Med Oral Patol Oral Cir Bucal. 2009 Mar 1;14(3):E108-E113.

Oral signs of intravenous chemotherapy with 5- Fluorouracil and Leucovorin Calcium in colon cancer treatment.

Mazzeo MA, Linares JA, Campos ML, Busamia BE, Dubersarsky C, Lavarda M, Jarchum G, Finkelberg AB.

Cátedra de Fisiología. Facultad de Odontología, Ciudad Universitaria, Córdoba, Argentina, finkelberg1@yahoo.com.

Several studies have shown how cytostatics may cause salivary gland hypofunction. The aim of this study was to determine potential salivary gland disorders in patients treated with 5- Fluorouracil (5-Fu) and Leucovorin calcium (LV) as well as to examine the correlation with certain oral health disorders that diminish the quality of life. Materials and methods:this research was observational and longitudinal. Twenty-five patients with colon cancer were assessed. Clinical history, oral health indexes and basal or stimulated saliva samples were recorded. Results: Basal and stimulated salivary flow dropped in the intermediate stage. Stimulated saliva pH decreased during treatment. Salivary, urea, sodium and potassium rose during the intermediate phase. Löe and Silness rates as well as simplified bleeding index increased during therapy but reverted by the end of treatment. Depth index of the vestibular gingival sulcus rose during the intermediate phase but did not return. Conclusion: This treatment caused functional salivary gland disorders as evidenced by basal and stimulated hyposialia, and acidification of stimulated saliva pH during the intermediate phase. Increase in basal urea may be due to protein catabolism arising from plasma or glands. Variation in Na+ and K+ of basal saliva might be assumed to be a possible duct disorder. Recovery of bleeding and Löe and Silness rates may point to a transient inflammatory effect associated to a decrease in salivary flow. Increase in the depth rates of the periodontal vestibular sulcus could be correlated with a higher risk of periodontal disease.

Med Oral Patol Oral Cir Bucal. 2009 Mar 1;14(3):E114-E117.

Pyostomatitis vegetans: A review of the literature.

Femiano F, Lanza A, Buonaiuto C, Perillo L, Dell'ermo A, Cirillo N.

Via Francesco Girardi, 2 Sant'Antimo (NA) 80029, Italy, femiano@libero.it.

Pyostomatitis vegetans (PV) is a rare condition characterized by pustules that affect the oral mucosa. It is a highly specific marker for inflammatory bowel disease and its correct recognition may lead to the diagnosis of ulcerative colitis or Crohn's disease. Thus, a presumptive diagnosis of PV should suggest a complete gastrointestinal investigation. PV pathogenesis is as yet unknown, although immunological and microbial factors have been suggested as possible aetiological factors. Pyostomatitis vegetans is characterized by erythematous, thickened oral mucosa with multiple pustules and superficial erosions. A peripheral eosinophilia has been observed in most cases reported. Histology shows epithelial acanthosis and superficial ulceration with intraepithelial and / or subepithelial abscesses containing large numbers of eosinophils. The underlying connective tissue exhibits neutrophil and eosinophil infiltration, with miliary abscesses in some cases. Treatment of PV focuses on control of the underlying disease.

Med Oral Patol Oral Cir Bucal. 2009 Mar 1;14(3):E118-E122.

Oral lichenoid disease as a premalignant condition: The controversies and the unknown.

Cortés-Ramírez DA, Gainza-Cirauqui ML, Echebarria-Goikouria MA, Aguirre-Urizar JM.

Medicina Bucal. Dpto. Estomatología, Universidad del País Vasco EHU, Barrio Sarriena s/n, Leioa 48940, Vizcaya, Spain, josemanuel.aguirre@ehu.es.

We grouped as oral lichenoid disease (OLD) a series of chronic inflammatory processes with autoimmune base that affect the epithelium of the oral mucosa. This disease presents in 2% of the population with a marked predilection for the female gender, especially perimenopausal women. Clinically, it is characterized by the presence of lineal reticular papules and histologically by liquefaction degeneration of the basal layer of the epithelium associated with an inflammatory infiltrate with a "band-like" disposition on the lamina propria, composed primarily of T lymphocyte cells. Its pathogenicity is associated with deregulation of the cellular immune system, where the activated cytotoxic CD8 and the CD4 T helper lymphocytes induce apoptosis of the epithelial cells. Classically it has been considered a precancerous condition, although the malignant transformation does not exceed 1% of cases. In recent years the differentiation between oral lichen planus (OLP) and oral lichenoid lesions (OLL) has become important, since the latter might have a greater malignant potential. In this paper, we analyse and update some controversial aspects of this frequent oral disease in relation to the diagnosis and malignant potential.

Med Oral Patol Oral Cir Bucal. 2009 Mar 1;14(3):E123-E128.

Pharmacological interactions of anti-microbial agents in odontology.

Gómez-Moreno G, Guardia J, Cutando A, Calvo-Guirado JL.

