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Background: The number of patients treated with coagulation disorders, and more specifically with anticoagulant therapy, has increased worldwide in recent years due to increased life expectancy in developed countries. The protocols for managing this type of patient in oral surgery has varied over recent years, especially after the appearance of new direct-acting oral anticoagulants (DOACs). The assessment of risk of bleeding in this type of patient when undergoing a surgical procedure continues to be a controversial issue for patients, dentists and general practitioners. The objective of this document is to offer recommendations, based on evidence, for decision making for patients with coagulopathies who require dental surgical intervention., Material and Methods: Based on the indications of the "Preparation of Clinical Practice guidelines in the National Health System. Methodological manual", we gathered a group of experts who agreed on 15 PICO questions based on managing patients with coagulation disorders in dental surgical procedures, such as fitting of implants or dental extractions., Results: The 15 PICO questions were answered based on the available evidence, being limited in most cases due to the lack of a control group. Two of the PICO questions were answered by the experts with a grade C recommendation, while the rest were answered with grade D., Conclusions: The results of this review highlight the need to undertake well designed clinical trials with control groups and with a representative sample size.

Background: Evaluating 2-years implant loss and marginal bone loss in patients with hereditary coagulopathies, comparing with a healthy control group., Material and Methods: 37 implants in 13 patients (17 haemophilia A, 20 Von-Willebrand disease) versus 26 implants in 13 healthy patients. Data measured through Lagervall-Jansson index (after surgery, at prosthetic loading, at 2 years)., Statistics: Chi-square, Haberman's, ANOVA, Mann-Whitney-U. Significance p<0.05., Results: Haemorrhagic accidents in 2 coagulopathies patients (non-statistical differences). Hereditary coagulopathies patients suffered more hepatitis (p<0.05), HIV (p<0.05) and less previous periodontitis (p<0.01). Non-statistical differences in marginal bone loss among groups. 2 implants were lost in the hereditary coagulopathies and none in the control group (non-statistical differences). Hereditary coagulopathies patients had longer (p<0.001), and narrower implants (p<0.05) placed. 43.2% external prosthetic connection in hereditary coagulopathies patients (p<0.001); change of prosthetic platform more frequent in control group (p<0.05). 2 implants lost: external connection (p<0.05). Survival rate 96.8% (hereditary coagulopathies 94.6%, control group 100%)., Conclusions: Implant and marginal bone loss at 2 years is similar in patients with hereditary coagulopathies and control group. Precautions should be taken on the treatment for hereditary coagulopathies patients, through prior haematological protocol. Implant loss only occurred in in a patient with Von-Willebrand´s disease.

Down syndrome patients show success rates in dental implants much lower than those observed in the general population. This retrospective case-control study aimed to identify possible genes that are related to the regulation of inflammatory responses and bone metabolism related to periimplantitis and implant loss, as well as genes related to bone quality. This process involved using the functional analysis of the gene expression software Transcriptome Analysis Console (TAC version 4.0 Applied Biosystems TM , Thermo Fisher Scientific, Waltham, MA, USA) and a search for possible candidate genes involved. The focus was placed on the 93 genes related to periodontitis, periimplantitis, bone loss, implant loss, and genes related to bone quality and regulators underlying the establishment and maintenance of osseointegration. Five genes showed statistically significant results ( p < 0.05) in our comparison. Four of them, IL1B ( p = 0.023), IL1RN ( p = 0.048), BGLAP ( p = 0.0372) and PTK2 ( p = 0.0075) were down-regulated in the periodontal disease and implant rejection group, and only one was overexpressed: FOXO1A ( p = 0.0552). The genes with statistically significant alterations described in this article determine that the group of Down syndrome patients with periodontal disease and implant failure is a group of patients genetically susceptible to suffering from both conditions together.

