Biomedical subjects

Cosme Gay-Escoda

Publications and source records attributed to Cosme Gay-Escoda.

At least 19 recordsLinked to original sources

PubMed2007

Delayed-onset infections after lower third molar extraction: a case-control study.

PURPOSE: To identify possible risk factors for delayed-onset infections and to develop a model for explaining the effects of these risk factors on the occurrence of delayed-onset infections in an outpatient clinic. MATERIALS AND METHODS: A retrospective case-control study comprising a total of 178 lower third molar extractions performed between 2001 and 2004 in the Oral Surgery and Orofacial Implantology Department of the School of Dentistry of the University of Barcelona, Spain. RESULTS: Bivariate analysis showed tooth sectioning, soft tissue and bone retention, and the position of the lower third molar (according to the classifications of Pell and Gregory, and of Winter) to be significantly associated with the development of delayed-onset infections. A logistic regression model included the following independent variables: position of the lower third molar according to Winter, and Pell and Gregory Classes I, II, and III, and degree of soft tissue retention. CONCLUSIONS: Lower third molars with total soft tissue retention, a lack of distal space and with a vertical or mesioangular tilt are more likely to develop delayed-onset infections. Tooth sectioning, bone retention, and depth of inclusion could also be risk factors for such infections. Heavy smokers seem to be more prone to this complication.

Adult↗

PubMed2006

Influence of lower third molar position on the incidence of preoperative complications.

OBJECTIVE: The present study sought to relate the clinical outcome of mandibular third molar impaction surgery to the orthopanoramic radiographically determined position of the affected teeth based on the classifications of Pell and Gregory, and Winter. STUDY DESIGN: A retrospective study was made of 165 patients undergoing the surgical extraction of lower third molars at School of Dentistry of the University of Barcelona, Barcelona, Spain. The positions of the 259 extracted third molars were documented according to the classifications of Pell and Gregory, and Winter, together with the type of mucosal and bony coverage involved. These tooth position parameters were radiologically assessed using Radio Memory software and were retrospectively correlated to the observed infectious, noninfectious, and neurological postsurgical outcomes. RESULTS: A statistically significant relationship (P < .05) was recorded between the appearance of infectious complications and the position parameters "Pell and Gregory classification," "mucosal coverage," and "bony coverage." A statistically significant relationship (P < .05) was observed between the appearance of noninfectious problems and the parameter "Winter classification." Finally, a significant association (P < .05) was recorded between the position variables and the existence of unwanted neurological changes. CONCLUSIONS: The mandibular position of the impacted third molar may be able to be correlated to the development of complications resulting from impaction removal. Vertical third molars in positions IIA and IIB of the Pell and Gregory classification, with partial mucosal and bony coverage, are the most susceptible to undesired outcomes.

Adolescent↗

PubMed2006

Stafne bone cavity: a retrospective study of 11 cases.

OBJECTIVE: To describe the clinical and radiological characteristics of patients with Stafne bone cavity. STUDY DESIGN: A retrospective, observational study of 11 cases of Stafne bone cavity. After finding an imagine compatible with Stafne bone cavity in the Orthopantomograph(r) of 11 patients, a sialography of the mandibular gland was made in 3 cases, computerized tomography (CT) in 6 cases, and in 4 cases surgical intervention to confirm the diagnosis. RESULTS: The average age was 51.5 years, predominantly males. The entity was diagnosed incidentally during a routine radiology in all cases. The sialography revealed glandular tissue within the defect, and the CT demonstrated the conservation of the lingual cortical and the peripheral origin of the lesion. Glandular tissue was found within the lesions of two of the patients who underwent surgery, and in the other two the cavity was empty. No progressive changes were found in any of the 11 cases. CONCLUSIONS: Stafne bone cavity was an incidental finding, presenting no evolutionary changes, and as such conservatory therapy based on periodic controls was indicated. Currently, complementary techniques such as CT are sufficient to establish a certain diagnosis.

Adult↗

PubMed2006

Antibiotic susceptibility of the bacteria causing odontogenic infections.