Facultad de Odontología, Universidad de Granada, Colegio Máximo s/n, Campus de Cartuja. E-18071. Granada, Spain, ggomez@ugr.es.

In this third article we describe the pharmacological interactions resulting from the use of anti-microbial agents. Although the antimicrobials prescribed in odontology are generally safe they can produce interactions with other medicaments which can give rise to serious adverse reactions which are well documented in clinical studies. Antibiotics with grave and dangerous life threatening consequences are erythromycin, clarithromycin and metronidazol and the anti-fungal agents are ketoconazol and itraconazol. Regarding the capacity of the anti-microbials to reduce the efficacy of oral anti-contraceptives the clinical studies to date are inconclusive, however, it would be prudent for the oral cavity specialist to point out the risk of a possible interaction. Therefore the specialist should be aware of possible interactions as a consequence of administering an antibiotic together with other medicaments the patient may be taking.

Med Oral Patol Oral Cir Bucal. 2009 Mar 1;14(3):E129-E132.

Evaluation of the buccal vestibule-palatal diffusion of 4% articaine hydrochloride in impacted maxillary third molar extractions.

Lima-Júnior JL, Dias-Ribeiro E, de Araújo TN, Ferreira-Rocha J, Honfi-Júnior ES, Sarmento CF, Seabra FR, de Sousa MS.

Severino Alves Ayres Street, n.1271, João Pessoa, PB, Brazil, CEP 58042-120, eduardodonto@yahoo.com.br.

Aims: The aim of this study was to evaluate the vestibular-palatal diffusion of 4% Articaine with epinephrine 1:100,000 and 1:200,000, in impacted maxillary third molar extractions, without palatal injection. Materials and Method: Two hundred teeth were selected from patients age 15 to 46. Patients were divided into 4 groups: 1A, were anesthetized with 4% articaine 1:100,000 and the surgery was initiated 5 minutes following anesthesia. 1B, used 4% articaine 1:100,000 but the surgery was started 10 minutes after anesthesia. 2A, used 4% articaine 1:200,000 the surgery was started 5 minutes after. 2B, used 4% articaine 1:200,000 but 10 minutes was allowed for anesthetic diffusion before the initiation of in groups (50 extractions each) only buccal vestibule anesthesia was initially administered (i.e. no palatal injections were used). Results: The rate of sufficient vestibule-palatal diffusion, as determined by the lack of necessity of supplemental palatal anesthesia, was: 1A(84%), 1B(98%), 2A(78%), 2B(82%). Chi-square (Chi (2)) and residual analyses showed that a higher vestibule-palatal diffusion was obtained using 4% articaine 1:100,000 with a period of 10 minutes (p<0.05). Conclusions: Most of the extractions could be performed only with vestibule anesthesia. However, vasoconstrictor concentration and the time interval between administration of the anesthetic and initiation of surgery did influence buccal vestibule-palatal diffusion of 4% articaine in the extraction models used.

Med Oral Patol Oral Cir Bucal. 2009 Mar 1;14(3):E133-E136.

Influence of perforation of the sinus membrane on the survival rate of implants placed after direct sinus lift. Literature update.

Viña-Almunia J, Peñarrocha-Diago M, Peñarrocha-Diago M.

Cirugía Bucal. Clínicas Odontológicas, Facultad de Medicina y Odontología, Universidad de Valencia, Gascó Oliag 1, 46021- Valencia, Spain, Miguel.Penarrocha@uv.es.

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 reservable 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.

Med Oral Patol Oral Cir Bucal. 2009 Mar 1;14(3):E137-E140.

Giant aneurysmal bone cyst of the mandible with unusual presentation.

Capote-Moreno A, Acero J, García-Recuero I, Ruiz J, Serrano R, De Paz V.

C/ Valderribas 10, 5º H, 28007 Madrid, Spain, anacapote@inicia.es.

Aneurysmal bone cysts are rare benign lesions of bone tissue, infrequent in craneofacial skeleton with regard to other structures like long bones or the spine. They are composed of sinusoidal and vascular spaces blood-filled and surrounded by fibrous tissue septa. We present a case of a 29-year-old Caucasian male with a big swelling in the left mandible associated to pain and rapid growth. He referred previous extraction of the left inferior third molar. On the X-ray study, an expansive multilocular and high vascularized bony lesion within the mandibular angle was observed. It produced expansion and destruction of lingual and buccal cortex. An incisional biopsy was performed showing a fibrous tissue with blood-filled spaces lesion suggestive of an aneurysmal bone cyst. After selective embolization of the tumour, surgical resection was done with curettage and immediate reconstruction of the defect with an anterior iliac crest graft. Aneurysmal bone cysts are non-neoplastic but locally aggressive tumours with occasional rapid growth that may be differenciated from other multilocular process like ameloblastoma, ossifying fibroma, epithelial cyst, giant cell granuloma and sarcomas. Treatment of choice consists on conservative surgical excision of the mass with curettage or enucleation. When resection creates a big defect, primary surgical reconstruction is recommended.

