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Biomedical subjects

Miguel Peñarrocha

Publications and source records attributed to Miguel Peñarrocha.

18 recordsLinked to original sources
PubMed2006

An update in periapical surgery.

Periapical surgery has largely improved at all levels due to new technologies provided by researchers throughout the last years. The aim of this article is to carry out a bibliographic revision of the last seven years. For this reason, we will analyse the studies published in Medline and the most important Spanish dental magazines. The subjects to investigate are mainly based on the incorporation of ultrasonic root-end, which allow the performance of small and adjusted retrograde cavities; as well as the new filling materials. We also include magnifying glasses or surgical microscope to the work material, plus surgical laser and the application of guided tissue regeneration.

Humans↗
PubMed2006

Periapical surgery of maxillary posterior teeth. A review of the literature.

In recent years, periapical surgery has evolved thanks to new diagnostic and technical advances. A review is made of the literature on periapical surgery of the antral teeth, based on a Medline search and on the revision of Spanish dental journals in the period between 1974 and 2003. The anatomy of the maxillary sinus is discussed, along with the diagnosis of periapical lesions and the relation of the maxillary sinus to the antral teeth. The surgical technique, special considerations and prognosis of periapical surgery in these teeth are also addressed. Recent studies postulate that the proximity of the antral teeth to the maxillary sinus should not be viewed as a contraindication to periapical surgery, and recommend such surgery in teeth with chronic periapical disease that are refractory to conventional endodontic management, despite the proximity of the maxillary sinus.

Humans↗
PubMed2006

Cherubism: a clinical, radiographic, and histopathologic comparison of 7 cases.

PURPOSE: Cherubism is an uncommon fibro-osseous disorder of the jaws that presents with varying degrees of involvement and a tendency toward spontaneous remission. Lesions are characterized by replacement of bone with fibrovascular tissue containing abundant multinucleated giant cells. We attempted to study the relationships among the degree of cherubism, the radiographic extent of the jaw lesions, the histopathologic findings, and the clinical course of 7 patients. PATIENTS AND METHODS: In 7 patients diagnosed with cherubism, we evaluated the degree of fibrosis and perivascular cuffing, the presence of focal hemosiderin deposits, and giant multinucleated cell density (absent, few, moderate, or severe). Clinical course and progression were also assessed using a 4-point scale (improvement, no changes, modest progression, and marked progression). RESULTS: The patients were followed up for an average of 8.5 years. Two patients exhibited clinical and radiographic improvement, while 3 showed no changes, and 2 progressed despite surgical treatment in 1 of them. CONCLUSION: The course of cherubism in 1 of our patients may represent evidence of an association between the presence of abundant multinucleated giant cells, an increased extent of the lesions, and a more aggressive behavior of the disease.

Adolescent↗
PubMed2005

Immediate loading in oral implants. Present situation.

The earliest antecedents of immediate loading were introduced by Ledermann in 1979. He placed overdenture in four interforaminal implants on the same day the surgery was carried out. In the original implantological protocol of Brånemark the immediate loading did not appear indicated, currently, it is being presented as a predictable alternative in several studies. We revised different articles on immediate loading from 1997 to 2002. We analysed different variables and concluded that immediate loading produces a success rate in posterior maxilla similar to the differed loading (90-100%). The characteristics of the implant, favourable to immediate loading, are: screw-shaped, with a rough surface, sand blasted and acid etching processed and a minimum length of 10 mm. The initial stability and a micro movement of the implant, inferior to 150 microm and a marginal to the insertion equal or superior to 32 N/cm are defined as a proper osseous. The bruxism stands out as an adverse factor according to several authors.

Crowns↗
PubMed2005

Implant rehabilitation of the atrophic upper jaw: a review of the literature since 1999.

The severely resorbed maxilla presents serious limitations for conventional implant placement. As a result, different techniques have been developed in the last two decades, with variable results. The most significant approaches comprise the placement of implants in anatomical abutments, elevation of the sinus floor, and reconstructive surgery with bone grafting. The present study reviews the most important articles on the management of the atrophic upper jaw published in the literature since 1999.