AIMS: An evaluation is made of bacterial species and susceptibility to various antibiotics used in application to odontogenic infections of periapical location and in pericoronitis of the lower third molar, with the aim of optimizing the antibiotherapy of such infections and thus preventing unnecessary side effects and over-treatment. MATERIAL AND METHODS: Sixty-four patients with odontogenic infection were selected on the basis of a series of inclusion and exclusion criteria. Samples were collected from lesions under maximally aseptic conditions, avoiding oral saprophytic contamination. The samples were cultured and incubated under aerobic and anaerobic conditions, followed by bacteriological identification and antibiotic susceptibility testing. RESULTS: A total of 184 bacterial strains were isolated and identified, comprising grampositive facultative anaerobes (68%), gramnegative strict anaerobes (30%) and grampositive facultative anaerobes (2%). Regardless of the origin of the odontogenic infection, the causal bacteria yielded the best results in terms of increased sensitivity and lesser resistance with amoxicillin / clavulanate and amoxicillin, respectively (p<0.05). DISCUSSION: There are increasingly numerous reports in the literature of growing bacterial resistance to antibiotics in infectious processes affecting non-buccodental territories. This same tendency has not been observed in relation to oral infections, though important resistance has been documented for certain concrete antibiotics. According to our results, the common-use antibiotics with the greatest sensitivity and lowest resistance were shown to be amoxicillin/clavulanate followed by amoxicillin alone.

Acetamides↗

PubMed2006

Spontaneous third-molar eruption after second-molar extraction in orthodontic patients.

INTRODUCTION: This retrospective study was conducted to assess the eruption of third molars by using panoramic radiographs and to identify the variables associated with unsuccessful eruption. METHODS: The subjects were 48 patients who had 128 permanent second molars extracted during or before orthodontic treatment. Their ages at extraction were 11 to 23 years. The position of the third molars was assessed from panoramic radiographs taken before second-molar extraction and after third-molar eruption. The median time of eruption was 3 to 4 years (interquartile range, 2 years). A successful final position was defined as eruption with proximal contact with the adjacent first molar and an angle between these 2 teeth of no more than 35 degrees. RESULTS: A total of 96.2% of the maxillary and 66.2% of the mandibular third molars erupted in good positions. The maxillary third molars uprighted and successfully replaced the second molars. In the case of Nolla developmental stage > 8, the proximal contact could remain open. Most mandibular third molars uprighted and successfully replaced the second molars. Most unsuccessful eruptions of mandibular third molars were due to excessive mesial tilting or lack of proximal contact. Unsuccessful third-molar eruptions occurred in older patients who had higher Nolla developmental stages. CONCLUSIONS: Maxillary third molars upright and acceptably replace maxillary second molars after extraction for orthodontic purposes. However, if the Nolla developmental stage is > 8, proximal contact could remain open. Most mandibular third molars also upright and acceptably replace the second molars after extraction. Unsuccessful third-molar eruption is most common in older patients with higher Nolla developmental stages. Most unsuccessful eruptions are due to excessive mesial tilting or lack of proximal contact.

Adolescent↗

PubMed2006

Frequency and evolution of lingual nerve lesions following lower third molar extraction.

PURPOSE: To calculate the frequency of lingual nerve (LN) damage caused by lower third molar extraction and describe the evolution of LN sensitivity as well as the prognosis of LN damage based on preoperative data. PATIENTS AND METHODS: A retrospective study of 4,995 lower third molar extractions performed in 3,513 outpatients of the Department of Oral and Maxillofacial Surgery (University of Barcelona, Spain) between January 1998 and September 2001. RESULTS: Twenty-four extractions (0.5%) resulted in LN impairment. All involved ostectomy, with tooth sectioning in 20 cases. Cox regression analysis showed no risk factors for the persistence of LN injury during lower third molar extraction. The sensitivity recovery rate was greater in the first 3 months and then gradually decreased. CONCLUSION: LN impairment usually recovers, the recovery rate being faster in the first months. LN damage is generally associated with ostectomy and tooth sectioning.

Adolescent↗

PubMed2006

Locally aggressive central odontogenic fibroma associated to an inflammatory cyst: a clinical, histological and immunohistochemical study.

The case describes a 38-year-old woman presenting a multilocular radiolucency affecting the entire right half of the lower jaw, with an unerupted third molar displaced to the region of the coronoid process. The histological study showed the presence of fibroblasts, focally with pleomorphic nuclei, dense collagen and an odontogenic epithelium with dystrophic calcifications. A cyst with an important inflammatory infiltrate was, moreover, observed.

