Incidencia de osteítis alveolar por exodoncia de terceros molares mandibulares impactados: una revisión sistemática / Incidence of alveolar osteitis due to extraction of impacted mandibular third molars: a systematic review

La extracción de terceros molares mandibulares impactados trae consigo, en muchas oportunidades, complicaciones posoperatorias como la osteítis alveolar o comúnmente llamada alveolitis seca que dificulta la cicatrización del alveolo. En este sentido, el objetivo de la revisión fue determinar la incidencia de la osteítis alveolar por exodoncia de terceros molares mandibulares impactados. Se realizó la búsqueda bibliográfica sin restricción de año ni de idioma en PubMed, Scopus, Science Direct, Lilacs y Scielo, empleando tèrminos estandarizados en Medical Subject Headings (MeSH NLM). La confección de la investigación se realizó siguiendo los lineamientos PRISMA-2020 y para la evaluación de la calidad y sesgo de los artículos se empleó las herramientas de la National Heart Lung and Blood Institute (NHLBI). Se obtuvieron (n=4907) estudios, los cuales se subieron al aplicativo web Rayyan para seleccionarlos siguiendo los criterios de inclusión y exclusión planteados previamente. Tras el análisis crítico se eligieron 2 estudios para su revisión, cuyos datos se extrajeron según los indicadores establecidos por los autores. Se concluye que existe una incidencia baja de osteítis alveolar despuès de la extracción de terceros molares mandibulares impactados, descartándose la relación entre el gènero y el padecimiento de esta complicación. Además se resalta la irrigación con clorhexidina y suero fisiológico como tratamiento para esta afección. (AU)

The extraction of impacted mandibular third molars often brings with it postoperative complications such as alveolar osteitis or commonly called dry socket that makes it difficult for the alveolus to heal. In this sense, the objective of the review was to determine the incidence of alveolar osteitis due to extraction of impacted mandibular third molars. The bibliographic search was carried out without restriction of year or language in PubMed, Scopus, Science Direct, Lilacs and Scielo, using standardized terms in Medical Subject Headings (MeSH NLM). The preparation of the research was carried out following the PRISMA-2020 guidelines and the tools of the National Heart Lung and Blood Institute (NHLBI) were used to evaluate the quality and bias of the articles. Studies (n=4907) were obtained, which were uploaded to the Rayyan web application to select them following the inclusion and exclusion criteria previously stated. After critical analysis, 2 studies were chosen for review, whose data were extracted according to the indicators established by the authors. It is concluded that there is a low incidence of alveolar osteitis after the extraction of impacted mandibular third molars, ruling out the relationship between gender and suffering from this complication. In addition, irrigation with chlorhexidine and physiological serum is highlighted as a treatment for this condition. (AU)

La alveolitis y sus factores de riesgo en la población adulta joven / Dry socket and its risk factors in a young adult population

Introducción: La alveolitis es la complicación más frecuente de la extracción dental, y constituye la causa más común de las consultas de Urgencias, pues los pacientes presentan dolor en el período postoperatorio. Aunque la etiología de esta afección no es muy conocida, se considera que es un trastorno multifactorial. Objetivos: Determinar el tipo de alveolitis más frecuente en la muestra objeto de estudio, así como establecer la relación entre los factores de riesgo y el tipo de alveolitis. Métodos: Se realizó un estudio descriptivo y trasversal en el Servicio de Urgencias de la Clínica Estomatológica «Celia Sánchez Manduley», de Santa Clara, Villa Clara, desde febrero de 2020 a junio de 2021. El estudio se realizó en un total de 51 pacientes diagnosticados con alveolitis dental. Se estudiaron las siguientes variables: tipo de alveolitis y factores de riesgo (edad, sexo, antecedentes de enfermedades, el uso de tabletas anticonceptivas, hábitos tóxicos, condiciones del medio bucal, características de la maniobra quirúrgica y cuidados postoperatorios); los datos fueron recogidos en un formulario. Resultados: Predominó la alveolitis seca en las pacientes del sexo femenino. El hábito de fumar y la práctica de una maniobra quirúrgica compleja fueron los factores de riesgo preponderantes. Conclusiones: Existe una relación significativa entre la presencia de alveolitis seca y las pacientes del sexo femenino asociadas a los hábitos tóxicos, el uso de tabletas anticonceptivas, y haber sido sometidas a una maniobra quirúrgica compleja.

Introduction: dry socket is the most frequent complication after a dental extraction and constitutes the most common cause of emergency consultations, since patients have pain in the postoperative period. It is considered to be a multifactorial disorder although the etiology of this condition is not well known. Objectives: to determine the most common type of dry socket in the sample under study, as well as to establish the relationship between risk factors and the type of dry socket. Methods: a descriptive and cross-sectional study was carried out in the emergency department at "Celia Sánchez Manduley" Dental Clinic, in Santa Clara, Villa Clara, from February 2020 to June 2021. The study was carried out in a total of 51 patients who were diagnosed with dry socket. Type of dry socket and risk factors such as age, gender, history of diseases, use of contraceptive tablets, toxic habits, conditions of the oral environment, characteristics of the surgical procedure and postoperative care were the variables studied; the data was collected in a form. Results: dry socket predominated in female patients. Smoking and performing a complex surgical maneuver were the predominant risk factors. Conclusions: there is a significant relationship among the presence of dry socket and female patients associated with toxic habits, the use of contraceptive tablets, and having undergone a complex surgical maneuver.

The validity of Salvadoria persica and Nigella sativa in the treatment of dry socket / La validez de Salvadoria persica y Nigella sativa en el tratamiento de la alveolitis seca

Objectives: To evaluate the effectiveness of a mixture of Salvadoria persica and Nigella sativa in treating dry socket and use as a substitute for alvogyl. Patients and method: 52 randomly selected patients with dry socket confirmed clinically by diagnosis, divided into 2 groups, each group containing 26 patient group A treated by admix, and group B treated by alvogyl, clinical features were recorded on the first, second, and third days after treatment. Results: Visual Analog Scale of pain showed a high score on day one but decreased significantly at 2 and 3 days in both groups. But there were no significant differences in pain scores between the two groups on day 1, day 2, or day 3 separately. The two groups revealed identical mean rank scores of pain during the whole study period. Conclusions: A mixture of Salvadoria persica and Nigella sativa showed a significant analgesic and anti-inflammatory effect in the treatment of dry socket and can be used as a substitute for alvogyl. (AU)

