RESUMEN
CONTEXT: It is well established that clinical features of acromegaly concern the teeth and the jaw, but less is known about the degree of oral and maxillofacial pathologies. PATIENTS: 28 acromegalics (13 females, 15 males) with a mean age 49±11 (mean±SD) years (range 31-70) were included in the study. 32% had active disease, 68% were well-controlled under the somatostatin analogue octreotide, the dopamine agonist cabergoline, and the GH receptor antagonist pegvisomant, or were cured after pituitary surgery and/or radiation. METHODS: All subjects undergone intensive and complex examinations of a plaster model and facial arch with articulator, an intra-oral bracket-pen registration, analysis of a digital picture, panoramic and lateral radiographs with cephalometry in comparison with a reference group (n=201). RESULTS: 42% had a diastema mediale (0.9±1.1 mm). Overbite and overjet (vertical overbite) correlated with the disease duration (r²=0.2237; p=0.011 respectively r²=0.3364; p=0.015). 96% had an asymmetric movement of the mandible. 57% had a prognathism. The protrusion of the mandible correlated significantly with the disease duration (r²=0.1784; p=0.028). The degree of the mandibular prognathism (SNB-angle) was higher in the acromegalic group (84°±7° vs. 81°±3°, p<0.05). The ANB-angle indicates the relation between maxilla and mandible and was negative in the acromegalic group and positive in the controls (-0.3°±5.0° vs. 1.6°±2.1°, p=<0.05) and correlated negative with the disease duration (r²=0.2553; p=0.0061). The mandibular angle was significantly greater in the acromegalic group (126°±9° acromegalic group vs. 121°±7°control group, p=0.003). The length of the mandible correlated with the disease duration (r²=0.2801; p=0.0038). 86% had an asymmetric face. The high of the midface was in the acromegalic group higher (6.1±0.7 vs. 5.5±0.4 cm, p=0.0009) as well as the lower bony high of the face (9.5±1.0 acromegalics vs. 6.9±0.5 cm controls, p=0.0009). The high of the lower bony face correlated with as well with the disease duration (r²=0.3224; p=0.0016). CONCLUSIONS: Patients with acromegaly suffer not only from cardiovascular, metabolic and neoplastic complications, but also from dental and jaw disorders. The high incidence of these manifestations and its relation to the disease duration requires a carefully work-up of oral and maxillofacial examinations in close collaboration with endocrinologists, dentists and dental surgeons.
Asunto(s)
Acromegalia/patología , Mandíbula/patología , Sobremordida/patología , Prognatismo/patología , Adulto , Anciano , Cefalometría , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: Sleep apnoea has been consistently reported to occur in acromegaly. In uncontrolled patients, the severity of sleep apnoea influences physical activity in the daytime. We investigated the influence of disease activity on tongue volume and sleep apnoea treated with the GH receptor antagonist pegvisomant in poorly controlled patients with acromegaly under octreotide. DESIGN AND METHODS: A total of 12 patients with active acromegaly (six females; six males; mean age 57+/-15 years; body mass index 29.4+/-4.2 kg/m(2); mean+/-S.D.) were treated with pegvisomant (13.5+/-5.0 mg/die) for 6 months. Tongue volume was examined by magnetic resonance imaging, and sleep apnoea was characterized by polysomnography before and after 6 months of treatment with pegvisomant. The mandibular length was determined by lateral X-ray films. RESULTS: IGF1 levels decreased after 6 months in all patients (407+/-114 to 199+/-23 microg/l; P=0.0001). The tongue volume decreased (105+/-33 to 83+/-33 ml; P=0.007) as well as the apnoea-hypnoea index (23+/-22 to 18+/-18/h; P=0.0066). The mandibular length correlated with the initial tongue volume (r(2)=0.6072, P=0.0028). CONCLUSION: In conclusion, successful treatment with pegvisomant can decrease tongue volume, which has benefits for coexisting sleep disordered breathing.