Alveolar Bone Loss↗
PubMed2004

Lower-half facial migraine: a report of 11 cases.

PURPOSE: Vascular pain of the face constitutes a variant of pain of the head, and includes migraine, cluster headache, paroxysmal hemicrania, and a facial variant of the so-called lower-half migraine. Lower-half facial migraine is a condition difficult to classify; according to the international classifications it could not be found as an individual entity. The objective of the present study is to determine the difficulties we encountered in diagnosis, the ineffective treatments provided, and the pharmacologic treatment effect. PATIENTS AND METHODS: A study is made of 11 cases of lower-half facial migraine, corresponding to 10 women and 1 man (mean age, 35 years), commenting on the clinical characteristics of the disorder and its treatment options. The location of the pain often mimics dental pain, and can lead to a mistaken diagnosis and to the application of inappropriate therapeutic measures. Forty-five percent of the patients had a history of endodontic treatment before the development of pain in the initially affected quadrant. Once the pain had developed, extractions were carried out in 36% of cases in an unsuccessful attempt to secure symptom relief. Our pharmacologic treatment consisted of ergotamine in 9 cases and the remaining 2 patients received indomethacin. RESULTS: Nine patients (82%) improved as a result of treatment, with an important reduction in the frequency of the pain episodes and intensity of pain. One patient failed to respond to ergotamine, while another patient failed to improve with indomethacin. Both were prescribed only minor analgesics. CONCLUSION: The treatment of migraine occurring in the face is no different than that provided for pain occurring in the head.

Adult↗
PubMed2003

Bifid mandibular canal.

PURPOSE: To determine the incidence and characteristics of bifid mandibular canals. METHODS: A retrospective study was performed using panoramic radiographs of 2012 patients subjected to dental treatment in the Dental Clinic of the Valencia University Dental School (Valencia, Spain) between 1996 and 1999. The goal was to investigate the presence of double mandibular canals. RESULTS: The extraoral panoramic radiographs revealed a total of 7 images suggestive of bifid canals. Mandibular computed tomography revealed the existence of this anatomic variant in 2 of 3 patients. An analysis was performed on the incidence of this type of image in extraoral panoramic radiography, its possible interpretations, and the clinical implications of bifid mandibular canals. CONCLUSIONS: In this study, 0.35% of canals were bifid. All cases were in women.

Adolescent↗
PubMedDate not supplied

Orofacial neurogenic pain and maxillofacial ischemic osteonecrosis. A review.

Cavitary alveolar osteopathy was described as an oral disorder of infectious origin characterized by the presence of osteopathic alveolar cavity lesions of significant size though radiologically undetectable and secondary to dental extractions for chronic infectious processes of the alveolar bone of the jaws. Such cavitary alveolar osteopathy has been implicated as a common cause in the origin of idiopathic trigeminal neuralgia and atypical facial pain. The concept of cavitary alveolar osteopathy caused by ischemic necrosis of alveolar bone was introduced in 1992. Recent coagulation studies have reported ischemic alterations in alveolar bone marrow as a cause of cavitation; following tooth extraction, maxillary osteonecrosis could result from thrombosis with or without hyperfibrinolysis, which in turn would lead to obstruction of the vascular spaces -- thereby compromising regional blood flow.

Facial Pain↗
PubMedDate not supplied

Cemento-ossifying mandibular fibroma: a presentation of two cases and review of the literature.

We present two clinical cases of radiolucent mandibular lesions in young women that simulated chronic periapical infectious pathology. The detection of both cases was fortuitous since they were totally asymptomatic. Diagnosis was reached in one case (upon periapical surgery and anatomo-pathologic study) after endodontic treatment and after verifying non-resolution of affected periapical area. The other case was an extensive lesion, which involved the periapices of the four inferior incisors in which surgery was directly performed upon verifying pulp vitality of these teeth. After surgery endodontic treatment was performed on the teeth that had lost their vitality. In both cases the histopathologic tests revealed the presence of a cemento-ossifying fibroma, the initial clinical and radiographic diagnosis of which could easily be overlooked.

