Medicina Oral Patologia Oral Y Cirugia Bucal最新文献

Introduction: Medication-related osteonecrosis of the jaws (MRONJ) is a serious condition associated with bone modifying agents (BMAs) intake, leading to impaired bone healing and increased morbidity. Despite various therapeutic approaches, an optimal treatment strategy remains elusive. Leukocyte- and Platelet- Rich fibrin (L-PRF) has emerged as a promising autologous biomaterial due to its regenerative properties. This study aimed to evaluate the efficacy of L-PRF in the treatment and prevention of MRONJ.

Material and methods: A prospective cohort study was conducted, including a total of 30 patients diagnosed with MRONJ (stage I or II) or at risk of developing it (non-MRONJ). Patient underwent standardized treatment involving surgical debridement followed by L-PRF application. Clinical and demographic data were collected, and healing outcomes were assessed at multiple follow-up intervals (7 days, 14 days, 1 month, 3 months and 6 months). Statistical analyses, including Kaplan-Meier survival estimates, were performed to evaluate treatment effectiveness.

Results: The study demonstrated an overall healing of 90%, with a complete recovery in 82.4% of confirmed MRONJ cases and 100% of at-risk patients. L-PRF exhibited good clinical outcomes, including reduced inflammation and pain, accelerated epithelialization, and improved tissue regeneration. The median healing time was estimated at 33.41 days for MRONJ patients and 11.00 for non-MRONJ. No significant differences in healing rates were observed based on age, sex, or systemic conditions.

Conclusions: L-PRF represents a promising adjunct in MRONJ management, improving healing outcomes and postoperative recovery. Its autologous nature and growth factor release enhance bone regeneration, suggesting its potential as both a therapeutic and preventive strategy. Further larger-scale clinical trials are needed to standardize protocols and validate long-term efficacy.

Background: The objective of this work is to identify the effectiveness and summarize the scientific evidence of zygomatic implants using the externalized technique, as well as to evaluate the possible complications associated with this technique.

Material and methods: The study was registered in PROSPERO (CRD42022330060) and the searches were carried out in 6 databases (PubMed, Cochrane, LILACS, Scopus, Embase and Google Scholar), by two researchers individually. The aggregated data were subjected to statistical analysis using the MedCalc program for the variables: success rate and frequency of complications, using a 95% confidence interval. The risk of bias of the included studies was determined using the Newcastle-Ottawa Scale (NOS) tool.

Results: 912 articles were found in the initial search and 15 of them were included in this systematic review. A total of 1555 zygomatic implants and 1865 conventional implants were part of the study, with an overall success rate of 96.7% for zygomatic implants and 97.9% for conventional implants. There was no statistically significant difference between the survival of zygomatic implants using the externalized technique when compared with conventional implants (p=0.015). There was no significant heterogeneity between studies (p=0.89, I²=0%). Regarding complications, the most prevalent were sinusitis, which showed a proportion of 3.028% (CI95% = 1.053, 5.980%) and infections, which showed a proportion of 1.56% (CI95% = 0.358, 3.590%). Only three articles included presented a low risk of bias.

Conclusions: Based on the present systematic review and with limited evidence, the use of zygomatic implants using the externalized technique proved to have a high implant success rate and few associated complications for the treatment of atrophic maxillae.

Background: Peri-implantitis is an inflammatory disease linked to bacterial biofilms that threatens the long-term success of dental implants. The growing problem of antibiotic resistance among peri-implant pathogens highlights the need to explore alternative antimicrobial agents with proven in vitro efficacy.

Material and methods: This in vitro study evaluated the antimicrobial activity of piperacillin/tazobactam compared with two commonly used antibiotics in dentistry: amoxicillin-clavulanate and minocycline. The minimum inhibitory concentrations (MICs) were determined using Etest® gradient diffusion strips against three key peri-implant pathogens: Porphyromonas gingivalis, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans. Cultures were incubated under anaerobic conditions to simulate the peri-implant environment.

Results: Piperacillin/tazobactam demonstrated MIC values comparable to those of amoxicillin-clavulanate and minocycline for P. gingivalis and A. actinomycetemcomitans, and lower MICs against P. intermedia. Statistical analysis confirmed that piperacillin/tazobactam is not inferior to these widely used antibiotics.

Conclusions: Piperacillin/tazobactam shows promising in vitro antimicrobial activity against key peri-implant pathogens and may serve as an effective alternative or adjunctive treatment in managing peri-implantitis. Further clinical studies are warranted to confirm its efficacy and safety in vivo.

Background: This study aimed to evaluate the profile and professional satisfaction of postgraduate students in Oral Pathology (OP) and Oral Medicine (OM) enrolled in Stricto sensu programs across various Brazilian institutions.

