Hemostatic agents used in apical surgery: a review

Objective: A review was made of the current literature on hemostatic agents used in apical surgery in order to determine their effectiveness and adverse effects. Material and methods: The main search terms used were: endodontic surgery, apicoectomy, apical surgery, periradicular surgery, hemostasis, hemostatic agents, and bleeding control. The authors searched the Medline database for articles published up to 1 September 2010. Experimental and clinical studies comparing the effectiveness and/ or adverse effects of two or more hemostatic agents and published between 2000 and 2010 were included in the review. Results: Four studies were analyzed: two clinical studies and two experimental studies. According to the clinical studies, epinephrine produces no changes in blood pressure or heart rate when used to control bleeding in periapical surgery. Aluminum chloride alone or in combination with ferric sulfate was found to be the most effective agent in the experimental studies, and the tissue damage it causes was not observed when the superficial bone layer was eliminated with rotary instruments. Conclusion: Additional controlled clinical trials are needed to not only assess the efficacy of the different hemostatic agents but also to investigate their influence upon healing and the outcome of periapical sur gery

Magnification in apical surgerymusing the endoscope: a review

Objective: A review is made to determine whether the use of the endoscope in endodontic surgery offers advantages in clinical practice, and whether it improves the clinical and radiographic outcomes of the procedure. Material and methods: The main search terms used were: endodontic surgery, apicoectomy, apical surgery, endoscope, and magnification devices . The authors searched the Medline database for articles published up to 1 September 2010. The review included experimental studies comparing endoscopic microstructural findings with the findings of the naked eye or other magnification devices, as well as prospective clinical trials comparing endodontic surgery with or without the use of an endoscope, or comparing the endoscope with some other magnification device. Results: Two experimental studies on the capability of the endoscope to identify microstructures and three prospective clinical trials were included in the review. The experimental studies showed the endoscope to be highly precise in application to intraoperative diagnoses in periapical surgery. There were no significant differences in the prognosis of periapical surgery when performed with or without endoscopy. Likewise, there were no significant differences among the use of endoscopy, magnifying lenses or the microscope. Conclusion: Experimental studies have demonstrated the usefulness of the endoscope in identifying microstructures during periapical surgery. However, further randomized and controlled clinical trials are needed to determine whether these advantages in clinical practice imply improved outcomes for periapical surgery

Bone regeneration using particulate grafts : an update

Objective: A review is made of the publications on bone regeneration using particulate grafts, with an evaluation of the success of implants placed in such regenerated areas. Material and Method: A Medline search using different key words was made of the articles published between 1999-2009 involving at least two patients subjected to grafting with autologous, homologous or xenogenic bone, non-bony substitutes, or a combination of these grafts for the placement of dental implants. Studies involving block grafting were excluded. A total of 11 studies were evaluated. Results: These grafts are indicated in cases of small or peri-implant bone defects such as dehiscences and fenestrations, with the possibility of combining a barrier membrane. However, some authors have used particulate block grafts to secure vertical or horizontal increments of the alveolar process. In most of these cases, graft healing until implant placement lasted 6-9 months. The most frequent complications in the receptor zone were wound dehiscences with exposure of the membrane. In almost all cases, prosthetic loading of the implants took place more than three months after their placement. The implant survival rate varied from 90.9% to 100%, with an implantation success rate of 85.7% to 100%. Conclusions: Although our sample is small, due to the difficulty of finding homogeneous studies, it can be concluded that particulate grafts are effective in correcting localized defects of the alveolar process. The complications of particulate grafting are few, and the success rate of implants placed in the reconstructed areas varies from 85.7% to 100%

Implant periapical lesion: diagnosis and treatment

The implant periapical lesion is the infectious-inflammatory process of the tissues surrounding the implant apex. It may be caused by different factors: contamination of the implant surface, overheating of bone during drilling, preparation of a longer implant bed than the implant itself, and pre-existing bone disease. Diagnosis is achieved by studying the presence of symptoms and signs such us pain, swelling, suppuration or fistula; in the radiograph an implant periapical radiolucency may appear. A diagnostic classification is proposed to establish the stage of the lesion, and determine the best treatment option accordingly. The following stages are distinguished: acute apical periimplantitis (non-suppurated and suppurated) and subcacute (or suppurated-fistulized) apical periimplantitis. The most adequate treatment of this pathology in the acute stage and in the subacute stage if there is no loss of implant stability is apical surgery. In the subacute stage, if there is implant mobility, the extraction of the implant is necessary

Survival of implants placed with the osteotome technique : an update. Review

A literature review is made to analyze the survival of implants placed with the osteotome technique. A PubMed search was made based on the key words ?osteotome AND dental implants?, corresponding to publications between 1998-2008. Th e inclusion criteria were: a) a minimum of 10 patients; b) a minimum follow-up of 6 months; c) implants placed using the osteotome technique with or without indirect sinus lift; and d) specification of the implant number and survival rate. Sixty-four articles were identified, of which 20 met the inclusion criteria. A total of 2006 implants were placed in 1312 patients using the osteotome technique. Th e duration of follow-up after prosthetic loading ranged from 6-144 months. Indirect sinus lift was carried out in all but one of the studies. Th e residual crest height ranged from 2.3-11.7 mm. with a mean gain in bone after sinus lift of 2.5-5.5 mm. Th e time from implant placement to prosthetic loading varied from 1.5-9 months. Th e percentage implant survival rate was 90.5-100%. Th e survival rate of implants placed with the osteotome technique is high and does not differ with respect to implant placement with the conventional techniqu

