Rui Figueiredo

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.

Iatrogenic Displacement of Lower Third Molar Roots Into the Sublingual Space: Report of 6 Cases

PURPOSE To describe the clinical characteristics of patients who have had sublingual displacement of a mandibular third molar root, to identify potential risk factors, and to provide the clinician with information on how to prevent and treat this complication. PATIENTS AND METHODS A retrospective analysis was performed of a series of 6 patients who underwent third molar removal with accidental displacement of a root into the sublingual space. All patients were attended at the Department of Oral Surgery, Faculty of Dentistry, University of Barcelona (Spain) from 2000 through 2010. RESULTS Four patients were men, and the mean age was 38.2 ± 11.3 years. In 1 case, the fragment was removed immediately after the complication, in the same surgical procedure. In 4 cases (66.7%), the displaced root remained asymptomatic (mean follow-up, 25.5 mo), and only 1 patient presented symptoms (swelling and pain in the sublingual region). A second surgical procedure using an intraoral approach was used to extract the displaced fragment in 2 patients. These 2 cases presented transitory nerve impairment of the lingual and inferior alveolar nerves, respectively. CONCLUSIONS Accidental displacement of a lower third molar root into the sublingual space is an uncommon complication. When the fragments are small, surgical removal of the displaced roots seems to be unnecessary, because patients usually remain symptom free. When surgery is needed, a considerable incidence of complications should be expected.

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.

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.

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.

Complications following an accidental sodium hypochlorite extrusion: A report of two cases

Sodium hypochlorite (NaOCl) is the most commonly used solution in root canal treatments, as it is a low-cost method that displays a very effective antimicrobial activity against microbiota of infected root canals. However, this solution can cause complications especially due to its cytotoxic features. When this solution is injected into the adjacent tissues, the patient usually experiences intense pain, and an urgent treatment should be implemented in order to prevent a long-term sequelae. This paper describes the clinical features of two patients that experienced an accidental extrusion of NaOCl after endodontic treatment of varying severity and with different treatments. Furthermore, it shows the long-term neurologic injuries that this type of accidents may cause and a treatment protocol for these situations will be suggested. Key words:Nerve damage, root canal irrigation, root canal treatment, sodium hypochlorite.

Treatment of Delayed-Onset Infections After Impacted Lower Third Molar Extraction

PURPOSE To describe the treatment of delayed-onset infections after lower third molar removal. PATIENTS AND METHODS A retrospective study was made of 33 delayed-onset infections after impacted lower third molar extraction diagnosed between 2001 and 2005 in the Oral Surgery and Implantology Department of the School of Dentistry of the University of Barcelona, Spain. RESULTS Antibiotic treatment was effective in 22 patients, whereas the remaining 11 needed an additional surgical procedure to resolve this postoperative complication. Patients with prolonged use of antibiotics after the onset of the infection were more likely to require surgical intervention. CONCLUSIONS Patients with delayed-onset infections should be treated initially with antibiotics for 7 days. If the infection does not respond favorably within that time, surgical debridement of the extraction site should be done.

Postoperative Infections After Dental Implant Placement: Prevalence, Clinical Features, and Treatment.

Purpose:To determine the prevalence and describe the clinical features and treatment of patients with early infections after implant placement. Materials and Methods:A retrospective cohort study was performed. Postoperative infections were defined as the presence of purulent drainage and/or increasing pain and swelling in the operated area before prosthetic loading. Patient-based infection prevalences and 95% confidence intervals for implant were determined. Patients who healed, were followed up to determine implant survival and success rates. Results:Three hundred thirty-seven participants (1273 implants) were included. Twenty-two postoperative infections were recorded (6.5% of the patients and 1.7% of the implants). These complications were usually diagnosed within the first month, and in 17 cases (77.3%) surgical treatment was performed because of antibiotic therapy failure. Twelve implants (54.6%) in 12 patients (54.6%) failed before prosthetic loading. The survival and success rates of the infected loaded implants were 80% and 50%, respectively, with a mean follow-up of 42.9 months (SD of 10.2 months). Conclusion:Four to 10% of patients receiving dental implants develop postoperative infections. This complication is important because applied treatments are usually ineffective and two-thirds of the infected implants fail, most before prosthetic loading.

Delayed-onset infections after impacted lower third molar extraction: involved bacteria and sensitivity profiles to commonly used antibiotics

OBJECTIVES The objectives of this study were to identify the bacteria involved in delayed-onset infections after lower third molar removal and to determine the most suitable antibiotic for such complication. STUDY DESIGN Bacterial samples were collected from 13 patients who developed delayed-onset infections after lower third molar extraction. After the identification of the bacterial isolates, the in vitro antimicrobial susceptibility of the isolated strains was determined. RESULTS A total of 11 patients (12 samples) were finally included in the study. Up to 7 bacteria genera were identified. Fusobacterium sp. was present in 11 patients, Prevotella sp. in 8 cases, and Peptostreptococcus sp. in 7. Some strains of these bacteria were not susceptible to amoxicillin, amoxicillin/clavulanate, and metronidazol, whereas no resistances were found to clindamycin. CONCLUSIONS Fusobacterium sp., Prevotella sp., and Peptostreptococcus sp. are frequently present in delayed-onset infections after lower third molar removal. Based on the results of the microbial susceptibility tests, clindamycin seems to be the most adequate antibiotic for the treatment of this complication.