Oral implant rehabilitation in a patient with Moebius syndrome

Introduction: Moebius syndrome is a rare congenital disorder characterized by unilateral or bilateral involvement of the sixth and seventh cranial nerves, resulting in a lack of facial expression and eye movements. These patients suffer a series of oral manifestations that may complicate their dental treatment, such as facial and tongue muscle weakness, uncontrolled salivation secondary to deficient lip sealing, micrognathia, microstomia, bifid uvula, gothic and fissured palate, fissured tongue, and glossoptosis. The underlying etiology remains unclear, though vascular problems during embryogenesis appear to be involved. Clinical case: We report the case of a woman with Moebius syndrome and total edentulism. Eight years ago she underwent complete oral rehabilitation with the placement of two implants in each dental arch. Discussion: Moebius syndrome has still an unknown etiology, although it is related to disorders during pregnancy. This kind of patient can be rehabilitated using oral implants (AU)

Erupted odontomas: A report of three cases and review of the literature

Introduction: Odontomas are benign odontogenic tumors composed of enamel, dentine, cement and pulp tissue. They are usually clinically asymptomatic, but often associated with tooth eruption disturbances. In exceptional cases the odontoma erupts into the mouth. The present study reports three cases of odontomas erupted into the oral cavity and reviews the literature. Clinical cases: The first case was an 11-year-old girl with impacted 4.6 associated to a radiopaque mass measuring about 2 cm in diameter. The histological diagnosis was complex odontoma. A clinical and radiological follow-up of 4.6 was carried out until its spontaneous eruption. The second case was a 26-year-old male presenting a hard, yellowish-brown mass located distal to the upper left second molar. Computed tomography confirmed the presence of a radiopaque lesion, and the histopathological study confirmed a complex odontoma. The third patient was a 27-year-old male reporting tongue irritation due to tooth eruption in the inferior lingual region. A periapical radiograph revealed a mixed radiopaque lesion associated to impacted 3.2. The histological report in this case indicated a compound odontoma. Discussion: Odontomas erupting into the oral cavity are rare. The first case was published in 1980, and since then only 17 cases have been reported in the literature. Eight of the 17 cases were complex odontomas; the rest were compound odontomas. Pain, swelling and infection were the most common symptoms, and 13 cases presented an impacted tooth associated with the lesion (AU)

Estudio comparativo de la eficacia anestésica de la Articaína al 4% respecto a la Lidocaína al 2% en el bloqueo troncal del nervio alveolar inferior durante la extracción quirúrgica de terceros molares inferiores / Comparative study of the anesthetic efficacy of 4% articaine versus 2% lidocaine in inferior alveolar nerve block during surgical extraction of impacted lower third molars

Objetivo: Valorar y comparar la eficacia anestésica de la Articaína al 4% respecto a la Lidocaína al 2%, ambas con una concentración de 1:100.000 de epinefrina en el bloqueo troncal del nervio alveolar inferior durante la extracción quirúrgica de terceros molares inferiores incluidos.Diseño del estudio: Se realizó un ensayo clínico aleatorio a doble ciego en una muestra de 30 pacientes programados para las extracciones quirúrgicas bilaterales de terceros molares inferiores simétricos en el Servicio de Cirugía Bucal del Máster de Cirugía e Implantología Bucal de la Universidad de Barcelona. Previo consentimiento del paciente, dos operadores efectuaron las intervenciones quirúrgicas de forma extemporánea, utilizando como anestésico local la Articaína al 4% o la Lidocaína al 2 % con la misma concentración de vasoconstrictor (epinefrina 1:100.000). Las variables estudiadas para cada anestésico fueron: tiempo de latencia (o de inicio del efecto anestésico), duración del efecto anestésico, cantidad de solución anestésica utilizada y la necesidad de reanestesiar la zona operatoria. Se utilizó una escala analógica visual para valorar la cantidad de dolor experimentado durante el acto quirúrgico y, así, evaluar subjetivamente la profundidad anestésica de las dos soluciones.Resultados: Se observaron diferencias estadísticamente significativas (p= .003) en cuanto a la duración del efecto anestésico,que fue mayor para la artcaína al 4% (220,8 minutos), respecto a la lidocaína al 2% (168,20 minutos). En las variables tiempo de latencia, cantidad de solución anestésica utilizada y necesidad de reanestesiar el campo operatorio se evidenciaron diferencias clínicas a favor de la articaína, aunque estas diferencias no fueron estadísticamente significativas.La valoración cualitativa de los anestésicos mediante la escala analógica visual mostró similitud en el dolor experimentado por los pacientes con ambos anestésicos.Conclusiones: De acuerdo con los resultados obtenidos se puede afirmar que la articaína al 4% muestra mejores característicasclínicas que la lidocaína al 2%, especialmente en cuanto al tiempo de latencia y duración del efecto anestésico. Sin embargo, no hubieron diferencias estadísticamente significativas que confirmen la superioridad de una solución respecto a la otra, al valorar la eficacia anestésica

