León (Spain) Health professionals’ knowledge and clinical practice towards the relationship between cardiovascular diseases and periodontal disease

Cardiovascular pathologies have a high prevalence in the geriatric population, with acute myocardial infarction being one of the main causes of death in Spain. These pathologies have a systemic inflammatory component that is of vital importance. We also know in dentistry that the main gingival pathogens are capable of generating a systemic inflammatory response, being indirectly involved in the development of the atherosclerotic lesion, assuming, therefore, that periodontal disease is a cardiovascular risk factor. The objective of this study is to determine the knowledge of health professionals who treat cardiovascular diseases about periodontal disease and its relationship with heart disease.A health survey was carried out on 100 Cardiologists, Internists and General Practitioners in the province of León. Points of interest in this survey: the professional’s own oral health, knowledge of the relationship between periodontal and heart disease and, lastly, the training received in medicine on oral health.60% of professionals reviewed their oral health annually and 20% randomly. 48% of health professionals were unaware of periodontal diseases, 77% claimed to have not received university training in this regard, only 13% of those surveyed acknowledged having received more than 10 hours of training on oral health in their experience and finally, 90% thought that training in both Medicine and Dentistry should be collaborative.The degree of knowledge of health professionals regarding oral health is poor (77%), therefore the number of collaborative consultations with dental professionals is low (<63%). Training projects targeting a correct preventive medicine are shown to be necessary

Use of autologous tooth-derived graft material in the post-extraction dental socket. Pilot study

The objectives of the present pilot study are to compare via CBCT the alveolar contraction suffered both vertically and horizontally between the control group and the group using autologous dental material (ADM), as well as to study the densitometric differences between both post-extraction sockets. A split-mouth study was performed in n = 9 patients who required two extraction of single-rooted teeth deemed suitable for deferred rehabilitation with osseointegrated implants. Two groups were formed ? a control group, in which the post-extraction socket was not filled, and an ADM group, in which the alveolar defect was filled with freshly processed autogenous dental material. Both dimensional and densitometric analyses of the alveoli were performed in both groups immediately after surgery (baseline), as well as 8 weeks and 16 weeks later. The mean height of alveolar bone loss was: VL (Control 1.77 mm, loss of 16.87% of initial alveolar height; ADM 0.42 mm, loss of 4.2% of initial alveolar height), HL-BCB (Control 2.22 mm, ADM 0.16 mm, p= 0.067 at 16 weeks). The mean bone loss of the vestibular width (VL-BCB) was much higher in the control group (1.91 mm at 1 mm, 1.3 mm at 3 mm, and 0.89 mm at 5 mm) than in the ADM group (0.46 mm at 1 mm, 0.21 mm at 3 mm, 0.01 at 5 mm, p=0.098 at 16 weeks). At 16 weeks, densitometric analysis of the coronal alveolar area revealed a bone density of 564.35 ± 288.73 HU in the control group and 922.68 ± 250.82 HU in the ADM group (p=0.045 ). In light of these preliminary results, autologous dentine may be considered a promising material for use in socket preservation techniques

Bases fisiológicas de la regeneración ósea II: el proceso de remodelado

El remodelado óseo es un proceso de reestructuración del hueso existente, que está en constante formación y reabsorción. Este fenómeno equilibrado permite, en condiciones normales, la renovación de un 5-10% del hueso total al año. A nivel microscópico el remodelado óseo se produce en las unidades básicas multicelulares, donde los osteoclastos reabsorben una cantidad determinada de hueso y los osteoblastos forman la matriz osteoide y la mineralizan para rellenar la cavidad previamente creada. En estas unidades hay osteoclastos, macrófagos, preosteoblastos y osteoblastos y están regidos por una serie de factores, tanto generales como locales, permitiendo el normal funcionamiento del hueso y el mantenimiento de la masa ósea. Cuando este proceso se desequilibra aparece la patología ósea, bien por exceso (osteopetrosis) o por defecto (osteoporosis). El propósito de este trabajo es realizar una revisión de los conocimientos actuales sobre los mecanismos bioquímicos y fisiológicos del proceso de remodelado óseo, resaltando de manera especial el papel de los factores reguladores del mismo, entre los que destacan los factores de crecimiento.Bone remodeling is the restructuring process of existing bone, which is in constant resorption and formation. Under normal conditions, this balanced process allows the renewal of 5 ' 10% of bone volume per year. At the microscopic level, bone remodeling is produced in basic multicellular units, where osteoclasts resorb a certain quantity of bone and osteoblasts form the osteoid matrix and mineralize it to fill the previously created cavity. These units contain osteoclasts, macrophages, preosteoblasts and osteoblasts, and are controlled by a series of factors, both general and local, allowing normal bone function and maintaining the bone mass. When this process becomes unbalanced then bone pathology appears, either in excess (osteopetrosis) or deficit (osteoporosis). The purpose of this study is to undertake a revision of current knowledge on the physiological and biological mechanisms of the bone remodeling process; highlighting the role played by the regulating factors, in particular that of the growth factors

