrane Collaboration's Tool for randomized clinical trials, while randomized clinical animal trials were assessed according to SYRCLE's tool. Additionally, quality of reporting animal studies were assessed according to ARRIVE guidelines. RESULTS: Out of the 248 articles that yielded the initial search, 11 papers about the effect of ascorbic acid on bone healing were selected. In most of the animal studies, vitamin C seemed to accelerate bone formation owing to an enhanced osteoblastic proliferation and differentiation and its antioxidant function when pro-oxidant substances were added. It was not possible to observe this phenomenon in human studies. CONCLUSIONS: Although additional well-performed animal and human studies are required, vitamin C seems to accelerate bone regeneration without adverse events. However, it is not possible to recommend a specific dose or route of administration of vitamin C to improve the bone healing process in humans as there was great heterogeneity among the included studies.

Alveolar ridge preservation: an overview of systematic reviews.

The aim of this overview was to assess the methodological quality of systematic reviews of randomized clinical trials on alveolar ridge preservation after a tooth extraction. During March 2020, two independent reviewers performed an electronic search of the PubMed (MEDLINE), Scopus, Web of Science, and Cochrane Library databases to identify all relevant systematic reviews including randomized clinical trials on alveolar ridge preservation. A manual search of articles in renowned journals was also conducted. The methodological quality of the included reviews was determined using the AMSTAR-2 tool. From the 53 initially retrieved studies, 11 were finally included: three systematic reviews and eight systematic reviews with meta-analyses. The methodological quality of the included reviews was low or critically low. Higher quality clinical studies should be conducted prior to performing further reviews and these should meet the methodological requirements that are fundamental to this type of research.

A systematic review and meta-analysis on the effectiveness of xenograft to prevent periodontal defects after mandibular third molar extraction.

BACKGROUND: To evaluate the use of guided bone regeneration with xenograft to prevent periodontal defect in the distal aspect of the second molar after the surgical removal of the mandibular third molar. MATERIAL AND METHODS: Three electronic databases (Pubmed, Cochrane Library and Scopus) were searched in April 2020. Randomized clinical trials in non-smokers and healthy patients, with at least six months follow-up, comparing periodontal probing depth, clinical attachment level, alveolar bone level and adverse events were selected by two independent investigators. The risk of bias assessment of the selected studies was evaluated by means of the Cochrane Collaboration's Tool. Finally, a meta-analysis of the outcomes of interest was performed. RESULTS: Despite 795 articles were found in the initial search, only three randomized controlled clinical trials were included. Pooled results favoured the use of the xenograft plus collagen membrane over the spontaneous healing in terms of periodontal probing depth gain (MD=2.36; 95% CI 0.69 to 4.03; P=0.005) and clinical attachment level gain (MD=2.52; 95% CI 0.96 to 4.09; P=0.002). No other statistically significant differences were found. CONCLUSIONS: Within the limitations of the present review, the xenograft plus collagen membrane exhibited better periodontal results than spontaneous healing without increasing postoperative complications. However, future well-designed studies with larger samples are required to confirm our results.

Short time guided bone regeneration using beta-tricalcium phosphate with and without fibronectin - An experimental study in rats.

BACKGROUND:  The aim of this histomorphometric study was to assess the bone regeneration potential of beta-tricalcium phosphate with fibronectin (ß-TCP-Fn) in critical-sized defects (CSDs) in rats calvarial, to know whether Fn improves the new bone formation in a short time scope. MATERIAL AND METHODS:  CSDs were created in 30 Sprague Dawley rats, and divided into four groups (2 or 6 weeks of healing) and type of filling (ß-TCP-Fn, ß-TCP, empty control). Variables studied were augmented area (AA), gained tissue (GT), mineralized/non mineralized bone matrix (MBM/NMT) and bone substitute (BS). RESULTS:  60 samples at 2 and six weeks were evaluated. AA was higher for treatment groups comparing to controls (p < 0.001) and significant decrease in BS area in the ß-TCP-Fn group from 2 to 6 weeks (p = 0.031). GT was higher in the ß-TCP-Fn group than in the controls expressed in % (p = 0.028) and in mm2 (p = 0.011), specially at two weeks (p=0.056). CONCLUSIONS:  Both ß-TCP biomaterials are effective as compared with bone defects left empty in maintaining the volume. GT in defects regeneration filed with ß-TCP-Fn are significantly better in short healing time when comparing with controls but not for ß-TCP used alone in rats calvarial CSDs.

Is the re-use of sterilized implant abutments safe enough? (Implant abutment safety).