Objetivos: Evaluar la eficacia de una mezcla de Salvadoria persica y Nigella sativa en el tratamiento de la alveolitis seca y su uso como sustituto del alvogyl. Pacientes y método: 52 pacientes seleccionados al azar con alveolitis seca confirmada clínicamente por diagnóstico, divididos en 2 grupos, cada grupo con 26 pacientes del grupo A tratado con admix y del grupo B tratado con alvogyl. Las características clínicas se registraron al primer, segundo y tercer día después del tratamiento. Resultados: La escala analógica visual del dolor mostró una puntuación alta el primer día, pero disminuyó significativamente a los 2 y 3 días en ambos grupos. No hubo diferencias significativas en las puntuaciones de dolor entre los 2 grupos los días 1, 2 y 3 por separado. Los dos grupos revelaron las mismas puntuaciones medias de rango de dolor durante todo el periodo de estudio. Conclusiones: Una mezcla de Salvadoria persica y Nigella sativa mostró un efecto analgésico y antinflamatorio significativo en el tratamiento de la alveolitis seca y puede utilizarse como sustituto del alvogyl. (AU)

Aplicación de una jalea de caléndula al 1% en pacientes con alveolitis / Application of a 1% calendula jelly in patients with alveolitis

Objetivo: demostrar los beneficios terapéuticos del uso de una jalea de caléndula al 1% en pacientes con alveolitis. Métodos: se realizó una intervención terapéutica en el Policlínico Julián Grimau, provincia Santiago de Cuba, Cuba, entre enero y junio de 2019. Por muestreo no probabilístico se reclutó una muestra de 24 pacientes con diagnóstico de alveolitis seca o húmeda, distribuyéndose en dos grupos: A (control) y B (estudio), los cuales recibieron tratamiento convencional y jalea de caléndula al 1%, respectivamente. Se analizaron las variables: edad, sexo, tipo de alveolitis, tiempo de remisión del dolor y de cicatrización, respuesta al tratamiento (mejorado y no mejorado) y beneficios terapéuticos. Se empleó el porcentaje como medida de resumen y el test estadístico Ji al cuadrado de Independencia con un nivel de significación (a) de 0,05. Resultados: se evidenció un predominio de la alveolitis en pacientes con 19-59 años de edad (50,0%), del sexo femenino (66,7%) y del tipo húmeda (75,0%). En ambos grupos de tratamiento, el mayor porcentaje de los pacientes (17) refirió alivio del dolor a las 48 horas. En el 83,3% de los pacientes, incluidos en el grupo B, se observó menor tiempo de cicatrización. El 100% de los pacientes se categorizó como mejorado. Conclusiones: la jalea de caléndula al 1% resulta beneficiosa, dada su capacidad analgésica y cicatrizante en el tratamiento de pacientes con alveolitis.

Objective: demonstrate the therapeutic benefits of a 1 % calendula jelly in patients with alveolitis. Methods: a therapeutic intervention was carried out at the Julián Grimau Polyclinic, Santiago de Cuba province, Cuba, between January and June 2019. By non-probabilistic sampling, a sample of 24 patients with a diagnosis of dry or wet alveolitis was recruited, distributed in two groups: A (control) and B (study), who received conventional treatment and 1% calendula jelly, respectively. The variables were analyzed: age, sex, type of alveolitis, time of remission of pain and healing, response to treatment (improved and not improved) and therapeutic benefits. The percentage was used as a summary measure and the Chi-square test of Independence with a significance level (a) of 0.05. Results: a predominance of alveolitis was evidenced in patients aged 19-59 years (50.0 %), female (66.7 %) and of the wet type (75.0 %). In both treatment groups, the highest percentage of patients (17) reported pain relief at 48 hours. In 83.3% of the patients included in group B, a shorter healing time was observed. 100 % of the patients categorized as improved. Conclusions: Calendula jelly 1 % is beneficial as an analgesic and healing in the treatment of patients with alveolitis.

Eficacia de la profilaxis antibiótica en la prevención de infecciones posquirúrgicas en la cirugía del tercer molar impactado / Efficacy of antibiotic prophylaxis to prevent postoperative infections in impacted third molar surgery

Introducción: La profilaxis antibiótica es controvertida, además que su uso inapropiado expone a los pacientes en riesgo de reacciones adversas y desarrollo de resistencia bacteriana. Objetivo: Realizar una revisión sistemática de ensayos clínicos aleatorizados que evaluaron le eficacia de la profilaxis antibiótica en la reducción de infecciones posoperatorias luego de la extracción de terceros molares impactados. Métodos: Fueron utilizadas las bases de datos ScienceDirect, Clinical trials.gov y Scopus para ubicar ensayos clínicos. Las variables primarias incluyeron: presencia de infecciones posoperatorias (de la herida y/o alveolitis), reacciones adversas, trismo y dolor. Se realizó un metaanálisis con los estudios homogéneos a través del análisis de efectos aleatorios. El riesgo de sesgo de los ensayos incluidos fue evaluado a través de la guía Cochrane. El riesgo relativo global fue calculado utilizando el enfoque del inverso de la varianza con el método de efectos aleatorios. Resultados: Fueron analizados cualitativamente 14 ensayos clínicos y 9 cuantitativamente. De un total de 874 pacientes, 49 (5,6 por ciento) presentaron infecciones posoperatorias (16/446 para el grupo experimental y 33/428 para el grupo placebo). El metaanálisis arrojó un riesgo relativo global de 0,5 (IC 95 por ciento: 0,27-0,94). El riesgo de sesgo para los estudios que utilizaron solo amoxicilina como medida profiláctica fue de 0,53 (IC 95 por ciento: 0,27-1,03). Las principales reacciones adversas incluyeron: diarreas, reacciones gastrointestinales, fiebre y dolor gástrico. Conclusiones: Los antibióticos sistémicos administrados antes de la cirugía fueron eficaces para reducir las frecuencias de aparición de infecciones posoperatorias luego de la extracción de terceros molares impactados(AU)

Introduction: Antibiotic prophylaxis is controversial, and its inappropriate use exposes patients to the risk of adverse reactions and the development of bacterial resistance. Objective: Carry out a systematic review of randomized clinical trials evaluating the efficacy of antibiotic prophylaxis for the reduction of postoperative infections after extraction of impacted third molars. Methods: The search for clinical trials was conducted in the databases ScienceDirect, Clinicaltrials.gov and Scopus. The primary variables considered were presence of postoperative infections (of the wound and/or alveolitis), adverse reactions, trismus and pain. A meta-analysis was made of homogeneous studies applying the random effects model. The risk of bias in the trials included was evaluated using the Cochrane guide. The inverse variance approach and the random effects method were used for estimation of the global relative risk. Results: Fourteen clinical trials were analyzed qualitatively and 9 quantitatively. Of the total 874 patients, 49 (5.6 percent:) developed postoperative infections (16 / 446 for the experimental group and 33 / 428 for the placebo group). The meta-analysis found a global relative risk of 0,5 (CI 95 percent: 0,27-0,94). Bias risk for studies using only amoxicillin as a prophylactic measure was 0,53 (CI 95 percent:: 0,27-1,03). The main adverse reactions were diarrhea, gastrointestinal reactions, fever and abdominal pain. Conclusions: The systemic antibiotics administered before the surgery were effective to reduce the frequency of appearance of postoperative infections after extraction of impacted third molars(AU)

