Accidental migration of dental implant into the nasal cavity: Spontaneous expulsion through the nose.

Implant migration into the nasal fossa is a rare complication and it requires extraction by anterior rhinoscopy. We report a clinical case of placement of short dental implants, fixed or intruded in the nasal fossa floor, which was aspirated by the patient and spontaneously expelled a few days later. To the best of our knowledge, there have been no reports of spontaneously expulsion through the nasal cavity. Key words:Dental implant, nasal cavity, accidental migration.

Risk of developing BRONJ among patients exposed to intravenous bisphosphonates following tooth extraction.

OBJECTIVE: A study was designed to measure of the incidence of bisphosphonate-related osteonecrosis of the jaws (BRONJ) following tooth extraction in patients receiving or who have received intravenous bisphosphonates (Zometa, zoledronic acid). METHOD AND MATERIALS: A prospective cohort study was made of 36 patients subjected to 62 tooth extractions. All these 36 patients had been treated or were receiving treatment with zoledronic acid. RESULTS: The incidence of BRONJ following 62 tooth extractions in patients treated with zoledronic acid 4 months after extraction was 14.5%. CONCLUSION: No statistically significant associations were found with patient age, sex, hygiene index, total treatment time, surgical difficulty, or extraction site. However, the factors that significantly influenced the final presence of osteonecrosis were related to tooth extractions in the absence of periodontal disease, and if sockets remained unhealed at the month of extraction.

Pseudotumors and tumors of the temporomandibular joint. A review

Objective: To review the pseudotumors and tumors of the temporomandibular joint (TMJ) published in journals included in Journal Citation Reports (JCR), and to evaluate whether there are clinical and radiological signs capable of differentiating between pseudotumors and tumors and between malignant and benign tumors. Material and Methods: A systematic Medline search was made of clinical cases of tumors and pseudotumors of the TMJ covering a 20-year period and published in journals included in JCR. Only cases with histological confirmation were included. A description is provided of the general characteristics of TMJ tumors, with comparison of the clinical, diagnostic, therapeutic and evolutive variables referred to pseudotumors, benign tumors and malignant tumors. Results: We identified 285 TMJ tumors published in 181 articles of 15 journals. The most frequent lesions were pseudotumors (synovial chondromatosis, pigmented villonodular synovitis, eosinophilic granuloma and osteochondroma).The mean age was 42 years and one month ± 16 years and two months. Tumors were more common infemales. The mean time from symptoms onset to consultation was 30 months and 8 days ± 41 months and 9 days, and almost 19.6% of the cases initially had been diagnosed and treated as TMJ dysfunction. The most frequent clinical manifestations were pain, swelling and the limitation of joint movements. The most common radiological findings in the case of benign and malignant lesions were radiopacities and radio transparencies, respectively. Nopanoramic X-ray alterations were observed in 14.6% of the benign tumors and in 7.7% of the malignant lesions. Surgery was the usual form of treatment. Sequelae were recorded in 18.2% of the cases, with tumor relapse in9.1%. The four-year survival rate in the case of malignant tumors was 72.2% (AU)

Pseudotumors and tumors of the temporomandibular joint. A review.

OBJECTIVE: To review the pseudotumors and tumors of the temporomandibular joint (TMJ) published in journals included in Journal Citation Reports (JCR), and to evaluate whether there are clinical and radiological signs capable of differentiating between pseudotumors and tumors and between malignant and benign tumors. MATERIAL AND METHODS: A systematic Medline search was made of clinical cases of tumors and pseudotumors of the TMJ covering a 20-year period and published in journals included in JCR. Only cases with histological confirmation were included. A description is provided of the general characteristics of TMJ tumors, with comparison of the clinical, diagnostic, therapeutic and evolutive variables referred to pseudotumors, benign tumors and malignant tumors. RESULTS: We identified 285 TMJ tumors published in 181 articles of 15 journals. The most frequent lesions were pseudotumors (synovial chondromatosis, pigmented villonodular synovitis, eosinophilic granuloma and osteochondroma). The mean age was 42 years and one month ± 16 years and two months. Tumors were more common in females. The mean time from symptoms onset to consultation was 30 months and 8 days ± 41 months and 9 days, and almost 19.6% of the cases initially had been diagnosed and treated as TMJ dysfunction. The most frequent clinical manifestations were pain, swelling and the limitation of joint movements. The most common radiological findings in the case of benign and malignant lesions were radiopacities and radiotransparencies, respectively. No panoramic X-ray alterations were observed in 14.6% of the benign tumors and in 7.7% of the malignant lesions. Surgery was the usual form of treatment. Sequelae were recorded in 18.2% of the cases, with tumor relapse in 9.1%. The four-year survival rate in the case of malignant tumors was 72.2%.

