Rol de la Clorhexidina en sus Diferentes Formatos para la Prevención de la Alveolitis Seca: Revisión Sistemática Exploratoria

El objetivo de este estudio fue investigar el rol de la clorhexidina en sus diferentes formatos en la prevención de la alveolitis seca posterior a la extracción dental. Se realizó una búsqueda electrónica en las bases de datos de PubMed, Scopus, Web of Science. hasta el año 2021. Dos revisores de forma independiente realizaron el análisis de los artículos. La búsqueda inicial dio como resultado 192 artículos. Se descartaron 59 artículos duplicados y se realizó una revisión general inicial de títulos y resúmenes, verificando que se cumplan los criterios de inclusión y exclusión preestablecidos. De 192 estudios, 25 cumplieron con los criterios de inclusión. De los 25 artículos, 10 incluyeron pacientes con factores de riesgo asociados a alveolitis seca. Respecto al sitio de extracción dental, 19 artículos incluyeron pacientes con terceros molares mandibulares. Dentro de los artículos filtrados se utilizaron tres formatos de clorhexidina: enjuague, gel bioadhesivo e irrigante; estos en diferentes concentraciones, y comparadas con distintos grupos placebos. De los estudios incluidos, 18 informaron que la clorhexidina en sus diferentes formatos proporcionaba disminución en la incidencia de alveolitis seca versus el grupo control. El uso de clorhexidina en sus diferentes formatos después de la extracción dental es altamente efectivo en la prevención de la alveolitis seca. Sin embargo, inferimos que se necesitan nuevas líneas investigativas que incluyan pacientes con factores de riesgo asociados, y estudios que no utilicen terapias complementarias, puesto que, estos factores pueden conducir a confusión en los resultados obtenidos.

The objective of this study was to investigate the role of chlorhexidine in its different formats in the prevention of dry socket after dental extraction. The electronic search was performed using keywords and MeSH terms in the databases of PubMed, Scopus, Web of Science, until 2021. The reviewers independently performed the analysis of the articles. The initial search resulted in 192 articles. 59 duplicate articles were discarded, and an initial general review of titles and abstracts was performed, verifying that the pre-established inclusion and exclusion criteria were met. Of 192 studies, 25 met the inclusion criteria. Of the 25 articles, 10 included patients with risk factors associated with dry socket. Regarding the site of dental extraction, 19 articles included patients with mandibular third molars. Within the filtered articles, three formats of chlorhexidine were used: rinse, bioadhesive gel and irrigant, in different concentrations, and compared with different placebo groups. Of the included studies, 18 reported that chlorhexidine in its different formats provided a decrease in the incidence of dry socket versus the control group. The use of chlorhexidine in its different formats after dental extraction, is highly effective in preventing dry socket. However, we infer that new research lines are needed that include patients with associated risk factors, and studies that do not use complementary therapies.

Antimicrobial and bone repair effects of boric acid in a rat model of dry socket (alveolar osteitis) following dental extraction.

BACKGROUND: Alveolitis occurs after dental extraction without blood clot formation, leading to an inflammatory process and bacterial contamination. Boric acid (BA) demonstrates anti-inflammatory, antimicrobial, and osteogenic properties. This study aims to evaluate the possible antimicrobial effects and bone repair of BA in a rat model of alveolitis (dry socket). METHODS: 33 male Wistar rats were submitted to the extraction of the upper right incisor and dry socket induction. They were first divided into two groups: dry socket (n = 17) and dry socket + 0.75 % BA (n = 16). Samples for the microbiological analysis were collected immediately after dental extraction, at the detection of clinical alveolitis, 7, and 14 days after BA application. For microCT and histological analysis, samples from euthanized rats were used in 14 and 28 days after alveolitis detection. RESULTS: Higher bacterial counts were found in 4-5 days after alveolitis induction, compared to the baseline in both experimental groups, decreasing significantly after 7 and 14 days of treatment with BA (P < 0.05). The microCT evaluation displayed increased bone volume, bone volume fraction, trabecular thickness, and bone mineral density in a time-dependent manner, regardless of BA treatment. On the other hand, the number of trabeculae and total bone porosity decreased over the 28 days of the experiment in the dry-socket group and both groups, respectively (P < 0.05). Histological analysis did not differ on bone repair in both experimental groups. CONCLUSION: This was the first report investigating the effects of BA in a rat model of alveolitis regarding microbiological and bone repair aspects. The BA local application decreased the total aerobic and facultative bacteria counts and does not seem to benefit the bone repair after alveolitis development. This study paves the way for more studies involving alveolitis and different BA applications.

