Evaluation of the indication for surgical extraction of third molars according to the oral surgeon and the primary care dentist. Experience in the Master of Oral Surgery and Implantology at Barcelona University Dental School

Introduction: Third molar extraction is the most frequent procedure in oral surgery. The present study evaluates the indication of third molar extraction as established by the primary care dentist (PCD) and the oral surgeon, and compares the justification for extraction with the principal reason for patient consultation. Patients and method: A descriptive study was made of 319 patients subjected to surgical removal of a third molar in the context of the Master of Oral Surgery and Implantology (Barcelona University Dental School, Barcelona, Spain) between July 2004 and March 2005. The following parameters were evaluated: sex, age, molar, type of impaction, position according to the classifications of Pell and Gregory and of Winter, and the reasons justifying extraction. Results: The lower third molars were the most commonly extracted molars (73.7%). A total of 69.6% of the teeth were covered by soft tissues only. Fifty-six percent of the lower molars corresponded to Pell and Gregory Class IIB, while 42.1% were in the vertical position. The most common reason for patient reference to our Service of Oral Surgery on the part of the PCD was prophylactic removal (51.0% versus 46.1% in the case of the oral surgeon). Discussion and conclusions. Our results show prophylaxis to be the principal indication of third molar extraction, followed by orthodontic reasons. Regarding third molars with associated clinical symptoms or signs, infectious disease-including pericoronitis- was the pathology most often observed by the oral surgeon, followed by caries. This order of frequency was seen to invert in the case of third molars referred for extraction by the PCD. A vertical position predominated among the third molars with associated pathology

Cirugía bucal y anticoagulantes orales: una propuesta de actuación

El tratamiento con anticoagulantes orales, fundamentalmente acenocumarol (Sintrom), es cada vez más frecuente en nuestro país. Se ha revisado la literatura médica y odontológica, sobre las pautas terapéuticas empleadas en cirugía bucal en pacientes anticoagulados por vía oral. Se propone un protocolo de actuación basado en que el mantenimiento del régimen anticoagulante oral y el uso local de antifibrinolíticos (ácido tranexámico al 4,8%) como enjuagues, después de la cirugía bucal, disminuye el riesgo tromboembólico y la posibilidad de complicaciones hemorrágicas es comparable a aquellos pacientes que disminuyen el acenocumarol antes de la cirugía bucal.

Valoración periodontal de caninos incluidos en situación vestibular a los tres años del tratamiento orotodóncico-quirúrgico

Para demostrar que los parámetros periodontales no se alteran por la fenestración con colgajo de reposición apical de los caninos incluidos, se seleccionaron 12 pacientes con canino incluido por vestibular y el canino contralateral correctamente erupcionado. El tratamiento fue ortodóncico-quirúrgico, con colgajo de reposición apical (9 casos) o de reposición apical lateral (3 casos). Tres años después de finalizar el tratamiento ortodóncico, se valoró el estado periodontal de los caninos mediante: índice de plata, índice gingival, sangrado al sondaje, profundidad de sondaje y anchura de encía queratinizada. No se hallaron diferencias estadísticamente significativas entre el grupo experimental (caninos fenestrados) y el control (caninos contralaterales).

Estudio del postoperatorio de 100 terceros molares mandibulares incluidos, en relación a la edad, el sexo, el tabaco y la higiene bucal

La extracción del tercer molar inferior incluido provoca efectos secundarios como dolor, inflamación y trismo. Presentamos un estudio cuyo objetivo fue relacionar la edad, el sexo, el tabaco y la higiene oral con el postoperatorio de 100 de terceros molares inferiores incluidos. La edad, el sexo y el consumo de tabaco no influyeron significativamente en el postoperatorio. Sólo hallamos una correlación estadísticamente significativa entre la higiene oral y el dolor a las 6 horas de la exodoncia.

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

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

A comparative study of silver amalgam and compomer as retrograde filling materials in periapical surgery

Objective: A comparative study is made of the histological effects of silver amalgam versus compomer (Dyract®) 90 days after placement as retrograde filling materials in experimental animals. Method: Six Beagle dogs were used, with total pulpectomy and orthograde material filling followed by periapical surgery of the 6 upper and 6 lower incisors (for a total of 72 teeth). Thirty-six teeth corresponded to the right side and were filled with the control material (silver amalgam), while the 36 teeth on the left side were filled with the compomer study material (Dyract®). After three months the animals were sacrificed and the histological study was carried out, with evaluation of bone formation, inflammation, and the tissue in contact with the filler material. The results obtained were subjected to a descriptive and comparative statistical analysis (chi-square test). Results: The samples retrogradely filled with compomer showed significantly greater percentage inflammation (76.19% versus 26.66% in the control group). On the other hand, a large proportion of samples with root cement growth were found in the compomer group. Filler material expulsion was also significantly more common when compomer was used. Conclusions: the comparative study of the histological findings showed greater inflammation but also greater root cement growth in the compomer group versus the controls

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.