Efectividad de la magnetoterapia en la terapéutica de las alveolitis / Effectiveness of magnet therapy in the treatment of alveolitis

Fundamento: la elevada incidencia de las alveolitis en los servicios estomatológicos precisa emplear técnicas de tratamiento eficaz e inofensivo que logren, en el menor tiempo posible, la curación del paciente. La magnetoterapia constituye una opción terapéutica. Objetivo: demostrar la efectividad de la magnetoterapia en la terapéutica de las alveolitis. Métodos: se realizó un estudio cuasi-experimental en la Clínica Estomatológica Ormani Arenado Llonch, de la provincia Pinar del Río, de septiembre de 2014 a agosto de 2015. El universo coincide con la muestra de estudio, que estuvo constituida por 100 pacientes con diagnóstico de alveolitis que cumplieron con los criterios de inclusión y exclusión. Se establecieron dos grupos de estudio comprendidos por 50 pacientes cada uno. En ellos se evaluaron las variables: grupo etario, sexo biológico, evolución y comparación del tratamiento en ambos grupos. Resultados: predominó el sexo femenino, entre 35 y 54 años de edad en ambos grupos. Prevaleció la variante de tratamiento curado en los grupos I y II con 80 % y 42 %. Se destacó la evolución satisfactoria con 96 % de pacientes curados en el grupo I y 92 % en el grupo II sin diferencias significativas. Conclusiones: se demostró la efectividad de la magnetoterapia en las alveolitis como alternativa de tratamiento seguro, técnico e inofensivo para los pacientes que acuden a consulta estomatológica.

Background: the high impact of alveolitis in the dentistry service requires the use of effective and harmless treatment techniques that achieve in less possible time the recovery of the patient. Magnet therapy constitutes a therapeutic option. Objective: to demonstrate the effectiveness of magnet therapy in the treatment of alveolitis. Methods: a quasi-experimental study was carried out in Ormani Arenado Llonch clinic, Pinar del Río, from September 2014 to August 2015. The universe coincides with the sample of study. The latter was made up of 100 patients with diagnosis of alveolitis. They all met inclusion and exclusion criteria. Two groups of study composed of 50 patients were created. In them the following variables were assessed: age group, sex, evolution and comparison of the treatment followed by both groups. Results: female sex prevailed, between 35 and 54 years of age in both groups. Variant of cured treatment in groups I and II was predominant, with 80 % and 42 %. Satisfactory evolution with 96 % of the cured patients in group I was highlighted as well as in group II, without significant differences. Conclusions: effectiveness of magnet therapy in alveolitis as a high save, technical and harmless alternative treatment for patients who attend the dentist’s.

Comportamiento de las alveolitis en los servicios de urgencias estomatológicas / Alveolitis in Emergency Dental Services

Fundamento: La alveolitis es la complicación postoperatoria más frecuente y dolorosa que acontece tras la extracción dentaria.Objetivo: determinar el comportamiento de las alveolitis en los servicios de urgencias estomatológicas.Métodos: se realizó un estudio descriptivo, de serie de casos, en la Clínica Estomatológica Ormani Arenado, provincia Pinar del Río, en el año 2014. Se trabajó con 80 pacientes, que cumplieron con los criterios de diagnóstico. Las variables analizadas fueron: edad, sexo, tiempo de aparición de la alveolitis, región anatómica afectada y factores de riesgo. Los datos fueron recogidos en un formulario confeccionado para este fin.Resultados: el sexo femenino fue el más afectado, representando el 60 %. Prevaleció el grupo de edades de 48 a 62 años. Se diagnosticó alveolitis con mayor frecuencia entre el segundo y tercer día después de realizada la extracción, 28,7 % y 38,75 % respectivamente. Fue la mandíbula la región anatómica más afectada (61,25 %) y la extracción traumática el factor predisponente más frecuente (47,50 %).Conclusión: en la población estudiada, las extracciones dentarias traumáticas constituyeron un factor de riesgo importante para el desarrollo de alveolitis; esta apareció mayormente en el transcurso del segundo y tercer días luego de la extracción, principalmente en la mandíbula.

Background: alveolitis is the most common and painful postoperative complication after tooth extraction.Objective: to determine the characteristics of alveolitis in emergency dental services. Methods: a case series study was conducted at the Ormani Arenado Dental Clinic in Pinar del Rio province during 2014. The sample included 80 patients who met the diagnostic criteria. The variables analyzed were: age, sex, time of onset, affected region, and risk factors. Data were collected in a form designed for this purpose.Results: women were most affected by alveolitis, accounting for 60% of all cases. The 48-62 age group predominated. Alveolitis was most commonly diagnosed the second and third day after tooth extraction, 28.7% and 38.75%, respectively. The lower jaw was the most affected region (61.25%) and the most frequent predisposing factor was a traumatic extraction (47.50%).Conclusions: in the population studied, traumatic tooth extractions were an important risk factor for the development of alveolitis. This condition appeared mostly during the second and third day after extraction, mainly in the lower jaw.

Eficacia de la tintura de propóleos al 5 por ciento en el tratamiento de la alveolitis / Effectiveness of 5 percent propolis tinction in treating alveolitis

Introducción: la alveolitis es una afección donde los síntomas álgicos son la principal razón por la que acuden los pacientes a consultas. Se decide evaluar la eficacia de la tintura de propóleos al 5 porciento para lograr una curación más rápida y la total restitución de los tejidos dañados, con menos molestias al enfermo. Método: se realizó un ensayo clínico controlado, con 68 pacientes de ambos sexos y mayores de 15 años, en el Policlínico Universitario Belkis Sotomayor Álvarez de Ciego de Ávila, desde enero 2010 a enero 2011, divididos en dos grupos (estudio y control), con el objetivo de determinar la eficacia del uso de la tintura de propóleos al 5 por ciento en el tratamiento de las alveolitis, en cuanto a: evolución del dolor de acuerdo al número de visitas, tipo, localización de la alveolitis y reacciones adversas presentes. El grupo de estudio recibió tratamiento con propóleos y el de control con alvogil. Las curas y visitas de evolución fueron diarias. Resultados: la eficacia del tratamiento de la alveolitis con la tintura de propóleos al 5 por ciento se observó en el 85,3 por ciento de los pacientes estudiados. Conclusiones: el propóleos resultó ser una terapia inocua y eficaz de elección en las alveolitis, independientemente de la intensidad del dolor, tipo y localización de la alveolitis. La intensidad del dolor disminuye a medida que aumenta el tiempo y las aplicaciones del propóleos(AU)

