Prótesis oculo-palpebral: A propósito de un caso clínico

La prótesis maxilofacial comprende aquellos dispositivos artificiales que restauran una parte ausente de la cara, debido a tumores, traumatismos, o como resultado de una anomalía congénita. El objetivo de este artículo es la exposición de un caso clínico que precisaba la confección de una prótesis óculo-palpebral tras sufrir una pérdida de sustancia por causa oncológica. Este tipo de prótesis son de las más difíciles de elaborar con buenos resultados pues intentan reconstruir un órgano móvil con una prótesis estática. La prótesis maxilofacial tiene la finalidad de aumentar la calidad de vida del paciente y ayudar a la seguridad emocional de los mismos, quedando así rehabilitados para poder integrarse nuevamente en la sociedad.

Influencia de diferentes sistemas de profilaxis en la adhesión de un sellador de fisuras al esmalte

Introducción: La adhesión de las resinas dentales al esmalte no depende solamente del grabado ácido del esmalte. Otros factores, como el pulido de la superficie del esmalte pueden influir en la fuerza de adhesión de las resinas. El objetivo de este estudio es evaluar la adhesión de un sellador de fisuras fotopolimerizable tras la utilización previa de distintos métodos de profilaxis y dos diferentes tiempos de grabado. Material y método: Ochenta terceros molares extraídos quirúrgicamente se seccionaron en dos mitades (vestibular y lingual). Los dientes se dividieron en ocho grupos de 20 muestras cada uno, de acuerdo con los métodos de profilaxis: polvo de piedra pómez, pasta fluorada, espray de bicarbonato y control (sin profilaxis); y dos tiempos de grabado: 15 y 30 segundos. Se midió la fuerza de adhesión mediante una prueba de tracción en una máquina de ensayos universal INSTRON. Resultados y conclusión: Se utilizó el test estadístico ANOVA, detectándose diferencias significativas en la resistencia a la tracción; el posterior test de Dunnett encontró estas diferencias entre los grupos control y de profilaxis con piedra pómez para 15 y 30 segundos de grabado respecto de los grupos tratados con pasta fluorada y espray de bicarbonato, para los mismos tiempos de grabado (p<0,05), siendo esta diferencia mayor en el grupo de espray con bicarbonato.

Prevalence of complications after the oral rehabilitation with implant-supported hybrid prostheses

Objectives: Assess the main problems referred by the patients and observed by the professionals after the bucodental rehabilitation with an implant-supported hybrid prothesis. Patients and Methods: A retrospective study was carried out in which there were 43 patients included who were visited in the Department of Oral Surgery and Orofacial Implantology of University of Barcelona Dental School for one year. An oral rehabilitation with an implant-supported hybrid prosthesis was made to those patients. The following variables were registered: age, gender, number of inserted implants, type of implant and principal problems produced by the hybrid prosthesis. Results: The rehabilitation with an implant supported hybrid prosthesis was only performed in 43 of 116 cases treated in one year (January, 2006 to January, 2007). They were 26 men and 17 women of ages between 37 and 74 years, being the rate age of 56,5 years. The main complication recorded was the mucositis, associated frequently with a difficulty to carry a correct oral hygiene and to an overextention of the tail of resin of the prosthesis. Other observed problems were the peri-implantitis, the break of the acrylic teeth and the loss of some of the prosthetic screws. Conclusions: The most frequent complication after the laying of an implant supported hybrid prosthesis was the mucositis, associated mainly with a prosthetic tail too long and to the consequent difficulty of carrying a correct oral hygiene. In spite of the high prevalence of observed complications, most of them were mild and resolved on subsequent visits.

Oral findings in Midline Syndrome: a case report and literature review

We describe a female patient with a midline syndrome. The patient presents agenesis of the corpus callosum, encephalocele, iris coloboma, hypertelorism, submucosal cleft palate and dental anomalies. Despite being very characteristic, her phenotypical traits do not coincide exactly with those reported to date in the literature. The karyotype and the molecular cytogenetic study do not show mutations. We identify the presence of dental anomalies in the mother and other family members, not being identified MSX1 and PAX9 mutations that could the related with their etiology. Despite the fact that dental agenesis has been related to a large number of other malformation syndromes and congenital conditions, dental anomalies have only rarely been mentioned when reporting midline syndromes. These dental phenotypical traits, present in the patient and her family, could be considered part of the midline syndrome in carriers as well as in the patients.

