Influence of different types of pulp treatment during isolation in the obtention of human dental pulp stem cells.

BACKGROUND: Different methods have been used in order to isolate dental pulp stem cells. The aim of this study was to study the effect of different types of pulp treatment during isolation, under 3% O2 conditions, in the time needed and the efficacy for obtaining dental pulp stem cells. MATERIAL AND METHODS: One hundred and twenty dental pulps were used to isolate dental pulp stem cells treating the pulp tissue during isolation using 9 different methods, using digestive, disgregation, or mechanical agents, or combining them. The cells were positive for CD133, Oct4, Nestin, Stro-1, CD34 markers, and negative for the hematopoietic cell marker CD-45, thus confirming the presence of mesenchymal stem cells. The efficacy of dental pulp stem cells obtention and the minimum time needed to obtain such cells comparing the 9 different methods was analyzed. RESULTS: Dental pulp stem cells were obtained from 97 of the 120 pulps used in the study, i.e. 80.8% of the cases. They were obtained with all the methods used except with mechanical fragmentation of the pulp, where no enzymatic digestion was performed. The minimum time needed to isolate dental pulp stem cells was 8 hours, digesting with 2mg/ml EDTA for 10 minutes, 4mg/ml of type I collagenase, 4mg/ml of type II dispase for 40 minutes, 13ng/ml of thermolysine for 40 minutes and sonicating the culture for one minute. CONCLUSIONS: Dental pulp stem cells were obtained in 97 cases from a series of 120 pulps. The time for obtaining dental pulp stem cells was reduced maximally, without compromising the obtention of the cells, by combining digestive, disgregation, and mechanical agents.

Oral bisphosphonate-related osteonecrosis of the jaws in dental implant patients: a case series.

Bisphosphonates have been associated with a serious adverse reaction known as bisphosphonate-related osteonecrosis of the jaws (BRONJ). The aim of this study was to describe its clinical characteristics in patients with dental implants who were taking bisphosphonates orally. We made a retrospective multicentre study in 3 hospitals in Galicia, Spain. The medical records and clinical and radiological follow-up of the oral cavity were reviewed for those patients given bisphosphonates and diagnosed with BRONJ after the placement of dental implants within the previous 3 years. The series comprised 9 white patients (mean age 66 years). The bisphosphonates were alendronate (n=6), ibandronate (n=2), and risedronate (n=1), and the most common indication was osteoporosis (n=7). The mean interval between the initiation of treatment and the onset of BRONJ lesions was 60 months. Most of the lesions were located around the mandibular implants (n=8). The mean interval between placement of dental implants and the onset of BRONJ was 34 (range 1-96) months. After treatment 7/9 patients recovered completely. The prevalence of BRONJ secondary to treatment with bisphosphonates taken orally after placement of dental implants may be higher than expected in a particular geographical region, but to date specific risk factors have not been identified. Clinical characteristics and the outcomes of treatment of lesions are similar to those seen in patients with BRONJ that is unrelated to placement of dental implants.

Tratamiento del dolor orofacial en pacientes con síndrome del ligamento estilomandibular (síndrome de Ernest) / Treatment of orofacial pain in patients with stylomandibular ligament syndrome (Ernest Syndrome)

Introducción: El síndrome de Ernest se define como una alteración del ligamento estilomandibular, caracterizado por la presencia de dolor en la región preauricular y en el ángulo mandibular, irradiado al cuello, el hombro y el ojo del mismo lado, asociado a dolor durante la palpación del ligamento estilomandibular. El objetivo es presentar las características clínicas, el tratamiento y la evolución de una serie de pacientes con el síndrome de Ernest. Métodos: Se realizó un estudio clínico, observacional, retrospectivo, entre los años 1998 y 2008. Se recogieron todos los datos con respecto a la edad, el sexo, eltiempo de evolución y las característicasdeldolor.Atodos lospacientes seles infiltró40mgdeacetónidodetriamcinolonaen la inserción mandibular del ligamento estilomandibular. Resultados: Se incluyó a 6 pacientes. La edad media fue de 40,3 anos (rango 35-51). El 100% eran mujeres. Cuatro de las 6 pacientes recibieron tratamientos odontológicos prolongados el mes previo a la aparición del dolor. El tiempo de evolución medio antes de la primera visita fue de 23 meses. Tras eltratamiento realizado, se obtuvo una resolución completa de todos los pacientes, con un periodo de seguimiento mínimo de 12 meses. Conclusiones: Se han analizado las características clínicas del dolor, el tratamiento recibido y la evolución de 6 pacientes con el síndrome de Ernest. Es importante realizar un correcto diagnóstico para poder establecer el tratamiento correcto. Creemos que esta enfermedad es más prevalente de lo encontrado en la literatura, pudiéndose confundir con otros dolores orofaciales (AU)