Material and methods: A cross-sectional, multicenter study surveyed 139 students from seven universities using a digital questionnaire with 29 questions on sociodemographic, motivations, and satisfaction. Data collection occurred between August and October 2024.

Results: Most participants were female (63.3%), aged between 25 and 30 years (59.7%), and enrolled in doctoral programs (55.4%). The most important reasons for pursuing postgraduate studies were knowledge enhancement (86.3%), personal satisfaction (84.9%), and financial factors (51.1%). Despite high satisfaction with their programs, and most of them (64%) feeling prepared for the job market, many students felt that job opportunities in OP/OM were limited. Older students reported greater satisfaction with the program (p = 0.020). Ethnicity influenced satisfaction with the pedagogical project (p < 0.001). Students with partners were more satisfied with the accessibility of the faculty (p = 0.004), as were those with children (p < 0.001). Job prospects were associated with satisfaction in several aspects, including the program (p < 0.001), the pedagogical project (p < 0.001) and the physical infrastructure (p = 0.034).

Conclusions: Demographic factors and personal perspectives were associated with students' satisfaction with their postgraduate programs. Addressing employment opportunities and improving program infrastructures, pedagogical projects, and access to advisors/professors could further enhance students' satisfaction and career outcomes in OP/OM.

Background: Le Fort I (LFI) osteotomy represents a secure procedure employed for correcting facial deformities and may be coupled with other facial osteotomies. However, notwithstanding professional proficiency, this technique is not exempt from issues or morbidities. Therefore, the objective of this study was to relate the types of vascular complications associated with LFI.

Material and methods: A scoping review was conducted with published articles up to April 2024 sourced from PubMed, LILACS, EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar. The analyzed data comprised: i) comprehensive details pertaining to each vascular lesion associated with LFI; and ii) pertinent anatomical characteristics along with their implications.

Results: A total of 2,415 papers were identified. After removing duplicates and applying the inclusion and exclusion criteria, 33 studies were selected. All included patients had dentofacial deformities. The observed vascular lesions or alterations included: pseudoaneurysm, arteriovenous fistula, section or laceration, maxillary avascular necrosis, internal carotid artery dissection, middle cerebral artery ischemia, and cervicofacial hematoma. Notably, pseudoaneurysm emerged as the most prevalent complication. The surgical features associated with these complications included the incision of the maxillary bone, extending upwards from the pterygomaxillary junction to the pyriform aperture and involving the lateral walls of the nasal cavity. Additionally, disruption of the nasal septum was noted. The internal maxillary artery and its terminal branches are the most exposed to the surgical trauma.

Conclusions: Understanding the potential complications, their clinical presentation, diagnostic methodologies, and management options is of paramount importance. Moreover, a multidisciplinary approach is frequently required to effectively address these complexities.

Background: This study aimed to conduct a bibliometric analysis of randomized controlled trials (RCTs) that evaluated quality of life following third molar surgery.

Material and methods: A bibliometric analysis was performed in accordance with the BIBLIO checklist across 11 databases: Web of Science, MEDLINE, EMBASE, CINAHL, PsycINFO, The Cochrane Library, Livivo, LILACS, Scopus, Epistemonikos, and Google Scholar. RCTs that assessed quality of life after third molar surgery were included. Searches were conducted on September 20, 2024, and updated on May 5, 2025.

Results: The initial search retrieved 4,217 records, of which 46 articles were included. The average annual number of publications between 2008 and 2024 was 2.7. A total of 192 authors contributed to the included studies, with the University of Mosul being the most productive institution. India and Iraq were the most prolific countries, each contributing five publications. Most articles were published in journals specializing in oral and maxillofacial surgery. The terms extracted from the titles co-occurrence analysis revealed distinct thematic clusters.

Conclusions: Scientific output on quality of life following third molar surgery has shown consistent growth. Future RCTs are encouraged to incorporate qualitative approaches to gain a broader understanding of the clinical and social impacts of surgical interventions.

Background: Oral Medicine (OM) is a dental specialty dedicated to diagnosing and non-surgical managing of oral diseases, often in medically compromised patients. In Mexico, no prior studies have examined the scope of the clinical practice of this specialty; thus, this study aims to examine the characteristics of patients treated at three different reference centers of OM in Mexico City, focusing on their diagnoses, sources of referral, and treatments.

Material and methods: This retrospective, observational and descriptive study reviewed 1,270 clinical records from three specialized OM centers between 2015 and 2022: a university clinic, an intrahospital service and a private OM practice. Demographic, clinical and therapeutic data were collected and analyzed using JMP Pro 16, with a significance level of p <0.05.