Chronic recurrent multifocal osteomyelitis, a rare disease. case report

ABSTRACT Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare inflammatory bone disease usually observed in children and adolescents. It is caused by an imbalance between proinflammatory and anti-inflammatory factors. To establish its diagnosis, it is necessary to integrate clinical and laboratory elements that are typically aimed at ruling out other conditions, constituting a diagnosis of exclusion. Treatment is based on non-steroidal anti-inflammatory drugs and other drugs in specific cases. Case presentation: A 16-year-old female patient with a 1-year history of joint pain, especially in the knees, accompanied by signs of local inflammation was admitted to the emergency department of a quaternary care hospital due to a fever >38.5°, odynophagia, asthenia, and adynamia over the last two days. The patient underwent multiple extension studies, including laboratory, imaging and histopathological tests, which ruled out various etiologic causes. She received empirical antibiotic treatment without remission of symptoms, so a diagnosis of CRMO was finally established and outpatient treatment with non-steroidal anti-inflammatory drugs and corticosteroids was indicated, obtaining a favorable response. Conclusions: CRMO should be considered in children and adolescents with bone pain and a poorly defined clinical history with non-specific laboratory, imaging and histopathological findings. To date, little is known about CRMO, so it is necessary to carry out research and expand the knowledge related to this disease.

RESUMEN Introducción. La osteomielitis multifocal recurrente crónica (CRMO) es una enfermedad inflamatoria ósea poco frecuente que se presenta principalmente en niños y adolescentes a causa de un desequilibrio entre factores proinflamatorios y antiinflamatorios. Para establecer su diagnóstico se deben integrar elementos clínicos y paraclínicos con el fin de descartar otras entidades, pues su diagnóstico es de exclusión. El tratamiento se basa en antiinflamatorios no esteroideos y otros medicamentos en casos específicos. Presentación del caso. Adolescente femenina de 16 años con cuadro clínico de un año de evolución consistente en episodios de dolor articular, especialmente en rodillas, acompañado de signos de inflamación local, quien ingresó al servicio de urgencias de un hospital de cuarto nivel por presentar fiebre >38.5°, odinofagia, astenia y adinamia durante los dos últimos días. A la paciente se le realizaron múltiples estudios de extensión, incluyendo exámenes de laboratorio, imagenológicos e histopatológicos, con los que se descartaron diversas causas etiológicas. Asimismo, la joven recibió tratamiento antibiótico empírico sin remisión de sus síntomas, por lo que finalmente se estableció el diagnóstico de CRMO y se indicó manejo ambulatorio con antiinflamatorios no esteroideos y corticoesteroides, con el cual se obtuvo respuesta favorable. Conclusiones. La CRMO debe ser considerada en niños y adolescentes con dolor óseo y un cuadro clínico poco definido con hallazgos de laboratorio, imagenológicos e histopatológicos inespecíficos. En la actualidad es poco lo que se conoce sobre la CRMO, por lo que es necesario realizar investigaciones y ampliar los conocimientos relacionados con esta enfermedad.

Osteítis de calota por sífilis secundaria. Presentación de caso / Calvarial osteitis due to secondary syphilis. Case presentation

RESUMEN Introducción: La sífilis es una infección de transmisión sexual causante de grandes estragos durante toda la historia de la humanidad, en la actualidad su prevalencia es preocupante. El compromiso óseo en la sífilis secundaria puede preceder o seguir a las lesiones mucocutáneas y en algunos casos ocurrir como única manifestación. Objetivo: Describir el caso clínico de un paciente con osteítis de calota en el curso de una sífilis secundaria, que permita a los profesionales de la salud asociar estas lesiones con las infecciones de transmisión sexual. Presentación de caso: Paciente masculino de 33 años de edad, estado civil soltero, con antecedentes patológicos personales de ser portador del Virus del herpes simple oral desde los 24 años, quien asiste a la consulta por presentar cefalea frontal izquierda, opresiva, pulsátil, de inicio leve que se intensifica e irradia al oído homolateral. El examen físico, que incluyó el sistema nervioso, fue negativo. Se indicaron estudios imagenológicos y de laboratorio, los que evidenciaron la presencia de imágenes osteolíticas en región parietal izquierda próxima a la sutura sagital y pruebas serológicas positivas que confirman el diagnóstico de manifestaciones óseas de osteítis de calota por sífilis secundaria. Conclusiones: Durante la sífilis secundaria el hueso del cráneo es el más afectado, al sufrir osteítis proliferativa. Es responsabilidad del personal de salud el diagnóstico oportuno y precoz de la enfermedad, a fin de evitar su progresión, morbilidad y posibles complicaciones.