Metallothioneins (MTs) are low molecular weight cysteine-rich proteins that can bind up to seven zinc ions. Among their numerous functions, MTs appear to act as protectors against oxidative and inflammatory injury. In our first published study, we reported downregulation of the isoforms MT1B (fold distance (FD) -2. 95; p = 0.0024), MT1F (FD -1.72; p = 0.0276), MT1X (FD -3.09; p = 0.0021), MT1H (FD -2.39; p = 0.0018), MT1M (FD -2.37; p = 0.0092), MT1L (FD -2. 55; p = 0.0048), MT1E (FD -2.71; p = 0.0014), MT2A (FD -2.35; p = 0.0072), MT1G (FD -2.24; p = 0.0118), and MT1A (FD -2.82; p = 0.0023) by comparing Down's syndrome patients with periodontal disease and implant failure to those without periodontal disease and with a positive progression of their implants. In this gene validation study, we intended to verify the results of our first gene expression analysis. Materials and Methods: In our retrospective case-control study, we performed retrotranscription (RT-qPCR) of 11 RNA-to-cDNA samples using the SuperScript™ VILO™ kit (50; reference 1,176,605) from Thermo Fisher. We conducted the study using the real-time PCR technique on the q-PCR ViiA 7 platform from Thermo Fisher. We chose the format of the Taqman Array Plate 16 Plus (reference 4,413,261) from Thermo Fisher, which accommodates 12 genes plus four controls ( GAPDH, 18S, ACTB, and HPRT1 ). We conducted the analysis of the plates using the Thermo Fisher Cloud Web Software. Results: The results obtained through gene validation analysis show that in PD+RI+ patients, the genes encoding the isoforms MT1F (FD 0.3; p = 0.039), MT1X (FD 338; p = 0.0078), MT1E (FD 307; p = 0.0358), and MT2A (FD 252; p = 0.0428) continue to show downregulation, whereas MT1B (FD 2.75; p = 0.580), MT1H (FD 281; p = 0.152), MT1L (FD 354; p = 0.0965), and MT1G (FD 336; p = 0.0749) no longer show statistically significant results.

Peri-implant bone loss leading to dental implant failure does not develop in the same way across subjects who apparently present the same condition-specifically, in the case of Down syndrome patients with the same genetic disorder-given that they do not necessarily develop immune-inflammatory disorders to the same extent., Methods: This retrospective case-control study was aimed at identifying the possible genes involved in implant failure in Down syndrome patients by matching the periodontal disease variable by means of a retrospective case-control study. This process involved using the functional analysis of gene expression software Transcriptome Analysis Console (TAC, Affymetrix, Thermo Fisher Scientific, Waltham, MA, USA) and a search for the possible candidate genes involved. Focus was placed on the 92 genes related to the inflammation identified from the TaqMan™ Array Plate Human Inflammation Kit (Thermo Fisher Scientific, Waltham, MA, USA)., Results: Six genes showed statistically significant results ( p < 0.05) in our comparison. Three of them-PLCG2 ( p = 0.0333), ALOX5 ( p = 0.03) and LTAH4 ( p = 0.0081)-were overexpressed in the implant reject group, and the following three were down-regulated: VCAM1 ( p = 0.0182), PLA2G2A ( p = 0.0034) and PLA2G10 ( p = 0.047)., Conclusion: Statistically significant differences exist in the gene expression involved in osteoclastogenesis, inflammatory response and host defensive response.

Objective: Analyze the 2-year clinical performance of single-unit titanium-zirconium (TiZr) alloy narrow-diameter (3.3 mm) dental implants with a hydrophilic surface (Straumann® Roxolid®, SLActive®) in patients with controlled type 2 diabetes mellitus (T2DM), measured using the glycated hemoglobin A (HbA1c) concentration test, compared with results in individuals without T2DM., Material and Methods: The studied sample consisted of 28 patients, 14 with T2DM (study group) and 14 without (control group). The plaque index, bleeding on probing, probing depth, clinical attachment level, gingival biotype, and marginal bone loss (MBL) at the site of the implants were assessed. HbA1c levels were assessed in all patients during each checkup., Results: Two years after implant placement and prosthetic restoration no implant failures were reported in either group, resulting in 100% survival and success rates in both groups. No statistically significant differences in MBL were found between the control and study groups (p > 0.05)., Conclusions: Within the limitations of this study, it can be concluded that reduced-diameter TiZr alloy implants with a hydrophilic surface represent a safe and predictable treatment option for patients with well-controlled T2DM. The clinical performance was comparable with that observed in individuals without T2DM in the medium term., Clinical Relevance: The narrow implants placed in patients with T2DM with well-controlled glycemia (HbA1c) showed a marginal bone loss and success and survival rates similar to those of the control group without DM2, in the medium term.