Complications of guided surgery and immediate loading in oral implantology: a report of 12 cases

Objectives: The growing interest in minimally invasive surgery, together with the possibility of fitting prostheses with immediate function, have led to the development of software capable of planning and manufacturing a surgical guide and prosthesis that can be placed upon conclusion of the implant surgery step. The present study evaluates the surgical and prosthetic complications of implant treatment with the guided surgery technique, together with patient comfort during and after treatment. Patients and methods: A retrospective observational study was made of 19 patients with partially or totally edentulous upper and/or lower maxillae, involving the placement of a total of 122 implants. All cases were planned and operated upon with the guided surgery technique. Results: A total of 122 implants were placed in 14 males and 5 females. The intraoperative surgical complications comprised a lack of primary stability, while the postoperative complications consisted of infections and a lack of implant osteointegration. Ten implants failed. The prosthetic complications in turn comprised loosening of the provisional prosthesis screws, prosthesis tooth fracture, and a lack of passive fit of the immediate prosthesis. The degree of patient satisfaction was evaluated using a verbal scale. Conclusions: Implant restoration with the guided surgery technique and immediate functional loading is a predictable procedure, provided patient selection and the surgical technique are adequate, affording lesser postoperative morbidity and increased patient satisfaction thanks to the immediate restoration of esthetics and function

Retrospective study of 145 supernumerary teeth

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 supernumerary teeth, 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 producing any symptomology.

Cirugía Bucal Ambulatoria en pacientes pediátricos. Casuística del año 2000 en la Clínica Odontológica de la Universidad de Barcelona

Objetivos: Este trabajo pretende demostrar que se pueden realizar la mayoría de las intervenciones quirúrgicas de la cavidad bucal en la población pediátrica en un medio ambulatorio, así como valorar y mostrar la actividad realizada en el Máster de Cirugía e Implantología Bucal de la Facultad de Odontología de la Universidad de Barcelona durante el año 2000. Diseño del estudio: Para la realización de este trabajo se ha contabilizado la actividad quirúrgica de las unidades de cirugía bucal y cirugía con láser en la población pediátrica en el Máster de Cirugía e Implantología Bucal de la Universidad de Barcelona. Resultados: De las 3187 intervenciones quirúrgicas realizadas en nuestro servicio, 489 fueron en pacientes menores de 18 años. La exodoncia quirúrgica de terceros molares inferiores fue la más frecuente (55'6%), seguida de otras extracciones dentarias (33'6%), quirúrgicas o no, y del resto de intervenciones (10'6%) que incluyeron: fenestraciones de caninos u otros dientes incluidos, exéresis de frenillos, de mucoceles y reubicaciones dentarias. Se presentaron complicaciones tras la extracción quirúrgica de los terceros molares en un 15'93% de los casos, siendo las más frecuentes el dolor (4'35%) y la tumefacción (4'35%), signos propios de la inflamación postoperatoria. Conclusiones: Nuestra experiencia muestra que la cirugía bucal ambulatoria puede practicarse de forma segura en la población pediátrica siempre y cuando se disponga de los medios y del personal sanitario adecuados

Graft materials in oral surgery: revision

Oral implantology is a common procedure in dentistry, especially for fully or partially edentulous patients. The implants must be placed in the best location from both the aesthetic and functional point of view. Because of this it is increasingly more frequent to resort to regeneration techniques that use substitutes of the bone itself, in order to be able to insert the implants in the most appropriate location. Material and Methodology: A review was performed on the literature from the last ten years based on the following search limitations: "graft materials', 'allograft', 'xenograft', 'autologous graft" and 'dentistry". Results: 241 works were obtained that after reading their respective summaries, they were reduced to 38, and 9 previous works were included in order to summarize the concepts. Discussion: Autologous grafts are the 'gold standard' of the bone regeneration. They have obvious advantages, but they also have drawbacks. This is why allogeneic and xenogeneic tissues are used. The former because of their clear similarity with the recipient's tissue and the latter due to their wide availability. Given that these grafts also have drawbacks, the industry has developed synthetic materials that have properties similar to those of human bone tissue. However, as of today, the ideal material to substitute human bone has not yet been found. In recent years the tendency has been to combine these synthetic materials with the patient's own bone, which is extracted during drilling in implant placement, with bone marrow aspiration, or with bone morphogenetic proteins. Thus the intention is to equip these substances with the osteogenic capacity. Conclusions: There is currently no ideal graft material, with the exception of those materials that come directly from the patient. We hope that in the coming years we will have products that will allow us to perform rehabilitations with better results and provide a better quality of life for our patients, especially those who have more complex situations to resolve, like the patients that are operated on for head and neck cancer