ABSTRACT Introduction: Syphilis is a sexually transmitted infection that has caused great havoc throughout the history of mankind; currently, its prevalence is of great concern. Bone involvement in secondary syphilis may precede or follow mucocutaneous lesions and, in some cases, occur as the only manifestation of the disease. Objective: To describe the clinical case of a patient with calvarial osteitis in the course of secondary syphilis to allow health professionals to associate these lesions with sexually transmitted infections. Case presentation: Thirty-three-year-old male patient, single, with personal pathological antecedents of being carrier of the oral herpes simplex virus since he was 24 years old who attends the consultation due to left frontal, oppressive, throbbing headache of mild onset that intensifies and radiates to the ipsilateral ear. Physical examination, which included the nervous system, was negative. Imaging and laboratory studies were ordered; the imaging studies showed the presence of osteolytic images in the left parietal region near the sagittal suture, and the positive serological tests confirmed the diagnosis of bone manifestations of calvarial osteitis due to secondary syphilis. Conclusions: In secondary syphilis, the skull bone is most often affected by proliferative osteitis. Risky sexual practices and self-medication have a negative influence on the expression of the disease. The health personnel is responsible for conducting a timely and early diagnosis of the disease in order to avoid its progression, morbidity, and possible complications.

Enfermedad ósea de Paget: reporte de caso / Paget's disease of bone: case report

La enfermedad ósea de Paget es una alteración metabólica generada por un disbalance entre la actividad osteoclástica y osteoblástica, llevando a un proceso de remodelación inadecuado que genera cambios en la estructura ósea. Aunque en muchos casos puede ser asintomática, se asocia a complicaciones severas como posibles fracturas, deformidades esqueléticas, neoplasias óseas y síntomas por compresión de estructuras nerviosas a nivel de cráneo y columna vertebral. Esta patología se presenta más frecuentemente pacientes de sexo masculino y en el Reino Unido, así como en países de población inmigrante británica, sin embargo es muy infrecuente en países latinoamericanos. Se presenta el caso de una paciente de 72 años, diagnosticada con enfermedad de Paget de acuerdo con hallazgos de imágenes y laboratorio, tratada con ácido zoledrónico para manejo sintomático.

Paget's disease of bone is a metabolic alteration generated by an imbalance between osteoclastic and osteoblastic activity, leading to an inadequate remodeling process that generates changes in the bone structure. Although in many cases it can be asymptomatic, it is associated with severe complications such as possible fractures, skeletal deformities, bone neoplasms and symptoms due to compression of nervous structures at the level of the skull and spine. This pathology occurs more frequently in male patients and in the United Kingdom, as well as in countries with a British immigrant population, however it is very rare in Latin American countries. The case of a 72-year-old patient is presented, diagnosed with Paget's disease according to imaging and laboratory findings, treated with zoledronic acid for symptomatic management.

Tibial brown tumor as a presentation of primary hyperparathyroidism / [Tumor pardo tibial como forma de presentación de un hiperparatiroidismo primario]

Cystic fibrous osteitis is a complication of a very evolved hyperparathyroidism. Because the determination of calcium, parathyroid hormone and vitamin D have become routine studies, this bone complication is uncommon in western countries. However, it should be considered in the differential diagnosis of hypercalcemia and lytic bone lesions. The treatment is to suppress the excess parathyroid hormone by parathyroidectomy and osteosynthesis in pathological fracture. We present the case of a female patient with primary hyperparathyroidism and a brown tumor in the right tibia.