Results: Most patients were women (71.6%), primarily in their sixth and seventh decades of life. Comorbidities were present in 74.7% of cases, and 63.2% of patients were on medications. In public institutions, the most frequent reason for consultation were tumors, while in the private clinic, it was burning mouth. Dentists were the main referrers (49%), yet only 24.2% of referrals included a diagnosis, of which 60% were accurate. The most prevalent oral conditions were non-odontogenic infections (26.4%), ulcerative and vesiculobullous lesions (15.2%), and oral potentially malignant disorders (14.8%). Pharmacologic treatment was provided to 71% of patients, while management of 29.9% included consultation with other specialists.

Conclusions: This study highlights significant differences in patient profiles, diagnosis, and referral accuracy between the public and private services of OM. The low diagnostic precision in medical and dental referrals underscores the need to strengthen OM education. Additionally, the wide spectrum of oral and maxillofacial disorders and their treatments emphasize the importance of multidisciplinary management and integration with other medical specialties. These findings support the need to evaluate educational programs, optimize referral pathways, and improve the quality of OM care in Mexico.

Background: The treatment of mandibular fractures can be orthopedic and/or surgical; in both modalities, intermaxillary fixation is a therapeutic tool that allows for the stabilization and reduction of fractures, guiding dental occlusion There are different methods of intermaxillary fixation, each with individual characteristics that provide therapeutic options for the practitioner. This study aims to perform a quantitative and qualitative comparison of different features of these intermaxillary fixation systems through a systematic review.

Material and methods: A systematic review was performed, following the PRISMA guidelines. The Pubmed, SCOPUS, Web of Science and Cochrane databases were searched. Several variables were considered and are presented comprehensively in tables and figures. The initial literature search resulted in 51 articles, of which 9 met the inclusion criteria for the analysis.

Results: Of the 51 identified articles, 28 were analyzed, with 19 excluded after full-text evaluation. Ultimately, 9 studies with 3,221 patients were included, comparing Erich arch bars (EAB), hybrid arch bars (HAB), and intermaxillary fixation screws (IMFS).

Discussion: The studies focused on simple fractures with sufficient teeth for orthopedic treatment, excluding isolated maxillary fractures. Results showed differences in installation time, occlusal stability, oral hygiene, and costs, with EAB being the most expensive. Patient quality of life and complications, such as screw loss and root perforations, were also evaluated. Most studies presented a low risk of bias.

Conclusions: Screw-based methods like IMFS and HAB offer shorter installation times than EAB, reducing surgery duration, costs, and biosecurity risks. While EAB remains a valid option, screw methods provide advantages in time, hygiene control, and biosecurity, with the choice depending on patient needs and surgical experience.

Background: Proteinuria is elevated protein in the urine possibly progressing to glomerular sclerosis, which was frequently observed in chronic kidney disease (CKD), diabetes, preeclampsia, etc. Previous studies have revealed that periodontitis and these diseases share common risk factors, so a study is necessary to discuss the potential relationship between periodontitis and proteinuria. For the moment, there are no reports that are concerned about the correlation between periodontitis and proteinuria.

Material and methods: We searched PubMed for studies associated with periodontitis and proteinuria published before March 2025.

Results: Existing evidence showed that periodontitis might increase the risk of proteinuria, as periodontal pathogens and periodontal inflammatory reactions were proven to injure the glomerulus and renal tubules contributing to the progression of proteinuria. On the other way, proteinuria might affect systemic inflammation and bone metabolism to increase the risk of periodontitis.

Conclusions: This article reviews the relationship between periodontitis and proteinuria, reveals their predictable potential for chronic kidney injury, and makes recommendations for the treatment of periodontitis and proteinuria.

Background: Peri-implant diseases are common complications that may lead to dental implant failure. An adequate prosthesis design is crucial to reduce the risk of complications, and to improve peri-implant health. The present study was carried out to assess the effect of prosthesis design upon the presence of peri-implant inflammation.

Material and methods: A cross-sectional study was conducted in patients with a single-unit implant-supported screw-retained crown. After removing the crowns, standardized photographs were made to assess several variables such as the length of the submucosal extension (SE) or the emergence angle (EA). Clinical signs of inflammation were also registered, and an experienced clinician probed the implants. The White (WES) and Pink Esthetic Scores (PES) were also recorded. Patients were classified into two groups according to the presence (positive bleeding on probing (BoP+)) or absence (negative bleeding on probing (BoP-)) of inflammation around the dental implant. Independent t-tests and one-way ANOVA were used to analyze the data.

Results: A total of 90 implants were analyzed. Fifty-two implants (57.8%) had BoP+ while 38 (42.2%) had no signs of inflammation of the peri-implant tissues (BoP-). Long SE was significantly associated with BoP+ sites. The EA did not seem to be related to the presence of inflammation (p=0.642). PES/WES showed a negative correlation with buccal EA (r=-0.227; p=0.032).

Conclusions: Long submucosal extensions in single-unit implant-supported crowns seem to be associated with peri-implant tissues inflammation (BoP+). A higher emergence angle on the buccal aspect was associated with poor esthetic outcomes.