Osteossarcoma de mandíbula inicialmente mimetizando lesão do periápice dental: relato de caso

O osteossarcoma é um tumor mesenquimal maligno, no qual as células cancerosas produzem matriz óssea. É o tumor maligno primário mais comum do osso, responsável por aproximadamente 20% dos sarcomas, sendo que 5% destes ocorrem nos maxilares. Possuem variados aspectos não só clínicos e histopatológicos como também no curso e prognóstico. Este artigo apresenta um relato de caso de paciente do sexo feminino, com 20 anos de idade, que nos foi encaminhada apresentando aumento de volume na região de pré-molar inferior esquerdo. Após diagnóstico clínico de lesão do periápice dental, a paciente foi submetida previamente a tratamento endodôntico do dente envolvido, a partir do qual, em um período de 11 dias, pode-se observar um considerável aumento da lesão provocando visível assimetria facial. A radiografia oclusal mostrava imagem compatível com área de destruição óssea e formação de osso anormal na região, com cortical externa exibindo evidente radiopacidade semelhante a raios de sol, sugerindo o diagnóstico de osteossarcoma. A lesão foi biopsiada e obteve-se o diagnóstico histopatológico de osteossarcoma. A paciente foi então submetida à mandibulectomia parcial e uma reconstrução da área, usando osso de costela e enxerto de pele da nádega, para o revestimento da mucosa oral envolvida. Aos 8 meses após a cirurgia houve recorrência local da lesão e a paciente foi a óbito aproximadamente 1 ano depois da recidiva.

Análise da fidelidade do traçado predictivo em pacientes submetidos à cirurgia ortognática em mandíbula

OBJETIVO: a proposta desse trabalho foi analisar a fidelidade dos traçados predictivos realizados para cirurgias ortognáticas, por meio de análise cefalométrica do pré e pós-operatório de sete dias, em pacientes submetidos à correção de deformidade mandibular. MÉTODOS: foram utilizadas telerradiografias cefalométricas de perfil de 17 pacientes submetidos à cirurgia ortognática de mandíbula. Foram realizados traçados cefalométricos do pré e do pós-operatório de 7 dias com marcação dos pontos côndilo (Co), pogônio (Pog), goníaco (Go), mento (Me), ponto B (B) e incisivo (I). A análise foi baseada na diferença obtida pela sobreposição dos traçados pré-operatório, predictivo e pós-operatório. Os pontos foram projetados em um plano cartesiano para medição das suas distâncias em milímetros. Os dados obtidos foram submetidos à análise estatística por meio do teste t de Student pareado (± = 0,05). RESULTADOS: no eixo horizontal, foi observada diferença média, entre a mudança planejada e a obtida nos traçados cefalométricos pós-operatórios, estatisticamente significativa nos pontos Pog (p = 0,014) e I (p = 0,008). No eixo vertical, não verificou-se diferença estatística significativa para os pontos cefalométricos marcados (p > 0,05). CONCLUSÕES: o traçado predictivo contribuiu para a avaliação pré-operatória do paciente e, consequentemente, para a otimização do tratamento. Entretanto, ele não se mostrou totalmente fiel nos casos analisados, com leve subestimação das alterações esqueléticas horizontais. Essas alterações devem ser consideradas no planejamento e acompanhamento pós-operatório dos pacientes submetidos à cirurgia ortognática em mandíbula.

Avaliação cefalométrica do perfil mole de pacientes face longa submetidos à cirurgia ortognática: estudo retrospectivo

OBJETIVO: o presente trabalho propôs-se a comparar o perfil tegumentar pós-operatório de pacientes Classe II, Padrão Face Longa, submetidos ao tratamento ortodôntico-cirúrgico, com os parâmetros descritos na análise cefalométrica de Legan e Burstone. METODOLOGIA: 32 telerradiografias pós-cirúrgicas, com um mínimo de 6 meses de acompanhamento, foram submetidas a traçado manual (repetido 4 vezes) e digitalização (também repetida 4 vezes) no programa DFPlus para análise cefalométrica. RESULTADOS: os resultados permitiram verificar que 9 das 11 medidas avaliadas encontravam-se estatisticamente diferentes da norma avaliada; contudo, ao se verificar o desvio padrão permitido na norma, os achados deste trabalho situam-se dentro da mesma, com exceção do ângulo mentocervical. CONCLUSÃO: as condições experimentais deste estudo permitiram concluir que, embora a população estudada tenha obtido resultados estéticos-funcionais satisfatórios, não se enquadrou nas normas da análise de Legan e Burstone, o que indica que a avaliação após a cirurgia ortognática deve ser principalmente clínica e que a estética facial não está totalmente relacionada com as medidas préestabelecidas na análise cefalométrica.