Natalia Martínez-Rodríguez

Meta-analysis of the increase in height in maxillary sinus elevations with osteotome

Objectives: To compare the different variations of sinus elevation techniques with osteotomes, to evaluate the increase in height achieved, and to quantify the osseointegration periods and the success rates for the implants placed. Study Design: A meta-analytic study with descriptive statistics was carried out on sinus elevations using osteotomes, analyzing a total of 11 articles published between the years 2003 and 2008. Results: Summers’ classic technique for performing sinus elevations with osteotomes differs from the current techniques being used with respect to the use of drills, the manner in which the sinus floor is fractured and how the sinus membrane is lifted, and especially on the type of graft used—the most current tendency being not to use a graft. The maximum gain in height is 4.62 mm, and the minimum gain in height is 2.07 mm, starting with a maximum residual bone height of 8.8 mm and a minimum of 4.1 mm. The osseointegration period is 4.9 months and the success rate is 95.5%. Conclusions: Performing sinus elevations with osteotomes is a predictable technique that enables achieving an increase in bone height and successful results, similar to those of other techniques used, in the placement of implants. Key words:Osteotomes, maxillary sinus elevation, dental implants, osseointegration.

Glossopharyngeal Neuralgia: A Presentation of 14 Cases

OBJECTIVE The aim of this study was to present a series of clinical cases on glossopharyngeal neuralgia as well as the therapeutic approach used. PATIENTS AND METHODS This observational, descriptive, and retrospective study was carried out on 14 patients who were diagnosed with glossopharyngeal neuralgia between the years 1997 and 2007 at the Oral-Facial and Implant Surgery Department and at the Otorhinolaryngology, Neurology, and Neurosurgery Departments of the Madrid University Hospital. RESULTS The study consisted of 8 women and 6 men. The neuralgia was found predominantly on the left side, and considering the 4 areas of topographical distribution into which the distribution of the ninth nerve is divided, the results of our study showed that the maximum of the areas affected was 3, with 2 areas being the most common. Accompanying symptoms were only recorded in 4 of the cases. In 12 of the cases, initial treatment was with prescription drugs consisting of different doses of carbamazepine. In the remaining cases, or once the other course of treatment was proven to be unsuccessful, surgical treatment was used, applying different techniques and obtaining a high rate of success with them. CONCLUSIONS Glossopharyngeal neuralgia is an uncommon pathology that is treated with medicine or surgery, with carbamazepine and vascular microdecompression being the treatments of choice.

Evaluation of the anaesthetic properties and tolerance of 1:100,000 articaine versus 1:100,000 lidocaine. A comparative study in surgery of the lower third molar

Objectives: To evaluate the anaesthetic properties and tolerance of articaine versus lidocaine at equal vasoconstrictor concentration. Study Design: A total of 96 male and female patients who underwent surgical treatment of the lower third molar participated. Patients were randomly assigned to articaine hydrochloride with epinephrine 1:100,000 and lidocaine hydrochloride with epinephrine 1:100,000. The variables analysed were latency period, duration of anaesthetic effect, tolerance and adverse reactions. Results: Both the latency period and the duration of anaesthetic effect were greater for articaine, although the differences were not statistically significant. Latency: mean difference of 2.70 ± 2.12 minutes (95%CI of -1.51 minutes - 6.92 minutes). Duration: mean difference of -33 minutes 5 seconds ± 31 minutes (95% CI -1 hour 35 minutes - 29 minutes). There were 4 adverse events that did not require the patients to be withdrawn from the study. Conclusions: The anaesthetics in this study have very similar properties for use in surgery and have demonstrated a good safety and tolerability profile Key words: Articaine, lidocaine, vasoconstrictor, adverse reactions.

Implant survival and complications in cases of inferior alveolar nerve lateralization and atrophied mandibles with 5-year follow-up.

The objectives of this study were to evaluate the survival after 5 years of implants placed using inferior alveolar nerve (IAN) lateralization in cases of mandibular atrophy and to determine the incidence of complications. Twenty-seven patients received 74 implants by means of the IAN lateralization technique. Implant survival after 5 years of loading was 98.6%. Eighteen months after surgery, the recovery of sensitivity was complete in 26 cases. Implant placement with IAN lateralization was seen to be a satisfactory and predictable technique. IAN lateralization requires a high level of technical skill, and strict criteria should be applied when prescribing this treatment.

