Malignant mental nerve neuropathy : systematic review

Malignant mental neuropathy (MMN) is a neurological manifestation of cancer, characterized by the presence of hypoesthesia or anesthesia restricted to the territory of the mental branch of the mandibular nerve. A systematic review of the literature has been made on MMN, analyzing the etiology, pathogeny, clinical characteristics, complementary tests and the prognosis. Sixteen studies, providing 136 cases were selected. Breast cancer and lymphomas were the most frequently associated malignant diseases. The most frequent pathogenic mechanisms producing neurological involvement were: peripherally, mandibular lesions; and centrally, tumors at the base of the cranium. Regarding clinical characteristics, manifestation of MMN was the primary symptom of malignant disease in 27.7% of cases, and a first symptom of recurrence in 37.7%. The group of selected studies included 50 orthopantomographs, 9 mandibular computed tomographies and 50 radiographic examinations of the cranial region. The most affected region was the mandible. The appearance of MMN is an ominous prognosis for the progression of the disease, with a mortality of 78.5% within a mean of 6.9 months

Vestibular bone window for the extraction of impacted lower third molars : four case reports

Four patients attending for the extraction of an impacted lower third molar are reported. The aim of this paper is was to describe a technical approach, which facilitates impacted lower third molar extraction, minimizing the ostectomy, thus reducing secondary postoperative manifestations and avoiding possible periodontal defects on the distal side of the second mandibular molar. To facilitate the extraction of the crown, roots or the complete molar, a small ostectomy in the form of a window can be made in the vestibular cortical, approaching the extraction through the resultant mesial space

Influence of perforation of the sinus membrane on the survival rate of implants placed after direct sinus lift : literature update

The aim of this paper was to review the procedures adopted when a perforation of the sinus membrane takes place during a direct sinus lift for filling with bone graft; and the survival of implants in those cases in which perforation of the sinus membrane occurred. A bibliographical search in PUBMED was carried out of articles published from 1997 to 2008, with the key words ?sinus perforation? and ?membrane perforation?. All articles specifying the two following criteria were included: (a) procedure in the case of perforation of the sinus membrane during direct sinus lift; and (b) the number and survival rate of implants placed in direct sinus lift with perforated and non perforated membrane. Six articles fulfilled the inclusion criteria. In all the articles the sinus lift was continued when a perforation of the sinus membrane took place. In maxillary sinus lift procedures with perforation of the membrane a 88.6% implant survival rate was obtained, and in maxillary sinus lifts with intact membrane the survival rate rose to 98%. In case of small perforation of the sinus membrane, it is possible to continue with the procedure; there is no consensus on the procedure when a perforated membrane is to be repaired, but the method of choice according to the majority of authors is to use a resorbable membrane. In the case of large perforation, there is no consensus either, although the majority of authors choose to abandon the procedure. The survival of the implants diminishes when they are placed in sinus lifts with perforated membrane

Factors that influence the position of the peri-implant soft tissues: a review

Introduction: The implantological rehabilitation of the anterior sector is one of the most demanding and complex treatments due to the necessity of obtaining an optimum esthetic result. At the level of the soft tissues, it involves obtaining the complete formation of the papilla and creating a harmonic contour of the gingival margin.Objective: A bibliographical review has been carried out on the factors that influence the final position of the soft tissues.Material and methods: A search has been carried out in the Pubmed database of articles written in English and Spanish. Articles that presented a clinical series of less than five patients and a monitoring of less than one year were excluded.Results: At the level of the papilla, there are two decisive factors that play an influential role: the formation of the biological width and the distance between the alveolar crest and the contact point. The position of the gingival margin depends mainly of the height and width of the facial bone, as well as on the biotype. The surgical technique, as well as certain prosthodontics aspects related to the implant, can influence the final position of the soft tissues.Conclusions: Although, today we know much more about the factors that influence the position of the soft tissues, there are still certain aspects that should be studied more in-depth, for example the influence of the micro and macro-structure of the implant in the position of the soft tissues