Asunto(s)
Acromegalia/complicaciones , Acromegalia/tratamiento farmacológico , Hormona de Crecimiento Humana/análogos & derivados , Síndromes de la Apnea del Sueño/tratamiento farmacológico , Síndromes de la Apnea del Sueño/etiología , Acromegalia/diagnóstico por imagen , Femenino , Hormona de Crecimiento Humana/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Masculino , Radiografía , Síndromes de la Apnea del Sueño/diagnóstico por imagen , Síndromes de la Apnea del Sueño/patología , Lengua/patologíaRESUMEN
PURPOSE: The aim of this retrospective study was to present the results of implant-supported telescopic prostheses in the mandible after removal of malignant tumors. MATERIALS AND METHODS: Between 1991 and 2000, 24 patients with squamous cell carcinoma (16 irradiated, eight nonirradiated) underwent mandibular rehabilitation with implant-supported telescopic prostheses. A total of 111 dental implants were placed. Treatment complications were observed. The cumulative survival rates of the implants and prostheses were evaluated by lifetable analysis. RESULTS: Within a mean follow-up period of 30 months (1 to 108 months), only three implants failed. All other implants are still in function. Of 24 patients, 23 were satisfied with their implant-supported telescopic restorations. Soft tissue, implant, or prosthetic complications occurred very rarely. The cumulative implant survival rate was about 97% and the cumulative prosthesis survival rate was about 95% at 9 years. CONCLUSION: Implants and implant-supported telescopic maxillofacial prostheses can successfully remain in function over a long period. Increased implant and prosthetic complications should not be expected. Therefore, telescopic implant attachments seem to be very useful as a treatment option for prosthetic restoration of the mandible in tumor patients.
Asunto(s)
Carcinoma de Células Escamosas/rehabilitación , Prótesis Dental de Soporte Implantado , Prótesis de Recubrimiento , Neoplasias Mandibulares/rehabilitación , Adulto , Anciano , Implantación Dental Endoósea , Implantes Dentales , Retención de Prótesis Dentales , Fracaso de la Restauración Dental , Femenino , Humanos , Tablas de Vida , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Suelo de la Boca , Estudios RetrospectivosRESUMEN
PURPOSE: The purpose of this study was to describe a new application of craniofacial implants, as anchoring elements for wigs. MATERIALS AND METHODS: In two patients, a split-skin graft was used to close a soft tissue defect in the occipital, parietal, temporal, and frontal region (defect size of 10 cm x 33 cm and 10 cm x 14 cm). Six titanium implants were placed in each patient. Six months after implant placement, abutment connection was performed and titanium magnets were adapted. Subsequently, an implant-retained wig was constructed. RESULTS: In a follow-up period of between 10 and 22 months no implant failed. The incorporated wigs effectively retain a functionally and cosmetically successful craniofacial rehabilitation. CONCLUSION: Despite these successful treatments, further research is needed before craniofacial implants as anchoring elements for wigs can be considered a standard option in the rehabilitation of craniofacial alopecic defects.
Asunto(s)
Cabello , Prótesis e Implantes , Diseño de Prótesis , Cráneo/cirugía , Adolescente , Adulto , Estética , Femenino , Estudios de Seguimiento , Hueso Frontal/lesiones , Hueso Frontal/cirugía , Humanos , Magnetismo/instrumentación , Masculino , Nevo Pigmentado/cirugía , Hueso Occipital/lesiones , Hueso Occipital/cirugía , Oseointegración , Hueso Parietal/lesiones , Hueso Parietal/cirugía , Cuero Cabelludo/cirugía , Neoplasias Cutáneas/cirugía , Trasplante de Piel/métodos , Hueso Temporal/lesiones , Hueso Temporal/cirugía , TitanioRESUMEN
Between 1988 and 1997, 18 irradiated patients (group 1, 83 implants) and 22 nonirradiated patients (group 2, 92 implants) received resection of the cancer-involved mandible and floor of the mouth and subsequently underwent mandibular rehabilitation with endosseous implants. Implant-supported prostheses were placed in 26 patients, while 13 patients received implant-tissue-supported prostheses. Between 1988 and 1991, patients were restored with implant-tissue-supported prostheses (based on 2 to 4 implants). This strategy was later changed because of the development of denture-related lesions. Since 1992, group 1 patients have been restored exclusively with implant-supported prostheses on 5 to 6 implants; group 2 patients have been rehabilitated alternatively with implant-tissue-supported prostheses on 4 implants. Special criteria for determining the success of implant-supported maxillofacial prostheses were developed. With a mean follow-up period of 37 months, 160 implants (91%) were clinically osseointegrated. Both types of restorations provided sufficient oral rehabilitation. However, only completely implant-supported prostheses avoided soft tissue ulcers. The cumulative success rate was approximately 75% after 7 years for group 1 patients and about 86% after 10 years for group 2 patients. The success rates for implants placed after the change in strategy were approximately 86% (group 1) and 94% (group 2) after 5 years. Based on these experiences, it is suggested that irradiated patients should be restored with exclusively implant-supported prostheses, without any mucosal contact.