Temporomandibular disorders. A case-control study.

OBJECTIVE: To compare the risk factors and clinical manifestations of patients with temporomandibular disorders (TMDs) diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) (axis I) versus an age and gender matched control group. STUDY DESIGN: A total of 162 patients explored according to the RDC/TMD (mean age 40.6±18.8 years, range 7-90; 11.1% males and 88.9% females) were compared with 119 controls, measuring differences in TMD risk factors (sleep disturbances, stress, psychoactive medication, parafunctions, loss of posterior support, ligament hyperlaxity) and clinical variables (joint sounds, painful muscle and joint palpation, maximum aperture). RESULTS: Myofascial pain (MFP) (single or multiple diagnoses) was the most frequent diagnosis (42%). The most common diagnostic combination was MFP plus arthralgia (16.0%). Statistically significant differences were observed in clenching (OR 2.3; 95%CI: 1.4-3.8) and in maximum active aperture (MAA) on comparing the two groups both globally (TMD vs. controls) (patients 36.7±8.6 mm, controls 43.1±5.8 mm; F=45.41, p=0.000) and on comparing according to diagnostic categories. MFP explained most of the observed differences in the risk factors: stress perception (OR=1.98;I.C.:1.01-3.89), psychoactive medication (OR=2.21; I.C.:1.12-4.37), parafunctions (OR=2.14;I.C.:1.12-4.11), and ligament laxity (OR=2.6;I.C.:1.01-6.68). Joint sounds were more frequent in patients with MFP (39.7% vs. 24.0%; χ²=4.66; p=0.03), and painful joint palpation was more common in patients with disc displacement with reduction (DDWR)(15.9% vs. 5.0%; χ²= 5.2; p=0.02) and osteoarthrosis (20.8% vs. 5.0%; χ²=7.0; p=0.008). CONCLUSIONS: There is a high prevalence of signs and symptoms of TMDs in the general population. Significant differences are observed in clenching and MAA between patients and controls considered both globally and for each diagnostic category individually. The analyzed risk factors (except loss of posterior support) show a statistically significant OR for the diagnosis of MFP.

Pediatric dental care in a tertiary public hospital. Four years of experience in the Service of Stomatology of Valencia University General Hospital (Valencia, Spain).

UNLABELLED: A study is made of the experience gained with the Child Oral Care Program (Plan de Atención Dental Infantil, PADI) in the Service of Stomatology of Valencia University General Hospital (Valencia, Spain) after four years in operation (July 2003 - July 2007). STUDY DESIGN: The sample comprised 2626 children between 5-14 years of age, pertaining to department 9 of the Valencian public health system. A clinical history was compiled in each case, a radiological study was made, and a treatment plan was elaborated including fillings, extractions, and control visits. RESULTS: Of the 2626 designated children, 2369 visited our Service - mostly referred from the Preventive Dental Care Units. A total of 5784 fillings were carried out (93.3% with silver amalgam, 5.6% with composites and the rest as provisional fillings). The permanent first molars were the teeth with the largest number of fillings (70.2% of the total). These were followed in order of frequency by the second molars (19.1%). As regards composite resin fillings, most involved the upper central incisors, followed by the upper lateral incisors. A total of 644 extractions were performed, corresponding to 110 permanent teeth and 534 temporary teeth. In the case of the permanent dentition, the first molars were the most commonly removed teeth. In the temporary dentition, the most frequently removed teeth were the second molars. CONCLUSIONS: The response of the population to this program has been very good, and reinforces the preventive measures already in place, with the provision of restorative treatments to improve the oral and dental health of the pediatric population, and yielding good results in terms of the program quality indicators. The Service of Stomatology (Valencia University General Hospital) is able to address the demand and offers the public health network integrated and continuous patient care.

