Miguel Peñarrocha

Oral lichen planus and chronic liver disease : a clinical and morphometric study of the oral lesions in relation to transaminase elevation

Serum transaminase levels (serum glutamic-oxaloacetic transaminase or serum glutamic-pyruvic transaminase) were found to be altered in 40 (21.39%) of 187 patients with oral lichen planus. The patients with oral lichen planus who had altered transaminase levels were on average older than those without liver disorders and exhibited a higher percentage of erosive lesions (p < 0.05) and tongue involvement. Histologically, no statistically significant differences were noted in the extension of inflammatory infiltration or in connective tissue density; nevertheless, the latter was greater in patients without altered transaminase levels. Finally, among those patients with altered liver test results and erosive lichen planus, serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase levels were found to be higher than levels in those patients without erosions. This indicates that behavior of the oral lesions is more aggressive as the degree of liver alteration increases. We emphasize that of the 40 patients with altered transaminase levels (all later proved to reflect chronic hepatitis through complementary diagnostic methods), 28 had hepatitis C virus infection.

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.

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.

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.

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.

Idiopathic trigeminal sensory neuropathy

Idiopathic trigeminal sensory neuropathy is a rare disorder characterized by transient sensory disturbances in the territory of one or more branches of the trigeminal nerve. Acute and chronic forms of the disease have been recognized, but the boundaries between these groups are not clearly defined. Six cases of idiopathic trigeminal sensory neuropathy are reported. All patients presented with sensory abnormalities limited to the territory of one trigeminal nerve, in the absence of other clinical features. The symptoms were on the left side of the face in five cases and on the right side in one. No bilateral involvement was seen. There were no cases of muscle weakness, and the corneal reflex was always present. In two cases, sensory disturbances began in the tongue or lips and later spread through the entire territory of the three trigeminal branches. Both patients recovered completely after 3 months. The other four patients had involvement of the second and third branches (two cases), or the third branch alone (two cases), and the symptoms persisted unmodified for 2 to 4 years. There were no clinical variables at onset to enable one to predict an acute or chronic evolution of the disease.

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.

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.

Piezoelectric vs. conventional drilling in implant site preparation: pilot controlled randomized clinical trial with crossover design

OBJECTIVE To compare implant stability throughout osseointegration, peri-implant marginal bone loss, and success rates of implants placed with conventional and mixed drilling/piezoelectric osteotomy. MATERIALS AND METHODS A pilot randomized-controlled trial was performed on 15 patients. Each patient received two implants in the mandibular molar region. All sites were prepared with conventionally up to the 2.8 mm wide drill. Osteotomies were randomly finalized with a 3 mm diameter drill (control group) or with two consecutive ultrasonic tips (2.8 mm and 3 mm wide, respectively) (test group). Resonance frequency analysis measurements were taken at implant placement and after 1, 3, 8, and 12 weeks. Peri-implant marginal bone loss 12 months after loading was calculated using periapical radiographs. Wilcoxon test for related samples was used to study differences in implant stability and in peri-implant marginal bone loss between the two groups. RESULTS Twenty-nine of 30 implants osseointegrated successfully (one failure in the control group). Stability was significantly higher in the test group at the 8th week assessment; differences were non-significant at all other time-points. Longitudinally, differences were observed between the patterns of implant stability changes: in the test group stability increased more progressively, while in the control group an abrupt change occurred between the 8th and 12th weeks assessments. No difference was found in peri-implant marginal bone loss between the groups. All 29 implants were functionally successful at the 15-month visit. CONCLUSIONS Within the limit of this pilot study (small sample size, short follow-up), data suggested that implant stability might develop slightly faster when implant site osteotomy is performed with a mixed drilling/ultrasonic technique.

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.