Forensic dentistry in human identification: A review of the literature

An update is provided of the literature on the role of odontology in human identification, based on a PubMed-Medline search of the last 5 years and using the terms: 'forensic dentistry' (n = 464 articles), 'forensic odontology' (n = 141 articles) and 'forensic dentistry identification' (n = 169 articles). Apart from these initial 774 articles, others considered to be important and which were generated by a manual search and cited as references in review articles were also included. Forensic dentistry requires interdisciplinary knowledge, since the data obtained from the oral cavity can contribute to identify an individual or provide information needed in a legal process. Furthermore, the data obtained from the oral cavity can narrow the search range of an individual and play a key role in the victim identification process following mass disasters or catastrophes. This literature search covering the last 5 years describes the novelties referred to buccodental studies in comparative identification, buccodental evaluation in reconstructive identification, human bites as a method for identifying the aggressor, and the role of DNA in dental identification. The oral cavity is a rich and noninvasive source of DNA, and can be used to solve problems of a social, economic or legal nature

Parámetros clínicos y características microbiológicas en pacientes con tejidos periimplantarios sanos, mucositis y peri-implantitis

La restauración de los dientes ausentes mediante implantes dentales constituye hoy en día un tratamiento rutinario y muy extendido. Varios estudios longitudinales han demostrado altas tasas de supervivencia de los implantes en función, que van desde el 90 % al 95 % en un periodo de hasta 20 años de seguimiento. Las complicaciones biológicas alrededor de los implantes dentales se clasifican en tempranas y tardías. Los fracasos tempranos son los que tienen lugar en el tiempo hasta la conexión del pilar al implante y son más fáciles de diagnosticar debido a la falta de osteointegración. Los fracasos tardíos son el resultado de la incapacidad de mantener la oseointegración, siendo la complicación más importante la peri-implantitis. Objetivos: En 54 pacientes portadores de 344 implantes dentales con al menos una arcada dentaria desdentada total, rehabilitada totalmente con implantes dentales, se tomaron en 146 cuadrantes dentales los parámetros clínicos y microbiológicos con los siguientes objetivos: 1. En pacientes con tejidos periimplantarios sanos, estudiar si hay diferencias clínicas y microbiológicas del tejido periimplantario entre fumadores y no fumadores. 2. En pacientes con algún implante dental con mucositis periimplantaria, determinar si existen diferencias a nivel clínico y microbiológico entre implantes con mucositis y con los tejidos periimplantarios sanos. 3. En pacientes con algún implante dental con peri-implantitis, determinar si existen diferencias a nivel clínico y microbiológico entre implantes con peri-implantitis y con los tejidos periimplantarios sanos. Material y Método: Se realizó un estudio de tipo prospectivo y transversal en la Unidad de Cirugía Bucal del Departamento de Estomatología de la Facultad de Medicina y Odontología de la Universitat de València. Durante el periodo comprendido entre enero de 2009 y junio de 2010, se seleccionaron consecutivamente 78 pacientes con al menos una arcada dentaria edéntula rehabilitada totalmente con implantes dentales. Todos los pacientes eran portadores de implantes TSA® Treatment Surface Avantblast (Phibo Dental Solutions, Sentmenat, Barcelona, España). A todos los pacientes intervenidos para la colocación de implantes dentales se les explicó el procedimiento y se les informó de los riesgos de la intervención. Se recogió la historia clínica completa de cada paciente y todos firmaron el documento de consentimiento informado. Conclusiones: Tras estudiar en 54 pacientes portadores de implantes dentales con tejidos periimplantarios sanos, mucositis periimplantaria y peri-implantitis, y teniendo en cuenta las limitaciones del presente estudio, puede concluirse: 1. El tabaco no influye en los parámetros clínicos ni microbiológicos en pacientes con tejidos periimplantarios sanos. 2. Los implantes con mucositis periimplantaria presentan una diferencia significativa en todos los parámetros clínicos (profundidad de sondaje, índice de placa modificado e índice gingival modificado) al compararlos con los implantes con tejidos periimplantarios sanos, a excepción del volumen de fluido crevicular periimplantario. No existen diferencias a nivel microbiológico. 3. Los implantes con peri-implantitis presentan una diferencia significativa en la profundidad de sondaje y en el índice gingival modificado al compararlos con los implantes con tejidos periimplantarios sanos. No existen diferencias en cuanto al índice de placa modificado, ni en el volumen de fluido crevicular periimplantario. A nivel microbiológico la microbiota subgingival está compuesta por un mayor número de patógenos periodontales en los implantes con peri-implantitis, presentando una diferencia significativa en las concentraciones de Porphyromonas gingivalis y en la asociación Porphyromonas gingivalis y Treponema denticola, así como en la carga bacteriana total. El tipo de restauración protésica puede contribuir al desarrollo de la aparición de peri-implatitis