Introduction: Ernest syndrome involves the stylomandibular ligament. It is characterised by pain in the preauricular area and mandibular angle, radiating to the neck, shoulder, and eye on the same side, and associated with pain during palpation of that ligament. The purpose of this study is to describe the clinical characteristics, treatment, and course of the disease in a series of patients with Ernest syndrome. Methods: Retrospective observational study covering the period from 1998 to 2008. We recorded patients’ age, sex, duration of the disorder, and pain characteristics. All patients were injected with 40mg triamcinolone acetonide atthe mandibularinsertion ofthe stylomandibular ligament. Results: The study included a total of 6 patients. Mean age was 40.3 years (range, 35-51). All of the subjects were women. Four patients had undergone lengthy dental treatments in the month priorto onset ofthe pain. The mean time between pain onset and first consultation was 23 months. The syndrome resolved completely in all cases after treatment, with a minimum follow-up period of 12 months. Conclusions: We analysed the clinical characteristics, treatment, and course of disease in 6 patients with Ernest syndrome. Correct diagnosis is the key to being able to provide proper treatment. This disorder is sometimes confused with other types of orofacial pain, and may therefore be more prevalent than the literature would indicate (AU)

Treatment of orofacial pain in patients with stylomandibular ligament syndrome (Ernest Syndrome).

INTRODUCTION: Ernest syndrome involves the stylomandibular ligament. It is characterised by pain in the preauricular area and mandibular angle, radiating to the neck, shoulder, and eye on the same side, and associated with pain during palpation of that ligament. The purpose of this study is to describe the clinical characteristics, treatment, and course of the disease in a series of patients with Ernest syndrome. METHODS: Retrospective observational study covering the period from 1998 to 2008. We recorded patients' age, sex, duration of the disorder, and pain characteristics. All patients were injected with 40mg triamcinolone acetonide at the mandibular insertion of the stylomandibular ligament. RESULTS: The study included a total of 6 patients. Mean age was 40.3 years (range, 35-51). All of the subjects were women. Four patients had undergone lengthy dental treatments in the month prior to onset of the pain. The mean time between pain onset and first consultation was 23 months. The syndrome resolved completely in all cases after treatment, with a minimum follow-up period of 12 months. CONCLUSIONS: We analysed the clinical characteristics, treatment, and course of disease in 6 patients with Ernest syndrome. Correct diagnosis is the key to being able to provide proper treatment. This disorder is sometimes confused with other types of orofacial pain, and may therefore be more prevalent than the literature would indicate.

Post-traumatic trigeminal neuropathy. A study of 63 cases.

INTRODUCTION: Trigeminal neuropathy is most often secondary to trauma. The present study explores the underlying causes and the factors that influence recovery. MATERIAL AND METHODS: A retrospective case study was made involving 63 patients with trigeminal neuropathy of traumatologic origin, subjected to follow-up for at least 12 months. RESULTS: Fifty-four percent of all cases were diagnosed after mandibular third molar surgery. In 37 and 19 patients the sensory defect was located in the territory innervated by the mental and lingual nerve, respectively. Pain was reported in 57% of the cases, and particularly among the older patients. Regarding patient disability, quality of life was not affected in three cases, while mild alterations were recorded in 25 subjects and severe alterations in 8. Partial or complete recovery was observed in 25 cases after 6 months, and in 32 after one year. There were few recoveries after this period of time. Recovery proved faster in the youngest patients, who moreover were the individuals with the least pain. CONCLUSION: Our patients with trigeminal neuropathy recovered particularly in the first 6 months and up to one year after injury. The older patients more often suffered pain associated to the sensory defect. On the other hand, their discomfort was more intense, and the patients with most pain and the poorest clinical scores also showed a comparatively poorer course.

Comparative study between manual injection intraosseous anesthesia and conventional oral anesthesia.