Pediatric dental care in a tertiary public hospital. Four years of experience in the Service of Stomatology of Valencia University General Hospital (Valencia, Spain)

A study is made of the experience gained with the Child Oral Care Program (Plan de Atención Dental Infantil,PADI) in the Service of Stomatology of Valencia University General Hospital (Valencia, Spain) after four years in operation (July 2003 - July 2007).Study design: The sample comprised 2626 children between 5-14 years of age, pertaining to department 9 of theValencian public health system. A clinical history was compiled in each case, a radiological study was made, and a treatment plan was elaborated including fillings, extractions, and control visits.Results: Of the 2626 designated children, 2369 visited our Service - mostly referred from the Preventive Dental Care Units. A total of 5784 fillings were carried out (93.3% with silver amalgam, 5.6% with composites and the rest as provisional fillings). The permanent first molars were the teeth with the largest number of fillings (70.2% of the total). These were followed in order of frequency by the second molars (19.1%). As regards composite resin fillings, most involved the upper central incisors, followed by the upper lateral incisors. A total of 644 extractions were performed, corresponding to 110 permanent teeth and 534 temporary teeth. In the case of the permanent dentition, the first molars were the most commonly removed teeth. In the temporary dentition, the most frequently removed teeth were the second molars.Conclusions: The response of the population to this program has been very good, and reinforces the preventivemeasures already in place, with the provision of restorative treatments to improve the oral and dental health of the pediatric population, and yielding good results in terms of the program quality indicators. The Service of Stomatology (Valencia University General Hospital) is able to address the demand and offers the public health network integrated and continuous patient care (AU)

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Mental neuropathy as a manifestation associated with malignant processes: its significance in relation to patient survival.

PURPOSE: Mental neuropathy (MN) is characterized by the presence of a sensory defect in the form of paresthesias or dysesthesias in the territory innervated by the mental nerve. MN may be the first manifestation of systemic cancer, a symptom of spread of an established tumor, or a sign of infiltration in an intraoral lesion. In any of these cases, the symptom is indicative of a very poor patient prognosis. MATERIALS AND METHODS: A total of 22 cancer patients with chin paresthesia were studied. Group 1 comprised patients with chin paresthesia who had a primary tumor in some other region at a distance from the oral cavity or maxillofacial zone. Group 2 in turn comprised patients with primary malignancies of the oral and/or maxillofacial territory and who likewise presented with chin paresthesia. Data were collected relating to patient age, gender, primary intraoral lesion (location, size, histologic diagnosis), primary systemic tumor, and mean patient survival. RESULTS: Group 1 consisted of 11 patients (8 men and 3 women), aged between 36 and 81 years (mean, 58.09 +/- 14.99 years), with different systemic cancers. The mean survival after the diagnosis of chin paresthesia was 14.8 +/- 16.5 months, and only 1 patient was still alive after 9 months. Group 2 consisted of 11 patients (8 men and 3 women), aged between 33 and 72 years (mean, 56.18 +/- 15.69 years). All presented with oral squamous cell carcinoma, with the single exception of 1 case of fibrosarcoma. In this group the mean survival of the 8 patients who died was 28.2 +/- 29.6 months. Three patients survived for a mean of 17 months. CONCLUSIONS: Chin paresthesia is a very important prognostic symptom determining the degree of infiltration of intraoral lesions, and in some cases it may be indicative of the existence of a primary tumor (identified or otherwise), with poor short-term survival--given that 81.9% of the patients studied (18 cases) had died before a mean of 20 months. Although mean survival was shorter (14.8 months) among the patients in group 1 than in group 2 (28.2 months), the difference was not statistically significant.

Mental nerve paresthesia associated with endodontic paste within the mandibular canal: report of a case.

The present study describes a case of endodontic paste (Endomethasone) penetration within and along the mandibular canal from the periapical zone of a lower first premolar following endodontic treatment of the latter. The clinical manifestations comprised anesthesia of the right side of the lower lip and paresthesia of the gums in the fourth quadrant, appearing immediately after endodontic treatment. The lip anesthesia was seen to decrease, with persistence of the gingival paresthesia, after 7 months.

Radiologic study of marginal bone loss around 108 dental implants and its relationship to smoking, implant location, and morphology.

PURPOSE: To investigate peri-implant bone resorption around 108 ITI dental implants 1 year after prosthetic loading using extraoral panoramic, conventional intraoral periapical, and digital radiologic techniques. MATERIALS AND METHODS: A total of 108 implants were placed (59 in the maxilla and 49 in the mandible) in 42 patients (16 men and 26 women) with a mean age of 44.2 years (range 14 to 68 years). Orthopantomographic, conventional periapical, and digital radiographs were obtained at loading and again 1 year later. Bone loss was calculated from the difference between the initial and final measurements. RESULTS: Mean loss in alveolar bone height was determined to be 1.36 mm by extraoral panoramic radiography, 0.76 mm by intraoral periapical radiography, and 0.95 mm by digital radiography. The implants located in the maxilla and those placed in patients who smoked 11 to 20 cigarettes per day were associated with significantly greater bone loss. DISCUSSION: The results in relation to peri-implant bone loss in the first year after loading were similar to those published by other authors. CONCLUSION: Conventional periapical films and digital radiographs were more accurate than orthopantomography in the assessment of peri-implant bone loss. Smoking and implant location in the maxilla were associated with increased peri-implant marginal bone resorption.