Asunto(s)
Carcinoma de Células Escamosas/rehabilitación , Implantación Dental Endoósea , Implantes Dentales , Neoplasias de la Boca/rehabilitación , Adulto , Anciano , Trasplante Óseo , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Pilares Dentales , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Diseño de Dentadura , Estudios de Seguimiento , Humanos , Neoplasias Mandibulares/radioterapia , Neoplasias Mandibulares/rehabilitación , Neoplasias Mandibulares/cirugía , Persona de Mediana Edad , Suelo de la Boca/efectos de la radiación , Suelo de la Boca/cirugía , Neoplasias de la Boca/radioterapia , Neoplasias de la Boca/cirugía , Úlceras Bucales/prevención & control , Oseointegración , Planificación de Atención al Paciente , Satisfacción del Paciente , Resultado del TratamientoRESUMEN
Between 1988 and 1997, tumor resection was carried out in 18 irradiated patients group 1: 36-72 Gy. 83 implants) and 22 nonirradiated patients (group 2: 92 implants) in the mandible and floor of the mouth, and these patients subsequently underwent mandibular endosseous implant rehabilitation. A total of 23 patients were treated with exclusively implant-supported prostheses, and 16 with implant tissue-supported constructions. Between 1988 and 1991, group 1 and 2 patients received implant tissue-supported prostheses (using two to four implants). Due to prosthesis-related pressure lesions, the strategy has now been changed. Since 1992, group 1 patients have received exclusively implant-supported prostheses (using five to six implants), while group 2 patients have received implant tissue-supported constructions (using four implants). Special criteria for the success of implant-supported maxillofacial prosthetics were drawn up. With an average follow-up period of 37 months 160 fixtures (91%) were clinically osseointegrated. Both types of restoration provided sufficient oral rehabilitation. However, only completely implant-supported prostheses avoided soft tissue ulcers. The overall success rate was about 77% after 7 years in group 1 and about 87% after 9 years in group 2. With regard to implants placed after strategy change, the 5-year success rate was approximately 86% (group 1) and 94% (group 2). In irradiated patients, an exclusively implant-supported prosthesis without any mucosal contact (thus avoiding soft tissue ulcers with a potential to develop osteoradionecrosis) should therefore be fabricated. Implant tissue-supported restoration is also possible in nonirradiated oral cancer patients.
Asunto(s)
Implantación Dental Endoósea , Neoplasias Mandibulares/rehabilitación , Neoplasias de la Boca/rehabilitación , Rehabilitación Bucal , Adulto , Anciano , Terapia Combinada , Análisis de Falla de Equipo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
The applicability of fatty acid analysis to the characterization of periodontal microflora was investigated using gas-liquid chromatography (GLC) and the software of the Sherlock Microbial Identification System (MIS) from MIDI Inc. Sulcus fluid was collected with paper points and anaerobically cultured in broth at 35 degrees C for four days. The broth-grown microbial population was extracted and the fatty acid methyl esters (FAME) were separated by GLC. The investigation of 67 specimens from asymptomatic sulci and of 32 specimens from inflamed sulci showed that the patterns of FAME profiles, the clustering of FAME profiles by computerized 2-D plot procedure, and the determination of the peak area index (PAI) of the FAME profiles differentiate between normal and pathological sulcus flora. Comparison of the clinical sulcus rating and the FAME data indicated that a pathological FAME profile may precede manifest periodontitis, and the normalization of the FAME profile may precede healing. It is concluded that the FAME analysis of sulcus fluid is a diagnostic aid for periodontological surveillance, for the initiation of preventive treatment of periodontitis, and for controlling the antimicrobial efficiency of therapeutic measures.
