Berta Garcia

Immediate Loading of Immediate Mandibular Implants With a Full-Arch Fixed Prosthesis: A Preliminary Study

PURPOSE To determine the survival of immediate dental implants with immediate loading in the partially edentulous mandible, by use of a full-arch screw-retained provisional restoration. MATERIALS AND METHODS Patients who were partially edentulous in the mandible with indications for extraction of the remaining teeth and with a minimum follow-up of 12 months after implant placement were included in the study. They were treated in chronologic order by the insertion of 6 Defcon dental implants (Impladent, Sentmenat, Spain) subjected to immediate loading (4 interforaminal and 2 posterior placements). Implants with a minimum primary stability of 60 implant stability quotient were loaded. All resin screw-retained prostheses were inserted and loaded with fully functional occlusion within 24 hours of implant placement. RESULTS Eleven patients were treated with immediate implants, although 2 patients were excluded from the study for having an implant stability quotient value below 60 in at least one of the implants after surgery and did not undergo restoration with immediate loading. Fifty-four implants were placed in 9 partially edentulous patients with immediate loading with a full-arch screw-fixed prosthesis. The patients wore this provisional prosthesis during the healing period (2 months) without complication and with a high level of comfort. The survival rate of the implants was 100% at 12 months of follow-up. CONCLUSION Immediate mandibular loading with immediate full-arch implant-supported and screw-retained restorations is a viable treatment alternative, yielding a 100% success rate in this small series of patients.

Influence of Oral Hygiene and Smoking on Pain and Swelling After Surgical Extraction of Impacted Mandibular Third Molars

PURPOSE To assess the pain and swelling during the first week after surgical extraction of impacted mandibular third molars and the relationship with oral hygiene and smoking before surgery and during the postoperative period. MATERIALS AND METHODS A prospective study was performed on patients undergoing surgical extractions of impacted mandibular third molars. Pain was recorded on a visual analog scale from 1 to 10 and swelling on a 4-point descriptive scale at 2, 6, and 12 hours after surgery and daily during the first postoperative week. Oral hygiene and smoking before surgery and during the postoperative period were recorded. Statistical analysis was performed of all the variables. A P value less than .05 was considered statistically significant. RESULTS A total of 50 patients (27 men and 23 women) with a mean age of 26.3 years (range 18 to 39) underwent surgical extraction of an impacted third molar. The maximum pain occurred during the first day and the maximum swelling at 24 hours after surgery. The patients with a lower brushing frequency before surgery reported greater pain. Likewise, the patients who smoked more after surgery experienced greater pain at 24 hours postoperatively. The hygiene after surgery and smoking before the surgical intervention had no statistically significant relationship to the occurrence of pain (P > .05). Swelling had no relationship with the variables studied (P > .05). CONCLUSIONS Surgical extraction of an impacted third molar caused moderate pain and swelling during the first 24 hours after surgery. A lower brushing frequency before surgery and during the first postoperative week as well as smoking after surgery were related to greater pain scores.

Periapical Surgery in Maxillary Premolars and Molars : Analysis in Terms of the Distance Between the Lesion and the Maxillary Sinus

PURPOSE This study compares periapical surgery (PS) of the maxillary premolars and molars in close proximity to the maxillary sinus with those not in close proximity, and assesses postoperative morbidity and prognosis. PATIENTS AND METHODS A prospective follow-up study was carried out on clinical cases of PS using the ultrasound technique. Only patients undergoing PS in maxillary premolars and molars were included in this study; minimum follow-up was set at 12 months. The cases were classified into 2 different groups in function of the proximity of the periapical lesion to the maxillary sinus: group 1, when the distance was less than 2 mm; group 2, when the distance was greater than or equal to 2 mm. Postoperative morbidity was measured, as well as a clinical and radiographic follow-up evaluating the overall mid- and long-term success rate using von Arx and Kurt criteria. SPSS 12 was used for the statistical analysis. All measures of estimated association were then tested for statistical significance, and declared significant for P less than .05. RESULTS PS was carried out on 92 patients, 106 teeth, and 129 periapical lesions. Group 1 was composed of 43 maxillary premolars and molars with 59 lesions, and group 2 of 63 teeth and 70 lesions. Maximum pain occurred during the first 6 hours and swelling reached its peak on the second day. The overall healing in maxillary premolars and molars was 75% success, 10% improvement, and 15% failure at 1-year follow-up. There were no significant differences between the 2 groups regarding postoperative pain, swelling, and outcome (P > .05). CONCLUSIONS The success of PS in maxillary premolars and molars at 12 months follow-up was 75%. Failure rates in premolars and molars in close proximity to the maxillary sinus were higher than unrelated premolars and molars, but the differences were not significant statistically.