Oral manifestations of chronic disseminated histiocytosis. A report of 10 cases.

Chronic disseminated histiocytosis is a systemic disorder resulting from tumor proliferation of Langerhans-type histiocytic cells. The etiology and pathogenesis are not fully clear, though the clinical manifestations are the result of the accumulation and infiltration of these types of cells in organs and tissues. The present study reports 10 patients (6 boys and 4 girls) with chronic disseminated histiocytosis. The patient age at onset of the disease varied from 4 months to 3.2 years (mean 1.7 years). All patients had oral lesions, and in 5 cases these were the first manifestation of the disease. The most frequent alterations were gingival bleeding (7 cases), aphthae measuring over 1 cm in diameter (6 cases), maxillary osteolytic lesions (6 cases), tooth loss due to expulsive folliculitis (5 cases), oral candidiasis (4 cases), orofacial swelling (3 cases), aphthae measuring under 1 cm in diameter (3 cases), and nonspecific oral pain (2 cases). All the oral lesions disappeared with the treatments prescribed, though some patients developed new outbreaks and exacerbations of the disease.

Marginal peri-implantitis due to occlusal overload. A case report.

The etiology of marginal peri-implantitis describes an infectious factor and a biomechanical factor resulting from occlusal overload. Clinical and experimental articles oriented to the biomechanical factor are scarce, so as the studies about the histology associated to periimplantitis. We present a case of marginal peri-implantitis on an implant in the mandibular molar zone caused by occlusal overload, which led to an osseous defect on the marginal crest. The treatment was composed of occlusal adjustment, removal of contaminated surgical tissue, and autogenous bone graft, which varies from the common treatment of infectious peri-implantitis. Histologic analysis of peri-implantitis tissue reveals a juxtaepithelial lympho-plasmocytorious infiltrate and a central zone of dense fibro-connective tissue with scanty inflammatory cells, which differs from the chronic inflammatory tissue associated with infectious peri-implantitis. Clinical and radiographic followup control after 12 months evidenced the remission of the symptoms and bone regeneration on the marginal crest. We consider that in the treatment of marginal peri-implantitis, it is necessary to continue the studies on the histological differences between the infectious types and those that are caused by occlusal overload.

Manifestaciones orales en la histiocitosis crónica diseminada: presentación de 10 casos / Oral manifestations of chronic disseminated histiocytosis. A report of 10 cases

La histiocitosis crónica diseminada es una enfermedad sistémica por proliferación tumoral de células histiocitarias tipo Langerhans. Su etiología y patogenia no esta del todo aclarada y las manifestaciones clínicas se producen por acúmulos e infiltrados de este tipo celular en los tejidos y órganos. Presentamos 10 pacientes, seis niños y cuatro niñas, con histiocitosis crónica diseminada. La edad de aparición de la enfermedad varió desde los 4 meses hasta los 3'2 años, con una edad media de 1'7 años. Todos los pacientes presentaron lesiones orales y en 5 de ellos éstas fueron la manifestación inicial de la enfermedad. Las alteraciones más frecuentes fueron: sangrado gingival (7 casos), aftas mayores de 1cm de diámetro (6 casos), alteraciones osteolíticas de los maxilares (6 casos), pérdida de dientes por foliculitis expulsiva (5 casos), candidiasis oral (4 casos), tumefacción orofacial (3 casos), aftas menores de 1cm (3 casos) y dolores orales inespecíficos (2 casos). Todas las lesiones bucales desaparecieron con los tratamientos utilizados a pesar de que algunos casos presentaron nuevos brotes y exacerbaciones de la enfermedad (AU)

Periimplantitis marginal por sobrecarga oclusal. A propósito de un caso / Marginal peri-implantitis due to occlusal overload. A case report