Background: Sometimes dental implants seem to be the only therapeutic alternative for the oral rehabilitation of patients with Down syndrome, given that they usually lose all their teeth early due to suffering aggressive periodontitis and they do not usually have the skills required to wear removable prostheses. However, the evolution of dental implants in these patients shows very adverse results. It is possible that basal genetic alterations, or at least some characteristics of these, may underlie these clinical results. The metabolic pathway of metallothioneins, molecules with an important influence on bone metabolism, could be one of the said alterations., Aims: To determine whether the expression of metallothioneins (MTs) and their metabolic pathway may be identified and related to the periodontitis and lack of osseointegration of dental implants in Down syndrome patients., Materials and Methods: Retrospective study of cases and controls by comparing patients with Down syndrome, periodontal disease, and implant failure (four patients, test group) with patients with Down syndrome, without periodontal disease, and without implant failure after two years of following (seven patients, control group), by extracting peripheral blood at the time of the dental examination to extract RNA and its subsequent processing in relation to gene expression of the metabolic pathway of metallothioneins., Results: The results identified low expression in the group of patients with periodontal disease and implant failure of genes MT1E, MT1H, MT1X, MT1A, MT1B, MT1C, MT1L, MT2A, MT1M, and MT1G., Conclusions: The low MT1 and MT2 gene expression seems to be related to the onset of periodontal disease and implant rejection in Down syndrome patients, although more data are required to confirm whether this relationship is due to one of the two conditions, to both independently, or to the two jointly-this last option being indicated by our current study.

Purpose: To evaluate prospectively the behavior of narrow-diameter (3.3-mm) titanium-zirconium alloy implants with a hydrophilic surface (Straumann Roxolid SLActive) in patients with type 2 diabetes mellitus in single-unit restorations, compared with a healthy control group (assessed using the glycosylated hemoglobin HbA1c test)., Materials and Methods: The patients evaluated in this study required single-unit implant treatment; 15 patients had type 2 diabetes mellitus, and 14 patients were healthy (control group [CG]). Marginal bone level (MBL) change around the implants was evaluated using conventional, sequential periapical digital radiographs. Patient HbA1c was assessed in each check-up. Normality test (Kolmogorov-Smirnov), univariate and multivariate logistic regression, analysis of variance (ANOVA), and Mann-Whitney U test were used for statistical analysis., Results: No differences in MBL change and implant survival and success rates were found between the diabetes mellitus group (DMG) versus the control group, either during the initial recording (DMG, 0.99 ± 0.56 vs CG, 0.68 ± 0.54; P > .05) or 6 months after restoration (DMG, 1.28 ± 0.38 vs CG, 1.11 ± 0.59; P > .05). No significant correlation between HbA1c levels and MBL change was detected in these patients (P > .05)., Conclusion: Patients with glycemic control exhibit similar outcomes to healthy individuals with regard to the investigated parameters. In light of these findings, the titanium-zirconium alloy small-diameter implants can be used in the anterior region of the mouth in type 2 diabetic patients.

Objectives: To evaluate implant survival rate and marginal bone loss (MBL) after 4 years in patients with Down syndrome and cerebral palsy, compared with a healthy control group., Material and Methods: The case group comprises 102 implants in 19 patients (71 cerebral palsy, 21 Down syndrome), and the control group comprises 70 implants in 22 healthy patients. One implant per patient was selected (n = 41 implants) to take clustering effects into account. MBL was measured using two panoramic radiographs (after surgery and 4 years later). Lagervall-Jansson's Index was used. Statistics used are chi-squared test and Haberman's post hoc test. p Value is significant at <0.05., Results: MBL was significantly higher in the cases in all samples (p < 0.001) and when one implant was selected per patient (p < 0.05). More implants were lost in the cases (p < 0.01), especially those with a higher MBL (p < 0.01). MBL (p < 0.05) and implant loss (p < 0.01) increased with age in the cases. The three-unit fixed dental prosthesis (FDP) showed higher MBL (p < 0.05). Down syndrome had a higher MBL than cerebral palsy (entire sample p < 0.0001, one implant per patient p < 0.05). All patients with Down syndrome saw some damage to bone support (entire sample p < 0.0001; one implant per patient p < 0.05). Implant loss occurred only in Down syndrome (p < 0.00001)., Conclusions: MBL and implant loss 4 years after placement are higher in neuropsychiatric disabilities. Down syndrome has a higher risk of MBL and implant loss; therefore, special precautions should be taken when deciding on treatment for these patients., Clinical Relevance: As a consequence of this pilot study, professionals should be very cautious in placing implants in patients with Down syndrome.