Adult↗

PubMed2006

Bilateral bifid mandibular condyle: case report and literature review.

Bifid mandibular condyle is an infrequent and normally asymptomatic morphological alteration of the mandibular condyle. Although the underlying cause is not clear, a number of theories have been proposed, including teratogenic effects in the embryo, vascular alterations during condyle development, and condylar remodeling following fracture. Since Schier first described this anomaly in 1948 in live individuals, further cases have been documented in the literature. We present a new case of bilateral bifid condyle. The disorder was asymptomatic and constituted a casual finding in a young male presenting for the surgical extraction of two impacted molars.

Adult↗

PubMed2005

Pyostomatitis vegetans. Report of two cases and review of the literature.

Pyostomatitis vegetans (PV) is a rare benign chronic mucocutaneous pustular disorder of unknown etiology, though it is usually associated with chronic inflammatory disease of the bowel-particularly ulcerative colitis. At the oral level PV manifests as an exophytic lesion with an erythematous perimeter and a creamy-yellow surface presenting a friable covering membrane which easily disintegrates, giving rise to the development of small ulcers or superficial erosions. The histology shows epithelial acanthosis and superficial ulceration. The underlying connective tissue exhibits neutrophil and eosinophil infiltration, with miliary abscesses in some cases. The present study describes 2 cases of PV associated with ulcerative colitis. The differential diagnosis should be established with Neumann type pemphigus vegetans, since in both cases the lesions are clinically similar and the histology reveals an important eosinophil response, acanthosis, and the formation of intraepithelial miliary microabscesses. The treatment of PV focuses on control of the disease. In the event the orofacial lesions persist, topical oral drugs such as corticoids, with additional antibiotherapy, multivitamin complexes, and nutritional supplements, can be provided.

Adult↗

PubMed2005

Incidence and evolution of inferior alveolar nerve lesions following lower third molar extraction.

OBJECTIVES: To calculate the incidence of inferior alveolar nerve (IAN) damage due to lower third molar extraction and to describe the evolution of IAN sensitivity and the prognosis of IAN damage based on preoperative data. STUDY DESIGN: A retrospective study of 4995 lower third molar extractions in 3513 outpatients. RESULTS: Fifty-five extractions (1.1%) resulted in IAN impairment. Cox regression analysis showed age to be a risk factor for the persistence of IAN injury due to lower third molar extraction. The sensation recovery rate was higher in the first 3 months. Fifty percent of the patients showed full recovery after 6 months. CONCLUSIONS: Most cases of IAN impairment following lower third molar extraction recover within 6 months, though in some cases recovery takes more than 1 year. Older patients are at an increased risk of incomplete recovery of chin and lip sensibility after third molar extraction.

Adolescent↗

PubMed2005

Incidence and clinical features of delayed-onset infections after extraction of lower third molars.

OBJECTIVE: To describe the incidence and clinical features of delayed-onset wound infections after lower third molar extractions in an outpatient clinic. STUDY DESIGN: Retrospective forward study of 958 lower third molar extractions in the Oral Surgery and Implantology Department of the School of Dentistry of the University of Barcelona (Spain). RESULTS: Fourteen delayed-onset wound infections were recorded after suture removal (1.5% of the extractions). These infections usually developed 3-5 weeks after extraction. Half of the cases presented a radiolucency around the crown of the third molar. In most cases, ostectomy (13/14) and tooth sectioning (11/14) had been made. CONCLUSIONS: Delayed infections were a rare postoperative complication of lower third molars extractions. Nevertheless, patients should be warned that infection can still occur several weeks after the surgical procedure.

Adolescent↗

PubMed2004

Facial nerve repair with epineural suture and anastomosis using fibrin adhesive: an experimental study in the rabbit.