Virtual articulator for the analysis of dental occlusion : an update

The future of dental practice is closely linked to the utilization of computer-based technology, specifically virtual reality, which allows the dental surgeon to simulate true life situations in patients. The virtual articulator has been designed for the exhaustive analysis of static and dynamic occlusion, with the purpose of substituting mechanical articulators and avoiding their errors. These tools will help both odontologists and dental prosthetists to provide the best individualized treatment for each patient. The present review analyzes the studies published in the literature on the design, functioning and applications of virtual articulators. A Medline-PubMed search was made of dental journals, with the identification of 137 articles, of which 16 were finally selected. The virtual articulator can simulate the specific masticatory movement of the patient. During mandibular animation, the program calculates the sites where the opposing teeth come into contact. The studies made to assess the reliability of the virtual articulator show good correspondence in visualization of the number and position of the dynamic contacts. The virtual articulator is a precise tool for the full analysis of occlusion in a real patient. © Medicina Oral S. L

Augmentation procedures for deficient edentulous ridges, using onlay autologous grafts: an update

The purpose of this review was to analyze publications related to augmentation procedures using autologous onlay grafts and to evaluate the survival/success rates of implants placed in the augmented areas. An automated search was made in Medline, of clinical publications from 2002 to 2007, including at least 5 patients and with a minimum follow-up of 6 months. Ten papers were included. These suggested that grafts are indicated when the height of the alveolar crest is less than 5mm, or the width less than 4mm. The surface resorption of grafts protected by guided bone regeneration membranes was less than for unprotected grafts. Calvarial grafts suffered less resorption than did iliac grafts. The healing period of the graft until implant placement was, in most cases, 4-6 months. The most frequent complications in the recipient site were wound dehiscences. Prosthetic loading time was, in almost all patients, 3 months after implant placement. Implant survival rate ranged from 97.1% to 100%. Although , due to the difficulty in finding homogenous studies, the sample is small, we can conclude that autologous onlay block bone grafts are an effective procedure for alveolar crest augmentation; graft surface resorption is reduced when the grafts are protected by regeneration membranes; few complications arise from the procedure; and the success rate for implants placed in the reconstructed area is between 89.5 and 95.7%

Oromandibular dystonia : a dental approach

Oromandibular dystonia consists of prolonged spasms of contraction of the muscles of the mouth and jaw. Primary idiopathic forms and secondary forms exist. Secondary dystonia develops due to environmental factors; some cases of cranial dystonia after dental procedure have been reported, but the causal relationship between these procedures and dystonia remains unclear. Traumatic situations in the mouth, such as poor aligned dentures or multiple teeth extractions may cause an impairment of proprioception of the oral cavity, leading to subsequent development of dystonia. The clinical characteristics of oromandibular dystonia are classified according to the affected muscles. The muscles involved may be the muscles of mastication, muscles of facial expression, or the muscles of the tongue. At present, there is no known cure for OMD. The mainstay of treatment for most focal dystonia is botulinum toxin injections. It is important for the dentist to be familiar with oromandibular dystonia, as it can develop after dental treatment and is often misdiagnosed as a dental problem

Influence of hemostatic agents upon the outcome of periapical surgery: dressings with anesthetic and vasoconstrictor or aluminum chloride

Objective: To evaluate the effects of different hemostatic agents upon the outcome of periapical surgery. Design: A retrospective study was made of patients subjected to periapical surgery between 2006-2009 with the ultrasound technique and using MTA as retrograde filler material. We included patients with a minimum follow- up of 12 months, divided into two groups according to the hemostatic agent used: A) dressings impregnated in anesthetic solution with adrenalin; or B) aluminum chloride paste (Expasyl TM). Radiological controls were made after 6 and 12 months, and on the last visit. The global evolution scale proposed by von Arx and Kurt (1999) was used to establish the outcome of periapical surgery. Results: A total of 96 patients (42 males and 54 females) with a mean age of 40.7 years were included. There were 50 patients in the aluminum chloride group and 46 patients in the anesthetic solution with vasoconstrictor group. No significant differences were observed between the two groups in terms of outcome after 12 months - the suc - cess rate being 58.6% and 61.7% in the anesthetic solution with vasoconstrictor and aluminum chloride groups, respectively (p>0.05). Conclusion: The outcome after 12 months of follow-up was better in the aluminum chloride group than in the anesthetic solution with vasoconstrictor group, though the difference was not significant

Maxillary sinus septa : A systematic review

This review analyzes articles published on the presence of septa in maxillary sinuses. An automated search was conducted on PubMed using different key words. This search resulted in 11 papers in which the presence of antral septa was assessed. These septa are barriers of cortical bone that arise from the floor or from the walls of the sinus and may even divide the sinus into two or more cavities. They may originate during maxillary development and tooth growth, in which case they are known as primary septa; or they may be acquired structures resulting from the pneumatization of maxillary sinus after tooth loss, in which case they are called secondary septa. Several methods have been used in their study, direct observation on dried skulls or during sinus lift procedures; and radiographic observation using panoramic radiographs or computed tomographs. Between 13 and 35.3% of maxillary sinuses have septa. They can be located in any region of the maxillary sinus and their size can vary between 2.5 and 12.7 mm in mean length. Some authors have reported a higher prevalence of septa in atrophic edentulous areas than in non-atrophic ones. If a sinus lift is conducted in the presence of maxillary sinus septa, it may be necessary to modify the design of the lateral window in order to avoid fracturing the septa