Prevalence, etiology, diagnosis, treatment and complications of supernumerary teeth

The aim of this article was to review the literature on supernumerary teeth, analyzing their prevalence, etiology, diagnosis, treatment and possible complications. An electronic search was made in the Pubmed-Medline database up to January 2014 using the key search terms "multiple supernumerary teeth" (n=279), "prevalence supernume rary teeth" (n=361), and "supernumerary teeth" (n=2412). In addition to the articles initially identified, others were included in the review proceeding from a manual search and from any references considered of relevance. Supernumerary teeth are those that exceed the normal dental formula. They are more common in men, more common in the upper maxilla, and more prevalent in permanent dentition. Complications associated with supernumerary teeth include dental impaction, delayed eruption, ectopic eruption, overcrowding, spacing anomalies and the formation of follicular cysts. The treatment of supernumerary teeth depends on their type, position, and possible complications, detected clinically and radiographically. No clear consensus exists as to the best time to extract unerupted supernumerary teeth

Osteonecrosis of the jaws in patients treated with bisphosphonates

The literature describes an increasing presence of bisphosphonate-induced osteonecrosis of the jaws (ONJ), characterized by the exposure for over 8 weeks of necrotic bone in the maxillofacial region, after bisphosphonate therapy, in the absence of prior maxillary radiotherapy. The present literature review examines the etiopathogenesis, risk factors, clinical forms, diagnosis, treatment and prevention of bisphosphonate-induced ONJ. In addition, a review is made of all the series involving over 15 patients diagnosed with this disorder between 1 January 2011 and 15 May 2011. A PubMed-Medline search was carried out with the following key words: 'bisphosphonates' and 'osteonecrosis'. The appearance of osteonecrosis is a serious complication, with an increasing incidence, that affects patient quality of life and causes important morbidity. All patients treated with bisphosphonates are at risk of developing osteonecrosis as a result of such medication. This potential complication therefore should be explained to the patient by both the prescribing physician and the dental surgeon in charge of oral treatment, with the obtainment of informed consent in all cases

Subcutaneous emphysema resulting from surgical extraction without elevation of a mucoperiosteal skin flap

Subcutaneous emphysema, is a rare occurrence in dental practice. It is usually benign and self-limiting; nevertheless, severe consequences can result from surgical treatment. Emphysema occurs when air is injected into the subcutaneous layer of the tissue, this may come from either an air turbine handpiece or air syringe. Due to the danger of developing emphysema, procedures using compressed air are not recommended in dental extractions involving the raising of a skin flap, bone sectioning or exeresis. Two determining factors are always involved with subcutaneous emphysema. On the one hand, a compressed air procedure (air turbine handpiece, air-water syringe), and on the other, a communication between the oral cavity and deeper tissue producing dissection. Early diagnosis and treatment are critical to prevent the trapped air leaking into other areas. The aim is to present a case of subcutaneous emphysema related to dental extraction, without raising a mucoperiosteal flap, possibly caused by close contact between the air turbine handpiece and the tooth during sectioning which forced air into the subcutaneous tissue

Oral rehabilitation with tilted dental implants : a metaanalysis

Objective: To compare the course of patients treated with tilted implants versus those treated conventionally with axial implants, analyzing the success rate and marginal bone loss. Material and M ethods: A PubMed search was made using the key words ?tilted implants?, ?angled implants?, ?angulated implants?, ?inclined implants? and ?maxillary atrophy.? A review was made of the articles published between 1999-2010. The inclusion criteria were the use of tilted implants, clinical series involving at least 10 patients, and a minimum follow-up of 12 months after prosthetic loading. The exclusion criteria were isolated clinical cases, studies with missing data, and publications in languages other than English or Spanish. The metaanalysis finally included 13 articles: 7 retrospective studies and 6 prospective studies. Results: On analyzing the success rate in the retrospective studies, two reported a higher success rate with tilted implants; one a higher success rate with axial implants; and two reported similar success rates with both implants. On analyzing the success rate in the prospective studies, two reported a higher success rate with tilted implants; two a higher success rate with axial implants; and two reported similar success rates with both implants. On examining marginal bone loss, three studies reported greater bone loss with axial implants and one with tilted implants. Conclusions: There was no evidence of differences in success rate between tilted and axial implants in either the prospective or retrospective studies subjected to review. The marginal bone loss observed with the tilted and axial implants likewise proved very similar. It thus can be deduced that tilted implants exhibit the same evolutive behavior as axial implants

Intraosseous anesthesia with solution injection controlled by a computerized system versus conventional oral anesthesia : a preliminary study