Distance Between Periapical Lesion and Mandibular Canal as a Factor in Periapical Surgery in Mandibular Molars

PURPOSE Mandibular molars with a periapical pathology that remains unresolved by endodontic treatment may be considered for periapical surgery (PS); even for those situated in close proximity to the mandibular canal. Our objective was to compare PS in mandibular molars situated close to the mandibular canal, and those at a greater distance, and to study the postoperative morbidity and prognosis of both groups. PATIENTS AND METHODS A follow-up study was made on PS carried out using the ultrasound technique. The cases were classified into 2 different groups in function of the proximity of the periapical lesion to the mandibular canal; group A when the distance was less than 2 mm and group B when it was equal to 2 mm. Only patients undergoing PS in mandibular molars were included in this study; minimum follow-up was set at 12 months. The postoperative morbidity was evaluated, as well as the mid- and long-term overall success. SPSS 12 (SPSS Inc, Chicago, IL) was used for statistical analysis. All estimated association measures were then tested for statistical significance, and declared significant for P values less than .05. RESULTS PS was carried out on 79 patients, with 98 lesions, involving 88 mandibular molars. Group A was made up of 22 patients with 27 periapical lesions in close proximity to the mandibular canal, involving 23 mandibular molars; and group B comprised 57 patients with 71 lesions not in close proximity to the mandibular canal, involving 65 molars. Sixty percent of the patients presented between no pain and mild pain on the second postoperative day and two thirds of the patients between mild and moderate swelling. Group A had higher average pain than group B (P < .05), peaking at 2 days, whereas in group B maximum pain was reached at 2 hours of the intervention. The success at 12 months in the mandibular molars was 66.6% with no statistically significant differences between the 2 groups (P > .05). CONCLUSION The success obtained in mandibular molars shows that periapical surgery is a valid treatment option, even in molars situated in close proximity to the mandibular canal.

Zygomatic Bone Graft for Oral-Antral Communication Closure and Implant Placement

The roots of molar and premolar maxillary teeth are often very close to the floor of the maxillary sinus. As a result, extraction of these teeth can leave an oral-antral communication or lead to a fistula that requires treatment. A woman with an oral-antral communication secondary to extraction of a maxillary molar is presented. The communication was closed by means of a bone graft harvested from the wall of the sinus (zygomatic bone). After 3 months, 2 dental implants were placed, one in the pterygoid area and the other with parasinusal angulation. Rehabilitation followed in the form of a screw-retained, fixed prosthesis 3 months after implant placement. There have been no complications after 1 year of follow-up. This surgical technique allowed closure of an oral-antral communication produced by molar extraction through placement of a zygomatic bone graft and subsequent placement of 2 dental implants.

Idiopathic Trigeminal Neuropathies: A Presentation of 15 Cases

PURPOSE The aim of this study is to present a clinical series of patients with trigeminal neuropathy and their treatment. PATIENTS AND METHODS We present a retrospective study of 15 cases of idiopathic trigeminal neuropathies, with unilateral involvement of 1 or more divisions of the trigeminal nerve. The clinical, radiologic, and laboratory data of the patients, in addition to the treatment and clinical evolution, were reviewed. The patients were followed up for a mean of 34.4 months (range, 12-120 months). RESULTS The study consisted of 11 women and 4 men. The numbness was predominantly located in the innervated mental area and extended in some cases to the first and second trigeminal divisions. Seven patients had slight continuous discomfort in association with the numbness, one of whom had added bouts of typical neurogenic pain. Of the 15 cases, 8 (53%) had acute idiopathic trigeminal neuropathies and fully recovered within 3 months and 7 (47%) were chronic cases, without full recovery after 3 months. Mild pain was felt by 57% of the chronic patients and 37% of the acute patients; treatment with amitriptyline achieved complete or partial improvement in over half of these patients. CONCLUSION Of the idiopathic trigeminal neuropathies, half were acute and half were chronic. Mild pain presented more frequently in the chronic patients and was relieved with amitriptyline.

Fixed Ceramometallic Prostheses Over Anterior and Transzygomatic Implants by Using the Sinus Slot Technique—Report of a Case

Atrophy of the upper jaw poses problems for fixed rehabilitation of implants. Of the different management possibilities that have been developed, transzygomatic implant placement is a good option and affords a high success rate. These implants are positioned in zygomatic bone by using 2 possible techniques. We present a 48-year-old woman with severe posterior maxillary atrophy in which the canine and frontozygomatic prominence were used to place 6 anterior and 2 transzygomatic implants by using the sinus slot technique for fixed bridge rehabilitation. The advantages of the sinus slot technique over the sinus window technique are discussed.