La osteítis fibrosa quística es la complicación de un hiperparatiroidismo muy evolucionado. Debido a que la determinación del calcio, hormona paratiroides y vitamina D han pasado a ser estudios rutinarios, esta complicación ósea es infrecuente en los países occidentales. Sin embargo, debe ser considerada en el diagnóstico diferencial de hipercalcemia y lesiones óseas líticas. El tratamiento de esta entidad va dirigido a suprimir el exceso de hormona paratiroides mediante la paratiroidectomia y osteosíntesis en los casos de fracturas patológicas. Se presenta el caso de una paciente con hiperparatiroidismo primario y un tumor pardo en la tibia derecha.

Septic Arthritis of the Pubic Symphysis in Adult: A Case Report.

Septic arthritis of the pubic symphysis is a rare condition. Risk factors include trauma, low-grade infection, urological or gynecological procedures, malignant tumors of the pelvis, sports, and intravenous drug abuse. This report describes a case of septic arthritis of the pubic symphysis in a 23-year-old male patient with no history of pelvic surgery, previous infections, or intense physical activity. Arthritis was diagnosed by blood culture positive for Enterococcus spp. and yeasts, and the patient was treated with antibiotics. This case emphasizes the importance of complementary exams to aid the treatment of septic arthritis of the pubic symphysis and shows that an invasive procedure, such as pubic symphysis puncture biopsy, may not be required.

Septic Arthritis of the Pubic Symphysis in Adult: A Case Report / Artrite séptica da sínfise pubiana em adultos: Relato de caso

Abstract Septic arthritis of the pubic symphysis is a rare condition. Risk factors include trauma, low-grade infection, urological or gynecological procedures, malignant tumors of the pelvis, sports, and intravenous drug abuse. This report describes a case of septic arthritis of the pubic symphysis in a 23-year-old male patient with no history of pelvic surgery, previous infections, or intense physical activity. Arthritis was diagnosed by blood culture positive for Enterococcus spp. and yeasts, and the patient was treated with antibiotics. This case emphasizes the importance of complementary exams to aid the treatment of septic arthritis of the pubic symphysis and shows that an invasive procedure, such as pubic symphysis puncture biopsy, may not be required.

Resumo A artrite séptica da sínfise púbica é uma condição rara. Os fatores de risco são trauma, infecção de baixo grau, procedimentos urológicos ou ginecológicos, tumores malignos da pelve, prática de esportes e uso de drogas intravenosas. O presente relato descreve um caso de artrite séptica da sínfise púbica em um paciente do sexo masculino, de 23 anos, sem história de cirurgias pélvicas, infecções prévias ou atividade física intensa. A artrite foi diagnosticada pela hemocultura que revelou crescimento de Enterococcus sp + leveduras, e o paciente foi tratado com antibioticoterapia. Este caso enfatiza a importância de exames complementares no auxílio do tratamento da artrite séptica da sínfise púbica, e demonstra que procedimentos invasivos, tais como a punção da sínfise púbica, podem não ser necessários.

Antimicrobial Photodynamic Therapy for the Treatment of Alveolar Osteitis in a Patient With Acute Lymphoid Leukemia: A Case Report.

Introduction: Acute lymphoid leukemia (ALL) is a malignant disease, the prognosis of which depends on the age of the patient and the treatment. The aim of this article was to report the treatment of this rare and interesting case of alveolar osteitis with antimicrobial photodynamic therapy (aPDT) in a patient with ALL that was resolved efficiently and quickly. Case Presentation: A 33-year-old male diagnosed with ALL attended the public service, complaining of pain in the region of tooth 48, without function. Extraction was performed, and the patient returned for postoperative follow-up, complaining of severe pain in the area of the alveolus. Clinical examination revealed osteitis. The alveolus was treated using aPDT with 0.005% methylene blue photosensitizer, followed by the application of a low-level red laser at a wavelength of 660 nm (321 J/cm2 - site). After 15 days, soft tissue closure was observed and complete filling of the alveolus was observed radiographically with a 7-month follow-up. Conclusion: The authors suggest that aPDT can be an effective treatment of alveolar osteitis in a patient with ALL.

