Dental implications in oral cancer patients

Objectives. A study is made of the dental implications of oral cancer, with a view to avoiding the complications that appear once oncological treatment is started. Patients and Methods. The study comprised a total of 22 patients diagnosed with oral cancer according to clinical and histological criteria in the Service of Maxillofacial Surgery (Dental Clinic of the University of Barcelona, Spain) during the period 1996-2005, and posteriorly treated in different hospital centers in Barcelona. Results. Of the 22 patients diagnosed with oral cancer in our Service, the present study finally analyzed the 12 subjects who reported for the dental controls. As regards the remaining 10 patients, 5 had died and 5 could not be located; these subjects were thus excluded from the analysis. All of the smokers had abandoned the habit. The most common tumor location was the lateral margin of the tongue. None of the patients visited the dentist regularly before the diagnosis of oral cancer. T1N0M0 was the most common tumor stage. Surgery was carried out in 50% of the cases, while 8.4% of the patients received radiotherapy and 41.6% underwent surgery with postoperative radiotherapy. In turn, 66.6% of the patients reported treatment sequelae such as dysgeusia, xerostomia or speech difficulties, and one patient suffered osteoradionecrosis. Forty-one percent of the patients did not undergo regular dental controls after cancer treatment. As regards oral and dental health, 16.6% presented caries, and 50% had active periodontal disease. Conclusions. Protocols are available for preventing the complications of oral cancer treatment, and thus for improving patient quality of life. However, important shortcomings in the application of such protocols on the part of the public health authorities make it difficult to reach these objectives

Effectiveness of substituting cyclosporin A with tacrolimus in reducing gingival overgrowth in renal transplant patients

Objectives: This study aims to evaluate the effectiveness of periodontal therapy combined with tacrolimus in the suppression of gingival overgrowth (GO) and the effect on GO of changing from cyclosporin A to tacrolimus. Patients and Methods: Sixteen renal transplant patients, averaging 52 years of age, whose kidney function was stable and were receiving treatment with cyclosporin A, were randomly assigned to one of two groups. In the experimental group, patients were instructed in oral hygiene and underwent periodontal treatment, whereas in the control group, only oral hygiene instructions were given. After the first visit and the change of medication from cyclosporine to tacrolimus in both groups, periodic clinical revisions were carried out for 3 months in order to assess the evolution of GO. Results: All patients showed a progressive decrease in GO. There were no statistically significant differences between the two groups (p>0.05). A greater decrease in GO occurred within the first month after changing the medication. Conclusions: No improved effectiveness in reducing GO was observed for periodontal therapy in combination with tacrolimus. Tacrolimus is an alternative to cyclosporine when attempting to avoid GO in patients with kidney transplants

Rehabilitation of atrophic maxilla: a review of 101 zygomatic implants

Introduction: Zygomatic implants are a good rehabilitation alternative for upper maxilla with severe bone reabsorption. These implants reduce the need for onlay-type bone grafting in the posterior sectors and for maxillary sinus lift procedures - limiting the use of bone grafts to the anterior zone of the upper jaw in those cases where grafting is considered necessary. Objective: To evaluate the survival of 101 zygomatic implants placed in upper maxilla presenting important bone reabsorption, with a follow-up of 1-72 months. Patients and methods: A retrospective study was made of 101 Zygoma® implants (Nobel Biocare, Göteborg, Sweden) placed in 54 patients with totally edentulous and atrophic upper maxilla, in the period between 1998-2004. There were 35 women and 19 men, subjected to rehabilitation in the form of fixed prostheses and overdentures using 1-2 zygomatic implants and 2-7 implants in the anterior maxillary zone. The principal study variables were smoking, a history of sinusitis, the degree of bone reabsorption, and peri-implant bone loss, among others. Results: The descriptive analysis of the 101 zygomatic implants placed in 54 patients with a mean age of 56 years (range 38-75) yielded a percentage survival of 96.04%, with four failed implants that were removed (two before and two after prosthetic loading). Nine patients were smokers, and none of the 54 subjects reported a history of sinus disorders. Discussion and conclusions: Zygomatic implants are designed for use in compromised upper maxilla. They allow the clinician to shorten the treatment time, affording an interesting alternative for fixed prosthetic rehabilitation. This study confirms that zygomatic bone offers predictable anchorage and acceptable support function for prostheses in atrophic jaws. However, these implants are not without complications. Longer-term evaluations are needed of zygomatic implant survival in order to establish a correct clinical prognosis

Ellis-Van Creveld Syndrome. Case report and literature review

Ellis-van Creveld syndrome is a genetic disorder that was first described by Richard Ellis and Simon van Creveld in 1940. The four principal characteristics are chondrodysplasia, polydactyly, ectodermal dysplasia and congenital heart defects. The orofacial manifestations include multiple gingivolabial musculofibrous fraenula, dental anomalies, hypodontia and malocclusion. The disease can be diagnosed at any age, even during pregnancy. The differentiation should be made between Jeune syndrome and other orofaciodigital syndromes

