Estudio jurisprudencial de la responsabilidad profesional del odontólogo en España

Introducción La incidencia de las reclamaciones legales de los pacientes es relativamente reciente en el ámbito de la odontología y hasta el momento los estudios relacionados con el análisis de sentencias contra odontólogos son escasos. Objetivo El objetivo general fue analizar las características médico-legales de las sentencias contra odontólogos y estomatólogos emitidas en segunda instancia o posteriores en España desde el año 1991 hasta marzo del año 2015. Material y método Se realizó un estudio observacional descriptivo de las sentencias publicadas desde enero de 1991 a marzo de 2015 por presuntos defectos de praxis en la asistencia de pacientes tratados por odontólogos o estomatólogos en España. La búsqueda se realizó a través de la base de datos Aranzadi Digital. Se incluyeron 504 sentencias y se registraron los datos referentes a: a) variables administrativas, b) variables en relación al acto odontológico, c) variables en relación al paciente, d) variables en relación al profesional implicado, y e) variables judiciales. Resultados Se incluyeron en el estudio un total de 504 sentencias relacionadas con presunta mala praxis durante el tratamiento odontológico siendo el último periodo (2011-2015) el que tuvo un mayor número de sentencias registradas. La provincia con mayor porcentaje de sentencias fue Madrid (22,4 %), seguida de Barcelona (13,7 %) y Asturias (6%); en el resto fue inferior al 5 %. El 91,9% de las sentencias pertenecieron a la jurisdicción civil, el 4,6% a la penal y el 3,6 % a la contencioso-administrativa. El 95,2 % tuvieron lugar en la Audiencia Provincial, el 2,6% en el Tribunal Superior de Justicia, el 1,7% en el Tribunal Supremo y el 0,8% en la Audiencia Nacional. Los tratamientos odontológicos más demandados fueron la colocación de implantes (15,1%), la prótesis fija sobre dientes (12,9%), la endodoncia (12,1%) y el tratamiento de implantes y prótesis sobre implantes (10,1%). En el resto de los tratamientos la incidencia fue menor al 10%. En cuanto al paciente el 69,9% fueron mujeres y el 30,1 % fueron hombres; mientras que en los profesionales implicados, los hombres constituyeron más del doble de las mujeres dentistas demandadas. En el 41,1 % de los casos el profesional quedó absuelto, en el 54,8% se le exigió responsabilidad civil, en el 5,4 % penal y 1,7 % contencioso-administrativa. La cantidad media indemnizada fue 15.149,7 euros. Conclusiones En los últimos años se ha observado un aumento de sentencias relacionadas con el tratamiento odontológico especialmente en el área de la cirugía e implantes y en el ámbito de las franquicias dentales. Sin embargo son necesarios un mayor número de estudios relacionados con eventos adversos y con el fracaso de tratamientos en la práctica odontológica para que nos proporcionen mayor información nos permitan unificar criterios odontológicos.Departamento de Anatomía Patológica, Microbiología, Medicina Preventiva y Salud Pública, Medicina Legal y Forens

Irritative and sensory disturbances in oral implantology. literature review

The aim of this study was to review irritative and sensory disturbances following placement of dental implants. A literature search was made of PubMed for articles published between 2000 and 2010. Studies that reported sensory disturbances directly caused by the placement of dental implants were included. Sensory deficits or trigeminal neuropathy are caused by damage to the third branch of the trigeminal nerve du-ring surgery. This manifests in the immediate postoperative period as a sensory deficit not usually associated with pain and generally transient. The literature reviewed reported irritative and sensory disturbances caused during surgery, after surgery, and as a result of complications. Postoperative pain appears after oral surgery as a result of inflammation associated with damage to tissue during surgery. Pain due to postoperative complications following implant placement was classified as neurogenic pain, peri-implant pain and bone pain. © Medicina Oral S. L

Radiographic signs associated with inferior alveolar nerve damage following lower third molar extraction

The aim was to carry out a literature review of preoperative radiographic signs in orthopantomography (OPG) and computed tomography (CT) related with the risk of inferior alveolar nerve damage during the surgical extraction of lower third molar (LTM). A search was made on PubMed for literature published between the years 2000 and 2009. In the reviewed literature, radiographic signs in the OPG that indicate a relationship between the LTM and the inferior alveolar canal are considered a risk factor for nerve damage. These signs are darkening and deflection of the root, and diversion and interruption in the white line of the canal. In the majority of these studies, the routine use of CT is not justified, and is only recommended when radiographic signs appear in the OPG that demonstrate a direct anatomical relationship between the LTM and the canal. In the CT, the absence of cortical bone in the canal implies a contact between the root of the LTM and the canal, and is related with the presence of some radiographic signs in the OPG. Some studies demonstrate that despite the absence of cortical bone, the risk of lesion or exposure of the nerve during the extraction of LTM was low

Clinical characteristics, treatment and outcome of 28 oral haemangiomas in paediatric patients