Objective: To compare a computerized intraosseous anesthesia system with the conventional oral anesthesia techniques, and analyze the latency and duration of the anesthetic effect and patient preference. Design: A simple-blind prospective study was made between March 2007 and May 2008. Each patient was subjected to two anesthetic techniques: conventional and intraosseous using the Quicksleeper® system (DHT, Cholet, France). A split-mouth design was adopted in which each patient underwent treatment of a tooth with one of the techniques, and treatment of the homologous contralateral tooth with the other technique. The treatments consisted of restorations, endodontic procedures and simple extractions. Results: The study series comprised 12 females and 18 males with a mean age of 36.8 years. The 30 subjects underwent a total of 60 anesthetic procedures. Intraosseous and conventional oral anesthesia caused discomfort during administration in 46.3% and 32.1% of the patients, respectively. The latency was 7.1±2.23 minutes for the conventional technique and 0.48±0.32 for intraosseous anesthesia ? the difference being statistically significant. The depth of the anesthetic effect was sufficient to allow the patients to tolerate the dental treatments. The duration of the anesthetic effect in soft tissues was 199.3 minutes with the conventional technique versus only 1.6 minutes with intraosseous anesthesia ? the difference between the two techniques being statistically significant. Most of the patients (69.7%) preferred intraosseous anesthesia. Conclusions: The described intraosseous anesthetic system is effective, with a much shorter latency than the conventional technique, sufficient duration of anesthesia to perform the required dental treatments, and with a much lesser soft tissue anesthetic effect. Most of the patients preferred intraosseous anesthesia

Interleukins IL-6, IL-8, IL-10, IL-12 and periimplant disease. An update

Introduction: A study is made of the usefulness of cytokines (such as interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and interleukin-12 (IL-12)) as markers of periimplant disease (mucositis and periimplantitis). An increase in the levels of these cytokines in dental implant crevicular fluid may give rise to a lack of osteointegration, bbone loss or implant failure. Obbjective: To review the literature relating IL-6, IL-8, IL-10 and IL-12 levels to dental implant surgery and periimplantitis. Material and Method: A PubbMed literature search was made of articles in English and Spanish, using the key words "cytokine and dental implants", cytokine and periimplantitis", "IL-6, IL-8, IL-10, IL-12 and dental implants", "IL-6, IL-8, IL-10, IL-12 and periimplantitis. Fourteen articles were found and classified into two groups relating interleukin levels to: a) periimplant disease; and b) their influence upon dental implant osteointegration without periimplant disease. Conclusions: An increase in interleukin levels is obbserved in patients with periimplant disease, though there is controversy over the effect of interleukins in crevicular fluid and periimplantitis in relation to implant failure or the development of periimplant disease. © Medicina Oral S. L

Effect of ozone therapy upon clinical and bacteriological parameters of the oral cavity: an update

Objective: To review the literature on ozone therapy in oral health, as assessed by different clinical and bacteriological parameters. Material and methods: A PubMed literature search was made using the key words “ozone dental”, and establishing as limits “randomized controlled trial” and “dental journal”. Thirteen articles were identified, with access to only 6 of them. Results: Four studies used ozone for the treatment of caries. One study examined its effect upon dental hypersensitivity, while another evaluated the efficacy of ozone as a tooth whitening technique. Five studies explored the bacteriological actions of ozone therapy in reference to different types of bacteria. Conclusion: The reviewed literature yields a number of studies describing a high antimicrobial potential of ozone therapy in different dental areas, though very few in vivo studies have evidenced the success of such treatment. Further studies are therefore needed in this field

Comparative study between manual injection intraosseous anesthesia and conventional oral anesthesia

Objective: To compare intraosseous anesthesia (IA) with the conventional oral anesthesia techniques. Materials and methods: A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for res-pective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. Results: A total of 200 oral anesthetic procedures were carried out in 100 patients. The mean patient age was 28.6±9.92 years. Fifty-five vestibular infiltrations and 45 mandibular blocks were performed. All patients were also subjected to IA. The type of intervention (conservative or endodontic) exerted no significant influence (p=0.58 and p=0.62, respectively). The latency period was 8.52±2.44 minutes for the conventional techniques and 0.89±0.73 minutes for IA - the difference being statistically significant (p<0.05). Regarding patient anesthesia sensation, the infiltrative techniques lasted a maximum of one hour, the inferior alveolar nerve blocks lasted between 1-3 hours, and IA lasted only 2.5 minutes - the differences being statistically significant (p?0.0000, ?=0.29). Anesthetic success was recorded in 89% of the conventional procedures and in 78% of the IA. Most patients preferred IA (61%) (p=0.0032). Conclusions: The two anesthetic procedures have been compared for latency, duration of anesthetic effect, anesthetic success rate and patient preference. Intraosseous anesthesia has been shown to be a technique to be taken into account when planning conservative and endodontic treatments. © Medicina Oral S. L