Anabolic steroid-induced myositis and osteitis. case report through a radiologic approach

ABSTRACT Introduction: Myositis is a rare complication of extra-articular anabolic steroid injections, while osteitis has not been reported as an adverse effect from this cause. This case report provides information about imaging findings of these two entities. Case presentation: A 37-year-old male, bodybuilder, presented pain and edema in the left gluteal region, associated with functional limitation, 5 days after receiving an intramuscular anabolic steroid injection (stanozolol). The man underwent an ultrasound scan and magnetic resonance imaging of the pelvis with contrast, which allowed making the diagnosis of myositis of the left gluteus maximus and osteitis of the iliac bone. The patient was treated with piperacillin-tazobactam and vancomycin for 10 days, without complications. No surgical management was required. Conclusion: Myositis is a rare complication of anabolic steroid injections and the pathophysiological mechanism of this substance is unknown. Osteitis, on the other hand, is an even rarer complication and, to the best of our knowledge, this is the first known case associated with this cause. Given the findings, the myositis reported herein has an infectious nature; however, further studies are required to demonstrate the actual causal association.

RESUMEN Introducción. La miositis es una complicación muy rara de las inyecciones extraarticulares de esteroides anabólicos y la osteítis no ha sido reportada como efecto adverso por esta causa. El presente reporte de caso aporta información sobre los hallazgos imagenológicos de estos dos tipos de inflamaciones. Presentación del caso. Paciente masculino de 37 años, dedicado al fisicoculturismo, quien cinco días después de recibir una inyección de estano-zolol presentó dolor y edema en la región glútea izquierda asociados a limitación funcional. El sujeto asistió a consulta por este motivo y se le realizó una ecografía y una resonancia magnética contrastada de pelvis, cuyos resultados permitieron diagnosticarle miositis del glúteo mayor izquierdo y osteítis del hueso ilíaco. Se indicó tratamiento con piperacilina-tazobactam y vancomicina por 10 días y no se requirió manejo quirúrgico dado que se obtuvieron buenos resultados. Conclusión. La miositis es una complicación rara de las inyecciones de esteroides anabólicos en donde el mecanismo fisiopatológico de estas sustancias es incierto. Por su parte, la osteítis es una complicación aún más rara de la cual se presenta el primer caso conocido por esta causa. Dados los hallazgos se plantea que la miositis reportada es de tipo infecciosa; sin embargo, se requieren estudios adicionales que demuestren la asociación causal real.

Enfermedad de Paget de hueso esporádica. Serie de casos y revisión de la literatura / Sporadic Paget's disease of the bone. Case series and literature review

RESUMEN La enfermedad de Paget ósea es una enfermedad metabólica del hueso de etiología no esclarecida, que se caracteriza por una fase de resorción aumentada seguida por una fase de osteoformación aberrante. Es frecuente en Europa, Norteamérica, Nueva Zelanda y Australia, pero infrecuente en Asia, Medio Oriente y África. En población colombiana hay reportes de casos. Generalmente cursa asintomática y se diagnostica incidentalmente por hallazgos radiográficos o fosfatasa alcalina elevada. El uso de bifosfonatos favorece el control del recambio óseo y permite prevenir complicaciones como las fracturas. Se presenta una serie de casos en Colombia y una revisión de la literatura.

A B S T R A C T Paget's disease of the bone is a metabolic bone disease of unknown origin, and is characterised by an increased phase of resorption, followed by an aberrant osteoformation phase. It is common in Europe, North America, New Zealand, and Australia, but infrequent in Asia, the Middle East, Africa, and in the Colombian population there are case reports. It is usually asymptomatic and is diagnosed incidentally by radiographic findings or an elevated alkaline phosphatase. The use of bisphosphonates favours the control of bone turnover and prevents complications such as fractures. A series of cases in Colombia is presented, along with a review of the literature.

Prevention of bone infection after open fracture using a chitosan with ciprofloxacin implant in animal model

Purpose To evaluate different concentrations of ciprofloxacin to prevent infection after open fracture contaminated with S. aureus in rats using absorbable local delivery system. Methods Fifty-two Wistar rats were assigned to six groups. After 4 weeks, all animals underwent 99mTc-ceftizoxima scintigraphy evaluation, callus formation measurement and histological analysis. ANOVA, t-Student and Kruskal Wallis were used for quantitative variables statistical analysis, whereas qui square and exact Fisher were used for qualitative variables. Results Treatment using 25% and 50% of ciprofloxacin incorporated at the fracture fixation device were effective in preventing bone infection compared to control group (p<0.05). Chitosan were not effective in preventing bone infection when used alone compared to control group (p>0.05). Histological findings demonstrated bone-healing delay with 50% of ciprofloxacin. No difference in callus formation were observed (p>0.05). Conclusion Local delivery treatment for contaminated open fracture using chitosan with ciprofloxacin is effective above 25%.(AU)