Dental considerations in diagnosis of maxillary sinus carcinoma

BACKGROUND Maxillary sinus carcinoma is a rare entity with an incidence of 0.2% and a low patient survival rate due to the frequency of late diagnosis. METHODS In this multicenter, transversal, retrospective, observational study, the authors analyzed patients who had received a diagnosis of maxillary sinus carcinoma, registering their oral symptoms, histologic type, treatment efficacy, and survival rate. RESULTS Maxillary sinus carcinoma was diagnosed in 24 patients (15 men and 9 women), of which 75% were squamous cell carcinomas. All patients had dental mobility, and some had swelling, orosinus fistula, or some dental loss. Mean patient survival rate was 38.83 months. CONCLUSIONS A history of pain or swelling of unknown origin, an unexplained widening of periodontal ligament space, or mobility of the teeth should be considered warning signs of maxillary sinus carcinoma. PRACTICAL IMPLICATIONS Recognition of oral symptoms by the dentist would help in making an early diagnosis of maxillary sinus carcinoma, improving the patients chances of survival and quality of life.

Comparison of peri-implant soft tissues in submerged versus transmucosal healing: A split mouth prospective immunohistochemical study

OBJECTIVE The present split-mouth prospective study involves an immunohistochemical evaluation of peri-implant soft tissue healing after the osseointegration period, comparing submerged and transmucosal approaches using two-piece implant systems. The null hypothesis was that both surgical procedures elicit a similar immune response of the peri-implant soft tissues. DESIGN Thirty-one healthy patients were included in this study, in which two implants were placed in the right and left maxillary pre-molar regions. A total of 62 dental implants were analyzed, establishing a control side with 31 submerged implants, and a study side with 31 exposed implants bearing healing abutments. After a three-month healing period, a soft tissue biopsy was collected and prepared for immunohistochemical analysis of the proportions of different lymphocyte subpopulations. RESULTS The comparative analysis between the submerged and transmucosal approaches failed to identify statistically significant differences in CD19+ B cells, CD4+ T cells, CD8+ T cells, CD25+ T cells or γd T cells. However, significant differences in NK lymphocytes (p = 0.012) were recorded with the submerged surgical procedure. CONCLUSIONS Peri-implant soft tissue immune response with submerged or transmucosal healing protocols demonstrated comparable outcomes after the osseointegration period. There is sufficient evidence that the null hypothesis of no difference cannot be rejected. To the best of our knowledge, this is the first study of its kind. Further research is therefore needed to further clarify the role of these lymphocyte subpopulations in peri-implant soft tissues.

Masseter and temporalis muscle electromyography findings after lower third molar extraction

Background The main clinical application of electromyography is to detect abnormalities in muscle function, to assess muscle activity for purposes of recruitment, and in the biomechanics of movement. Objectives To analyze electromyography (EMG) findings for masticatory muscles during chewing following surgical extraction of lower third molars, and to determine any correlation between pain, inflammation, trismus, and the EMG data registered. Material and Methods This prospective study included 31 patients. Surface EMG was used to study masseter and temporalis muscle function before lower third molar extraction and 72 hours and seven days after surgery. Clinical variables, pain, inflammation, and trismus were registered before and after surgery. Results Studying the area and size of the masticatory muscles, higher values were found for temporalis than masseter muscles, regardless of the surgical side, which points to the greater involvement of the temporalis muscle in mastication. Comparing the side where surgery had been performed with the non-surgical side, a sharp and statistically significant reduction in amplitude and area were noted on the surgical side reflecting major functional affectation. One week after surgery, amplitude and area had almost returned to base-line values, indicating almost complete recovery. While pain decreased progressively after surgery, inflammation peaked at 72 hours, while mouth opening reached a minimum at this time, returning to normality within the week. Conclusions Surgical extraction of lower third molars produces changes to electromyography activity that are more evident during the first hours after surgery and closely related to the intensity of pain suffered and the patient’s inflammatory responses, although they are not related to mouth opening capacity. Key words:Third molar surgery, electromyography, pain, inflammation, trismus, masticatory muscles.