Celia Carrillo

Relationship between histological diagnosis and evolution of 70 periapical lesions at 12 months, treated by periapical surgery.

PURPOSE To relate the histologic diagnosis and radiographic size with the prognosis of 70 biopsies obtained via periapical surgery. MATERIALS AND METHODS Seventy biopsies obtained during periapical surgery were histologically analyzed following curettage of the tissue, establishing the diagnosis as either apical granuloma, radicular cyst, or scar tissue. The radiographic size of the lesion (area in mm(2)) before surgery and after 1 year of follow-up was measured. The evolution at 12 months after surgery was evaluated according to the criteria of von Arx and Kurt. A statistical study was made, the inter-variable relationships were studied using analysis of variance with subsequent Tukey testing and calculation of Pearson correlation coefficient. RESULTS Results indicated that 65.7% of lesions were granulomas, 25.7% scar tissue, and 8.6% cysts. The larger lesions had the worst prognosis. Cysts had the worst evolution at 12 months after surgery, this result being statistically significant. CONCLUSIONS The prognosis for the periapical lesion depended on the type of lesion and its radiographic size, with cysts and larger lesions having the worst evolution.

Marginal Bone Loss in Dental Implants Subjected to Early Loading (6 to 8 Weeks Postplacement) With a Retrospective Short-Term Follow-Up

PURPOSE To evaluate the success rate and marginal bone loss in dental implants loaded after 8 weeks in the maxilla and after 6 weeks in the mandible, after 1 year of follow-up. MATERIALS AND METHODS A retrospective case series study was made. The sample was composed of subjects having 1 or more implants placed and loaded early between 2004 and 2006. Success rate was evaluated following Busers criteria. A protocol was made in which patient age, gender, implant location, diameter and length, type of bone, type of prosthesis, and the location of the opposing teeth were collected. Marginal bone loss was evaluated after 1 year of loading on intraoral x-ray findings. A statistical analysis was made to process the variables. RESULTS A total of 106 dental implants were positioned in 30 patients, in whom 102 prostheses were placed. The fixation success rate was 98.1%; mean bone loss was 0.58 mm after 1 year of loading. The factors seen to exert a significant influence on bone loss were the zone of the arch and the teeth opposing the implant. CONCLUSION The recorded success rate and bone loss were similar to the values reported in the literature, thus supporting early loading as a safe and predictable procedure that allows a reduction in treatment time.

Correlation of Radiographic Size and the Presence of Radiopaque Lamina With Histological Findings in 70 Periapical Lesions

PURPOSE This study was conducted to relate the histological diagnosis of chronic inflammatory periapical lesions with the radiographic images of these lesions. MATERIALS AND METHODS A total of 70 biopsy specimens obtained during periapical surgery were stained with hematoxylin and eosin and examined under a microscope. Histological analysis established the diagnosis as granuloma, cyst, or scar tissue. The location of the lesion was recorded, as were the radiographic size (maximum and minimum diameter in mm and area in mm(2)) and the presence of radiopaque lamina around the lesion, using an image analyzing system. RESULTS The distribution of the biopsy specimens was 65.7% granulomas, 25.7% scar tissue, and 8.6% cysts, 1 of which was a keratocyst. The largest lesions were cysts and epithelialized granulomas, with statistically significant differences. Radiopaque lamina was observed around 9 lesions; of these, only 2 were histologically diagnosed as cysts, with the rest as granulomas. CONCLUSIONS Most of the apical lesions were granulomas. Cysts had the largest radiotransparent images; however, in the 70 cases studied, neither the radiographic size nor the presence of associated radiopaque lamina alone was sufficient to determine the type of lesion. Histological analysis is required.

Computer-guided implant placement in a patient with severe atrophy.