Prevention of bone infection after open fracture using a chitosan with ciprofloxacin implant in animal model

Abstract Purpose To evaluate different concentrations of ciprofloxacin to prevent infection after open fracture contaminated with S. aureus in rats using absorbable local delivery system. Methods Fifty-two Wistar rats were assigned to six groups. After 4 weeks, all animals underwent 99mTc-ceftizoxima scintigraphy evaluation, callus formation measurement and histological analysis. ANOVA, t-Student and Kruskal Wallis were used for quantitative variables statistical analysis, whereas qui square and exact Fisher were used for qualitative variables. Results Treatment using 25% and 50% of ciprofloxacin incorporated at the fracture fixation device were effective in preventing bone infection compared to control group (p<0.05). Chitosan were not effective in preventing bone infection when used alone compared to control group (p>0.05). Histological findings demonstrated bone-healing delay with 50% of ciprofloxacin. No difference in callus formation were observed (p>0.05). Conclusion Local delivery treatment for contaminated open fracture using chitosan with ciprofloxacin is effective above 25%.

Síndrome Sapho: reporte de caso / SAPHO syndrome: report of a case

El síndrome SAPHO es una enfermedad inflamatoria de origen multifactorial que incluye una asociación entre manifestaciones dermatológicas y osteoarticulares. La presencia de osteítis e hiperostosis definen la enfermedad. No existe un tratamiento estándar, pero se usan AINES como primera línea. Se presenta el caso de un varón de 18 años con acné severo en dorso, pecho, barbilla y zona retroauricular, asociado a fiebre alta y placas eritematosas en ambas piernas. La gammagrafía presenta hipercaptación en tibia derecha, con relación a osteítis no infecciosa. Tuvo evolución favorable con antibióticos y corticoide oral.

SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) is a multifactorial inflammatory condition that includes an association between dermatological and bone and joint manifestations. The presence of osteitis and hyperostosis define this disease. There is no standard therapy for SAPHO syndrome, but NSAIDs are used as first line. We present the case of an 18-year-old male subject with severe acne on his back, chest, chin, and the retroauricular area, being this associated to high fever and erythematous plaques in both legs. The bone scan showed right leg hyper-uptake, related to non-infectious osteitis. The patient did well with antibiotics and oral steroids.

DIAGNOSIS AND MANAGEMENT OF PAGET'S DISEASE OF BONE - SERIES OF 8 CASES.

Paget's disease of bone is a chronic condition characterized by focal abnormalities of absorption and formation of bone, and it may lead to anatomical deformities, pain, fractures, and malignant transformation. It is common in the UK, Australia, New Zealand, and North America and has a strong hereditary component, affecting first- to third-degree relatives. The etiology remains unclear and treatment is based on control of the disease with bisphosphonates, with the aim of relieving symptoms and correcting laboratory abnormalities. Surgical treatment may also be necessary to correct deformities or treat pathological fractures. This study evaluated the management and course of 8 patients with Paget's disease of bone, followed in the Orthopedic Clinic of this hospital. Among these patients, 1 had concomitant advanced prostate carcinoma, highlighting the association between Paget's disease and secondary bone diseases that can affect the differential diagnosis. Level of evidence IV, Study type: Case Series.

A doença de Paget Óssea é uma afecção crônica, caracterizada por distúrbio focal da absorção e formação ósseas, podendo levar a deformidades anatômicas, dor, fraturas e malignização das lesões. É frequente no Reino Unido, Austrália, Nova Zelândia e América do Norte. Mantém forte relação de incidência com parentes de primeiro a terceiro graus. Sua etiologia ainda permanece incerta e o tratamento se baseia no controle da doença, com uso de bisfosfonados, visando melhora dos sintomas e das alterações laboratoriais. O tratamento cirúrgico também pode ser necessário, para correção de deformidades ou para tratamento de fraturas. Este estudo compilou oito pacientes em acompanhamento pela doença de Paget Óssea, no Ambulatório de Ortopedia deste hospital, acerca do tratamento realizado e como evoluíram. Dentre os pacientes acompanhados, houve um caso de carcinoma de próstata concomitante ao Paget, chamando atenção para outras patologias ósseas que são diagnósticos diferenciais ou coexistem com a doença. Nível de evidência IV, Tipo de Estudo: Série de Casos.