Introduction: alveolitis is a condition where pain symptoms are the main reason why patients attend consultations. It was decided to evaluate the effectiveness of propolis 5 percent to achieve a faster recovery and full restoration of damaged tissues, with less discomfort to the patient. Method: a controlled clinical trial was carried out with 68 patients of both sexes and over 15 years at Belkys Sotomayor Álvarez Universitary Polyclinic in Ciego de Ávila, from January 2010 to January 2011, divided into two groups (study and control), in order to determine the efficacy of propolis 5 percent in the alveolitis treatment, in terms of: pain evolution according to the number of visits, type, alveolitis location and present adverse reactions. The study group was treated with propolis and the control group with alvogil. The recovery and evolution visits were daily. Results: the alveolitis efficacy treatment with propolis 5 percent was observed in 85,3 percent of studied patients. Conclusions: the propolis proved to be an innocuous and effective therapy of choice in alveolitis, regardless of pain intensity, type and location. Pain intensity decreases with increasing time and applications of propolis(AU)

Factores asociados a la alveolitis en mayores de 18 años / Factors associated to alveolitis in people over 18 years old

Mediante un estudio descriptivo transversal, fueron estudiados 362 adultos que padecían de alveolitis, con el objetivo de describir la asociación de diferentes factores con la aparición de alveolitis seca y húmeda en mayores de 18 años; los pacientes recibieron atención en la clínica “Celia Sánchez Manduley” de Santa Clara, de diciembre del 2007 a diciembre del 2009. La deficiente labor del estomatólogo mostró diferencias muy significativas entre ambos tipos de alveolitis, y existió predominio de la modalidad seca. Se encontró una asociación muy significativa entre el uso excesivo de anestesia y la alveolitis seca, y entre la incorrecta maniobra de extracción y la alveolitis húmeda. De las conductas inadecuadas del paciente, se asociaron de manera significativa a la alveolitis seca, el hábito de fumar después de la extracción y, muy significativamente, la exposición al sol luego de la exodoncia y el no cumplimiento de las indicaciones pre- y postoperatorias.

A number of 362 adults who suffered from alveolitis were studied through a descriptive and transversal study, which has as objective to describe the association of different factors with the apparition of dry and humid alveolitis in people over 18 years old; these patients received care in "Celia Sánchez Manduley" Clinic from December, 2007 to December, 2009.The deficient work of the stomatologist showed very significant differences between both types of alveolitis, and dry type predominated. A very significant association between the excessive use of anaesthesia and dry alveolitis was found, as well as, between the inappropriate manoeuvre of extraction and dry one. Smoking habit after extraction was associated significantly to dry alveolitis in patients with inadequate conducts, as well as, sun exposure after exodontic procedure and non fulfilment of pre and postoperative indications.

Caracterização morfométrica e molecular do papel de citocinas pró e anti-inflamatórias no processo de reparo ósseo alveolar em condições homeostáticas e infecciosas / Morphometric and molecular characterization of the role of pro- and anti-inflammatory cytokines in alveolar bone repair process under homeostatic and infectious conditions

O metabolismo ósseo é influenciado por fatores endócrinos, genéticos, de crescimento, sistema RANK/RANKL/OPG, além de uma variedade de moléculas regulatórias, como as citocinas. Citocinas têm sido implicadas na patogênese de doenças ósseas, no entanto, ainda pouco se sabe sobre os mecanismos envolvidos na interação entre o sistema ósseo e imunológico no processo de reparo ósseo. O objetivo deste estudo foi caracterizar o papel de TNF-α e IL-10 no reparo ósseo alveolar em condições homeostáticas (controle [C]) e infecciosas (alveolite experimental [A]) pós exodontia em camundongos C57Bl/6 (WT), TNFp55KO e IL-10KO. Após a cirurgia nos grupos infectados foi induzida a alveolite por meio de isquemia do alvéolo e uma suspensão de secreção purulenta. As maxilas foram coletadas em 0h, 7, 14 e 21 dias após a extração do incisivo superior para análises histológica, histomorfométrica e molecular (RealTimePCR). Na análise histomorfométrica foram quantificados os parâmetros coágulo, células inflamatórias, fibras, fibroblastos, vasos sanguíneos, matriz óssea, osteoblastos, osteoclastos, e outros espaço do líquido intersticial e medula óssea. Na análise molecular (RealTimePCR) foram quantificados a expressão de fatores de crescimento, marcadores ósseos e de matriz extracelular, citocinas e quimiocinas envolvidos no processo. Os dados obtidos foram submetidos ao teste OneWay ANOVA seguido do teste de comparação múltipla de Tukey. Os resultados demonstraram que nos camundongos WT-C houve a formação inicial de coágulo (0 hora) com início da expressão de BMP2, BMP4, BMP7, TGFb1 and VEGFa que tiveram aumento gradativo com pico em 7 dias. A expressão de TNF-α e IL10 também tiveram seus picos aos 7 dias em paralelo com contagem de leucócitos, associado com a expressão de CCL2, CCL5 e CXCL1. Nos períodos seguintes houve uma diminuição inflamatória e o aumento de marcadores osteoblásticos/osteogênicos. A indução da alveolite experimental em WT-A resultou no aumento marcante...

Bone metabolism is influenced by endocrine, genetic and growth factors, RANK/RANKL/OPG system, besides a variety of regulatory molecules, such as cytokines. Cytokines have been implicated in pathogenesis of bone diseases, however, little is known about the mechanisms involved in the interaction between skeletal and immune system in the bone repair process. The objective of this study was characterized the role of TNF-α and IL-10 in alveolar bone repair under homeostatic (control [C]) and infectious (experimental alveolitis [A]) conditions in C57Bl/6 (WT), TNFp55KO and IL-10KO mice. After surgery, in infectious groups was induced by ischemia alveolitis the well and a suspension of pus. The maxillas were collected at 0h, 7, 14 and 21 days after extraction of the maxillary incisor for histologic, histomorphometric and molecular (RealTimePCR). In histomorphometric analysis parameters were measured clot, inflammatory cells, fibers, fibroblasts, blood vessels, bone matrix, osteoblast, osteoclast, and other space - the interstitial fluid and bone mar row. Molecular analysis (RealTimePCR) were quantified the expression of growth factors, bone markers and extracellular matrix, cytokines and chemokines involved in the process. The data were submitted to the OneWay ANOVA test followed by Tukey's multiple comparison test. The results showed that in WT-C initial clot formation (0 hours) with early expression of BMP2, BMP4, BMP7, and TGFb1 VEGFa who had gradual increase peaking in 7 days. The expression of TNF-α and IL10 also peaked at 7 days in parallel with leukocyte count, associated with CCL2, CCL5 and CXCL1. In late periods there were decrease of inflammation and markers osteoblastic / osteogenic increased. Induction of experimental alveolitis in WT resulted in a marked increase in expression of TNF-α accompanied by increased expression of CXCL1 and CCL5, increased leukocyte count and decreased of IL10 expression that peaked at 14d, besides prominent...

