Eduard Valmaseda-Castellón

Postoperative complications in smoking patients treated with implants: a retrospective study.

PURPOSE To identify the risk of complications (eg, implant loss, infection, peri-implantitis, and mucositis) in a group of patients treated with osseointegrated implants and to assess the effect of smoking on this risk. MATERIALS AND METHODS A retrospective cohort study of patients treated in the Unit of Implantology, University of Barcelona Faculty of Dentistry was performed. All patients had already undergone prosthetic treatment, and the minimal follow-up time after implant surgery was 6 months. RESULTS A total of 295 patients fulfilled the inclusion criteria; 56.9% were women and 43.1% were men. They received a total of 1,033 implants. There were 209 complications (32 cases of implant loss, 2 cases of infection, 70 cases of peri-implantitis, and 105 cases of mucositis). The smoking habit was associated with an increased risk of complications (P = .008). CONCLUSION Smokers had an increased risk of complications, including infection, implant loss, mucositis, and peri-implantitis, compared with nonsmoking patients.

Eruption disturbances of the first and second permanent molars: Results of treatment in 43 cases ☆ ☆☆

Impaction or retention of first and second permanent molars is an uncommon condition with diverse therapeutic approaches. To ascertain the success rate of different treatment possibilities, a retrospective study was made of 25 patients with a total of 43 permanent molars with eruption disturbances. In most cases, the nonerupted teeth were mandibular second molars (65%), followed by maxillary second molars (21%). Their position, degree of impaction (inclusion), clinical features, repercussion on the neighboring teeth, type of treatment, and outcome were evaluated. Infraocclusion was often associated with malposition of neighboring teeth, as well as extrusion and infraocclusion of opposing teeth. Due mostly to a delay in the diagnosis of the condition, an acceptable final position of the nonerupted molar was obtained in only 8 of 13 conservatively treated second molars. In order to prevent this situation, radiographic examination (ideally during the early mixed dentition period) and early diagnosis of eruption disturbances of permanent first and second molars are recommended, particularly when considering that these anomalies are associated with a high rate of occlusal disturbances that may require orthodontic correction.

Hemodynamic changes during the surgical removal of lower third molars.

PURPOSE This study was conducted to determine the hemodynamic changes in healthy patients during the surgical removal of lower third molars, and to evaluate whether these variations are attributable to patient anxiety and pain experienced during the surgical procedure. PATIENTS AND METHODS A prospective study was made of 80 normotensive individuals (40 females and 40 males, mean age, 27 years [range, 18 to 67 years]) seen in the Service of Oral Surgery in the context of the Masters Degree Program in Oral Surgery and Implantology, School of Dentistry, University of Barcelona, for surgical extraction of the lower third molars. Local anesthesia comprised 4% articaine with vasoconstrictor (adrenalin 1:100.000). The following parameters were monitored in each of the surgical interventions: systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and oxygen saturation (SaO(2)). Finally, tests of patient anxiety (Corahs Dental Anxiety Scale and Kleinknechts Dental Fear Scale) were carried out, and the degree of pain experienced during the surgical procedure was assessed by means of a visual analog scale. RESULTS The females showed higher levels of anxiety. The most anxious patients had the lowest BP values and the highest HR, although the differences did not reach statistical significance. The variations in BP and HR during surgical extraction of the molars were within normal limits. In the case of BP, no significant changes were recorded; the highest mean SBP and DBP values were observed at the time of ostectomy and/or tooth sectioning. The lowest HR values were recorded at baseline, before the start of the surgical procedure, whereas the highest values were obtained during incision and flap raising. The SaO(2) values showed no significant changes and were lower at the start of the surgical procedure. CONCLUSIONS Most of the cardiovascular changes induced by the surgical extraction of molars were within normal ranges, considering the anxiety and stress induced by surgery. We consider it essential to avoid pain and minimize patient anxiety to ensure safe clinical practice.

Does Computed Tomography Prevent Inferior Alveolar Nerve Injuries Caused by Lower Third Molar Removal

PURPOSE To verify the utility of computed tomography (CT) in preventing inferior alveolar nerve (IAN) injury owing to lower third molar extraction in close relation to the IAN on orthopantomogram. MATERIALS AND METHODS A retrospective cohort study design of 150 lower third molar extractions was performed. Patients were divided in 2 groups: the CT group (n = 95) underwent panoramic radiography and mandibular CT and the control group (n = 55) underwent only panoramic radiography. RESULTS Six extractions (4%) in the control group and 15 (10%) in the CT group resulted in IAN impairment (P > .05). Logistic regression models did not show that undergoing CT decreased the risk of IAN injury from lower third molar extraction. CONCLUSIONS Patient age and positive radiographic signs (darkening of the root and narrowing of the inferior alveolar canal) were associated with more requests for CT scanning. CT does not seem to significantly decrease the risk of producing IAN injury.

Effect of preoperative ibuprofen on pain and swelling after lower third molar removal: a randomized controlled trial

The aim of this study was to compare the analgesic and anti-inflammatory effects of preoperative and postoperative administration of ibuprofen after the surgical removal of impacted lower third molars. A triple-blind, randomized, placebo-controlled clinical trial of 120 patients requiring the surgical removal of lower third molars was performed. The subjects were randomized into the experimental group (patients were administered 600 mg of ibuprofen (p.o.) 1h before the surgical procedure, followed by placebo just after the end of the operation) or into the control group (subjects received the same medication but the administration sequence was reversed). Pain was assessed using visual analogue scales, and consumption of rescue analgesic. The facial swelling and trismus were evaluated by measuring facial reference distances and maximum mouth opening. There were no significant differences between the two study groups regarding postoperative pain, rescue analgesics consumption, facial swelling and trismus. There was a slightly higher need for rescue analgesics in the experimental group. The preoperative intake of ibuprofen does not seem to reduce pain, facial swelling and trismus after impacted lower third molar removal when compared to the postoperative administration of the same drug.