Background: A comparative study is made of the anesthetic efficacy of 4% articaine versus 2% lidocaine, both with epinephrine 1:100,000, in truncal block of the inferior alveolar nerve during the surgical extraction of impacted lower third molars.Study design: A randomized double-blind clinical trial was conducted of 30 patients programmed for the bilateral surgical extraction of symmetrical lower third molars in the context of the Master of Oral Surgery and Implantology (University of Barcelona, Barcelona, Spain). Following the obtainment of informed consent, two operators performed surgery on an extemporaneous basis, using as local anesthetic 4% articaine or 2% lidocaine with the same concentration of vasoconstrictor (epinephrine 1:100,000). The study variables for each anesthetic were: latency (time to action) and duration of anesthetic effect, the amount of anesthetic solution used, and the need of re-anesthetize the surgical zone. A visual analog scale was used to assess pain during surgery, and thus subjectively evaluate the anesthetic efficacy of the two solutions.Results: Statistically significant differences (p = 0.003) were observed in the mean duration of anesthetic effect (220.86 min. for 4% articaine vs. 168.20 min. for 2% lidocaine). Latency, the amount of anesthetic solution and the need to re-anesthetize the surgical field showed clinical differences in favor of articaine, though statistical significance was not reached. The pain scores indicated similar anesthetic efficacy with both solutions.Conclusions: The results obtained suggest that 4% articaine offers better clinical performance than 2% lidocaine, particularlyin terms of latency and duration of the anesthetic effect. However, no statistically significant differences in anesthetic efficacy were recorded between the two solutions

Estudio retrospectivo de 145 dientes supernumerarios / Retrospective study of 145 supernumerary teeth

Objetivo: El presente estudio retrospectivo pretende describir la distribución de los dientes supernumerarios en una población de pacientes que acuden a una Unidad ambulatoria de Cirugía Bucal.Introducción: Los dientes supernumerarios y la hiperodoncia múltiple se asocian normalmente con diferentes síndromes como el de Gardner o con fisuras faciales; sin embargo, pueden aparecer en pacientes sin ningún tipo de patología. Su prevalencia oscila entre el 0,5 y el 3,8% en la dentición permanente y entre el 0,35 y el 0,6% en la decidua.Pacientes y método: Para ello, se revisaron 36.057 historias clínicas de pacientes que acudieron a nuestro Servicio entre septiembrede 1991 y marzo de 2003. Se recogieron los siguientes datos: edad, sexo, número de dientes supernumerarios extraídos, localización, morfología y tipo de diente supernumerario. El número de pacientes incluidos en el estudio fue de 102.Resultados: De los 147 dientes supernumerarios descubiertos en la cavidad bucal, se extrajeron un total de 145. El grupo más frecuente fue el de los mesiodens (46,9%), seguido por los premolares supernumerarios (24,1%) y los cuartos molares supernumerarios o distomolares (18%). El 74,5% de los dientes supernumerarios se localizaban en el maxilar superior y un 46,9% de los dientes supernumerarios se localizaban en palatino/lingual. La morfología heteromórfica aparecía en dos tercios de los dientes supernumerarios, siendo la más frecuente la conoide. El 29,7% de los dientes supernumerarios producían la inclusión de los dientes permanentes, siendo el mesiodens el que la producía con mayor frecuencia.Conclusiones: Los mesiodens producen con elevada frecuencia la retención de los incisivos permanentes, que erupcionanespontáneamente después de la extracción de los dientes supernumerarios, si tienen espacio suficiente en la arcada y conservan la fuerza eruptiva. Los premolares supernumerarios tienen normalmente morfología eumórfica y son un hallazgo radiológico casual, al no producir ningún tipo de sintomatología

Objective: The goal of the present retrospective study is to describe the distribution of the supernumerary teeth in a population of patients that have been attended at the Public Clinic of the Department of Oral Surgery.Background: Supernumerary teeth and multiple hyperdontia are usually associated with different syndromes, such as Gardner syndrome, or with facial fissures; however, they can appear in patients without any pathology. Their prevalence oscillates to 0.5-3.8% in patients with permanent teeth and to 0.35-0.6% in patients with primary teeth.Patients and Methods: A total of 36,057 clinical histories of patients that were admitted at the clinic between September of 1991 and March of 2003 were revised. The following data were extrapolated: age, sex, number of extracted supernumeraryteeth, localization, morphology and type of supernumerary teeth. Consequently, 102 patients were included into the present study.Results: Of the 147 supernumerary teeth identified in the oral cavities of patients 145 were extracted. The most frequent supernumerary teeth identified were mesiodens (46.9%), followed by premolars (24.1%) and fourth molars or distal molars (18%). As for location, 74.5% of the supernumerary teeth were found in the superior maxillary bone and 46.9% of the supernumerary teeth were present in the palatine/lingual area. Heteromorphology was found in two thirds of the supernumerary teeth, with conical shape being the most frequent. Finally, 29.7% of the supernumerary teeth had occlusion with permanent teeth, and mesiodens were the predominating type of supernumerary teeth that showed this feature.Conclusions: Mesiodens very frequently cause retention of permanent incisors, which erupt spontaneously after the extraction of supernumerary teeth, if there is sufficient space in the dental arch and if they conserve the eruptive force. Generally, supernumerary premolars are eumorphic and are casually discovered during radiological exam, if not producingany symptomology