Asunto(s)
Bacterias/clasificación , Ácidos Grasos/análisis , Bolsa Periodontal/microbiología , Periodontitis/microbiología , Anaerobiosis , Bacterias/crecimiento & desarrollo , Bacterias/aislamiento & purificación , Técnicas de Tipificación Bacteriana , Cromatografía de Gases , Análisis por Conglomerados , Medios de Cultivo , Humanos , Periodontitis/diagnóstico , Programas InformáticosRESUMEN
After orbital exenteration and high- dose irradiation (60 Gy on average), 17 endosseous implants were placed periorbitally in 5 patients. No hyperbaric oxygen therapy was performed. All implants were primarily covered with regional or free flaps. After second-stage surgery and aesthetic rehabilitation with an external maxillofacial prosthesis, the pocket depth and implant stability (periotest) were checked, an occipitonasomental radiograph was taken and the soft tissue assessed in short recall intervals. When the implant was uncovered, osseointegration was stable. Within a follow-up period of 35 months, no fixation had failed. In two patients, peri-implant inflammation (microbiologically confirmed Staphylococcus aureus) occurred, which was clinically only determined by soft tissue oedema and rubor. The results demonstrate primary soft tissue covering as essential for non-irritating implant osseointegration in the irradiated orbita. In extraoral implants the clinical estimation of the peri-implant soft tissue, including a microbiological examination, is required for early detection of peri-implant inflammation in order to avoid secondary implant failure. In contrast, periotest and pocket depth are not relevant in recognizing an ensuing peri-implant inflammation.
Asunto(s)
Tornillos Óseos , Ojo Artificial , Evisceración Orbitaria/métodos , Órbita/efectos de la radiación , Neoplasias Orbitales/radioterapia , Traumatismos por Radiación/cirugía , Colgajos Quirúrgicos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Orbitales/cirugía , Oseointegración/efectos de la radiación , Complicaciones Posoperatorias/etiología , Reoperación , Cicatrización de Heridas/efectos de la radiaciónRESUMEN
After resection of an oropharyngeal tumor, 157 dental implants were placed in 17 irradiated (44 Gy on average) and 20 non-irradiated patients. Within a control period of 37 months, 15 implants had failed. The reason for implant failure was analyzed, whereby indicative parameters were revealed. Eleven implants in four irradiated and one non-irradiated oral cancer patients showed no primary osseointegration during the healing period because of mandible fracture, overloading or for unknown reasons. Four implants in one irradiated and three non-irradiated oral-cancer patients were lost subsequently on average 39 months after second-stage surgery due to biomechanical overloading or bacterial infection. No osteoradionecrosis development due to implant failure was observed in irradiated patients. In all cases, peri-implant pocket depth, implant stability and peri-implant bone resorption increased before definitive implant failure. Therefore, these findings seem to be useful as indicative parameters in the prediction of implant failure.
Asunto(s)
Implantación Dental Endoósea , Mandíbula/efectos de la radiación , Neoplasias Orofaríngeas/radioterapia , Osteorradionecrosis/etiología , Adulto , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Orofaríngeas/cirugía , Orofaringe/efectos de la radiación , Orofaringe/cirugía , Oseointegración/efectos de la radiación , Falla de Prótesis , Radioterapia Adyuvante , Factores de RiesgoRESUMEN
Purulent mediastinitis is a rare but serious complication of a descending odontogenic infection with a high mortality. Diagnosis is difficult and frequently delayed. Physical examination is often nondiagnostic, but may include pronounced edema of the neck and chest. CT scan is the single most important tool for early diagnosis. The treatment is always is surgical, in combination with an extremely high dose of combined antibiotics. Ultimately, we only could save our patient with this therapy.
Asunto(s)
Absceso/cirugía , Mediastinitis/cirugía , Infecciones Estafilocócicas/cirugía , Infecciones Estreptocócicas/cirugía , Extracción Dental , Absceso/diagnóstico por imagen , Adulto , Antibacterianos , Terapia Combinada , Quimioterapia Combinada/uso terapéutico , Humanos , Masculino , Mediastinitis/diagnóstico por imagen , Tercer Molar/diagnóstico por imagen , Tercer Molar/cirugía , Radiografía Panorámica , Reoperación , Choque Séptico/diagnóstico por imagen , Choque Séptico/cirugía , Infecciones Estafilocócicas/diagnóstico por imagen , Infecciones Estreptocócicas/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Eight partially irradiated oral cancer patients were treated using either mandibular implant and mucosa-supported telescopic coping prostheses or a restoration that was completely implant-supported with telescopic copings. Both types of restorations provided sufficient positional stability and peri-implant hygiene, and functional and esthetic improvement. However, only the completely implant-supported telescopic prosthesis avoided soft tissue ulcers that had the potential for the development of osteoradionecrosis. This type of restoration can especially be recommended for irradiated patients.