Computer software associated with imaging techniques facilitates diagnosis, planning, and management in cases of severe maxillary atrophy, by reducing the incidence of complications and improving the postoperative course and functional outcome. This article reports on a case of a 66-year-old woman with maxillary atrophy. Computer software was used to plan and position 6 maxillary and 4 mandibular implants, taking maximum advantage of the remaining bone. Bicorticalization was sought by angulation and implant fixation in the buttresses, while rehabilitation was carried out by means of a fixed screw-retained upper prosthesis and a lower overdenture. No implants were lost after 36 months of follow-up. This technique optimized precise implant placement as planned without the need for more complex reconstruction techniques.

Symptoms Before Periapical Surgery Related to Histologic Diagnosis and Postoperative Healing at 12 Months for 178 Periapical Lesions

PURPOSE To compare the preoperative signs and symptoms with the histologic diagnosis and postoperative healing at 12 months for 178 periapical lesions. MATERIALS AND METHODS A total of 152 patients who had undergone periapical surgery from 2005 to 2008 were studied. The study included patients presenting with signs and symptoms before periapical surgery with a sufficient tissue sample (periapical lesion) for histologic analysis and a minimal follow-up of 12 months. The signs and symptoms present in the soft tissues at the initial examination were recorded. The histologic analysis established the diagnosis as granuloma, cyst, or scar tissue. The postoperative healing at 12 months was evaluated according to the criteria of von Arx and Kurt. RESULTS Of the 152 patients, 147, with 178 periapical lesions, were included in the present study. No significant relationship was found between the preoperative signs and symptoms, lesion type, and evolution. However, scar tissues were asymptomatic in 78.1%, and 36.4% of granulomas were painful. Of the 8 cysts, 50% were asymptomatic and 50% caused pain. Fibrous scars created no soft tissue alterations in 68.7%. Granulomas had fistulized in 31.7%, and 75% of cysts had produced no alterations. The lesions with swelling had worse healing, and those with no soft tissue alterations had better postoperative healing. CONCLUSIONS Chronic periapical lesions (granuloma, cyst, and scar tissue) are usually asymptomatic and do not create soft tissue alterations. However, they can deteriorate, producing pain and fistulization. Worse postoperative healing was observed for lesions with swelling, although the difference was not significant.

Rehabilitation of Reabsorbed Maxillae With Implants in Buttresses in Patients With Combination Syndrome

PURPOSE To assess the success and marginal bone loss, after 1 year of loading, of implants placed in anatomic buttresses of atrophic maxillae to rehabilitate patients with combination syndrome. MATERIALS AND METHODS A case series retrospective study of 22 patients with combination syndrome who were treated with implants in anatomic buttresses in the atrophic maxilla was performed. The inclusion criteria were Classes IV and V Cawood and Howell maxillary atrophy, rehabilitation with implants placed in anatomic buttresses, the presence of anterior remnant teeth in the mandible, and a minimum follow-up of 12 months after implant loading. The criteria of Buser et al were used to evaluate implant success, and marginal bone loss was measured on periapical radiographs. Statistical analysis was performed to relate implant success and marginal bone loss to gender, degree of maxillary atrophy, implant technique, and prosthesis type. RESULTS A total of 18 patients fulfilled the inclusion criteria. A total of 117 implants were placed; 32 were placed with the conventional technique in the alveolar ridges with enough height and width, 35 were positioned palatally, 30 were tilted in the frontomaxillary buttress, 10 were placed in the pterygomaxillary area, 6 were placed in the nasopalatine canal, and 4 were zygomatic implants. The follow-up ranged from 1 to 7 years after implant loading. Of the 117 implants, 7 failed, for an implant success rate of 94%. The mean marginal bone loss was 0.63 mm. A statistically significant relation was found between bone loss and implant placement technique and the level of maxillary atrophy, being greater in tilted implants and in Class V Cawood and Howell maxillary atrophy. CONCLUSIONS Implants in anatomic buttresses allow rehabilitation of atrophic maxillae in patients with combination syndrome. The implant success rate was high, and a mean marginal bone loss of 0.63 mm was recorded.