In vitro evaluation of the temperature increment at the external root surface after Er,Cr: YSGG laser irradiation of the root canal

Objectives: A study was made to determine the temperature increment at the dental root surface following Er,Cr:YSGG laser irradiation of the root canal. Design. Human canines and incisors previously instrumented to K file number ISO 30 were used. Irradiation was carried out with glass fiber endodontic tips measuring 200 μm in diameter and especially designed for insertion in the root canal. The teeth were irradiated at 1 and 2 W for 30 seconds, without water spraying or air, and applying a continuous circular movement (approximately 2 mm/sec.) in the apico-coronal direction. Results: At the 1 W power setting, the mean temperature increment was 3.84ºC versus 5.01ºC at 2 W. In all cases the difference in mean value obtained after irradiation versus the mean baseline temperature proved statistically significant (p< 0.05). Conclusions: Application of the Er,Cr:YSGG laser gives rise to a statistically significant temperature increment at the external root surface, though this increment is probably clinically irrelevant, since it would appear to damage the tissues (periodontal ligament and alveolar bone) in proximity to the treated tooth

Ellis-Van Creveld Syndrome. Case report and literature review

Ellis-van Creveld syndrome is a genetic disorder that was first described by Richard Ellis and Simon van Creveld in 1940. The four principal characteristics are chondrodysplasia, polydactyly, ectodermal dysplasia and congenital heart defects. The orofacial manifestations include multiple gingivolabial musculofibrous fraenula, dental anomalies, hypodontia and malocclusion. The disease can be diagnosed at any age, even during pregnancy. The differentiation should be made between Jeune syndrome and other orofaciodigital syndromes

Evaluation of healing criteria for success after periapical surgery

Introduction: In periapical surgery, the absence of standardization between different studies makes it difficult to compare the outcomes. Objective: To compare the healing classification of different authors and evaluate the prognostic criteria of periapical surgery at 12 months. Material and methods: 278 patients (101 men and 177 women) with a mean age of 38.1 years (range 11 to 77) treated with periapical surgery using the ultrasound technique and a 2.6x magnifying glass, and silver amalgam as root-end filling material were included in the study. Evolution was analyzed using the clinical criteria of Mikkonen et al., 1983; radiographic criteria of Rud et al., 1972; the overall combined clinical and radiographic criteria of von Arx and Kurt, 1999; and the Friedman (2005) concept of functional tooth at 12 months of surgery. Results: After 12 months, 87.2% clinical success was obtained according to the Mikkonen et al., 1983 criteria; 73.9% complete radiographic healing using Rud et al. criteria; 62.1% overall success, following the clinical and radiographic parameters of von Arx and Kurt, and 91.9% of teeth were functional. The von Arx and Kurt criteria was found to be the most reliable. Conclusion: Overall evolution according to von Arx and Kurt agreed most closely with the other scales

Granuloma periférico de células gigantes. A propósito de 5 casos y revisión de la literatura

El granuloma periférico de células gigantes (GPCG) es una lesión reactiva benigna relativamente frecuente de la cavidad bucal. Se origina a partir del periostio o de la membrana periodontal tras una irritación o un traumatismo crónico que actúa localmente. Se manifiesta en forma de nódulo de color rojo-púrpura, situado en la encía o en el reborde alveolar edéntulo, preferentemente en la mandíbula. Aparece a cualquier edad, con una mayor incidencia entre la quinta y sexta décadas de la vida, con una ligera predilección por el sexo femenino. Es una lesión de las partes blandas que muy rara vez implica el hueso subyacente, aunque puede causarle una erosión superficial. Se han revisado cinco casos de GPCG que afectaban a 3 hombres y a 2 mujeres de edades comprendidas entre los 19 y 66 años, presentándose tres de ellos en el maxilar superior. En dos casos se observaba radiográficamente una reabsorción ósea en forma de"aplanamiento". El tratamiento consistió en realizar la exéresis-biopsia, efectuándose dos casos mediante láser de CO2 y tres con bisturí frío. No se ha observado ninguna recidiva en el seguimiento postoperatorio (rango de 10 meses a 4 años). En el diagnóstico diferencial se deben descartar lesiones de características clínicas e histológicas muy similarescomo el granuloma central de células gigantes-, que asientan en el interior del propio maxilar y cuyo comportamiento es más agresivo; solamente el estudio radiológico permitirá esta distinción. El diagnóstico precoz y preciso de esta lesión permite efectuar un tratamiento conservador sin riesgo para los dientes vecinos ni para el hueso adyacente