Movement evaluation of overerupted upper molars with absolute anchorage: An in-vitro study

Introduction: The overeruption of upper molars due to the premature loss of antagonist teeth can be treated with the help of miniscrews. The aim of this study was to evaluate the movement of a typodont molar according to the biomechanical approach used with miniscrews. Study design: The study was conducted with four plaster models filled with typodont wax. In each model we used one absolute anchorage on the palatal side and another on the buccal side in different positions, thus generating four different biomechanical systems. A force of 150 g was applied to each side of the resin tooth. Periapical radiographs were taken preintrusion and immediately after completion of the intrusion. Photographs were taken in both the sagittal and occlusal planes every 3 min. The radiographic films and photographs were measured and compared. Results: A vertical movement of the molar was observed in all the models, with system 4 showing the greatest movement. Rotation in the occlusal plane only occurred in system 2, while in system 1 there was a change in the axial axis of 37 degrees. Conclusions: The anchorage site and the combination of forces applied may determine the resulting tooth movement

A comparison of the dental status and treatment needs of older adults with and without chronic mental illness in Sevilla, Spain

Objectives: To study the dental status and treatment needs of institutionalized older adults with chronic mental illness compared to a non-psychiatric control sample. Study Design: The sample size was 100, in which 50 were psychogeriatric patients (study group; SG) classified according to DSM-IV, with a mean age of 69.6 ± 6.7 years, and 50 non-psychiatric patients (control group; CG), with a mean age of 68.3 ± 6.9 years. Clinical oral health examinations were conducted and caries were recorded clinically using the Decayed, Missing and Filled Teeth Index (DMFT). Results were analyzed statistically using the Student"s t-test or analysis of variance. Results: Caries prevalence was 58% and 62% in SG and CG, respectively. DMFT index was 28.3 ± 6.6 in SG and 21.4 ± 6.07 in CG (p < 0.01). Mean number of decayed teeth was higher in SG (3.1) compared to CG (1.8) (p=0.047). Mean number of missing teeth were 25.2 and 16.4 in SG and CG respectively (p<0.05). DMFT scores were higher in SG in all the age groups (p < 0.01). Mean number of teeth per person needing treatment was 3.4 in SG and 1.9 in CG (p= 0.037). The need for restorative dental care was significantly lower in the SG (0.8 teeth per person) than in the CG (1.7 teeth per person) (p = 0.043). Conclusions: Institutionalized psychiatric patients have significantly worse dental status and more dental treatment needs than non-psychiatric patients.

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

Effect of water contamination on the shear bond strength of five orthodontic adhesives

Objectives: To evaluate the shear bond strength and site of failure of brackets bonded to dry and wet enamel. Study design: 50 teeth were divided into ten groups of 5 teeth each (10 surfaces). In half the groups enamel was kept dry before bonding, and in the other half distilled water was applied to wet the surface after etching. The following groups were established: 1)Acid/Transbond-XT (dry/wet) XT; 2) Transbond Plus Self Etching Primer (TSEP)/Transbond-XT paste (dry/wet); 3) Concise (dry), Transbond MIP/Concise (wet), 4) FujiOrtho-LC (dry/wet); 5) SmartBond (dry/wet). Brackets were bonded to both buccal and lingual surfaces. Specimens were stored in distilled water (24 hours at 37ºC) and thermocycled. Brackets were debonded using a Universal testing machine (cross-head speed 1 mm/min). Failure sites were classified using a stereomicroscope. Results: No significant differences in bond strength were detected between the adhesives under wet and dry conditions except for Smart- Bond, whose bond strength was significantly lower under dry conditions. For all the adhesives most bond failures were of mixed site location except for Smartbond, which failed at the adhesive-bracket interface. Conclusions: Under wet conditions the bonding capacity of the adhesives tested was similar than under dry conditions, with the exception of SmartBond which improved under wet conditions

Contention postorthodontique avec attelle rigide en résine

Nous avons fait un examen clinique de 30 cas de contention postorthodontique avec attelle rigide en résine, de canine à canine sur les deux maxillaires. On décrit la fabrication de l'attelle, sa mise en place, les incidents possibles ou les problèmes cliniques apparus (mauvaise adhérence, gingivite ...) et les aspects psychologiques ou subjectifs du patient