OBJECTIVE: To compare intraosseous anesthesia (IA) with the conventional oral anesthesia techniques. MATERIAL AND METHOD: A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for respective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. RESULTS: A total of 200 oral anesthetic procedures were carried out in 100 patients. The mean patient age was 28.6±9.92 years. Fifty-five vestibular infiltrations and 45 mandibular blocks were performed. All patients were also subjected to IA. The type of intervention (conservative or endodontic) exerted no significant influence (p=0.58 and p=0.62, respectively). The latency period was 8.52±2.44 minutes for the conventional techniques and 0.89±0.73 minutes for IA - the difference being statistically significant (p<0.05). Regarding patient anesthesia sensation, the infiltrative techniques lasted a maximum of one hour, the inferior alveolar nerve blocks lasted between 1-3 hours, and IA lasted only 2.5 minutes - the differences being statistically significant (p≤0.0000, Φ=0.29). Anesthetic success was recorded in 89% of the conventional procedures and in 78% of the IA. Most patients preferred IA (61%)(p=0.0032). CONCLUSIONS: The two anesthetic procedures have been compared for latency, duration of anesthetic effect, anesthetic success rate and patient preference. Intraosseous anesthesia has been shown to be a technique to be taken into account when planning conservative and endodontic treatments.

Analysis of the peri-implant microbiota in 90 dental implants and its relationship to crevicular fluid volume.

OBJECTIVE: To evaluate the presence within the peri-implant sulcus of Tannerela forsythia (Tf), Porphyromonas gingivales (Pg), Treponema denticola (Td) and Aggregatibacter actinomycetemcomitans (Aa), and relate these bacteria to the peri-implant crevicular fluid volume (PICFV). MATERIAL AND METHOD: A prospective and cross-sectional clinical case series study was made. For the measurement of crevicular fluid, use was made of the Periotron® 8000 (Proflow Incorporated. New York, USA), measuring the volume in Periotron units (PU). For the detection of periodontopathogenic bacteria we used the IAI-PadoTest 4.5 (IAI Inc., IAI Institute, Zuchwil, Switzerland) - a system for the detection of Tf, Pg, Td and Aa based on the use of RNA arrays. RESULTS: We included 34 patients (19 females and 15 males) with a mean age of 56.4 years. Of these subjects, 30.8% were smokers and 69.2% non-smokers. Out of a total series of 213 implants, we analyzed the crevicular fluid and microbiota in 90 implants. A total of 16.5% of the implants presented mucositis, while 83.5% were in healthy peri-implant conditions. The microbiological study revealed the presence of Tf in 17.1% of the implants, Pg in 9.3%, Td in 13.6%, in Aa in none of the implants. The mean Periotron reading was 93.4 PU (range 12-198 PU). A statistically significant (p<0.05) relationship was observed between PICFV and the total percentage bacteria (Tf, Pg and Td) - with a strong association between the Td levels and smoking (p<0.01). In the implants with mucositis, the concentration of Pg and Td was greater. CONCLUSIONS: In the implants studied, the subgingival peri-implant microbiota was characterized by low levels of Pg, Tf, Td, and none of the patients proved positive for Aa. These bacteria showed a positive correlation to crevicular fluid volume, and a statistically significant relationship was observed between Td and smoking.

Apical surgery of a maxillary molar creating a maxillary sinus window using ultrasonics: a clinical case.

AIM: To describe a method of carrying out apical surgery of a maxillary molar using ultrasonics to create a lateral sinus window into the maxillary sinus and an endoscope to enhance visibility during surgery. SUMMARY: A 37-year-old female patient presented with tenderness to percussion of the maxillary second right molar. Root canal treatment had been undertaken, and the tooth restored with a metal-ceramic crown. Radiological examination revealed an apical radiolucency in close proximity to the maxillary sinus. Apical surgery of the molar was performed through the maxillary sinus, using ultrasonics for the osteotomy, creating a window in the lateral wall of the maxillary sinus. During surgery, the lining of the sinus was exposed and elevated without perforation. The root-end was resected using a round tungsten carbide drill, and the root-end cavity was prepared with ultrasonic retrotips. Root-end filling was accomplished with MTA(®) . An endoscope was used to examine the cut root face, the prepared cavity and the root-end filling. No intraoperative or postoperative complications were observed. At the 12-month follow-up, the tooth had no clinical signs or symptoms, and the radiograph demonstrated progressing resolution of the radiolucency. KEY LEARNING POINTS: When conventional root canal retreatment cannot be performed or has failed, apical surgery may be considered, even in maxillary molars with roots in close proximity to the maxillary sinus. Ultrasonic sinus window preparation allows more control and can minimize perforation of the sinus membrane when compared with conventional rotary drilling techniques. The endoscope enhances visibility during endodontic surgery, thus improving the quality of the case.

Intentional replantation for the management of maxillary sinusitis.