State of the art and clinical recommendations in periapical implant lesions. 9th Mozo-Grau Ticare Conference in Quintanilla, Spain

This manuscript summarizes the statements and clinical recommendations in periapical implant lesions, as per the state of the art and expert opinion agreement among the participants in the 9th Mozo-Grau Conference 2016 held in Quintanilla (Valladolid, Spain). The current status of the concept, frequency, etiology, diagnosis, clinical classification, surgical procedure and prognosis are described. If following implant placement localized pain develops in the periapical area, with or without radiographic changes, the diagnosis of periapical implant lesion should be suspected. It is important to monitor the condition in order to identify any change in its evolution. Radiological changes in the periapical radiographs are not always manifest in the early stages, and in this regard small-volume cone beam computed tomography can help us visualize such peri-implant changes. The early diagnosis of periapical implant lesions during the osseointegration phase and the provision of early treatment result in increased implant survival rates, thereby avoiding the need for implant extraction

Immediate loading with fixed full-arch prostheses in the maxilla: review of the literature

Objectives: To critically review the evidence-based literature on immediate loading of implants with fixed full- arch prostheses in the maxilla to determine 1) currently recommended performance criteria and 2) the outcomes that can be expected with this procedure. Study Desing: Studies from 2001 to 2011 on immediate loading with fixed full-arch maxillary prostheses were reviewed. Clinical series with at least 5 patients and 12 months of follow-up were included. Case reports, studies with missing data and repeatedly published studies were excluded. In each study the following was assessed: type of study, implant type, number of patients, number of implants, number of implants per patient, use of post-extrac - tion implants, minimum implant length and diameter, type of prosthesis, time until loading, implant survival rate, prosthesis survival rate, marginal bone loss, complications andmean follow-up time. Criteria for patient selection, implant primary stability and bone regeneration were also studied. Results: Thirteen studies were included, reporting a total of 2484 immediately loaded implants in 365 patients. Currently accepted performance criteria regarding patient and implant selection, and surgical and prosthetic pro - cedures were deduced from the reviewed articles. Implant survival rates went from 87.5% to 100%, prosthesis survival rates from 93.8% to 100% and radiographic marginal bone loss from 0.8 mm to 1.6 mm.No intraoperative complications and only minor prosthetic complications were reported. Conclusions: The literature on immediate loading with fixed full-arch prostheses in the maxilla shows that a successful outcome can be expected if adequate criteria are used to evaluate the patient, choose the implant and perform the surgical and prosthetic treatment. Lack of homogeneity within studies limits the relevance of the con - clusions that can be drawn, and more controlled randomized studies are necessary to enable comparison between the immediate and the conventional loading procedures

Conventional radiofrequency treatment in five patients with trigeminal neuralgia

Introduction: In trigeminal neuralgia, when drug treatment proves ineffective, other management options must be considered. In this context, conventional radiofrequency of Gasser's ganglion is a safe and effective alternative. Material and Methods: We describe 5 patients with long-evolving trigeminal neuralgia subjected to conventional radiofrequency according to the Sweet technique, with a follow-up of two years. Results: Pain relief was complete after two months in all cases. One patient suffered an unexpected episode of nausea, vomiting and foul odor sensation that subsided after three days of rest and drug treatment. Three patients described non-painful hypoesthesia in the region of the treated nerve branch that subsided within three months. The patients remained free of symptoms over long-term follow-up. In one case the same radiofrequency technique had to be repeated after 21 months because of the reappearance of symptoms in the same zone, followed by immediate pain relief. Conclusions: In our series of patients trigeminal neuralgia was not controlled by drug treatment, and conventional radiofrequency targeted to Gasser's ganglion proved very effective, with no major complications

Dental implants with versus without peri-implant bone defects treated with guided bone regeneration