Diagnosis and management of paget's disease of bone - series of 8 cases / Diagnóstico e manejo da doença de paget óssea - série de 8 casos

ABSTRACT Paget's disease of bone is a chronic condition characterized by focal abnormalities of absorption and formation of bone, and it may lead to anatomical deformities, pain, fractures, and malignant transformation. It is common in the UK, Australia, New Zealand, and North America and has a strong hereditary component, affecting first- to third-degree relatives. The etiology remains unclear and treatment is based on control of the disease with bisphosphonates, with the aim of relieving symptoms and correcting laboratory abnormalities. Surgical treatment may also be necessary to correct deformities or treat pathological fractures. This study evaluated the management and course of 8 patients with Paget's disease of bone, followed in the Orthopedic Clinic of this hospital. Among these patients, 1 had concomitant advanced prostate carcinoma, highlighting the association between Paget's disease and secondary bone diseases that can affect the differential diagnosis. Level of evidence IV, Study type: Case Series.

RESUMO A doença de Paget Óssea é uma afecção crônica, caracterizada por distúrbio focal da absorção e formação ósseas, podendo levar a deformidades anatômicas, dor, fraturas e malignização das lesões. É frequente no Reino Unido, Austrália, Nova Zelândia e América do Norte. Mantém forte relação de incidência com parentes de primeiro a terceiro graus. Sua etiologia ainda permanece incerta e o tratamento se baseia no controle da doença, com uso de bisfosfonados, visando melhora dos sintomas e das alterações laboratoriais. O tratamento cirúrgico também pode ser necessário, para correção de deformidades ou para tratamento de fraturas. Este estudo compilou oito pacientes em acompanhamento pela doença de Paget Óssea, no Ambulatório de Ortopedia deste hospital, acerca do tratamento realizado e como evoluíram. Dentre os pacientes acompanhados, houve um caso de carcinoma de próstata concomitante ao Paget, chamando atenção para outras patologias ósseas que são diagnósticos diferenciais ou coexistem com a doença. Nível de evidência IV, Tipo de Estudo: Série de Casos.

Clinical Manifestations, Management, and Outcomes of Osteitis/Osteomyelitis Caused by Mycobacterium bovis Bacillus Calmette-Guérin in Children: Comparison by Site(s) of Affected Bones.

OBJECTIVE: To evaluate the clinical manifestations, management, and outcomes of Mycobacterium bovis Bacillus Calmette-Guérin (BCG) osteitis/osteomyelitis. STUDY DESIGN: We reviewed 71 cases of BCG osteitis/osteomyelitis registered in Taiwan's vaccine injury compensation program (VICP) in 1998-2014. Demographic, clinical, laboratory, treatment, and outcome data were compared according to site(s) of infection. RESULTS: Involvement of a long bone of the lower extremity was present in 36.6% of the children, followed by foot bone (23.9%), rib or sternum (15.5%), upper extremity long bone (9.9%), hand bone (7%), multiple bones (4.2%), and vertebrae (2.8%). Children with lower extremity long bone involvement had a longer interval from receipt of BCG vaccine to presentation (median, 16.0 months; P = .02), and those with foot bone infection had higher rates of swelling (94.1%; P = .02) and local tenderness (76.5%; P = .004). Surgical intervention was performed in 70 children, with no significant difference in the number of procedures by site (median, 1.0 procedure per patient). Among the 70 children who received antimicrobial therapy, those with vertebral and multifocal infections had a longer duration of treatment (P < .001) and/or second-line antituberculosis medications (P = .002). Three children with vertebral and multifocal infections had major sequelae with kyphosis or leg length discrepancy. Outcomes were good for children with involvement of the ribs, sternum, and peripheral bones without multifocal involvement. The average time for functional recovery was 6.2 ± 3.9 months. CONCLUSION: Children with BCG osteitis/osteomyelitis in different bones had distinct presentations and outcomes. Pediatricians should consider BCG bone infection in young vaccinated children with insidious onset of signs and symptoms, and consider affected site(s) in the management plan.

Infection, Alveolar Osteitis, and Adverse Effects Using Metronidazole in Healthy Patients Undergoing Third Molar Surgery: A Meta-analysis.