Asunto(s)
Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Prótesis de Recubrimiento , Irradiación Craneana/efectos adversos , Índice de Placa Dental , Retención de Prótesis Dentales/instrumentación , Prótesis de Recubrimiento/efectos adversos , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Mandíbula/cirugía , Persona de Mediana Edad , Neoplasias de la Boca/rehabilitación , Úlceras Bucales/etiología , Neoplasias Orofaríngeas/rehabilitación , Satisfacción del Paciente , Índice PeriodontalRESUMEN
Obturator prostheses require anchoring elements in the partially resected maxilla to provide stability and oronasal separation. Anchoring elements are usually overstressed because of the lack of collateral support. Intraoral titanium implants can provide additional retention and avoid mechanical overstress of the anchoring elements in the residual maxilla. Treatment with intraoral implants into the zygoma for the support of an obturator prosthesis is reported.
Asunto(s)
Maxilar/cirugía , Obturadores Palatinos , Prótesis e Implantes , Titanio , Cigoma/cirugía , Implantación Dental Endoósea , Implantes Dentales , Prótesis Dental de Soporte Implantado , Prótesis de Recubrimiento , Humanos , Masculino , Neoplasias Maxilares/cirugía , Persona de Mediana Edad , Recurrencia Local de Neoplasia/cirugía , Osteotomía , Diseño de Prótesis , Ajuste de Prótesis , Sarcoma/cirugía , Estrés Mecánico , Propiedades de SuperficieRESUMEN
Thirteen irradiated and 14 nonirradiated patients were treated after resection of a malignant oral lesion. With a follow-up period of 26 months, 3 of 48 implants in nonirradiated patients and 4 of 57 implants in irradiated patients failed. In comparison to implant-tissue-supported prostheses, exclusively implant-supported prostheses demonstrated better results with regard to soft tissue trauma and function of the prosthesis.
Asunto(s)
Implantación Dental Endoósea , Implantes Dentales , Prótesis Dental de Soporte Implantado , Neoplasias de la Boca/rehabilitación , Adulto , Anciano , Diseño de Prótesis Dental , Fracaso de la Restauración Dental , Femenino , Estudios de Seguimiento , Humanos , Masculino , Mandíbula/patología , Mandíbula/efectos de la radiación , Mandíbula/cirugía , Neoplasias Mandibulares/radioterapia , Neoplasias Mandibulares/rehabilitación , Neoplasias Mandibulares/cirugía , Persona de Mediana Edad , Suelo de la Boca/patología , Suelo de la Boca/efectos de la radiación , Suelo de la Boca/cirugía , Mucosa Bucal/patología , Mucosa Bucal/efectos de la radiación , Mucosa Bucal/cirugía , Neoplasias de la Boca/radioterapia , Neoplasias de la Boca/cirugía , Oseointegración , Satisfacción del Paciente , Resultado del TratamientoRESUMEN
Two collectives of patients who required radiation therapy were built. In order to determine the adequate occasion and extension of surgical teeth restoration in dependence on radiation therapy, both collectives were compared. The first group implicated 21 manifest ORN. The triggers of these ORN were evaluated. In the second collective the ORN occurrence after 225 generous surgical teeth restorations before radiation therapy were prospectively fixed and analysed. In comparison of both collectives the concept of generous removing of all potential dentogene inflammations before radiation therapy was successful in prevention of the septic ORN.
Asunto(s)
Neoplasias de la Boca/radioterapia , Cuidados Preoperatorios , Extracción Dental , Humanos , Mandíbula/efectos de la radiación , Maxilar/efectos de la radiación , Suelo de la Boca/efectos de la radiación , Osteorradionecrosis/prevención & control , Estudios Prospectivos , Dosificación Radioterapéutica , Factores de RiesgoRESUMEN
Helicobacter pylori causes human type B gastritis and is involved in the etiology of peptic ulcer disease. The routes of transmission of H. pylori are still unclear. The microorganism may be transmitted orally, since H. pylori has been detected in dental plaques. To confirm the hypothesis that dental plaques are a reservoir of H. pylori, 100 dental plaque specimens from 55 dental surgery patients were incubated on one nonselective and up to four selective agar media for the detection of H. pylori. In addition, urease activity of the plaque material was tested, and the gingival status of the patients was assessed. H. pylori was not cultivated from any of the specimens investigated. Plaque material from 12 patients with moderate and severe gingivitis showed urease activity. The results do not confirm the hypothesis that dental plaques are a relevant reservoir of viable H. pylori cells. However, non-cultivatable forms of H. pylori may survive in dental plaques. Urea cleaving activity of dental plaque may be a marker of gingival inflammation.