BACKGROUND: The reuse of implant healing abutments is common in dental practice. Effective elimination of bacteria and viruses is accomplished by conventional sterilization. The aim of this work was to explore the eventual survival of microorganisms on sterilized healing abutments and to rule out the presence of transmissible organic material after standard procedures. MATERIAL AND METHODS: A total of 55 healing abutments previously used in patients will be washed and sterilized in a steam autoclave at 121 C for 15 min. Each healing abutment will be cultured in Brain Heart Infusion broth (BHI) under strict aseptic conditions. Besides, two control groups will be included: one of 3 unused healing abutments, and the other of just medium. After 10 days at 37°C under a 5% CO2 100 µl of the broth will be plated on solid media (Brain Infusion Agar, BHIA) and Columbia Blood agar to test for sterility. The remaining volume will be centrifuged, the sediment fixed, and a Gram stain performed to discard the presence of non-cultivable microorganisms. Moreover, to determine the presence of remaining organic material after the cleaning and sterilizing treatments, the bioburden will be determined by measuring total organic carbon (TOC) in another 10 previously used healing abutments, cleaned and sterilized, that will be submerged in Milli-Q water and sonicated. RESULTS: No bacterial growth was detected on any of the 58 cultured abutments, indicating that the sterilization was completely satisfactory in terms of removal of live bacteria or spores. Nevertheless, significant amounts of organic carbon may still be recovered (up to 125,31 µg/abutment) after they have been sterilized. CONCLUSIONS: Significant amounts of the bioburden remained adhered to the surfaces in spite of the cleaning and sterilization procedures. Taking into account our results and data from other authors, the presence of infectious particles on the reused healing abutments such as prions cannot be ruled out.

Bone regeneration in diabetic patients. A systematic review.

BACKGROUND: Oral bone regeneration techniques (OBRT) attempt to provide the appropriate bone volume and density to correctly accomplish dental implant treatments. The objective was to determine whether differences exist in the clinical outcomes of these techniques between diabetic and non-diabetic patients, considering the level of scientific evidence. MATERIAL AND METHODS: A systematic review following PRISMA statements was conducted in the PubMed, Scopus and Cochrane databases with the search terms: "Diabetes Mellitus", "guided bone regeneration", "bone regeneration", "alveolar ridge augmentation", "ridge augmentation", bone graft*, "sinus floor augmentation", "sinus floor elevation", "sinus lift", implant*. Articles were limited to those published less than 10 years ago and in English. Inclusion criteria were: human studies of all bone regeneration techniques, including at least 10 patients and the using OBRT in diabetic and non-diabetic patients. Non-human studies were excluded. They were stratified according to their level of scientific evidence related to SORT criteria (Strength of Recommendation Taxonomy). RESULTS: The initial search provided 131 articles, after reading the abstracts a total of 33 relevant articles were selected to read the full text and analyzed to decide eligibility. Finally, seven of them accomplished the inclusion criteria: two controlled clinical trials, one cohort study and four case series. CONCLUSIONS: A low grade of evidence regarding the use of OBRT in diabetic patients was found. The recommendation for this intervention in diabetic patients is considered type C due to the high heterogeneity of the type of diabetic patients included and the variability of the techniques applied.

Alveolar distraction osteogenesis for dental implant treatments of the vertical bone atrophy: A systematic review.

BACKGROUND: To determine if alveolar vertical distraction osteogenesis obtains better results compared to other bone regeneration treatments (guided bone regeneration with membranes and / or filling material, or autogenous bone graft) in terms of bone gain, complications, and implant survival and success rates. MATERIAL AND METHODS: An electronic search was performed in Pubmed (MEDLINE), Cochrane Library and Scopus databases in March 2017. Besides, a manual search was carried out. Inclusion criteria were randomized controlled trials published within the last 10 years with at least 1 year of follow-up after implant placement. No language restriction was applied. Exclusion criteria were studies in patients with bone defects produced by trauma, congenital malformation or oncologic surgical treatment. The methodological quality of the selected studies was evaluated by means of the Cochrane Collaboration's Tool for assessing risk of bias. The reports were classified into different levels of recommendation according to the "Strength of Recommendation Taxonomy ". RESULTS: Out of 221 articles, two randomized controlled trials were finally selected for the inclusion in the systematic review. Bone gain and complications were higher with the alveolar vertical distraction osteogenesis compared to the autologous bone graft. There was higher bone resorption with the autologous bone graft. Implant survival and success rates were similar between studies, despite of the used technique. CONCLUSIONS: Both alveolar distraction osteogenesis and autogenous bone graft are effective bone regeneration techniques for the treatment of mandibular vertical bone atrophy. A level B recommendation can be established for the use of alveolar vertical distraction osteogenesis for the treatment of the mandibular vertical bone atrophy.

Efficacy of different methods used for dry socket prevention and risk factor analysis: A systematic review.