PURPOSE: The aim of this systematic review and meta-analysis was to evaluate the risk of surgical infection, alveolar osteitis, and adverse effects using systemic metronidazole in comparison with placebo in healthy patients undergoing third molar surgery. MATERIALS AND METHODS: The eligible reports were identified from diverse science sources. Clinical trials meeting the inclusion and exclusion criteria and an acceptable Oxford Quality Score were included in this study. The evaluation of risk was done using the Risk Reduction Calculator and Review Manager 5.3., from the Cochrane Library. A significant risk reduction was assumed when the upper limit of the 95% confidence intervals was <1 and the lower limit did not cross zero (negative number) alongside a p value of <0.05 for the overall test. Data of 667 patients from five clinical trials were used for the assessment of risk. RESULTS: Our analysis showed no reduction of the risk of infection or dry socket in patients receiving metronidazole compared to whom took placebo. Meanwhile, the adverse effects did not exhibit a difference between the studied groups. CONCLUSION: The routine use of systemic metronidazole to prevent surgical site infection and/or dry socket in healthy patients undergoing third molar surgery is not recommended.

Maxillomandibular giant osteosclerotic lesions

Abstract Giant Osteosclerotic Lesions (GOLs) are a group of rarely reported intraosseous lesions. Their precise diagnosis is important since they can be confused with malignant neoplasms. Objective This retrospective study aimed to record and analyze the clinical and radiographic Giant Osteosclerotic Lesions (GOLs) detected in the maxillomandibular area of patients attending to our institution. Materials and Methods: Informed consent from the patients was obtained and those cases of 2.5 cm or larger lesions with radiopaque or mixed (radiolucid-radiopaque) appearance located in the maxillofacial bones were selected. Assessed parameters were: age, gender, radiographic aspect, shape, borders, size, location and relations to roots. Lesions were classified as radicular, apical, interradicular, interradicular-apical, radicular-apical or located in a previous teeth extraction area. Additionally, several osseous and dental developmental alterations (DDAs) were assessed. Results Seventeen radiopacities in 14 patients were found and were located almost exclusively in mandible and were two types: idiopathic osteosclerosis and condensing osteitis. GOLs were more frequent in females, and in the anterior and premolar zones. 94.2% of GOLs were qualified as idiopathic osteosclerosis and one case was condensing osteitis. All studied cases showed different osseous and dental developmental alterations (DDAs). The most common were: Microdontia, hypodontia, pulp stones, macrodontia and variations in the mental foramina. Conclusions GOLs must be differentiated from other radiopaque benign and malignant tumors. Condensing osteitis, was considered an anomalous osseous response induced by a chronic low-grade inflammatory stimulus. For development of idiopathic osteosclerosis, two possible mechanisms could be related. The first is modification of the normal turnover with excessive osseous deposition. The second mechanism will prevent the normal bone resorption, arresting the osseous breakdown process.

Chlorhexidine for prevention of alveolar osteitis: a randomised clinical trial

Abstract Objective To determine the effectiveness of chlorhexidine 0.12% mouthwash (CHX) after tooth extraction for the prevention of alveolar osteitis (AO). Material and methods We conducted a double-blind randomised clinical trial stratified by risk factors. We enrolled a cohort of 822 patients who underwent dental extractions, and were considered to be at risk of developing AO (previous surgical site infection, traumatic extraction, and tobacco smoking). After extraction, patients were randomly allocated for CHX group or placebo group, matched by risk factors. The primary outcome was clinical diagnosis of AO: increasing postoperative pain for 4 d within and around the socket, and total or partial breakdown of the blood clot in the socket with or without bone exposure. Results Follow-up was completed by 744 participants (372 chlorhexidine and 372 placebo). We detected no significant differences between the two groups at baseline. After completed follow-up, risk factors were equally distributed between the two groups. Overall incidence of OA was 4.97%, in which 27 participants treated with placebo (7.26%) and 10 participants treated with CHX (2.69%) developed AO. CHX reduced the incidence of AO by 63% [Absolute Risk Reduction: 4.57 (95% CI 1.5-7.7), Number Needed to Treat: 21.88 (95% CI 13.0-69.3), Fisher's exact test: p=0.006]. No adverse effects were reported. Conclusion The use of chlorhexidine 0.12% mouthwash after tooth extraction is safe and effective in reducing the incidence of AO in high-risk patients.