Caracterização morfométrica e molecular do papel de citocinas pró e anti-inflamatórias no processo de reparo ósseo alveolar em condições homeostáticas e infecciosas / Morphometric and molecular characterization of the role of pro- and anti-inflammatory cytokines in alveolar bone repair process under homeostatic and infectious conditions

O metabolismo ósseo é influenciado por fatores endócrinos, genéticos, de crescimento, sistema RANK/RANKL/OPG, além de uma variedade de moléculas regulatórias, como as citocinas. Citocinas têm sido implicadas na patogênese de doenças ósseas, no entanto, ainda pouco se sabe sobre os mecanismos envolvidos na interação entre o sistema ósseo e imunológico no processo de reparo ósseo. O objetivo deste estudo foi caracterizar o papel de TNF-α e IL-10 no reparo ósseo alveolar em condições homeostáticas (controle [C]) e infecciosas (alveolite experimental [A]) pós exodontia em camundongos C57Bl/6 (WT), TNFp55KO e IL-10KO. Após a cirurgia nos grupos infectados foi induzida a alveolite por meio de isquemia do alvéolo e uma suspensão de secreção purulenta. As maxilas foram coletadas em 0h, 7, 14 e 21 dias após a extração do incisivo superior para análises histológica, histomorfométrica e molecular (RealTimePCR). Na análise histomorfométrica foram quantificados os parâmetros coágulo, células inflamatórias, fibras, fibroblastos, vasos sanguíneos, matriz óssea, osteoblastos, osteoclastos, e outros espaço do líquido intersticial e medula óssea. Na análise molecular (RealTimePCR) foram quantificados a expressão de fatores de crescimento, marcadores ósseos e de matriz extracelular, citocinas e quimiocinas envolvidos no processo. Os dados obtidos foram submetidos ao teste OneWay ANOVA seguido do teste de comparação múltipla de Tukey. Os resultados demonstraram que nos camundongos WT-C houve a formação inicial de coágulo (0 hora) com início da expressão de BMP2, BMP4, BMP7, TGFb1 and VEGFa que tiveram aumento gradativo com pico em 7 dias. A expressão de TNF-α e IL10 também tiveram seus picos aos 7 dias em paralelo com contagem de leucócitos, associado com a expressão de CCL2, CCL5 e CXCL1. Nos períodos seguintes houve uma diminuição inflamatória e o aumento de marcadores osteoblásticos/osteogênicos. A indução da alveolite experimental em WT-A resultou no aumento marcante...

Bone metabolism is influenced by endocrine, genetic and growth factors, RANK/RANKL/OPG system, besides a variety of regulatory molecules, such as cytokines. Cytokines have been implicated in pathogenesis of bone diseases, however, little is known about the mechanisms involved in the interaction between skeletal and immune system in the bone repair process. The objective of this study was characterized the role of TNF-α and IL-10 in alveolar bone repair under homeostatic (control [C]) and infectious (experimental alveolitis [A]) conditions in C57Bl/6 (WT), TNFp55KO and IL-10KO mice. After surgery, in infectious groups was induced by ischemia alveolitis the well and a suspension of pus. The maxillas were collected at 0h, 7, 14 and 21 days after extraction of the maxillary incisor for histologic, histomorphometric and molecular (RealTimePCR). In histomorphometric analysis parameters were measured clot, inflammatory cells, fibers, fibroblasts, blood vessels, bone matrix, osteoblast, osteoclast, and other space - the interstitial fluid and bone mar row. Molecular analysis (RealTimePCR) were quantified the expression of growth factors, bone markers and extracellular matrix, cytokines and chemokines involved in the process. The data were submitted to the OneWay ANOVA test followed by Tukey's multiple comparison test. The results showed that in WT-C initial clot formation (0 hours) with early expression of BMP2, BMP4, BMP7, and TGFb1 VEGFa who had gradual increase peaking in 7 days. The expression of TNF-α and IL10 also peaked at 7 days in parallel with leukocyte count, associated with CCL2, CCL5 and CXCL1. In late periods there were decrease of inflammation and markers osteoblastic / osteogenic increased. Induction of experimental alveolitis in WT resulted in a marked increase in expression of TNF-α accompanied by increased expression of CXCL1 and CCL5, increased leukocyte count and decreased of IL10 expression that peaked at 14d, besides prominent...

Caracterização morfométrica e molecar do papel da iNOS no processo de reparo ósseo alveolar em condições homeostáticas e infecciosas / Morphometric and molecular characterization of the role of iNOS in alveolar bone repair process in homeostatic and infectious conditions

A óxido nítrico sintase induzível (iNOS) é uma enzima responsável pela síntese do óxido nítrico, envolvido na regulação de vários processos fisiológicos, com destaque para relevantes efeitos sobre o tecido ósseo. Entretanto, o papel da iNOS no reparo ósseo alveolar permanece pouco conhecido. Assim, o objetivo deste estudo foi caracterizar o papel da iNOS no processo de reparo ósseo alveolar pósexodontia em condições homeostáticas (controle) e infecciosas em camundongos. Para isso, foram utilizados animais das linhagens WT (C57Bl/6) e iNOSKO, divididos em 2 grupos, condição homeostática (exodontia do incisivo superior direito) e alveolite experimental (induzida pela inoculação de uma suspensão de cultura bacteriana), e analisados de acordo com os diferentes períodos experimentais (0, 7, 14 e 21 dias pós-exodontia), através da análise histomorfométrica e molecular. Na análise histomorfométrica, avaliou-se a densidade de volume das estruturas referentes ao coágulo sanguíneo, tecido conjuntivo e tecido ósseo. Na análise molecular, quantificou-se a expressão de mRNA codificando genes de marcadores do metabolismo ósseo; marcadores de osteoclastos; citocinas e quimiocinas, através de reações de RealTimePCR. A expressão de iNOS esteve presente durante todo o processo de reparo ósseo alveolar nos camundongos C57Bl/6, porém de maneira mais expressiva no período de 7 dias pós-exodontia, e se mostrou aumentada pela indução de alveolite. A análise histomorfométrica demonstrou discretas alterações no processo de reparo ósseo alveolar, na ausência de iNOS, tanto em condições homeostáticas quanto infecciosas. Em condições homeostáticas, a ausência de iNOS não impactou de forma significativa o processo de reparo ósseo alveolar pósexodontia, mas se mostrou associada à modulação de vasos sanguíneos. Já em condições infecciosas, a ausência de iNOS se mostrou associada à modulação de células inflamatórias, osteoblastos e osteoclastos. De forma geral, conclui-se que embora...