Approaching invasive species in Madagascar

While a number of plants, animals, and insects in Madagascar have been called 'invasive', the topic of invasive species has until recently received less attention here than in other island contexts. Some species, often alien to Madagascar and introduced by humans, have expanded their range rapidly and have had both negative and positive effects on landscapes, on native biodiversity, and on livelihoods. Examples include the prickly pear (raketa), the silver wattle (mimosa), and, recently, the Asian common toad (radaka boka). Building on a conceptual approach to 'invasive species', this paper emphasizes the importance of inclusive and deliberative site- and population - specific management of invasive species. It analyses three separate concepts commonly used in definitions of invasion: the origin, behaviour, and effects of particular species. It places these concepts in their broader social and ecological context, with particular attention to local perspectives on invasive species. We illustrate these concepts with Malagasy examples and data. The examples demonstrate that while invasions can have dramatic consequences, there can be multiple, often competing, interests as well as site - specific biophysical, environmental, and cultural considerations that need to be taken into account when designing policy and management interventions. We conclude with a number of lessons learned. RESUME FRANCAIS Contrairement à la plupart des autres îles, et en dépit du qualificatif 'invasif' rattaché depuis longtemps à certaines espèces qui s'y sont naturalisées, les réflexions autour de l'approche des espèces invasives à Madagascar demeurent récentes. L'opuntia (Opuntia spp.) figure certes parmi les plus anciens exemples d'espèces traités dans la littérature sur les invasions biologiques. Mais ce n'est vraiment qu'avec le retentissement médiatique autour de la détection en 2011 de la présence du crapaud masqué (Duttaphrynus melanostictus) et la recherche d'une parade appropriée que s'est affirmée la nécessité de traiter cette question des espèces invasives en tant que telle. Une posture nativiste et uniforme qui ignorerait la spécificité des contextes biophysiques et socio - économiques locaux, mais aussi la pluralité des formes d'invasion biologique et des défi- nitions qui s'y rattachent, ne saurait être privilégiée. L'article montre qu'il s'agit de situer les réflexions dans un contexte insulaire socio - économique dans lequel les espèces allogènes tiennent depuis longtemps une large place. Il défend en outre la nécessité d'envisager les espèces invasives non pas selon une forme de perception unique et autoritariste, mais selon une diversité de points de vue, conforme aux conflits d'intérêts qui se manifestent parfois, et mettant plutôt en avant le caractère exogène des espèces invasives, leurs effets (négatifs, mais aussi positifs) sur le milieu, ou leur mode de fonctionnement (disper- sion, dominance) dans des contextes spécifiques et locaux. Il convient en particulier d'observer qu'aux coûts générés par les invasions biologiques peuvent s'ajouter des bénéfices économiques, et que les impacts écologiques néfastes peuvent se combiner avec des incidences heureuses, y compris auprès d'espèces indigènes en situation critique. En outre, le point de vue des populations humaines, leur connaissance d'espèces invasives quotidiennement rencontrées, leur réticence à scin- der le vivant en espèces indigènes et allogène, mais aussi leur vision pragmatique, ne sauraient être mésestimés, et moins encore oubliés. Enfin, l'article invite à prendre du recul face aux effets rhétoriques liés aux discours conventionnels sur les inva- sions biologiques, à éviter les amalgames et les généralisations excessives, à tenir compte des contraintes environnementales mais aussi des aspirations socio - économiques des populations locales, et à prendre en compte la diversité des spécificités locales, qu'elles soient biophysiques ou sociales. En conclusion, il est sans doute heureux que Madagascar n'ait rejoint que très récemment la mouvance internationale des réflexions sur les espèces invasives : cela lui permet en effet d'être en mesure de disposer d'une position équilibrée, déjouant certains discours catastrophistes, et préférant une approche résolument contextualisée, à l'échelle nationale comme aux échelles régionales.

Periimplantitis

La rehabilitación bucodentaria mediante implantes proporciona un porcentaje de éxito muy elevado. En este trabajo se describen algunas de las complicaciones de esta técnica, como la enfermedad periimplantaria y, dentro de ella, la periimplantitis, una reacción inflamatoria donde coexiste, junto con la inflamación, una pérdida del soporte óseo del implante. La etiología de la enfermedad está condicionada por el estado del tejido periimplantario, el diseño del implante, el desajuste de sus componentes, la morfología externa del mismo y la sobrecarga mecánica. Los microorganismos más relacionados con el fallo de integración de un implante son las espiroquetas y las formas móviles Gramnegativo anaerobias, salvo que el origen sea debido a una sobrecarga mecánica pura. El diagnóstico se basa en los cambios de coloración de la encía, sangrado y profundidad del sondaje de las bolsas periimplantarias, supuración, radiología y pérdida progresiva de la altura ósea que rodea al diente. El tratamiento será diferente según se trate de una mucositis o una periimplantitis. Se basará en corregir los defectos técnicos, aplicar un tratamiento quirúrgico y utilizar técnicas de descontaminación (arenado con partículas de carbono, ácido cítrico, tetraciclinas de aplicación tópica y láser quirúrgico). En este trabajo también se expone un estudio microbiológico de la periimplantitis efectuado en la Facultad de Odontología de la Universidad de Barcelona que determina que el antibiótico que demostró una mayor eficacia, en el antibiograma, fue la asociación de amoxicilina con ácido clavulánico.