Objective: To present a large series of oral haemangiomas in children, analyzing the clinical characteristics, treatment and outcome of oral haemangiomas in 28 children. Material and Methods: We conducted an observational retrospective study, reviewing medical records with clinical diagnosis of haemangioma between 1990 and 2006 at the Children?s Maxillofacial Surgery Service of the Hospital Universitario la Fe, Valencia. All patients with a clinical, radiographic, pathologically confirmed diagnosis of oral haemangioma were included. Results: The study included 28 patients (19 females and 9 males) with a mean age of 4.27 years (range 0-14 years). Nine were congenital haemangioma. The most frequent location of oral haemangioma was in the lip with 23 cases, followed by three cases in the tongue and 2 in the buccal mucosa. The mean diameter of the lesion was 1.67 cm (range 1-3cm). The mean duration of the lesion was 6.3 months (range 1 month to 5 years). Of the 28 haemangiomas, 13 were surgically removed, 2 were treated with embolization and 13 disappeared spontaneously. The mean follow up was 2.7 months (1-8 months). There were no cases of recurrence. Conclusions: Haemangiomas usually present in children, and can be seen from birth. They have a predilection for females. They are uncommon in the oral cavity. In the oral region, the most common location is the lip. Most congenital haemangioma regress spontaneously without treatment. The treatment of choice is surgical excision of the lesion

Risk factors associated with early failure of dental implants. A literature review

The aim of the study was to examine articles published on risk factors associated with early failure of dental implants. We conducted a search on PubMed for articles published between January 2000 and December 2009 using the keywords 'dental implants' and 'early failure'. Seven studies that specified the number of early failed implants and studied the associated risk factors were included. Early failures are caused by the inability of tissue to establish osseointegration prior to prosthetic restoration; however the causal factors and mechanisms are unclear. In the reviewed literature there was a higher percentage of early than late failures; nevertheless, few articles were found that analyzed risk factors associated with early implant failure. In the majority of studies, statistically significant factors associated with early implant failure were smoking, quantity and quality of bone, and posterior implant location. The low number of studies in the literature does not allow definitive conclusions to be drawn. © Medicina Oral S. L

Orofacial dermoid cysts in pediatric patients : a review of 8 cases

Objective: The aim was to analyze the clinical characteristics, treatment and outcome of 8 orofacial dermoid cysts (DC) in pediatric patients. Material and Methods: A retrospective observational study was made, reviewing the medical records with clinical diagnosis of dermoid cyst between 1987 and 2006 in the Children?s Maxillofacial Surgery Department of the Hospital Universitario La Fe, Valencia, Spain. The following data were collected: sex, age, location, size and duration of the lesion, treatment, length of follow-up, and recurrence. Results: Eight patients (3 girls and 5 boys) with a mean age of 2.7 years (range 0-12 years). Four DC were located in the oral area (3 sublingual and 1 lingual), one in the periorbital and three in the nasal areas. The size ranged from 0.8 cm to 4 cm. The mean duration of the lesion was 13.7 months (range 4 days to 2 years). All DC were diagnosed pathologically following surgical removal of the lesion. There were no recurrences. Conclusion: The appearance of DC in the maxillofacial region of pediatric patients is uncommon. The floor of the mouth is the most frequently affected area in the oral cavity. Treatment is surgical removal of the lesion. Recurrence is unusual

Radiological assessment of peri-implant bone loss: a 12-month retrospective study

Introduction: Following dental implant loading, marginal bone loss after one year must be evaluated to check correct maintenance of the bone levels. Objectives: To assess implant treatment success and quantify marginal bone loss 6 and 12 months after loading. Material and method: Sixty-one MIS® implants with a 1.8 mm machined neck were placed in 26 patients. Implant success was based on the criteria of Buser. Radiological controls were made 6 and 12 months after loading, measuring bone loss mesial and distal. Results: Twenty-two patients with 56 implants were included: 32 in the maxilla and 24 in the mandible. Two implants failed in two patients during the osseointegration phase (both in the maxilla), yielding an implant success rate of 96.4%. After 6 months, bone loss was 0.80±1.04 mm mesial and 0.73±1.08 mm distal, while after 12 months bone loss was 0.92±1.02 mesial and 0.87±1.01 distal. Conclusions: Bone loss 6 and 12 months after machined neck implant placement was within the normal ranges described in the literature

All-cause mortality in the cohorts of the Spanish AIDS Research Network (RIS) compared with the general population: 1997Ł2010

Abstract Background: Combination antiretroviral therapy (cART) has produced significant changes in mortality of HIVinfected persons. Our objective was to estimate mortality rates, standardized mortality ratios and excess mortality rates of cohorts of the AIDS Research Network (RIS) (CoRIS-MD and CoRIS) compared to the general population. Methods: We analysed data of CoRIS-MD and CoRIS cohorts from 1997 to 2010. We calculated: (i) all-cause mortality rates, (ii) standardized mortality ratio (SMR) and (iii) excess mortality rates for both cohort for 100 personyears (py) of follow-up, comparing all-cause mortality with that of the general population of similar age and gender. Results: Between 1997 and 2010, 8,214 HIV positive subjects were included, 2,453 (29.9%) in CoRIS-MD and 5,761 (70.1%) in CoRIS and 294 deaths were registered. All-cause mortality rate was 1.02 (95% CI 0.91-1.15) per 100 py, SMR was 6.8 (95% CI 5.9-7.9) and excess mortality rate was 0.8 (95% CI 0.7-0.9) per 100 py. Mortality was higher in patients with AIDS, hepatitis C virus (HCV) co-infection, and those from CoRIS-MD cohort (1997. Conclusion: Mortality among HIV-positive persons remains higher than that of the general population of similar age and sex, with significant differences depending on the history of AIDS or HCV coinfection