AIM: To present a case that emphasizes the importance of the use of intentional replantation as a technique to successfully treat a periapical lesion and an odontogenic maxillary sinusitis through the alveolus at the same time. SUMMARY: This case report presents a patient with odontogenic maxillary sinusitis secondary to periapical disease of a maxillary molar that had previously received root canal treatment. The molar was extracted, with drainage and rinsing of the maxillary sinus. The apices were resected extra-orally, the retrograde cavities prepared with ultrasound and retrograde fillings of silver amalgam placed. The tooth was then replanted. After 2 years, the patient was asymptomatic, periapical radiography showed no evidence of root resorption and computed tomography scanning demonstrated the resolution of maxillary sinusitis. KEY LEARNING POINTS: *When root canal treatment or periapical surgery cannot be undertaken or has failed, intentional replantation may be considered. *This alternative treatment may be predictable in certain cases.

Trigeminal neuropathy.

Trigeminal neuropathies (TNs) are well recognized disorders characterized and manifesting as skin and mucosal numbness in the region innervated by the trigeminal nerve. Facial numbness indicates trigeminal sensory alteration affecting the trigeminal system. TNs always pose differential location difficulties as multiple diseases are capable of producing them: they can be the result of traumatism, tumors, or diseases of the connective tissue, infectious or demyelinating diseases, or may be of idiopathic origin. Their importance is explained by the fact that TN may represent the first manifestation of tumor disease, or of relapse in patients with prior neoplastic processes. As such, these manifestations are ominous, and patient life expectancy is often short. The clinical exploration reveals a loss of sensitivity in the cutaneous territory corresponding to the affected nerve, which can be partial (hypoesthesia) or complete (anesthesia). The sensory defect is occasionally associated with hyperesthesia (i.e., the patient suffers a decrease in sensory perception, but when sensation is perceived, it may cause considerable discomfort). Complementary studies are needed to establish the etiologic diagnosis, with laboratory tests to discard the possible causative diseases underlying the trigeminal neuropathy, and the opportune radiographic examinations in the form of plain X-rays or a routine cranial computed tomography scan.

Tetracycline compound placement to prevent dry socket: a postoperative study of 200 impacted mandibular third molars.

PURPOSE: Our objective was to study whether the placement of intra-alveolar tetracycline prevents dry sockets or improves the postoperative period. PATIENTS AND METHODS: A comparative clinical study of the surgical removal of 200 impacted mandibular third molars is made, with particular reference to postextraction pain, inflammation, trismus, and the incidence of dry socket. In 50% of these cases, a pharmacologic preparation that includes tetracycline was placed in the socket after removal of the impacted molar. RESULTS: Dry socket was diagnosed in 4 cases (2%), with no relation to intra-alveolar tetracycline placement being observed. The patients who were administered intra-alveolar tetracycline had less pain and trismus and consumed fewer analgesics than the patients who received no such treatment, although statistical significance was not reached. CONCLUSIONS: The intra-alveolar placement of tetracycline compound after the surgical removal of impacted mandibular third molars did not affect the incidence of dry socket.

Leprosy: dental and periodontal status of the anterior maxilla in 76 patients.

OBJECTIVE: To evaluate the presence of oral disease, as assessed by dental and periodontal indices, in the anterior maxilla of a group of 76 patients with leprosy, compared with a group of matched control subjects. MATERIALS AND METHODS: The study included 76 patients with leprosy (age range 40-82 years; 39 males), resident in the sanatorium of San Francisco de Borja de Fontilles (Alicante, Spain). Clinical examination was carried out to evaluate the decayed missing and filled index, and the periodontal status in the anterior maxilla, using the Löe-Silness dental plaque index, mean periodontal probing depth and the average periodontal attachment loss. RESULTS: In the leprosy patients, a large proportion of maxillary incisors and canines were missing. The mean plaque index in leprosy was 2.35 +/- 0.7, with a probing depth of 2.96 +/- 0.8, and an average attachment loss of 4.18 +/- 1.3, indices all statistically greater than in controls. There were no differences detected in the oral indices measured according to the presence or absence of facial destruction or the type of leprosy. CONCLUSIONS: Patients with leprosy show a tendency to poor dental and periodontal health, unrelated to the presence of facial destruction or the type of leprosy.

A retrospective study (1994-1999) of 441 ITI(r) implants in 114 patients followed-up during an average of 2.3 years.

