Análisis de la capacidad de osteointegración de diferentes revestimientos de superficie de implantes dentales de titanio

La presente tesis doctoral, presentada por compendio de publicaciones, tuvo como objetivo evaluar la dinámica de cicatrización ósea alrededor de implantes dentales con diferentes recubrimientos y tratamientos superficiales, y compararla con implantes con superficie grabada convencional sin tratamiento adicional. Está basada en cuatro artículos publicados en revistas con factor de impacto, del primer cuartil. Todos los artículos giran entorno a los revestimientos y funcionalización de las superficies de los implantes dentales de titanio ya que, en la actualidad, los revestimientos de superficie se han transformado en una de las líneas de investigación con mayor atractivo para los investigadores del sector dental. El primer estudio, evaluó la osteointegración y la formación ósea a diferentes niveles, de los implantes de titanio recubiertos con quitosano, en la mandíbula de un modelo de canino, observándose que, en los implantes recubiertos con quitosano, el análisis de la tendencia en el grupo experimental mostró una significación estadística considerable, en comparación con el grupo control. El segundo, analizó el efecto de la BMP-7 sobre los parámetros biológicos relacionados con la osteointegración de implantes dentales de titanio, con superficies tratadas mediante ácido carboxietilfosfónico. Los resultados preliminares de este estudio preclínico mostraron que, al cabo de cuatro semanas, los implantes experimentales con superficie tratada con ácido carboxietilfosfónico, funcionalizado con BMP-7, obtuvieron diferencias estadísticamente significativas para los parámetros histomorfométricos BIC (Bone Implant Contact) y BIC corregido, en comparación con el grupo de control; sin embargo, no se encontraron diferencias entre los grupos para la formación de hueso nuevo y la densidad ósea. El tercer artículo se centró en una visión general de los conceptos y teorías actuales de la osteointegración y las superficies y recubrimientos actuales de los implantes dentales de titanio, con especial atención a la investigación in vivo, de los implantes recubiertos con quitosano y una perspectiva actual sobre el futuro de los recubrimientos de los implantes dentales de titanio; además se describió un novedoso método de revestimiento, en vías de patentado. El cuarto artículo es una revisión sistemática y metaanálisis, sobre la efectividad de las superficies bioactivas en la osteointegración de los implantes dentales de titanio, con la conclusión que la modificación de las superficies de los implantes, mediante moléculas bioactivas orgánicas, aunque parece favorecer la osteointegración en las primeras fases de cicatrización, no aporta pruebas definitivas de ello

Changes in crevicular cytokines after application of melatonin in patients with periodontal disease

A clinical trial was designed to evaluate the effects of topical application of melatonin on the crevicular fluid levels of interleukins and prostaglandins and to evaluate changes in clinical parameters. A consecutive sample of 90 patients were recruited from the Health Centre of Pinos Puente in Granada, Spain and divided into 3 groups: 30 patients with diabetes and periodontal disease, who were given melatonin; 30 patients with diabetes and periodontal disease, who were given a placebo, and 30 healthy individuals with no history of systemic disease or clinical signs of periodontal disease, who were also given a placebo. The 30 patients with diabetes and periodontitis were treated with topical application of melatonin (1% orabase cream formula) for 20 days by. The rest of the patients with diabetes and periodontitis and healthy subjects were treated with a placebo of orabase cream. We measured the gingival index by exploring the percentage of standing teeth bleeding on probing. The periodontogram was performed with a Florida Probe. In the diabetic patients who were given topical melatonin, there was a statistically significant decrease in the two clinical parameters. By contrast, in diabetic patients who were given the topical placebo, there was no statistically significant variation. In patients with diabetes and periodontal disease, treatment with topical melatonin was associated with a significant improvement in the gingival index and in pocket depth, and a statistically significant reduction in concentrations of interleukin-1?, interleukin-6 and prostaglandin E2 in gingival crevicular fluid

Cirugía bucal

Memoria ID-029. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2021-2022

Gingival hyperplasia as an early manifestation of acute myeloid leukemia. A retrospective review

We study the prevalence of acute myeloid leukemia (AML) among patients with severe gingival enlargement. We retrospective reviewed the clinical records of patients with severe gingival enlargement, between 2011 and 2018. The Saxer and Mühlemann index were used to measure inflammation and gingival bleeding. The degree of dental mobility was measured by the Nyman and Lindhe technique. A correlation analysis was carried out to test whether there were any associations among the different variables. In the sample of 117 patients the mean gingival bleeding index was ?3 and the degree of dental mobility ?2.3. 1.7% of patients, with severe gingival hyperplasia were diagnosed with AML. We found a significant association between gingival bleeding and aging (p<0.001) and a trend (0.54) between bleeding and suffering from AML. Severe gingival enlargement, abundant gingival bleeding, and dental mobility could be early manifestations of a blood dyscrasia

Efficacy of music therapy on stress and anxiety prior to dental treatment: a systematic review and meta-analysis of randomized clinical trials