Periodontal health and lateral lower lip piercings: a split‐mouth cross‐sectional study

AIM To assess periodontal health of individuals with a lateral lower lip piercing and describe associated periodontal, dental and mucosal complications. MATERIAL AND METHODS A split-mouth study was performed in a sample of 50 patients with a lateral lower lip piercing who attended the Periodontal Pathology and Surgery Unit of the Dental School of the University of Barcelona. The patients underwent periodontal, dental and mucosal examination on both the piercing and the control sides. RESULTS Piercing users were predominantly women (78%), with a mean age of 21.3 years (SD=4.4). The amounts of keratinized and attached gingiva were significantly lower on the piercing side, and the prevalence of gingival recession was higher (p=0.012). The canine and first bicuspid teeth were the most affected. Tooth fractures and cracks were more frequent on the piercing side (20%) when compared with the control (4%). Mucosal alterations were found in seven patients. CONCLUSIONS The use of lateral lower lip piercings enhances gingival recession and reduces the amounts of keratinized and attached gingiva. These ornaments are also associated with tooth fractures and cracks.

Long-term results of functional open surgery for the treatment of internal derangement of the temporomandibular joint.

We studied 20 consecutive patients with internal derangements of the temporomandibular joint (TMJ), a median of 51 months after open operation on the joint and a rehabilitation programme. The design was a retrospective clinical study. The maximal opening and lateral active movements and the presence of clicking and joint pain were recorded preoperatively, after complete rehabilitation, and at the time of follow-up. Patients completed visual analogue scales of pain before operation and at the time of follow-up. Operation and postoperative rehabilitation reduced the variability of the opening and lateral movements, significantly increased maximal opening, and reduced clicking and pain.

Patient anxiety and surgical difficulty in impacted lower third molar extractions: a prospective cohort study

Encountering patients who are fearful and anxious is common in dental practice and these factors can increase the complexity of dental procedures. A prospective cohort study was performed to assess whether patient anxiety influences the difficulty of impacted lower third molar extraction and to identify other predictive factors of surgical difficulty; 102 extractions done under local anaesthesia were assessed. Several preoperative variables were recorded (demographic, anatomical, and surgical) and patient anxiety was assessed through the use of various questionnaires. Extraction difficulty was measured using the operation time (OT) and a 100-mm visual analogue scale (difficulty VAS) completed by the surgeon. Patients with deep impacted third molars that required bone removal and tooth sectioning showed higher levels of preoperative anxiety. Significant correlations were found between questionnaire scores and the surgical difficulty (OT and difficulty VAS). OT was also related to age, depth of impaction, third molar angulations, proximity of the third molar roots to the mandibular canal, hard and soft tissue coverage, and the need to perform an ostectomy and tooth sectioning. Impacted lower third molar extraction is significantly more difficult in anxious patients. Other demographic, radiological, and surgical factors were also found to be significantly related to the surgical difficulty.

Bupivacaine 0.5 % versus articaine 4 % for the removal of lower third molars. A crossover randomized controlled trial

Objective: To compare the anesthetic action of 0.5% bupivacaine in relation to 4% articaine, both with 1:200,000 epinephrine, in the surgical removal of lower third molars. As a secondary objective hemodynamic changes using both anesthetics were analyzed. Study Design: Triple-blind crossover randomized clinical trial. Eighteen patients underwent bilateral removal of impacted lower third molars using 0.5% bupivacaine or 4% articaine in two different appointments. Preoperative, intraoperative and postoperative variables were recorded. Differences were assessed with McNemar tests and repeated measures ANOVA tests. Results: Both solutions exhibited similar latency times and intraoperative efficacy. Statistical significant lower pain levels were observed with bupivacaine between the fifth (p=0.011) and the ninth (p=0.007) postoperative hours. Bupivacaine provided significantly longer lasting soft tissue anesthesia (p<0.05). Systolic blood pressure and heart rate values were significantly higher with articaine. Conclusions: Bupivacaine could be a valid alternative to articaine especially due to its early postoperative pain prevention ability. Key words:Bupivacaine, articaine, third molar, anesthesia, postoperative pain.

Accuracy of periapical radiography in assessing bone level in implants affected by peri-implantitis: a cross-sectional study

AIM The aim of this study was to assess the accuracy of periapical radiography in measuring peri-implant bone levels. MATERIALS AND METHODS Twenty-five subjects with 46 implants in need of surgical treatment for peri-implantitis were included in this cross-sectional study. Prior to surgery, periapical radiographs were taken, a prediction of type of defect was made and radiographic peri-implant bone levels (RxBL) were determined at the mesial and distal aspects. Intra-operatively, the peri-implant bone level (SurgBL) was assessed mesially, distally, buccally and orally and the type of defect was recorded. A paired t-test was applied to detect differences between inter-proximal RxBL and SurgBL. ANOVA was used to compare SurgBL at different circumferential positions. RESULTS The mean inter-proximal RxBL was 4.0 ± 2.2 mm and the mean inter-proximal SurgBL was 5.3 ± 2.3 mm. The difference between RxBL and SurgBL was statistically significant (p = 0.014). There were no significant differences in SurgBL at the mesial, distal, buccal and oral aspects (p > 0.05). CONCLUSIONS The intra-operatively measured peri-implant bone levels were more apical than the radiographic bone levels. The intra-operatively assessed peri-implant bone levels (SurgBL) were similar at all the circumferential positions around the implant.