Endosseous dental implant fractures an analysis of 21 cases

Implant fracture is an infrequent cause of implant failure. The present study evaluates 21 fractured implants, with an analysis of patient age and sex, the type, length and diameter of the implant, positioning in the dental arch, the type of prosthetic rehabilitation involved, the number of abutments and pontics, the presence or absence of distal extensions or cantilevers, and loading time to fracture. Implant fracture was more common in males than in females (15:4), and the mean patient age was 56.9 years. Most cases (n = 19) corresponded to implant-supported fixed prostheses - 16 with cantilevers of different lengths- while only two fractured implants were supporting overdentures instead of fixed prostheses. The great majority of fractured implants (80.9%) were located in the molar and premolar regions, and most fractured within 3-4 years after loading. It is important to know and apply the measures required to prevent implant fracture, and to seek the best individualized solution for each case - though complete implant removal is usually the treatment of choice

Relationship between oral cancer and implants: clinical cases and systematic literature review

The use of implants for oral rehabilitation of edentulous spaces has recently been on the increase, which has also led to an increase in complications such as peri-implant inflammation or peri-implantitis. Chronic inflammation is a risk factor for developing oral squamous cell carcinoma (OSCC). Objectives: To review the literature of cases that associate implant placement with the development of oral cancer. Study design: We present two clinical cases and a systematic review of literature published on the relationship between oral cancer and implants. Results: We found 13 articles published between the years 1996 and 2009, referencing 18 cases in which the osseointegrated implants are associated with oral squamous cell carcinoma. Of those, 6 articles were excluded because they did not meet the inclusion criteria. Of the 18 cases reported, only 7 cases did not present a previous history of oral cancer or cancer in other parts of the body. Conclusions: Based on the review of these cases, a clear cause-effect relationship cannot be established, although it can be deduced that there is a possibility that implant treatment may constitute an irritant and/or inflammatory cofactor which contributes to the formation and/or development of OSCC.

Periodontal health and esthetic results in impacted teeth exposed by apically positioned flap technique

Objectives: This study evaluates the periodontal health status and the esthetic results of teeth subjected to orthodontic traction, after their exposure by an apically positioned flap. Study design: Fifteen patients were included in the study, ages between 11 and 28 years old. The fenestrated teeth and their homologous contralateral normally erupted teeth, used as control, were evaluated. Results: Statistically significant differences were found in the position of the gingival margin (p = 0.005), with an average distance between cemento-enamel junction (CEJ) and gingival margin of 2.47 mm (SD 1.19) in control teeth and of 1 mm (SD 1.31) in the operated teeth, and in the depth of palatal probing (p = 0.031), with 2.1 mm (SD 0.9) for the experimental teeth and 1.7 mm (SD 0.8) for the control teeth. The gingival index, the bleeding during probing and the probing depth did not show statistically significant differences. The patient"s subjective esthetic evaluation was more favorable for the control teeth in most of the cases. Conclusions: The surgical approach for the impacted teeth by means of the apically positioned flap resulted to be a predictable technique allowing the maintenance of the periodontal health on a long-term basis.

Bacterial adhesion efficiency on implant abutments: a comparative study

The attachment of Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 28213 onto six different materials used to manufacture dental implant abutments was quantitatively determined after 2 and 24 h of contact between the materials and the bacterial cultures. The materials were topographically characterized and their wettability determined, with both parameters subsequently related to bacterial adhesion. Atomic force microscopy, interferometry, and contact angle measurement were used to characterize the materials" surfaces. The results showed that neither roughness nor nano-roughness greatly influenced bacterial attachment whereas wettability strongly correlated with adhesion. After 2 h the degree of E. coli attachment markedly differed depending on the material whereas similar differences were not observed for S. aureus, which yielded consistently higher counts of adhered cells. Nevertheless, after 24 h the adhesion of the two species to the different test materials no longer significantly differed, although on all surfaces the numbers of finally adhered E. coli were higher than those of S. aureus