The inducible nitric oxide synthase (iNOS) is an enzyme responsible for the synthesis of nitric oxide, a reactive molecule involved in the regulation of several physiological processes, highlighting relevant effects on bone tissue. However, the role of iNOS in alveolar bone repair remains unknown. The aim of this study was to characterize the role of iNOS in alveolar bone healing process after dental extraction in homeostatic and infectious conditions in mice. With this aim, WT (C57Bl/6) and iNOSKO mice strains were divided into 2 groups, homeostatic condition (extraction of the upper right incisor) and experimental alveolitis (induced by inoculation of a suspension of bacterial culture), and analyzed according to the different experimental periods (0, 7, 14 and 21 days post-extraction), through molecular and histomorphometric analysis. In histomorphometric analysis, the volume density of structures related to blood clot, tissue and bone were evaluated. The molecular analysis quantified the expression of mRNA encoding genes of defined as bone metabolism markers; osteoclast markers, as well cytokines and chemokines through RealTimePCR reactions. The expression of iNOS was detected during the all process of the alveolar bone repair in C57Bl/6 mice, with an expression peak at 7 days post-extraction time point, and was significantly enhanced by alveolitis induction. Histomorphometric analysis showed small changes in alveolar bone repair process in the absence of iNOS, in both homeostatic as infectious conditions. Under homeostatic conditions, the absence of iNOS did not impact significantly the process of alveolar bone healing after dental extraction, but it was associated with modulation of blood vessels formation. In the infectious conditions scenario, the absence of iNOS was associated with modulation of inflammatory cells, osteoblasts and osteoclasts counts. In general, it is concluded that even the enzyme iNOS module some aspects of alveolar bone...

Levantamento dos tratamentos utilizados para a alveolite pelos cirurgiões-dentistas de Passo Fundo - RS / Survey of treatments for alveolitis by dentists of Passo Fundo - RS

Introdução: a exodontia é um procedimento de rotina da cirurgia bucal. Entre as complicações pós-operatórias inerentes a esse procedimento cita-se a alveolite. A etiologia desse processo não está absolutamente clara e geralmente desenvolve dor de intensidade severa entre o primeiro e quarto dias após o procedimento cirúrgico. As condições locais são caracterizadas por perda prematura ou necrose do coágulo sanguíneo e odor desagradável. A literatura relata a utilização de inúmeros medicamentos e técnicas empregadas para o seu tratamento. Objetivo: o objetivo do presente estudo foi obter maiores informações a respeito do tratamento empregado para a alveolite pelos cirurgiões dentistas da área central de Passo Fundo - RS, Brasil. Métodos: foram enviados 102 questionários e 54 foram respondidos, os quais foram analisados descritivamente. Resultados: quarenta e sete cirurgiões-dentistas afirmaram tratar alveolite, sendo a forma mais utilizada de tratamento (46,8%) a curetagem, com irrigação com soro fisiológico. Quanto à utilização de medicação local, 41 (87,2%) utilizam, sendo que o mais prevalente foi o Alveosan® (Odonto Comercial Importadora Ltda., São Paulo - SP, Brasil) (29,2%). Trinta e três profissionais (70,2 %) utilizam algum tipo de medicação sistêmica (analgésico, anti-inflamatório e antibiótico, isolados ou associados). Conclusão: Embora sabido que há di-vergências de opiniões e diversas formas de tratamento para a alveolite na literatura, todas as formas de terapêutica utilizadas pelos cirurgiões dentistas pesquisados estão dentro das relatadas na literatura, porém nemtodas são aceitáveis atualmente.

Experimental dry socket: microscopic and molecular evaluation of two treatment modalities / Alveolite experimental: análise microscópica e molecular de duas modalidades de tratamento

PURPOSE: To evaluate two treatment modalities of dry socket in rats and to discuss the first findings of the molecular analysis in this experimental model. METHODS: 84 rats underwent a tooth extraction were divided in 4 groups: I-uninfected socket (control), II-infected socket without any treatment, III-infected socket treated with irrigation of 2 percent sodium iodide and 3 percent hydrogen peroxide solution, IV-infected socket submitted to curettage, irrigation with physiological saline solution and fulfilled with metronidazole paste as base. The groups were subdivided in postoperative sacrifice periods: 6/15/28 days. A quantitative and a qualitative microscopic analysis was performed. Also, a quantitative analysis was performed using a RealTimePCR to evaluate the genes expression in the wound healing: Collagen Type I/COL-I, vascular endothelial growth factor/VEGF, osteocalcin/OCN, alkaline phosphatase/ALP, runt-related transcription factor 2/RUNX2 and tumor necrosis factor alpha/TNF-α. RESULTS: The group I showed higher bone formation, followed by groups IV, III, II respectively. The group II presented higher inflammatory infiltrate and the wound healing was delayed compared with other groups. It was obtained a significant positive correlation between bone neoformation and the expression of OCN and RUNX2, inflammatory infiltrate with TNF-α and a negative correlation between bone neoformation and TNF-α. CONCLUSION: No significant difference was found between the treatments.

OBJETIVO: Avaliar duas modalidades de tratamento da alveolite em ratos e discutir os primeiros achados de uma análise molecular neste modelo experimental. MÉTODOS: 84 ratos foram submetidos a uma extração dentária e foram divididos em quatro grupos: I- alvéolo não infectado (controle), II- alvéolo infectado sem tratamento, III- alvéolo infectado tratado com irrigação de iodeto de sódio a 2 por cento e solução de peróxido de hidrogênio a 3 por cento, IV- alvéolo infectado submetido à curetagem, irrigação com solução salina fisiológica e preenchimento com pasta a base de metronidazol. Os grupos foram subdivididos em períodos de sacrifício pós-operatório: 6/15/28 dias. Uma análise quantitativa e qualitativa microscópica foi realizada. Além disso, uma análise quantitativa foi realizada utilizando RealTimePCR para avaliar a expressão de genes no reparo alveolar: o colágeno tipo I / COL-I, o fator de crescimento endotelial vascular / VEGF, osteocalcina / OCN, fosfatase alcalina / ALP, fator de transcrição runt relacionados 2 / RUNX2 e fator de necrose tumoral alfa / TNF-α. RESULTADOS: O grupo I mostrou maior formação óssea, seguido pelos grupos IV, III, II, respectivamente. O grupo II apresentou maior infiltrado inflamatório e a cicatrização foi atrasada em comparação com outros grupos. Foi obtida uma correlação positiva entre a neoformação óssea e a expressão de OCN e RUNX2, infiltrado inflamatório com TNF-α e uma correlação negativa entre a neoformação óssea e TNF-α. CONCLUSÃO: Nenhuma diferença significativa foi encontrada entre os tratamentos.

Prevalência de alveolite após a exodontia de terceiros molares impactados / Dry socket prevalence after sutgical removal of impacted third molars

Uma das complicações que pode ocorrer após a remoção cirúrgica de terceiros molares não irrompidos é a alveolite. É uma condição que se instala por atraso da cicatrização, devido à desintegração do coágulo sanguíneo no alvéolo após a exodontia. O paciente apresenta mau hálito, dor persistente que não é aliviada pelo uso de analgésicos e, geralmente, não apresenta sinais e sintomas de uma infecção como febre, edema e eritema. Com o objetivo de avaliar a prevalência de alveolite no pós-operatório de pacientes submetidos à cirurgia bucal, estudamos uma amostra constituída por 131 pacientes submetidos à remoção de terceiros molares não irrompidos, com o uso de alta rotação para osteotomia ou odontossecção, de acordo com o protocolo cirúrgico da disciplina de Cirurgia e Traumatologia Buco-Maxilo-Facial da Faculdade de Odontologia de São José dos Campos da UNESP. A verificação da instalação da alveolite foi realizada por meio do acompanhamento clínico observacional da área operada, durante dez dias de pós-operatório. Foram observados 197 pós-operatórios e foi constatada a presença de dois casos de alveolite, na área de terceiros molares inferiores. Os resultados mostraram uma prevalência de 1,015% do total de cirurgias, e de 1,290% de alveolite em cirurgias de extração de terceiros molares inferiores. Com os resultados obtidos concluiu-se que a prevalência de alveolite, após exodontia de terceiros molares não irrompidos realizada com o uso de caneta de alta rotação, foi baixa e não contribuiu para a ocorrência de alveolite pós-operatória.

