Rafael Martinez-de-Fuentes

Osteonecrosis of the Maxilla Associated With Cancer Chemotherapy in Patients Wearing Dentures

Osteonecrosis of the jaw (ONJ) in patients with cancer and hematologic diseases associated with chemotherapy, but not receiving treatment with bisphosphonates (BPs), is a very rare condition. However, as long-term survival of patients receiving chemotherapy increases, the occurrence of this serious complication may also increase. We identified 2 patients in our department who presented with maxillary osteonecrosis (ON) as a complication of aggressive cancer chemotherapy. They had exposed necrotic bone in close relation to the misuse of removable dental prostheses. We are presenting these cases to point out that cancer chemotherapy in patients wearing dentures may lead to an increased risk of ON, which may require prophylactic measures to ensure proper maintenance of dental prostheses. Acute myeloid leukemia (AML) is a type of hematologic disease treated with aggressive chemotherapy, which causes severe neutropenia for more than 10 days in each cycle. The chemotherapy regimen used for the treatment of AML includes 4 cycles of aggressive multiagent chemotherapy (induction, consolidation, and 2 intensification cycles). The 2 cytostatic agents usually associated with the chemotherapy regimen are cytosine arabinoside (ara-C) and an anthracycline drug (daunorubicin or idarubicin). 1 For 2t o 3 weeks after aggressive chemotherapy, a severe phase of leukopenia, neutropenia, thrombocytopenia, and immunosuppression may provoke several complications, 2,3 especially infectious, which is why patients are frequently admitted to the hospital during this time. The most common complications are gingival bleeding, oral mucositis, gingival hyperplasia, opportunistic infections such as candidiasis, herpes viral

Laypersons' perception of facial and dental asymmetries.

The purpose of this article was to determine the individual visual perception thresholds of certain facial and dental discrepancies for a symmetric face model (SFM). A facial photograph of a female subjects smile was digitally manipulated into an artificially symmetric picture. Modifications were made on the SFM for shifts in the dental midline, nose, and chin (group 1) and cants of dental midline and incisal plane (group 2), resulting in a total of 24 different images divided into two groups. One-hundred randomly selected laypersons divided into two groups were used to evaluate each image according to their own personal beauty and esthetic criteria using a visual analog scale. The visual perception thresholds found for the SFM were 2 mm for a dental midline shift, 4 mm for nose deviation, 5 degrees for dental midline cant, and 3 degrees for frontal incisal plane cant. Chin deviations of 6 mm or less were not noticed. Dental midline shift, nose deviation, dental midline cant, and incisal plane cant relative to an SFM have an impact on the perception of facial attractiveness. Chin deviations did not have a statistically significant impact.

Treatment of recurrent mandibular ameloblastoma.

Ameloblastoma is a locally invasive benign odontogenic tumor with a high rate of recurrence in the long term. The authors conducted a retrospective study of patients with mandibular ameloblastoma in order to evaluate recurrent ameloblastoma management. The study included data from 31 patients over a period of 10 years. Data collected included age, gender, tumor location, histological findings, initial treatment, number of recurrences and year of onset, type of treatment of recurrence, reconstruction and follow-up. Recurrences were detected in nine patients (29%). Tumor recurrences appeared at 32 months on average following the initial surgical procedure. Recurrences were associated mainly to inadequate initial therapeutic approach and were treated by bone resection with a safety margin of at least 1 cm beyond the radiographically visible margins. Immediate reconstruction of bone defects was performed with grafts or free flaps.

Biometric analysis of the clinical crown and the width/length ratio in the maxillary anterior region

STATEMENT OF PROBLEM Restorative dentistry often involves correcting tooth size discrepancies. Therefore, dental biometrics should play an important role in the planning of an esthetic restoration. PURPOSE The purpose of this study was to analyze the clinical crown width, length, and width/length ratio of maxillary central incisors, lateral incisors, and canines in an adult population. The study also aimed to determine whether a correlation exists between natural tooth dimensions and the optimal tooth dimension guidelines suggested for planning esthetic restorations. MATERIAL AND METHODS Stone casts were poured from irreversible hydrocolloid impressions of 412 healthy adult participants. These casts were used to measure the maximum mesiodistal width and maximum crown-root length of the maxillary central incisors, lateral incisors, and canines with a digital precision caliper (0.01 mm). The width/length ratio was calculated for each tooth, and 40 casts were selected to test the reliability of the measuring method. RESULTS The mean age of the participants in the sample was 33.94 years; 60.7% were women and 39.3% were men. The mean width value was 8.71 mm for central incisors, 6.75 mm for lateral incisors, and 7.81 mm for canines. The mean length was 10.23 mm for central incisors, 8.59 mm for lateral incisors, and 9.93 mm for canines. The average width/length ratio was 85% for central incisors and 79% for lateral incisors and canines. CONCLUSION The data obtained from the population studied are similar to those from previous research studies with similar methodology. However, great discrepancies in the absolute values were found when compared with other studies of ideal tooth dimension guidelines on the personal preferences and the esthetic perception of dentists. The perception of what is considered natural seems to differ from what is considered esthetically perfect.

Maxillomandibular osteomyelitis associated with osteopetrosis.

Osteopetrosis is a heterogeneous disorder characterized by abnormal bone remodeling and increased bone density primarily due to defective osteoclast resorption. The diagnosis is based on a history of numerous fractures and radiological findings indicative of osteosclerosis, usually sufficient for a definitive diagnosis. We present a quite rare case of osteopetrosis complicated by recurrent episodes of maxillomandibular osteomyelitis associated with cutaneous fistulization and purulent nasal discharge. We used intravenous antibiotic therapy and necrotic bone debridement that prevented the appearance of acute infections over a 3-year follow-up, but the complete healing of the case was not achieved.

Inserción de un implante simultáneo a la extracción de un canino superior incluido

Presentamos el caso clinico de una paciente adulta con un canino superior incluido, en la que se llevo a cabo un plan de tratamiento multidisciplinar y secuencial quirurgico-ortodoncico-protesico. En un primer tiempo, se instauro un tratamiento ortodoncico con el que disponer de un espacio intercalar adecuado para la posterior reposicion del canino superior. En un segundo tiempo, se realizo la extraccion del canino incluido junto con un tratamiento combinado de regeneracion osea e insercion inmediata de un implante, para finalizar con la restauracion protesica mediante una corona implantosoportada. Se revisa ademas la literatura al respecto y el estado actual del problema.