Adult↗
PubMedDate not supplied

Oral manifestations of chronic disseminated histiocytosis. A report of 10 cases.

Chronic disseminated histiocytosis is a systemic disorder resulting from tumor proliferation of Langerhans-type histiocytic cells. The etiology and pathogenesis are not fully clear, though the clinical manifestations are the result of the accumulation and infiltration of these types of cells in organs and tissues. The present study reports 10 patients (6 boys and 4 girls) with chronic disseminated histiocytosis. The patient age at onset of the disease varied from 4 months to 3.2 years (mean 1.7 years). All patients had oral lesions, and in 5 cases these were the first manifestation of the disease. The most frequent alterations were gingival bleeding (7 cases), aphthae measuring over 1 cm in diameter (6 cases), maxillary osteolytic lesions (6 cases), tooth loss due to expulsive folliculitis (5 cases), oral candidiasis (4 cases), orofacial swelling (3 cases), aphthae measuring under 1 cm in diameter (3 cases), and nonspecific oral pain (2 cases). All the oral lesions disappeared with the treatments prescribed, though some patients developed new outbreaks and exacerbations of the disease.

Child, Preschool↗
PubMedDate not supplied

Marginal peri-implantitis due to occlusal overload. A case report.

The etiology of marginal peri-implantitis describes an infectious factor and a biomechanical factor resulting from occlusal overload. Clinical and experimental articles oriented to the biomechanical factor are scarce, so as the studies about the histology associated to periimplantitis. We present a case of marginal peri-implantitis on an implant in the mandibular molar zone caused by occlusal overload, which led to an osseous defect on the marginal crest. The treatment was composed of occlusal adjustment, removal of contaminated surgical tissue, and autogenous bone graft, which varies from the common treatment of infectious peri-implantitis. Histologic analysis of peri-implantitis tissue reveals a juxtaepithelial lympho-plasmocytorious infiltrate and a central zone of dense fibro-connective tissue with scanty inflammatory cells, which differs from the chronic inflammatory tissue associated with infectious peri-implantitis. Clinical and radiographic followup control after 12 months evidenced the remission of the symptoms and bone regeneration on the marginal crest. We consider that in the treatment of marginal peri-implantitis, it is necessary to continue the studies on the histological differences between the infectious types and those that are caused by occlusal overload.

Bite Force↗
PubMedDate not supplied

Immediate implants after extraction. A review of the current situation.

Immediate implants are positioned in the course of surgical extraction of the tooth to be replaced. The percentage success of such procedures varies among authors from 92.7-98.0%. The main indication of immediate implantation is the replacement of teeth with pathologies not amenable to treatment. Its advantages with respect to delayed implantation include reduced post-extraction alveolar bone resorption, a shortening of the rehabilitation treatment time, and the avoidance of a second surgical intervention. The inconveniences in turn comprise a general requirement for membrane-guided bone regeneration techniques, with the associated risk of exposure and infection, and the need for mucogingival grafts to seal the socket space and/or cover the membranes. The surgical requirements for immediate implantation include extraction with the least trauma possible, preservation of the extraction socket walls and thorough alveolar curettage to eliminate all pathological material. Primary stability is an essential requirement, and is achieved with an implant exceeding the alveolar apex by 3-5 mm, or by placing an implant of greater diameter than the remnant alveolus. Esthetic emergence in the anterior zone is achieved by 1-3 mm sub-crest implantation. Regarding guided regeneration of the alveolar bone, the literature lacks consensus on the use of membranes and the type of filler material required. While primary wound closure is desirable, some authors do not consider it to be of great relevance.