BACKGROUND: Dry socket is one of the most common complications that develops after the extraction of a permanent tooth, and its prevention is more effective than its treatment. OBJECTIVES: Analyze the efficacy of different methods used in preventing dry socket in order to decrease its incidence after tooth extraction. MATERIAL AND METHODS: A Cochrane and PubMed-MEDLINE database search was conducted with the search terms "dry socket", "prevention", "risk factors", "alveolar osteitis" and "fibrynolitic alveolitis", both individually and using the Boolean operator "AND". The inclusion criteria were: clinical studies including at least 30 patients, articles published from 2005 to 2015 and written in English. The exclusion criteria were case reports and nonhuman studies. RESULTS: 30 publications were selected from a total of 250. Six of the 30 were excluded after reading the full text. The final review included 24 articles: 9 prospective studies, 2 retrospective studies and 13 clinical trials. They were stratified according to their level of scientific evidence using SIGN criteria (Scottish Intercollegiate Guidelines Network). CONCLUSIONS: All treatments included in the review were aimed at decreasing the incidence of dry socket. Locally administering chlorhexidine or applying platelet-rich plasma reduces the likelihood of developing this complication. Antibiotic prescription does not avoid postoperative complications after lower third molar surgery. With regard to risk factors, all of the articles selected suggest that patient age, history of previous infection and the difficulty of the extraction are the most common predisposing factors for developing dry socket. There is no consensus that smoking, gender or menstrual cycles are risk factors. Taking the scientific quality of the articles evaluated into account, a level B recommendation has been given for the proposed-procedures in the prevention of dry socket.

Knowledge, aptitudes, and preferences in implant dentistry teaching/training among undergraduate dental students at the University of Barcelona.

BACKGROUND: Oral implant rehabilitation should be considered a treatment option for any edentulous patient and Implant Dentistry is currently a discipline taught in the undergraduate formation. The level of knowledge acquired and how the students perceive the quality of training in Implant Dentistry could assess to know if it is necessary to improve the syllabus. MATERIAL AND METHODS: A questionnaire was developed with 11 questions: Basic knowledge (7); Perception of training received (2); Ways in which students would receive training (2). To be responded anonymously and voluntarily for undergraduates students in the Faculty of Dentistry (University of Barcelona, Spain). RESULTS: One hundred and seven students, 76 third year (Group A) and 31 fourth year (Group B) answered the questionnaire. In Group A, 98.68% of students and in Group B 93.54% believed they were poorly informed; 100% of both groups would prefer to receive more training as part of the degree or as postgraduate training through modular courses imparted by experts (A: 71,05%, B: 70,96%) Training through postgraduate programs or training given by private businesses were the least desirable options (A: 42%, B: 64.51%). Questions about basic knowledge acquired received varying responses, which might indicate a certain level of confusion in this area. CONCLUSIONS: The undergraduate syllabus must be revised to include sufficient content and training to allow the student to indicate implant-based treatments based on evidence. Students would prefer training to be included in the undergraduate syllabus.

Revisión bibliográfica de Implantología Bucofacialdel año 2007 / Bibliographical review of Oral Implantology of the year 2007

Se expone una revisión de la literatura científica publicada en revistas indexadas durante el año 2007 sobre Implantología Bucofacial. La escasez de tiempo de que disponen los profesionales para consultar las múltiples fuentes de información, ha motivado a los autores a resumirlos artículos publicados y clasificarlos en los siguientes apartados: generalidades, pacientes especiales, superficies y diseños, tejidos blandos, implantes inmediatos, carga inmediata, complicaciones, elevación sinusal, técnicas avanzadas, plasma rico en plaquetas y factores de crecimiento, cirugía guiada, cirugía mínimamente invasiva y mini implantes, con la intención de facilitar una puesta al día (AU)

The lack of the available time of the professionals involved in the Odontological field and the difficulty to maintain a good level of information about Oral Implantology, arouse the interest of the authors to expose a synthetic review of the publications. Inside this article there are different aspects related to treatment planning, special patients, design and surfaces, immediateload, PRP, guided surgery and others (AU)

Broken anesthetic injection needles: report of 5 cases.

A broken anesthetic needle is a rare complication in clinical practice. This article reports on 5 patients referred for removal of broken needles. The needles were located in the pterygomandibular space or near the maxillary tuberosity. These complications were the result of an unexpected movement by the patient or an incorrect anesthetic technique. The article also describes the case of a patient in whom an image observed in a routine panoramic radiograph could have been caused by a broken needle.

[Surgical treatment of recurrent mandibular luxation. A combined technic]. / Traitement chirurgical de la luxation récidivante de la mandibule. Technique mixte.

Six patients with recurrent dislocation of the temporomandibular joint underwent surgical operation which consisted of Myrhaug's technique (resection of the zygomaticoarticular eminence). In four of these six cases, Myrhaug's technique was associated with the retroposition of the temporal muscle (Ullik and Zenker's technique). Resection of the zygomaticoarticular eminence and retroposition of the temporal muscle could be carried out easily and briefly. The simultaneous performance of both surgical procedures has been extremely useful to achieve a definite resolution of recurrent dislocations of the temporomandibular joint.