OBJECTIVE: Implantation is a common practice in the oral rehabilitation of edentulous patients, affording good results in extensive patient series. The aim was to determine the average success rate and analyze the causes of implant failure. MATERIAL AND METHODS: In the present retrospective study (1994-1999) a total of 441 ITI(r) implants were performed in 114 patients (58 females (51%) and 56 males (49%) aged 44.5 years on average; range 12-82 years), with a mean follow-up of 2.3 1.3 years. Data recorded included patient age and sex, smoking habit, oral hygiene, the number, length, diameter and type of implants, their location and the prostheses fitted. RESULTS: After 2.3 1.3 years of follow-up, the implant success rate was 96.2%. In 7 patients a total of 15 implants failed during the osseointegration period, while in two patients a total of two implants failed following dentures placement. The failures were mainly attributed to over-drilling during the surgical procedure, or to an overloading upon tightening in the osseointegration period. No significant relation was observed between implant loss and the rest of the clinical parameters studied, with the sole exception of implant length (failure increasing with shorter lengths)(chi-square; p = 0.001).

Relationship between oral surgical and endodontic procedures and episodic cluster headache.

OBJECTIVE: We sought to evaluate the possible relationship between oral surgery and endodontic procedures and the subsequent appearance of cluster headache (CH) in 54 patients. STUDY DESIGN: This study included 54 patients diagnosed and treated for episodic CH. The characteristics of pain, the extractions, and the endodontic procedures performed in the same or a contralateral quadrant were recorded and analyzed by using the chi-square test. RESULTS: Prior tooth extraction or endodontics had been performed in the pain-affected quadrant in 58% of cases and in the contralateral quadrant in 33%. The differences between quadrants were statistically significant. After the onset of pain, extractions were performed in the affected quadrant in 44% of patients. CONCLUSIONS: Although the appearance of pain after dental extraction could suggest a relationship between damage to the nerve supply and the development of CH, the possibility that dental extraction and endodontics may have been performed in response to CH-related pain must also be taken into account. With respect to the differential diagnosis of pain, it is easy for CH to be misdiagnosed as dental pulp pain.

Oral hygiene and postoperative pain after mandibular third molar surgery.

OBJECTIVE: The purpose of this study was to evaluate the association between oral hygiene before surgery and pain, inflammation, and trismus after the surgical removal of 190 impacted lower third molars. STUDY DESIGN: Patient hygiene was assessed by the simplified oral hygiene index. The maximum active interincisal oral opening was determined before surgery by using a millimeter scale, from the upper incisive edge to the lower incisive edge. Pain and inflammation were in turn recorded in written form by each patient 2, 6, and 12 hours after the operation and every day thereafter for 7 days. RESULTS: Maximum postoperative pain was recorded 6 hours after extraction, with peak inflammation after 24 hours. The patients with the poorest oral hygiene reported higher pain levels throughout the postoperative period and more analgesic consumption in the first 48 hours. In contrast, oral hygiene appeared to exert no influence on either trismus or inflammation. CONCLUSIONS: Poor oral hygiene before the surgical removal of 190 impacted lower third molars is correlated with greater postoperative pain.

[Benign paroxysmal positional vertigo secondary to surgical maneuvers on superior maxilla]. / Vértigo posicional paroxístico benigno secundario a maniobras odontológicas sobre maxilar superior.

The benign paroxysmal positional vertigo (BPPV) is a common vestibular end organ disorder. BPPV may be idiopathic or secondary to head traumas, viral labyrinthitis, otology surgery and many others conditions. We report two cases of BPPV secondary to surgical maneuvers on superior maxillary. We have not found this etiology in scientific literature but, the increase of this kind of surgery, can produce an increase of its frequency. For this reason the otoneurologists and oral surgeons must bear in mind this possibility to make a right diagnostic and treatment of the syndrome.

Eosinophilic granuloma of the jaws: a report of three cases.

Three cases of eosinophilic granuloma involving two boys and a girl are reported. Osteolytic lesions of the jaws were seen in all three patients. The two boys presented mandibular lesions, while the girl had lesions in both jaws. Patient age at the onset of the disease was 6 and 9 years in the boys and 10 years in the case of the girl. The affected zone was painful to palpation in all cases, with intra- and extraoral swelling and bone bulging that caused slight facial deformity and bleeding of the gums. Biopsies were obtained in all three cases, and the histopathological study confirmed the diagnosis. The clinical course was favorable in all three children.

Trigeminal neuralgia associated to basilar artery dolichoectasia.

A case of trigeminal neuralgia attributed to basilar artery dolichoectasia is described. Underlying vascular malformations and tumors of the cerebellopontine angle can be detected in patients with trigeminal neuralgia by means of noninvasive techniques such as computed tomography and magnetic resonance imaging; such diagnostic tools are therefore indicated in patients with trigeminal neuralgia to discard possible central nervous disorders.