Med Oral Patol Oral Cir Bucal. 2009 Mar 1;14(3):E141-E145.

CAD / CAM dental systems in implant dentistry: Update.

Fuster-Torres MA, Albalat-Estela S, Alcañiz-Raya M, Peñarrocha-Diago M.

C/Gascó Oliag 1, 46021 Valencia, Spain, miguel.penarrocha@uv.es.

CAD/CAM systems (computer-aided design / computer aided manufacturing) used for decades in restorative dentistry have expanded its application to implant dentistry. This study aimed to look through CAD/CAM systems used in implant dentistry, especially emphasizing implant abutments and surgical templates manufacturing. A search of articles published in English at Medline and Scopus databases at present was conducted, introducing "dental CAD/CAM" , "implants abutments" and "surgical guide CAD/CAM" as key words. These systems consist of three components: 1) data capture using optical systems or laser scanning, 2) CAD for the design of the restoration, and 3) CAM to produce the restoration through the information generated by computer. CAD/CAM abutments present the advantages of being specific to each patient and providing a better fit than the rest of abutments, in addition to being much more tough as they employ materials such as titanium, alumina and zirconium. In order to improve accuracy during implant placement we use stereolithography to manufacture CAD/CAM surgical templates. Using this method, minimally invasive surgery is performed without a flap, and the prosthesis is delivered, achieving immediate functional loading to the implants.

Med Oral Patol Oral Cir Bucal. 2009 Mar 1;14(3):E146-E152.

A descriptive study of 113 unerupted supernumerary teeth in 79 pediatric patients in Barcelona.

Ferrés-Padró E, Prats-Armengol J, Ferrés-Amat E.

Passatge Aneto, 7, bajos, 08303-Mataró, Barcelona, Spain, 26867jpa@gmail.com.

Unerupted supernumerary teeth, depending on the morphology, number and distribution can give rise to various alterations in the eruption and development of those permanent teeth to which they are related. Objectives: We aimed to make an epidemiological and descriptive study of the clinical characteristics of patients in Barcelona, their surgical treatment and how said treatment was hindered. Materials and methods: A descriptive study including 113 supernumerary teeth from 79 healthy pediatric patients between 5 and 19 years of age, which underwent surgery in our hospital during a 2 year period (May 2005 / May 2007), taking into account the variables of personal data, gender, age, location, number, morphology, position-axis, radiological study, surgical treatment, related pathologies, and surgical complications. Results: Male patients (51) were more frequently affected than female (28) patients mainly within the central incisors-mesiodens (53.16%), in which the unique form (68.52%) predominates in conoid morphology (69.62%). Surgical treatment was done by palatal/lingual extraction (49.37%), with few surgical complications (only 1 case of post-surgical bleeding). Conclusion: Incidence in supernumerary teeth is higher among male patients (ratio M:F of 1.82:1). They are most frequently located in the maxilla (82%), specifically, in the premaxilla (77%). Most cases presented only one supernumerary tooth (68.5%) and, in multiple cases, the premolar region is predominant. The conoid shape is the commonest morphology (69.62%). Surgical extraction, was done by palatal/lingual in 49.37% of the cases, as opposed to the vestibular approach in 45.57%.

Med Oral Patol Oral Cir Bucal. 2009 Mar 1;14(3):E153-E157.

Modification of the working length after rotary instrumentation: A comparative study of four systems.

Martín-Micó M, Forner-Navarro L, Almenar-García A.

Clínica Odontológica, Universitat de Valencia, C/ Gascó Oliag, 1, 46010 Valencia, Spain, forner@uv.es.

Objetive: To determine variation in post-instrumentation working length and root area in the following endodontic rotary systems: ProTaper, RaCe, Mtwo and K3. Study design: A sample of 40 resin blocks with a 33 degrees angle and a double curvature (measuring 14 mm and 16 mm respectively) was used. The working length was measured digitally, and verified using a number 10 K file. A specific procedure was followed for each rotary system. The canal was measured between each file, and the variation was noted in order to determine which file showed the greatest variation within the same system. The different systems were then compared. 1.5 x pre and post-instrumentation microscopic photographs were taken, and measurements of the area were taken with an image analysis programme. Results: The area was found to increase by the following amounts: 21.85 mm(2) using ProTaper; 20.16 mm(2) using Mtwo; 17.24 mm(2) using K3; and 16.09 mm(2) using RaCe. The differences in variation of the working length were: 0.81 mm using ProTaper; 1.07 mm using Mtwo; 0.31 mm using K3; and 0.81 mm using RaCe. Conclusions: Clinically speaking, the values for the variation in working length are not very significant. All the rotary systems analysed showed a tendency to straighten the canal and to eliminate the apical curvature. The ProTaper system was found to produce the most significant modification to the canal area and structure.