Daniel Torres Lagares

Use of anesthetics associated to vasoconstrictors for dentistry in patients with cardiopathies: review of the literature published in the last decade

Objective: The use of local anesthetics associated to vasoconstrictor agents in dentistry is thoroughly justified and is widely extended, but we cannot ignore the fact that anesthetic infiltration poses risk of complications throughout the dental treatment period. The objective of the present review is to document the reported effects the use of the local anesthetics most widely employed in dentistry, with or without association to vasoconstrictor agents may have in patients with any sort of cardiopathy. Study Design: We have searched for randomized clinical trials on the assessment of the cardiovascular effects of local anesthetics used in dentistry, without limits as regards age or sex, conducted in patients with any type of cardiopathy which were published during the last decade and were index-linked in Cochrane, Embase and Medline. Results: We have found six randomized clinical trials index-linked in Medline and Cochrane in the past ten years. These trials compare different types of anesthetics: lidocaine 2%, mepivacaine 2%, prilocaine 2% , associated or not to different vasoconstrictor concentrations such as adrenaline or felypressin. The cardiopathies affecting the patients included in the different trials range from hypertension, ischemic heart disease, arrythmias, chronic coronary disease to heart transplantation. Conclusions: The use of anesthetics associated to vasoconstrictor agents is justified in the case of patients with cardiopathies (once we get over the period in which any type of dental manipulation is contraindicated) and in controlled hypertensive patients. In any case, we must be very careful with the choice and execution of the anesthetic technique, being it possible to use a dose between 1.8 and 3.6 ml, on a general basis. Further studies are necessary to establish the effects of these drugs on severe hypertensive patients or in patients with other more advanced cardiopathies. Key words:Vasoconstrictor agents, epinephrine/adverse effects, local anesthetics, dental restoration, oral surgery, cardiovascular diseases, coronary arteriosclerosis, heart disease, hypertension, arrhythmias, coronariopathy.

Is periodontal disease a risk factor of maxillar chemical osteonecrosis associated with bisphosphonates

espanolObjetivo: La enfermedad periodontal constituye una de las patologias mas comunes a nivel oral. Su componente infeccioso e inflamatorio ha sido propuesto como factor de riesgo en la aparicion de quimio-osteonecrosis maxilar inducida por bisfosfonatos. El objetivo de esta revision bibliografica es revisar los resultados obtenidos en la literatura en cuanto a esta controvertida relacion. Material y Metodos: Siguiendo los items de las guias PRISMA del ano 2010, se realizo una revision bibliografica en Pubmed de los articulos publicados en los ultimos diez anos. Resultados: La busqueda inicial en Pubmed devolvio 194 resultados. Tras la verificacion manual se anadieron 30 mas. Tras la aplicacion de los criterios de inclusion y exclusion se estudiaron en profundidad un total de 12 articulos (7 a favor de la hipotesis de considerar la enfermedad periodontal como un factor de riesgo de aparicion de osteonecrosis maxilar y 5 en contra). Conclusiones: Existe controversia en la literatura en considerar la enfermedad periodontal como factor de riesgo en la aparicion de quimio-osteonecrosis maxilar inducida por bisfosfonatos. Aunque en el consenso de la American Association of Oral and Maxillofacial Surgeons de 2014 la proponen como un factor local de la misma, la evidencia en que se basa dicha afirmacion es aun debil y controvertida. EnglishObjective: Periodontal disease is one of the most common oral pathologies. Its infectious and inflammatory component has stimulated it to be proposed as a risk factor for bisphosphonate-induced maxillary chemo-osteonecrosis. But, because there are studies that find association and others do not, the objective of this literature review will be to gather the results obtained in the literature regarding this relationship so controversial. Materials and Methods: Following the items in the PRISMA guidelines of the year 2010, a bibliographic review was carried out in Pubmed of the last ten years. Results: The initial search in Pubmed returned 194 results and 30 in the manual verification, following the proposed elegibility criteria a flow chart was made. After applying the inclusion and exclusion criteria, a total of 12 articles were studied in depth (7 in favor of the hypothesis of considering periodontal disease as a risk factor for the appearance of ONJ and 5 against). Conclusions: There is controversy in the literature to consider periodontal disease as a risk factor for bisphosphonate-induced maxillary chemo-osteonecrosis. Nevertheless, in the consensus of the American Association of Oral and Maxillofacial Surgeons of 2014, they propose it as a local factor of the same.

Nanobiomaterials in hard tissue engineering

Abstract In this chapter we will conduct a focused review of the main types of resorbable biomaterials like PLGA (polylactic-glycolic acid copolymer), and their surface modifications on the nanoscale (like the nanocomposites of metallic oxides, oxygen plasma, hydroxyapatite, etc.), their applications in biomedicine, and future prospects. We will also talk about the current advances in nanotechnology, and the surgical method of guided bone regeneration where these biomaterials are used. Subsequently, we will comment on the background of the previous, more favorable, in vitro studies that used this kind of biomaterial tested in human osteoblast cell culture. On a second level, we will examine an animal histomorphometric study, in vivo, of a successful evaluation of PLGA membranes with a new surface modification consisting of a physical pretreatment using oxygen plasma to favor their degradation into bone tissue in the healing phase, together with the addition of nanocomposites of osteogenic mediators like titanium oxide. The membranes were tested at 1-month regeneration in 8 experimental rabbits with 2 surgically generated critical bone defects. To compare the potential effect of these membranes, a number of studies and comparisons have been performed, the following analyses and methods are used: a qualitative comparison of the integral structure and bone density generated, the osteoid and the presence or absence of abnormal inflammation were performed using toluidin blue dye (BT), a quantitative histomorphometric analysis of the percentage of newly formed bone was obtained using the Von Kossa stain (VK), a quantitative study of growth in millimeters per day was made by labeling with the Calcein clinic method (C), a quantitative study of the level of bone resorption was made using enzymatic staining with sodium-tartrate-resistant acid phosphatase, the enzymatic staining with alkaline phosphatase was used to make a qualitative comparison of the normal presence of osteoblastic apposition, related to controls (with only simple PLGA).