Bases fisiológicas de la regeneración ósea I: histología y fisiología del tejido óseo

El hueso es el único tejido del organismo capaz de regenerarse, permitiendo la restitutio ad integrum tras el trauma. Cuando se produce una fractura, se coloca un implante osteointegrado o se realiza un injerto para aumentar el sustrato óseo antes de la inserción de implantes, lo que se pretende es la regeneración ósea, es decir, la formación de hueso nuevo que, tras un proceso de remodelado, sea idéntico al preexistente. El hueso es un tejido dinámico en constante formación y reabsorción. Este fenómeno equilibrado, denominado proceso de remodelado, permite la renovación de un 5-15 % del hueso total al año en condiciones normales (1). El remodelado óseo consiste en la reabsorción de una cantidad determinada de hueso llevada a cabo por los osteoclastos, así como la formación de la matriz osteoide por los osteoblastos y su posterior mineralización. Este fenómeno tiene lugar en pequeñas áreas de la cortical o de la superficie trabecular, llamadas 'unidades básicas de remodelado óseo'. La actuación terapéutica en los campos de la Traumatología y Ortopedia, Cirugía Oral y Maxilofacial e Implantología, se asienta sobre los principios biológicos de la regeneración ósea, en los que están implicados células, matriz extracelular y señales osteoinductivas. El objetivo de este trabajo es realizar una puesta al día de los conocimientos actuales sobre los mecanismos bioquímicos y fisiológicos de la regeneración ósea, resaltando de manera especial el papel que en ella juegan las células y las proteínas de la matriz ósea.Bone is the only body tissue capable of regeneration, allowing the restitutio ad integrum following trauma. In the event of a fracture or bone graft, new bone is formed, which following the remodeling process is identical to the pre-existing. Bone is a dynamic tissue in constant formation and resorption. This balanced phenomena, known as the remodeling process, allows the renovation of 5-15% of the total bone mass per year under normal conditions (1). Bone remodeling consists of the resorption of a certain amount of bone by osteoclasts, likewise the formation of osteoid matrix by osteoblasts, and its subsequent mineralization. This phenomenon occurs in small areas of the cortical bone or the trabecular surface, called 'Basic Multicellular Units' (BMU). Treatment in Traumatology, Orthopedics, Implantology, and Maxillofacial and Oral Surgery, is based on the biologic principals of bone regeneration, in which cells, extracellular matrix, and osteoinductive signals are involved. The aim of this paper is to provide an up date on current knowledge on the biochemical and physiological mechanisms of bone regeneration, paying particular attention to the role played by the cells and proteins of the bone matrix

Efficacy of Phentolamine Mesylate in Reducing the Duration of Various Local Anesthetics

Background: To evaluate changes in the effectiveness of phentolamine mesylate in combination with different local anesthetics (LAs) and vasoconstrictors. A prospective randomized double-blind study was conducted with 90 patients divided into three groups, with each group being administered one of three different LAs: lidocaine 2% 1/80,000, articaine 4% 1/200,000, and bupivacaine 0.5% 1/200,000. Methods: We compared treatments administered to the mandible involving a LA blockade of the inferior alveolar nerve. Results were assessed by evaluating reduction in total duration of anesthesia, self-reported patient comfort using the visual analog pain scale, incidence rates of the most common adverse effects, overall patient satisfaction, and patient feedback. Results: The differences among the three groups were highly significant (P < 0.001); time under anesthesia was especially reduced for both the lip and tongue with bupivacaine. The following adverse effects were reported: pain at the site of the anesthetic injection (11.1%), headaches (6.7%), tachycardia (1.1%), and heavy bleeding after treatment (3.3%). The patients' feedback and satisfaction ratings were 100% and 98.9%, respectively. Conclusions: Efficient reversal of LAs is useful in dentistry as it allows patients to return to normal life more readily and avoid common self-injuries sometimes caused by anesthesia. Phentolamine mesylate reduced the duration of anesthesia in the three studied groups, with the highest reduction reported in the bupivacaine group (from 460 min to 230 min for the lip and 270 min for the tongue [P < 0.001]

