RESUMEN
This case report describes the presence of a radiopaque artifact appearing in multiple intraoral periapical and bitewing radiographs during routine periodontal maintenance, in an edentulous area with a history of a ridge preservation procedure. Clinical examination of the area showed a normal soft tissue appearance. Upon further investigation of the patient's recent past medical history, it was found that the artifact was due to the presence of a dermal filler (Radiesse--Merz Aesthetics, San Mateo, CA), which remained after a facial cosmetic procedure. This unusual finding is an indication that clinicians should consider facial cosmetic dermal fillers as part of the differential diagnosis when unusual radiopaque objects are found during routine dental radiographs.
Asunto(s)
Materiales Biocompatibles/administración & dosificación , Técnicas Cosméticas , Durapatita/administración & dosificación , Radiografía Dental , Artefactos , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Enfermedades Periodontales/diagnóstico por imagen , Enfermedades Periodontales/terapiaRESUMEN
OBJECTIVE: We examined the presence of bacterial DNA in synovial fluids of native or clinically aseptically failed prosthetic joints from patients having periodontal disease and arthritis to determine whether there is bacterial spread from the oral cavity to the joints. METHODS: A total of 36 subjects were enrolled in the study. Among these, 11 were diagnosed with rheumatoid arthritis (RA) and 25 were diagnosed with osteoarthritis (OA). Eight patients with OA and 1 patient with RA had failed prostheses. Synovial fluid was aspirated from the affected hip or knee joint. Pooled subgingival plaque samples were collected, followed by clinical periodontal examination. Bacterial DNA was extracted from the collected synovial fluid and dental plaque samples were followed by polymerase chain reactions and DNA sequence analysis of the 16S-23S rRNA genes. RESULTS: Of the 36 patients, bacterial DNA was detected in the synovial fluid samples from 5 patients (13.9%): 2 with RA (1 native and 1 failed prosthetic joints) and 3 with OA (1 native and 2 failed prosthetic joints). Of these 5 patients, 2 were diagnosed with periodontitis and had identical bacterial clones (Fusobacterium nucleatum and Serratia proteamaculans, respectively) detected in both the synovial fluid and the dental plaque samples. Fusobacterium nucleatum was the most prevalent, detected in 4 of the 5 positive samples. No cultures were done and no patients were treated with antibiotics or developed clinical infection. CONCLUSIONS: The present findings of bacterial DNA in the synovial fluid suggest the possibility of organisms translocating from the periodontal tissue to the synovium. We suggest that patients with arthritis or failed prosthetic joints be examined for the presence of periodontal diseases and be treated accordingly.
Asunto(s)
Artritis Reumatoide/microbiología , ADN Bacteriano/análisis , Osteoartritis/microbiología , Periodontitis/microbiología , Líquido Sinovial/microbiología , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/terapia , Bacterias/genética , Bacterias/aislamiento & purificación , Femenino , Prótesis de Cadera/microbiología , Humanos , Prótesis de la Rodilla/microbiología , Masculino , Persona de Mediana Edad , Osteoartritis/terapia , Periodontitis/terapia , Reacción en Cadena de la Polimerasa , Insuficiencia del TratamientoRESUMEN
A 66-year-old patient was referred to the Periodontal Clinic at Case Western Reserve University for implant placement in the mandibular left first molar area. The patient reported a history of oral bisphosphonate intake for the last 7 years for the treatment of osteoporosis. Autogenous bone block grafting was planned to augment the ridge before implant placement. The surgery was performed under local anesthesia, and the implant was successfully placed 8 months after ridge augmentation. Healing was uneventful postoperatively, and the buccolingual width of the ridge increased significantly, allowing placement of a 5-mm-diameter dental implant. The patient showed proper healing of both the donor site and the recipient site, in spite of the long-term oral bisphosphonate therapy, with no resulting osteonecrosis of the jawbone.