Incidencia de la alveolitis / Incidence of the alveolitis

Fundamento: La alveolitis es un estado de infección localizado, donde el alveolo está deshabitado o contiene restos de coágulo necrótico y la asocian con mayor frecuencia a las extracciones difíciles y traumáticas, exceso de anestesia local, estado general, factores bacterianos y otras. Objetivo: Determinar la incidencia de la aveolitis en la clínica Las Margaritas. Método: Se realizó un estudio observacional, descriptivo, longitudinal y prospectivo en la clínica Las Margaritas, municipio Carirubana, estado Falcón, Venezuela desde enero de 2005 a agosto de 2006. El universo del estudio estuvo constituido por la totalidad de los pacientes a los que se les realizaron exodoncias y la muestra por 76 pacientes que se presentaron con alveolitis y cumplieron los criterios de inclusión y exclusión. Las variables estudiadas en la investigación fueron la edad y el sexo, zonas afectadas, tipo de alveolitis y tiempo de aparición. Resultados: El sexo más afectado fue el femenino con 46 pacientes para el 60,5 %, y los masculinos con 39,5 por ciento. En cuanto a la edad esta afección prevaleció más en el grupo de de 35 a 44 años de los cuales 19 pertenecieron al sexo femenino, en el masculino predominó el grupo de 45 a 54 años con 13 enfermos. Conclusiones: La zona dentaria con mayor incidencia fue la mandíbula, en la zona de molares con 37 casos, seguida de la de premolares con 20 alveolitis, en la arcada superior solo se presentaron 17 pacientes, en los incisivos y caninos no se encontró gran incidencia de esta infección.

Background: The alveolitis is a located infection state, where the alveolus is uninhabited or it contains remains of necrotic coagulum and associate it with more frequency to the difficult and traumatic extractions, excess of local anesthesia, general state, bacterial factors and others. Objective: To determine the incidence of the aveolitis in Las Margaritas clinic. Method: An observational, descriptive, longitudinal and prospective study in Las Margaritas clinic, Carirubana municipality, Falcon state, Venezuela was performed, from January 2005 to August 2006. The universe of the study was constituted by the totality of patients to whom exodontias were carried out and the sample by 76 patients that showed up alveolitis and completed the inclusion and exclusion criteria. The studied variables in the investigation were age and sex, affected areas, type of alveolitis and apparition time. Results: The female sex was the most affected with 46 patients for a 60,5 percent , and the masculine one with 39,5 percent. Regarding age this affection prevailed more in the group from 35 to 44 years of which 19 belonged to the female sex, in the masculine one prevailed the group from 45 to 54 years with 13 sick persons. Conclusions: The dental area with more incidence was the mandible, in the molars area with 37 cases, followed by premolars with 20 alveolitis, in the superior arch just 17 patients showed up, in the incisor and canine tooth it was not found great incidence of this infection.

Incidencia de la alveolitis / Incidence of the alveolitis

Fundamento: La alveolitis es un estado de infección localizado, donde el alveolo está deshabitado o contiene restos de coágulo necrótico y la asocian con mayor frecuencia a las extracciones difíciles y traumáticas, exceso de anestesia local, estado general, factores bacterianos y otras. Objetivo: Determinar la incidencia de la aveolitis en la clínica Las Margaritas. Método: Se realizó un estudio observacional, descriptivo, longitudinal y prospectivo en la clínica Las Margaritas, municipio Carirubana, estado Falcón, Venezuela desde enero de 2005 a agosto de 2006. El universo del estudio estuvo constituido por la totalidad de los pacientes a los que se les realizaron exodoncias y la muestra por 76 pacientes que se presentaron con alveolitis y cumplieron los criterios de inclusión y exclusión. Las variables estudiadas en la investigación fueron la edad y el sexo, zonas afectadas, tipo de alveolitis y tiempo de aparición. Resultados: El sexo más afectado fue el femenino con 46 pacientes para el 60,5 %, y los masculinos con 39,5 por ciento. En cuanto a la edad esta afección prevaleció más en el grupo de de 35 a 44 años de los cuales 19 pertenecieron al sexo femenino, en el masculino predominó el grupo de 45 a 54 años con 13 enfermos. Conclusiones: La zona dentaria con mayor incidencia fue la mandíbula, en la zona de molares con 37 casos, seguida de la de premolares con 20 alveolitis, en la arcada superior solo se presentaron 17 pacientes, en los incisivos y caninos no se encontró gran incidencia de esta infección(AU)

Background: The alveolitis is a located infection state, where the alveolus is uninhabited or it contains remains of necrotic coagulum and associate it with more frequency to the difficult and traumatic extractions, excess of local anesthesia, general state, bacterial factors and others. Objective: To determine the incidence of the aveolitis in Las Margaritas clinic. Method: An observational, descriptive, longitudinal and prospective study in Las Margaritas clinic, Carirubana municipality, Falcon state, Venezuela was performed, from January 2005 to August 2006. The universe of the study was constituted by the totality of patients to whom exodontias were carried out and the sample by 76 patients that showed up alveolitis and completed the inclusion and exclusion criteria. The studied variables in the investigation were age and sex, affected areas, type of alveolitis and apparition time. Results: The female sex was the most affected with 46 patients for a 60,5 percent , and the masculine one with 39,5 percent. Regarding age this affection prevailed more in the group from 35 to 44 years of which 19 belonged to the female sex, in the masculine one prevailed the group from 45 to 54 years with 13 sick persons. Conclusions: The dental area with more incidence was the mandible, in the molars area with 37 cases, followed by premolars with 20 alveolitis, in the superior arch just 17 patients showed up, in the incisor and canine tooth it was not found great incidence of this infection(AU)

Análise morfométrica e molecular da alveolite induzida em ratos com diferentes modalidades de tratamento / Molecular and morphometric analysis of induced dry socket in mice with different treatment conditions