PURPOSE: An experimental model in rabbits was used to compare epineural suturing and fibrin adhesive anastomosis for facial nerve repair. MATERIALS AND METHODS: Thirty-four facial nerves from 17 rabbits were isolated, transected, and anastomosed, with an evaluation of their electrophysiologic and histologic parameters. The rabbits were divided into 2 groups of 5 and 12 animals, respectively: a 10-mm defect was made in the right facial nerve in the first group, with transection and epineural suturing of the left nerve, followed by death after 120 days. This was the control-versus-epineural suture group. In the second group, the right facial nerve was transected and subjected to epineural suturing, while the left nerve was transected and anastomosed using fibrin adhesive. The rabbits were killed 15, 30, 60, and 120 days after the microsurgical procedure. This was the epineural suture-versus-fibrin adhesive group. RESULTS: From day 30, the number of regenerated axons increased with time in the epineural suture and fibrin adhesive anastomotic specimens. Epineural suture showed more regenerated axons and a faster linear rate of regeneration than anastomosis with fibrin adhesive. The reduction in conduction velocity decreased significantly with time with the same linear pattern for both suture techniques. CONCLUSIONS: Epineural suturing offered superior performance versus anastomosis with fibrin adhesive in terms of axon count but not in decrease in conduction velocity.

Anastomosis, Surgical↗

PubMed2004

Periimplantitis.

Orodental rehabilitation through the use of implants offers very high success rates. In this paper, we describe some of the complications involved with this technique, such as periimplant disease and, within this category, periimplantitis, an inflammatory reaction in which there is a loss of the bony support of the implant accompanied by inflammation. The aetiology of the disease is conditioned by the status of the tissue surrounding the implant, implant design, degree of roughness, the poor alignment of implant components, external morphology and excessive mechanical load. The microorganisms most commonly associated with implant failure are spirochetes and mobile forms of Gram-negative anaerobes, unless the origin is the result of simple mechanical overload. Diagnosis is based on changes of colour in the gum, bleeding and probing depth of periimplant pockets, suppuration, x-ray and gradual loss of bone height around the tooth. Treatment will differ depending upon whether it is a case of mucositis or periimplantitis. Therapeutic objectives focus on correcting technical defects by means of surgery and decontamination techniques (abrasion with carbon particles, citric acid solution, topical tetracycline application and laser surgery). This study also presents a microbiological study of periimplantitis conducted by the Barcelona School of Dentistry that determined that the antibiotic therapy proven to be most efficacious in the antibiogram was the association of amoxycillin and clavulanic acid.

Alveolar Bone Loss↗

PubMed2003

Evaluation and comparison of 2 needle models in terms of blood aspiration during truncal block of the inferior alveolar nerve.

PURPOSE: We conducted a study to determine the possible differences in blood aspiration between 2 needles of the same length and external gauge but with different internal gauges during truncal block of the inferior alveolar nerve. The working hypothesis was that increased blood aspiration may be expected with larger internal gauge needles. MATERIALS AND METHODS: Four clinicians subjected 346 patients to inferior alveolar nerve block and infiltrating anesthesia of the buccal nerve trajectory for the surgical or conventional extraction of the lower third molar. A nonautoaspirating syringe system with 2 types of needle were used: a standard 27-gauge x 35-mm needle with an internal gauge of 0.215 mm and an XL Monoprotect (manufactured by Sofic, Mazamet, France, and distributed by Laboratorios Inibsa, Barcelona, Spain) 27-gauge x 35-mm needle with an internal gauge of 0.265 mm. The following information was recorded for each patient: needle type, gender, anesthetic technique (direct or indirect truncal block) and the number of bone contacts during the procedure, the patient-extraction side, the operator performing the technique, and blood aspiration (either positive or negative). RESULTS: No significant differences (P <.05) were observed on contrasting the blood aspiration positivity with the internal gauge of the needles. Likewise, no significant differences were seen on correlating aspiration to the anesthetic technique used, the number of bone contacts, the operator, or the patient-extraction side. Blood aspiration was observed in 8.7% of cases. CONCLUSIONS: No significant differences were recorded in terms of blood aspiration and internal gauge, operator, patient-extraction side, or the anesthetic technique involved. Consequently, our initial working hypothesis can be rejected, because no increased percentage of blood aspirations was observed for greater internal gauges.

Adult↗

PubMed2003

Ion implantation: surface treatment for improving the bone integration of titanium and Ti6Al4V dental implants.