Evaluation of healing criteria for success after periapical surgery

Introduction: In periapical surgery, the absence of standardization between different studies makes it difficult to compare the outcomes. Objective: To compare the healing classification of different authors and evaluate the prognostic criteria of periapical surgery at 12 months. Material and methods: 278 patients (101 men and 177 women) with a mean age of 38.1 years (range 11 to 77) treated with periapical surgery using the ultrasound technique and a 2.6x magnifying glass, and silver amalgam as root-end filling material were included in the study. Evolution was analyzed using the clinical criteria of Mikkonen et al., 1983; radiographic criteria of Rud et al., 1972; the overall combined clinical and radiographic criteria of von Arx and Kurt, 1999; and the Friedman (2005) concept of functional tooth at 12 months of surgery. Results: After 12 months, 87.2% clinical success was obtained according to the Mikkonen et al., 1983 criteria; 73.9% complete radiographic healing using Rud et al. criteria; 62.1% overall success, following the clinical and radiographic parameters of von Arx and Kurt, and 91.9% of teeth were functional. The von Arx and Kurt criteria was found to be the most reliable. Conclusion: Overall evolution according to von Arx and Kurt agreed most closely with the other scales

L’humanisme a l’Espanya dels segles XV i XVI. Estat de la qüestió

L'objectiu d'aquest estat de la qüestió és analitzar com s'ha tractat historiogràficament l'entrada d'un corrent intel·lectual i cultural nou com és l'humanisme. A partir de la bibliografia suggerida pels principals manuals especialitzats d'Història d'Espanya es veu com l'objecte d'estudi aquí contemplat genera dues escoles interpretatives: per una banda, aquells autors hispanistes i d'influència hispanista que defensen un humanisme vinculat amb Erasme de Rotterdam i centrat en la religió i l'espiritualitat. Així mateix, els autors que segueixen aquesta interpretació destaquen la feina del Cardenal Cisneros com a promotor de profundes transformacions en el clergat espanyol i com a promotor de la fundació de la Universitat d'Alcalà, lloc on es va desenvolupar aquest tipus d'humanisme. Per altra banda, la segona escola interpretativa la formen autors espanyols que prenen com a referència a Luis Gil Fernández. Aquests contemplen la recuperació dels autors grecollatins, dels temes i les formes clàssiques com la fita fonamental de l'humanisme. Segons aquesta escola, els estudis de gramàtica i la pedagogia són també objectius dels autors humanistes.

Supernumerary molars. A review of 53 cases

Supernumerary molars are not uncommon and may be found nearly anywhere in the dental alveolar arches. A series of 36 patients that presented with 53 supernumerary molars are reviewed. They occurred more frequently in the maxilla (86.8%), had little or no clinical significance, tended to be impacted, and were not associated with the impactation of the third molar. Four cases of maxillary fifth molars are described

"Chelsea boys": paradigmas sexuales de un cómic "queer"

Más allá del barrio neoyorquino que da título a este serie de volúmenes –aunque en diálogo tanto con su realidad como con sus representaciones anteriores, como Rear Window, dónde se presenta ya como espacio sexualizado–; y más allá del estereotipo gay que la misma expresión representa, Chelsea Boys aparece como un espacio de ruptura de clichés. En el contexto del cómic gay norteamericano que se repasa en este artículo, constituye una propuesta plural, donde la universalidad de las situaciones que representa superan tanto el localismo como la rigidez estereotípica de algunas creaciones anteriores. En él emerge una comunidad queer a través de cuya representación se plantean cuestiones cruciales en y para la/s realidad/es gays.

Surgical reconstruction of TMJ

Certain situations and pathological processes that arise with temporomandibular joint destruction can only be resolved with surgical reconstructive procedures in order to attempt a functional and anatomical rehabilitation of this joint. Many of these situations can be surgically treated with the patient's own autologous tissues. However, in some patients reconstruction is complex and the use of autologous tissues is unadvisable whereas reconstruction utilizing alloplastic materials may be an appropriate alternative. The following report describes 4 clinical cases in which autologous grafts or Christensen joint prosthesis are employed in temporomandibular joint reconstruction

Supernumerary premolars. Report of 10 cases

Supernumerary premolars are 'extra' teeth morphologically belonging to the premolar group. Hyperdontia affecting premolars can be single (when only one supernumerary tooth is found), multiple (if several teeth are involved) or related to a syndrome such as cleidocranial dysplasia. Supernumerary premolars are the third most frequent group of supernumerary teeth, following mesiodens and fourth molars; the prevalence among the general population ranges from 0.09-0.64%. The present study describes 10 cases of supernumerary premolars treated in our Service of Oral and Maxillofacial Surgery of the Dental Clinic of the University of Barcelona. A late onset was demonstrated in one case, contrasting the present pantomograph with another obtained 5 years before. In only one case did the presence of a supernumerary premolar alter normal tooth eruption. Two supernumerary premolars were affected by follicular cysts

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 confi rmed 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