En la etiología de la periimplantitis marginal se describen un factor infeccioso y otro biomecánico, por sobrecarga oclusal. Los trabajos experimentales y clínicos orientados al factor biomecánico son escasos, al igual que los estudios sobre histopatología asociada a la periimplantitis. Presentamos un caso de periimplantitis marginal en un implante de zona molar mandibular, causado por sobrecarga oclusal, que provocó un defecto óseo en la cresta marginal. El tratamiento consistió en un ajuste oclusal, el retiro quirúrgico del tejido contaminado y un injerto de hueso autógeno, lo cual difiere del tratamiento habitual en la periimplantitis infecciosa. En el análisis histológico del tejido periimplantario encontramos un infiltrado linfo-plasmocitario yuxtaepitelial y una zona central de tejido fibroconectivo denso, con escasa células inflamatorias, que difiere del tejido inflamatorio crónico asociado a la periimplantitis infecciosa. El control clínico y radiográfico a 12 meses evidenció la remisión del cuadro y recuperación ósea de la cresta marginal. Estimamos que en el tratamiento de la periimplantitis marginal, es necesario continuar los estudios acerca de las diferencias histológicas entre los cuadros infecciosos y aquellos originados por sobrecarga oclusal (AU)

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Cemento-ossifying mandibular fibroma: a presentation of two cases and review of the literature.

We present two clinical cases of radiolucent mandibular lesions in young women that simulated chronic periapical infectious pathology. The detection of both cases was fortuitous since they were totally asymptomatic. Diagnosis was reached in one case (upon periapical surgery and anatomo-pathologic study) after endodontic treatment and after verifying non-resolution of affected periapical area. The other case was an extensive lesion, which involved the periapices of the four inferior incisors in which surgery was directly performed upon verifying pulp vitality of these teeth. After surgery endodontic treatment was performed on the teeth that had lost their vitality. In both cases the histopathologic tests revealed the presence of a cemento-ossifying fibroma, the initial clinical and radiographic diagnosis of which could easily be overlooked.

Fibroma cemento-osificante mandibular: Presentación de dos casos y revisión de la literatura / Cemento-ossifying mandibular fibroma: a presentation of two cases and rewiev of the literature

Presentamos dos casos clínicos de lesiones radiotransparentes mandibulares en mujeres jóvenes, que simularon patología infecciosa crónica periapical. En ambos el hallazgo fue casual puesto que no produjeron ningún tipo de Estomatología. En un caso se llegó al diagnóstico (tras la cirugía periapical y el estudio anatomo-patológico) después de realizar la endodoncia del diente implicado y comprobar la no resolución del área periapical. En el otro caso, cuya lesión abarcaba el periápice de los 4 incisivos inferiores, se realizó directamente la cirugía tras comprobar la vitalidad pulpar positiva de estos dientes. Con posterioridad a la intervención quirúrgica se realizó la endodoncia de los dientes que habían perdido la vitalidad.En ambos casos el examen histopatológico, mostró la presencia de un fibroma cemento osificante, cuyo diagnóstico inicial clínico y radiográfico, en ocasiones, puede pasar desapercibido. (AU)

Efectos de los vasoconstrictores usados en Odontología sobre la presión arterial sistólica y diastólica / Effects of vasoconstrictors in Dentistry upon systolic and diastolic arterial pressure

Introducción. Está descrito que los vasoconstrictores que se asocian a los anestésicos locales utilizados habitualmente en la clínica dental pueden influir, al igual que otros factores, como la ansiedad o el estrés, en la presión arterial.Objetivos. Nuestro objetivo fue analizar los cambios de la presión arterial sistólica y diastólica en tres grupos de pacientes en los que se realizó un tratamiento dental convencional (extracción de un molar), de tal forma que pudiéramos determinar si estas variaciones se debían al uso o no de vasoconstrictor, o más bien a otros factores, como la ansiedad propia de los pacientes.Material y métodos. Se estudiaron un total de 43 pacientes varones, sanos, normotensos, y se agruparon según el tipo de anestésico utilizado en: Grupo 1: lidocaína al 2 por ciento con epinefrina al 1/80.000; Grupo 2: mepivacaína al 3 por ciento con epinefrina al 1/80.000; y Grupo 3: mepivacaína al 3 por ciento sin vasoconstrictor. En todos ellos se realizó un test de ansiedad de Hamilton y se tomó la presión antes y después de inyectar el anestésico, durante la extracción dental y al finalizar.Resultados. No hubo diferencias estadísticamente significativas en las variaciones de la presión arterial entre los grupos en base al uso o no de vasoconstrictor en estos sujetos sanos. Encontramos un aumento de la presión sistólica, a mitad del tratamiento, que se repitió en los tres grupos de estudio.Conclusión. Podemos decir que el uso de un anestésico con vasoconstrictor no modifica substancialmente las cifras de tensión arterial, observándose, en cambio, un aumento de la presión sistólica en todos los grupos, atribuible a la ansiedad propia del momento (AU)