Implant-prosthetic Rehabilitation with and without Platform Switching: A Retrospective Clinical Cohort Study

[EN] Aim: The study aimed to retrospectively compare peri-implant bone loss, prosthetic complications, and patient-reported outcome measures (PROMs) after implant-prosthetic treatment on abutments with platform switch or platform match. Materials and methods: Records of patients, who received implant-prosthetic treatment on abutments with/without platform switch in a single dental clinic between November 2015 and November 2018, were retrospectively analyzed. Analysis was restricted to the following patient selection criteria: no need for any bone grafting procedures before/during implant placement, and no serious systemic disease. Implants were conventionally loaded with screwed prosthetic restorations after a healing period of 3 months. Crestal bone loss was measured by digital radiography at implant placement and after at least 2 years under functional implant loading conditions. Patient satisfaction was recorded with the visual analogue scale (VAS) at the time of the follow-up examination. Results: Clinical records of 59 patients were available for analysis. Patients of the study cohort received in total 128 implants with different lengths and diameters according to the manufacturer’s specifications. Prosthetic restorations were fixed either on abutments with platform switch (BEGO PS-UNI: n = 74; 57.8%) or platform match (BEGO SUB-TEC Universal: n = 54; 42.2%). No implant was lost and no failure of prosthetic restoration was recorded during follow-up, except for prosthetic screw loosening in 32 implants (25.0%). Abutment type and location (maxilla vs mandible) had a significant impact on peri-implant bone loss (OR = 3.4; 2.8). A significant reduced rate of bone loss was observed at implant sites, provided with abutments according to the platform switch concept (35.1 vs 64.8%). No significant correlation was recorded between less bone loss and a higher patient satisfaction, while loosening of the prosthetic screw was significantly associated with lower satisfaction scores. Conclusion: BEGO PS-UNI abutments with a platform switch design revealed significant less crestal bone loss after a mean observation period of 20.8 months. Clinical significance: Abutments with a platform switch design may lead to less peri-implant bone loss. In order to maintain a higher patient satisfaction, clinicians should focus on the quality of the implant-prosthetic connection in screwed restorationsS

Alteraciones cardíacas y respiratorias en pacientes sometidos a sedación inhalatoria consciente con óxido nitroso: Para procedimientos de Cirugía Oral, Implantología y Periodoncia

[ES] El objetivo de este trabajo es determinar la eficacia y seguridad de la sedación inhalatoria consciente con una mezcla de óxido nitroso con oxígeno para tratamientos de Cirugía Oral, Periodoncia e Implantología en pacientes adultos fóbicos o ansiosos. Para ello, 60 pacientes fóbicos no cooperadores fueron tratados mediante procedimientos de Cirugía Oral, 30 de ellos mediante anestesia local con articaína, y otros 30 mediante anestesia local con articaína asociada a sedación inhalatoria consciente con óxido nitroso. Se registraron la frecuencia cardiaca, la presión arterial sistólica y diastólica, la saturación parcial de oxígeno, la frecuencia respiratoria, la capacidad vital forzada, el volumen espiratorio por segundo y el flujo máximo de espiración. Entre los resultados, se registraron en los procedimientos con sedación inhalatoria pequeñas oscilaciones en los parámetros, siempre dentro del margen de seguridad, predominando la normocardia en la frecuencia cardiaca, la normotensión con algunas oscilaciones en presión arterial sistólica, la normotensión con tendencia al alta en la presión arterial diastólica, donde se observa una estabilidad de la saturación parcial de oxígeno, con normopnea en la frecuencia respiratoria y con descensos estadísticamente significativos en la capacidad vital forzada, el volumen espiratorio por segundo y el flujo espiratorio máximo. La investigación llega a la conclusión de que la sedación inhalatoria consciente con óxido nitroso para procedimientos de Cirugía Oral, Implantología y Periodoncia es un método seguro y eficaz para obtener colaboración del paciente, evitando así procedimientos de anestesia general. Sin embargo, la reducción estadísticamente significativa del volumen respiratorio aconseja tener precaución con las condiciones previas del paciente caso de presentar depresión basal del volumen respiratorioN

Análisis experimental de la acción esterilizante y vitrificante del Láser CO(2) sobre las estructuras dentarias

Tesis Univ. Complutense de MadridDepto. de Anatomía y EmbriologíaFac. de MedicinaTRUEpu