Animals↗
PubMedDate not supplied

Radiologic study of marginal bone loss around 108 dental implants and its relationship to smoking, implant location, and morphology.

PURPOSE: To investigate peri-implant bone resorption around 108 ITI dental implants 1 year after prosthetic loading using extraoral panoramic, conventional intraoral periapical, and digital radiologic techniques. MATERIALS AND METHODS: A total of 108 implants were placed (59 in the maxilla and 49 in the mandible) in 42 patients (16 men and 26 women) with a mean age of 44.2 years (range 14 to 68 years). Orthopantomographic, conventional periapical, and digital radiographs were obtained at loading and again 1 year later. Bone loss was calculated from the difference between the initial and final measurements. RESULTS: Mean loss in alveolar bone height was determined to be 1.36 mm by extraoral panoramic radiography, 0.76 mm by intraoral periapical radiography, and 0.95 mm by digital radiography. The implants located in the maxilla and those placed in patients who smoked 11 to 20 cigarettes per day were associated with significantly greater bone loss. DISCUSSION: The results in relation to peri-implant bone loss in the first year after loading were similar to those published by other authors. CONCLUSION: Conventional periapical films and digital radiographs were more accurate than orthopantomography in the assessment of peri-implant bone loss. Smoking and implant location in the maxilla were associated with increased peri-implant marginal bone resorption.

Adolescent↗
PubMedDate not supplied

Implants in anatomical buttresses of the upper jaw.

The skull presents a series of dense bony buttresses that conform a protective frame around the different craniofacial cavities. The middle third portion presents two anterior buttresses (frontomaxillary and frontozygomatic) and a posterior buttress (pterygomaxillary). In certain situations these structural supports allow the rehabilitation of free upper extremities in atrophic jaws by positioning parasinusal angulated implants--thereby avoiding the need for more complex reconstruction techniques such as sinus lifting or autografting procedures. The present study presents a review of the literature on implant insertion in anatomical buttresses of the upper jaw.

Alveolar Bone Loss↗
PubMedDate not supplied

Localized vertical maxillary ridge preservation using bone cores and a rotated palatal flap.

The aim of vertical augmentation of the alveolar ridge is to restore resorbed alveolar ridges. This technique is critical to the placement of dental implants in a favorable position and the enhancement of restoration esthetics. The present report describes a technique for surgical preservation of the anterior maxillary process using maxillary bone from the surgical site and raising a soft tissue rotated palatal flap. Maxillary lateral incisor extraction and periapical surgery of the central incisors were first carried out. Two bone cores were harvested from the neighboring buccal vestibular region and placed in the sockets of the lateral maxillary incisors. After 3 months, implants were placed; 12 weeks later, the prosthetic restorations were cemented. There were no complications after 2 years of follow-up. This technique constitutes a viable approach for preserving the anterior sector alveolar ridge with the posterior placement of dental implants.

Adult↗
PubMedDate not supplied

Zygomatic implants using the sinus slot technique: clinical report of a patient series.

PURPOSE: The management of 5 patients with extreme maxillary atrophy and treatment consisting of maxillary fixed prostheses supported by conventional implants and zygomatic fixations positioned according to the sinus slot technique is reported. MATERIALS AND METHODS: A total of 16 conventional implants were placed, together with 2 pterygoid implants and 10 zygomatic fixations. In 2 cases zygomatic fixation could not be performed on the alveolar ridge, thus requiring palatal displacement. One patient presented nasogenian ecchymosis. The fixed rehabilitations were either screwed or cemented after 5 to 6 months. RESULTS: Follow-up from implantation lasted 12 to 18 months, during which the prostheses and implants remained stable and in function. DISCUSSION: The placement of zygomatic fixations based on the sinus slot technique offers advantages over the conventional technique, though extreme atrophy of the alveolar processes does not allow fixation at the supracrestal level, and complications may develop. CONCLUSION: While zygomatic fixation is a valid alternative for treating the atrophic jaw, long-term studies are required to confirm its efficacy.

Adult↗