Background: The guided bone regeneration (GBR) technique is highly successful for the treatment of peri-implant bone defects. The aim was to determine whether or not implants associated with GBR due to peri-implant defects show the same survival and success rates as implants placed in native bone without defects. Material and Methods: Patients with a minimum of two submerged dental implants: one suffering a dehiscence or fenestration defect during placement and undergoing simultaneous guided bone regeneration (test group), versus the other entirely surrounded by bone (control group) were treated and monitored annually for three years. Complications with the healing procedure, implant survival, implant success and peri-implant marginal bone loss were assessed. Statistical analysis was performed with non-parametric tests setting an alpha value of 0.05. Results: Seventy-two patients and 326 implants were included (142 test, 184 control). One hundred and twenty-five dehiscences (average height 1.92±1.11) and 18 fenestrations (average height 3.34±2.16) were treated. At 3 years post-loading, implant survival rates were 95.7% (test) and 97.3% (control) and implant success rates were 93.6% and 96.2%, respectively. Mean marginal bone loss was 0.54 (SD 0.26 mm) for the test group and 0.43 (SD 0.22 mm) for the control group. No statistically significant differences between both groups were found. Conclusions: Within the limits of this study, implants with peri-implant defects treated with guided bone regeneration exhibited similar survival and success rates and peri-implant marginal bone loss to implants without those defects. Large-scale randomized controlled studies with longer follow-ups involving the assessment of esthetic parameters and hard and soft peri-implant tissue stability are neede

Ostectomy versus osteotomy with repositioning of the vestibular cortical in periapical surgery of mandibular molars : a preliminary study

Introduction: Accessing the tooth roots in periapical surgery (PS) requires the elimination of periapical bone. Objective: To compare the postoperative morbidity and prognosis following PS on mandibular molars by ostectomy, or by osteotomy with repositioning of the vestibular cortical. Material and Methods: A retrospective clinical study of mandibular molars subjected to PS with ultrasound. Two groups were considered according to the surgical procedure used to access the roots: Group 1 (G1) with ostectomy and Group 2 (G2) with osteotomy and repositioning of the vestibular cortical. Only patients who had properly followed the post-operative instructions, adequately completed the post-operative questionnaires, and with a minimum of 12 months follow-up were included in the study. Post-operative morbidity was evaluated, and a clinical and radiographic follow-up was carried out using the criteria established by von Arx and Kurt in 1999. The SPSS program version 15 for Windows was used, considering values of p?0.05 as statistically significant. Results: Seventy-five patients, including 18 men and 57 women, with 87 mandibular molars and 107 periapical lesions were subjected to PS. The mean age of the patients was 38.5 years old (range 15 ? 74 years old). The patients were monitored for an average of 27.2 months (range 12 ? 120 months). Sixty-six patients (78 teeth) were treated in G1, and 9 patients (9 teeth) in G2. There was no relationship between the size of the ostectomy and pain, swelling or prognosis (p>0.05). Patients who underwent ostectomy presented more swelling than those subjected to osteotomy (p0.05). Conclusions: There was no statistically significant relationship between the surgical procedure used and postoperative pain or prognosis. Patients who underwent an ostectomy presented more swelling than those who were treated with an osteotomy and repositioning of the vestibular cortical

Software applied to oral implantology : update

Software in combination with imaging techniques is used increasingly for diagnosis, planning and treatment in oral implantology. Computer-aided surgery allows a great accuracy in implant positioning to be obtained, taking advantage of the amount of bone available and facilitating minimally invasive surgery. It is a significant aid in determining implant number, location, angle and characteristics. A CT with a radiographic template positioned in the mouth is made for the patient. Data are stored on a CD in DICOM 3 format and then introduced in the computer where implant treatment will be planned, using the chosen software. Navigation improves surgical accuracy through the aid of software based on the images captured from CT or MRI and a surgical instrument tracking system. Infrared light-emitting diodes are connected to rotatory instruments and to the patient?s template. Information is collected by special-purpose cameras, allowing the procedure to be viewed in real time on a monitor. It is useful in situations where an exact implantation is demanded, such as anatomical limitations, little space, atrophic maxillae, sinus lifts or zygomatic implants. Articles reviewed agree in emphasizing the reliability and accuracy of the planning and computer-assisted navigation systems available in the market. Nevertheless, many applications are still in the development phase