Dental implants subjected to surface treatment have shown better bone integration than implants which have only been turned (machined). Three main types of treatment are presently available: the addition of material or coating, the removal of material, and surface modification. Ion implantation corresponds to the third approach. A histomorphometric study is made following the rabbit tibial bone placement of 88 commercial dental implants of pure titanium and Ti6AI4V subjected to surface treatment in the form of different ion implants (C+, CO+, N+, Ne+). Light microscopic, scanning electron microscopic (SEM), electron microsonde (EDS) and X-ray photoelectron spectroscopy (XPS) studies were made. The results indicate improved bone integration (expressed as percentage bone-implant contact) in those specimens subjected to ion implantation versus the non-treated controls, the difference being statistically significant for the groups treated with C+ and CO+. In these groups, XPS showed a Ti-O-C junction (bone-implant interface) involving covalent type bonds, these being stronger and more stable than the ion-type bonds usually established between the titanium oxide and bone.

Alloys↗

PubMedDate not supplied

Erbium:YAG laser application in the second phase of implant surgery: a pilot study in 20 patients.

PURPOSE: Conventional implant dentistry implies 2 surgical stages. In this context, pain is often present in the second stage, despite the fact that it is comparatively less aggressive for the patient. The present pilot study proposes application of Erbium:YAG (Er:YAG) laser for second-stage implant surgery. MATERIALS AND METHODS: Twenty patients were studied with a total of 50 implants in which osseointegration was complete. The subjects were divided into 2 groups: a control group (10 patients with 25 implants), subjected to conventional second-stage surgery; and a group of 10 subjects (also with 25 implants) treated with the Er:YAG laser at second-stage implant surgery. RESULTS: The use of Er:YAG laser obviated the need for local anesthesia and minimized postoperative pain and time needed before starting the second stage. With regard to surgical duration, quality of hemostasis, and success in implant treatment, no differences were reported. DISCUSSION: In the second stage of implant surgery, different types of laser have been used, taking advantage of their bacteridal effect; disadvantages arise from inducing damage to the implant surface and adverse thermal effects. CONCLUSION: The advantages afforded by laser treatment include technical simplicity, the possibility of obviating local anesthesia, absence of postoperative pain and edema, and complete tissue healing by day 5, thus facilitating rapid prosthetic rehabilitation. The technique described can be used in all cases except situations where esthetic considerations prevail in anterior areas, or in the event of a lack of keratinized gingiva surrounding the implant.

Adult↗

PubMedDate not supplied

Periodontitis as a risk factor in patients with ischemic heart disease.

Cardiovascular disease, and particularly ischemic heart disease (IHD), constitutes one of the principal causes of mortality in the western world. Interest has recently increased in the relationship between IHD and different infectious processes as triggering factors of the former, such as Chlamydia pneumoniae and Helicobacter pylori infection. Periodontitis has also been related to an increased risk of coronary disease, since both disorders share common characteristics such as patient age and sex, and a smoking habit, among other aspects. There are many similarities between vascular pathology induced by bacteria and the natural history of atherogenesis. The principal mechanism of action underlying periodontitis and IHD centers on the effect of bacteria and their endotoxins upon inflammatory reaction, hemostasia and lipid metabolic alterations. However, some authors are of the opinion that periodontitis constitutes an epiphenomenon, and that further studies are needed to clarify the cause-effect relation between these two multifactor pathologies.

Adult↗

PubMedDate not supplied

Association between B and/or C chronic viral hepatitis and oral lichen planus.

INTRODUCTION: The chronic liver disease is a pathology produced, mainly, by the alcohol chronic abuse and by the hepatitis B and/or C virus infection. In the last years, it has been widely discussed the possible association between chronic liver disease and oral lichen planus. Recently, it has been suggested that the association between oral lichen planus and liver disease has a viral origin. MATERIAL AND METHOD: The objective of this transversal matched study is to know if there is a relationship between B and/or C viral chronic hepatitis and oral lichen planus. Two groups of 100 patients were selected: a case group with patients. Infected with hepatitis B and/or C virus, and a control group without liver disease matched in age and gender. Oral cavity was explored to detect lichen planus in both groups, but we registered other mucosal alterations. RESULTS: We did not found any patient of the case group with oral lichen planus, but four patients with this disease in the control group. CONCLUSIONS: In our study we did not found any association between the infection with the hepatitis B and/or C virus and oral lichen planus.

Adult↗