IntroductionStress and anxiety are emotional states that often accompany patients who have to receive dental treatments, leading them to postpone or avoid treatments with the consequent deterioration of their oral health and, hence, their general condition. Music therapy has been shown to be an alternative to other treatments that are invasive and not without danger, such as anxiolytics or sedation. This systematic review and meta-analysis evaluated the effect of music therapy on anxiety and stress prior to dental treatments.MethodsStudies published in PubMed (through Medline), Web of Science (WOS), Embase, and Cochrane Library databases were consulted up to October 2023. The inclusion criteria were established for intervention studies (randomized controlled trials, RCTs) according to the PICOS (population, intervention, comparison, outcomes, and study) strategy in subjects with dental stress and anxiety (participants) treated with music therapy (intervention) in comparison with patients without music therapy (control) and evaluating the response to treatment (outcomes).ResultsA total of 154 results were obtained, with 14 studies finally selected. The risk of bias and the methodological quality were assessed using the Cochrane Risk of Bias Tool and the Jadad scale, respectively. A random-effects meta-analysis was used to quantify the results of the pooled studies, while a fixed-effects meta-analysis was used for studies in the pediatric population. The meta-analysis of pooled studies found statistical significance in the subgroups of anxiety and anxiety–stress (p = 0.03 and p = 0.05, respectively), with an overall effect in favor of the intervention group (p = 0.005). Meta-analysis of the studies in the pediatric population showed considerable statistical significance for the experimental group (p &lt; 0.00001).ConclusionMusic therapy as a treatment for stress and anxiety, prior to dental treatment, proved to be effective in both children and adults although more well-designed randomized clinical studies are needed to validate its efficacy.Systematic review registrationINPLASY, identifier 202312000

Role of chitosan in titanium coatings. trends and new generations of coatings

Survival studies of dental implants currently reach high figures. However, considering that the recipients are middle-aged individuals with associated pathologies, research is focused on achieving bioactive surfaces that ensure osseointegration. Chitosan is a biocompatible, degradable polysaccharide with antimicrobial and anti-inflammatory properties, capable of inducing increased growth and fixation of osteoblasts around chitosan-coated titanium. Certain chemical modifications to its structure have been shown to enhance its antibacterial activity and osteoinductive properties and it is generally believed that chitosan-coated dental implants may have enhanced osseointegration capabilities and are likely to become a commercial option in the future. Our review provided an overview of the current concepts and theories of osseointegration and current titanium dental implant surfaces and coatings, with a special focus on the in vivo investigation of chitosan-coated implants and a current perspective on the future of titanium dental implant coatings

Safety and Efficacy of a New Synthetic Material Based on Monetite, Silica Gel, PS-Wallastonite, and a Hydroxyapatite Calcium Deficient: A Randomized Comparative Clinic Trial

Background and Objectives: Maxillary bone defects related to post-extraction alveolar ridge resorption are usual. These defects may lead to failure in further surgical implant phases given the lack of bone volume to perform the dental implant. The objective of this clinical assay was to evaluate the safety and efficacy of an experimental synthetic bone substitute in the preservation of post-extraction maxillary alveoli. Materials and Methods: 33 voluntary patients who had at least one maxillary premolar tooth that was a candidate for exodontia (n = 39) and subsequent implant rehabilitation participated. The regenerated alveoli were monitored by means of periodic clinical examinations (days 9 ± 1, 21 ± 4, 42 ± 6, and 84 ± 6), measuring the height and width of the alveolar crest (days 0 and 180 ± 5), measurement of radiodensity using tomographic techniques (days 0–5 and 175 ± 5), and histological examination of biopsies collected at 180 ± 5 days. Results: No significant differences were observed during the entire follow-up period between the two groups with respect to the safety variables studied. A variation in width of −0.9 ± 1.3 mm and −0.6 ± 1.5 mm, and a variation in height of −0.1 ± 0.9 mm and −0.3 ± 0.7 mm was observed for experimental material Sil-Oss® and Bio-Oss®, respectively. The radiodensity of the alveoli regenerated with the experimental material was significantly lower than that corresponding to Bio-Oss®. However, the histological study showed greater osteoid matrix and replacement of the material with newformed bone in the implanted beds with the experimental material. Conclusions: Both materials can be used safely and proved equally effective in maintaining alveolar flange dimensions, they are also histologically biocompatible, bioactive and osteoconductive. The experimental material showed the advantage of being resorbable and replaced with newformed bone, in addition to promoting bone regeneration

Creación de un repositorio digital multimedia para la mejora del aprendizaje práctico en el área del conocimiento de la cirugía bucal

Memoria ID-137. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2020-2021

Use of Virtual Reality for the Management of Anxiety and Pain in Dental Treatments: Systematic Review and Meta-Analysis

(1) Background: Dental treatments often cause pain and anxiety in patients. Virtual reality (VR) is a novel procedure that can provide distraction during dental procedures or prepare patients to receive such type of treatments. This meta-analysis is the first to gather evidence on the effectiveness of VR on the reduction of pain (P) and dental anxiety (DA) in patients undergoing dental treatment, regardless of age. (2) Methods: MEDLINE, CENTRAL, PubMed, EMBASE, Wiley Library and Web of Science were searched for scientific articles in November 2019. The keywords used were: &ldquo;virtual reality&rdquo;, &ldquo;distraction systems&rdquo;, &ldquo;dental anxiety&rdquo; and &ldquo;pain&rdquo;. Studies where VR was used for children and adults as a measure against anxiety and pain during dental treatments were included. VR was defined as a three-dimensional environment that provides patients with a sense of immersion, transporting them to appealing and interactive settings. Anxiety and pain results were assessed during dental treatments where VR was used and in standard care situations. (3) Results: 32 studies were identified, of which 8 met the inclusion criteria. The effect of VR in children was significant, both for anxiety (standardized mean difference (SMD) = &minus;1.75) and pain (SMD = &minus;1.46). (4) Conclusions: The findings of the meta-analysis show that VR is an effective distraction method to reduce pain and anxiety in patients undergoing a variety of dental treatments; however, further research on VR as a tool to prepare patients for dental treatment is required because of the scarcity of studies in this area