A alveolite é uma complicação pós-operatória de carácter inflamatório que acomete alvéolos de dentes recém-extraídos. A incidência dessa complicação varia de 1 a 4% e pode chegar a 30%. O objetivo deste estudo foi analisar os mecanismos biológicos envolvidos no processo de reparo de alvéolos intencionalmente infectados, em ratos; comparar diferentes modalidades de tratamento e correlacionar os resultados encontrados através de duas análises (microscópica e molecular). Foram utilizados 84 ratos, divididos nos grupos: I: alvéolo não infectado; II: alvéolo infectado sem nenhum tratamento; III: alvéolo infectado tratado com irrigação de solução de iodeto de sódio a 2% e peróxido de hidrogênio a 3% na proporção de 1:1; e IV: alvéolo infectado submetido à curetagem, irrigação com soro fisiológico e preenchimento com uma pasta à base de metronidazol. Os animais foram eutanasiados aos 6, 15 e 28 dias pós-operatório. Foi realizada a análise quantitativa da expressão de genes envolvidos no processo de reparo [colágeno tipo I (COL-I), fator de crescimento do endotélio vascular (VEGF), osteocalcina (OCN), fosfatase alcalina (ALP), runt-related transcription factor 2 (RUNX2) e fator de necrose tumoral alfa (TNF-α)], através da RealTimePCR, correlacionando sua expressão com as características microscópicas observadas qualitativa e quantitativamente. Com base nos resultados da análise microscópica e molecular, podemos concluir que os marcadores RUNX2, OCN e TNF-α podem ser usados como indicadores para avaliar a neoformação óssea e a quantidade de infiltrado inflamatório em alveolite. Os marcadores ALP e VEGF não representaram adequadamente o que se observou microscopicamente. Embora o tratamento da alveolite com a pasta à base de metronidazol promova maior densidade de neoformação óssea aos 28 dias, não há diferenças entre os tratamentos.

Dry socket is an inflammatory postoperative complication that undertakes sockets of recently extracted teeth. The incidence of such complication varies from 1 to 4% and might reach up to 30%. The objective of this study was to analyze the biological mechanisms involved in the repair process of intentionally infected sockets in mice; compare different treatment conditions and correlate the results of two different analysis (microscopic and molecular). 84 mice were used in this study, divided according the following groups: I: uninfected socket; II: infected socket without any treatment; III: infected socket treated with irrigation of 2% sodium iodide and 3% hydrogen peroxide solution at 1:1 proportion; and IV: infected socket submitted to curettage, physiological saline solution irrigation and fulfillment with metronidazole base paste. The animals were killed at a postoperative period of 6, 15 and 28 days. A quantitative analysis was performed using a RealTimePCR to evaluate the genes expression involved [Collagen Type I (COL-I), vascular endothelial growth factor (VEGF), osteocalcin (OCN), alkaline phosphatase (ALP), runt-related transcription factor 2 (RUNX2) and tumor necrosis factor-alpha (TNF-α)], in the repair process, correlating its expression with the microscopic characteristics observed in both qualitative and quantitative manner. Based in the results of the microscopic and molecular analysis, it can be concluded that the RUNX2, OCN and TNF-α markers can be used as indicators to evaluate the dry socket bone neoformation and inflammatory infiltrate quantity. The ALP and VEGF markers did not represented appropriately what was observed microscopically. Although the dry socket treatment with metronidazole base paste promotes an increase in the bone neoformation density at 28 days, no difference was found among the treatments.

Eficacia del trttamiento homeopático en la alveolitis dental / Efficacy of the homeopathic treatment in the dental alveolitis

Se realizó un ensayo clínico fase II temprano, unicéntrico, abierto y secuencial en la Clínica Estomatológica "Tula Aguilera", desde Octubre de 2004 a Mayo de 2005, con el objetivo de evaluar la eficacia del tratamiento homeopático en la alveolitis dental. Se incluyeron en la investigación a los pacientes con este diagnóstico clínico y sin tratamiento previo. La muestra quedó conformada por 31 pacientes, a los que se les aplicó caléndula homeopática a la 30cH en el alvéolo y se les indicó, según la modalización de sus síntomas, los remedios homeopáticos: cinco gotas sublinguales tres veces al día. El resultado del tratamiento se determinó clínicamente a las 24, 48 y 72h según una escala establecida, donde se consideraron las variables inflamación y dolor. De forma general se evalúo como eficaz el tratamiento realizado y los resultados más significativos se obtuvieron a las 48h del mismo, además se detectó una relación entre factores generales y el retardo en la reparación tisular. La presencia de agravaciones homeopáticas se pudo identificar en dos pacientes y éstas no obstaculizaron la realización del tratamiento. La mayoría de los pacientes manifestaron su satisfacción con el tratamiento recibido.

An early phase II clinical trial, unicentric, open and sequential was conducted at "Tula Aguilera", Odontology Clinic from October 2004 to May 2005, with the objective to evaluate the efficacy of the homeopathic treatment in the dental alveolitis. It were included in the investigation the patients with this clinical diagnosis and without previous treatment. The sample remained conformed by 31 patients, to the ones it were applied homeopathic calendula to the 30cH in the socket and it were indicated them, according to the modalization of its symptoms, the homeopathic remedies: five sublingual drops three times a day. The result of the treatment was clinically determined at 24, 48 and 72h according to an established scale, where inflammation and pain variables were considered. In general, it was evaluated as efficient the applied treatment and the most significant results were obtained at the 48h after that, besides a relation between general factors and the retardation in the tissular repair, was detected. The presence of homeopathic aggravations could be only identified in two patients and these did not hinder carrying out the treatment. The majority of the patients declared their satisfaction with the treatment received.

Alveolitis: Revisión de la literatura y actualización

La alveolitis es la complicación más frecuente de la extracción dentaria. Su frecuencia varía del 1 al 4 % y puede llegar del 20 al 30 % en extracciones de terceros molares mandibulares. Se describen algunos factores de riesgo que aumentan su incidencia, aunque se habla de un origen multifactorial. La clínica y los síntomas subjetivos nos permiten su diagnóstico y clasificación. Para tratar las alveolitis se han utilizado localmente distintos productos para inducir la formación del coágulo: antibióticos, anestésicos, analgésicos y antiinflamatorios, asociados o no con corticoides, analgésicos y antibióticos sistémicos. También la medicina natural y tradicional ocupa un lugar importante en el tratamiento de esta urgencia estomatológica, y se destacan terapéuticas como: la apiterapia, la acupuntura y la ozonoterapia, además tecnologías de avanzada como los soft láser.

Alveolitis is the most frequent complication of tooth extraction. Its frequency varies from 1 to 4 % and may reach 20 to 30 % in extractions of mandibular third molars. Some risk factors increasing its incidence are described, although reference is made to a multifactorial origin. The clinic and the subjective symptoms allow us to make its diagnosis and to classify it. Different products have been used in the treatment of alveolitis to induce clot formation: antibiotics, anesthesics, analgesics and anti-inflammatories associated or not with corticoids, analgesics and systemic antibiotics. Natural and traditional medicine also play an important role in the treatment of this stomatological emergency and therepeutics such as the apiotherapy, the acupuncture, the ozone therapy and state-of-the art technologies as the soft laser are stressed.