Introduction: Chemotherapy-associated osteonecrosis of the jaw caused by bisphosphonates is an exposure of necrotic bone with more than eight weeks of evolution that is attributable to bisphosphonates and no prior radiation therapy. Its etiopathogenesis remains unknown, although there are two hypotheses that may explain it: the drug's mechanism of action, and the risk factors that can lead to osteonecrosis. There is a wide range of treatment options for managing chemotherapy-associated osteonecrosis of the jaw, from conservative treatments to surgical procedures of varying levels of invasiveness, which are sometimes supplemented with adjuvant therapies., Objective: The objective of this article is to group the therapeutic options for osteonecrosis of the jaw (ONJ) into seven different protocols and to evaluate their effectiveness in relation to stage of ONJ., Material and Methods: A literature review was carried out in PubMed following the PRISMA criteria. A total of 47 were collected after compiling a series of variables that define ONJ, applied treatments, and the clinical results obtained., Results and Discussion: The 47 articles selected have a low to average estimated risk of bias and are of moderate to good quality. According to the data obtained, Protocol 3 (conservative treatment, clinical and radiological follow-up, minimally invasive surgical treatment, and adjuvant therapies) is the most favorable approach for ONJ lesions caused by oral bisphosphonates. For lesions caused by intravenous bisphosphonates, Protocol 2 (conservative treatment, clinical and radiological follow-up, minimally invasive surgical treatment, and no adjuvant therapies) is the best approach. When comparing the different stages of ONJ, Protocol 1 (conservative treatment, clinical and radiological follow-up) promotes better healing of Stage 1 ONJ lesions caused by orally administered bisphosphonates, and Protocol 3 is recommended for Stage II. For ONJ lesions attributable to intravenous bisphosphonates, Protocol 7 (conservative treatment, clinical and radiological follow-up, and adjuvant therapies) provides the best results in Stage 0; in Stages I, II, and III, Protocol 1 gives better results., Competing Interests: The authors have declared that no conflict of interest exist.

Cri du chat syndrome is an autosomal disorder. Because it affects few people in the population it is considered a rare disease, yet it is one of the most common autosomal chromosomal syndromes in humans. It entails pathognomonic alterations that affect the craniofacial and oral anatomy of patients. The aim of this study is to review these craniofacial and oral abnormalities in patients with Cri du chat syndrome. The PubMed Medline database was searched using two different strategies. First, we used "Dentistry" and "Cri du chat" as keywords; second, we used "Cri du chat" and "craniofacial." Seven articles in which the main orofacial and cranio-skeletal characteristics of patients with Cri du chat syndrome were described were selected according to the inclusion and exclusion criteria. Cri du Chat syndrome entails pathognomonic characteristics in the craniofacial area (epicanthus, short philtrum, and wide nasal bridge), the oral area (mandibular retrognathism and anterior open bite) and the cranial region (alterations at the cranial base angle and a small upper airway). However, more studies on larger samples are needed to specify the orofacial and craniofacial characteristics of patients with Cri du chat syndrome more accurately. Clin. Anat. 29:555-560, 2016. © 2015 Wiley Periodicals, Inc., (© 2015 Wiley Periodicals, Inc.)

Background: Fitting implants in osteoporotic patients has traditionally been controversial, and there is little scientific evidence relating osteoporosis to marginal bone loss (MBL). The aims of this study are as follows: 1) to evaluate the possibility of a correlation between osteoporosis, as measured by the mandibular cortical index (MCI), and MBL and 2) to assess how various systemic diseases, periodontitis, and placement of implants in regenerated bone are correlated with MBL and MCI., Methods: This retrospective study examines 212 implants inserted in 67 patients. To take a possible cluster failure into account, an implant for each patient was selected (n = 67 implants). MBL was assessed. Osteoporosis was evaluated using the MCI. Both MBL and MCI were assessed from panoramic radiographs. χ(2) test was performed (Haberman post hoc test). Significance was P <0.05., Results: When the total sample implant (N = 212) was evaluated, a significant association was found between the presence of osteoporosis and MCI (P <0.001) and between the presence of diabetes mellitus and MCI (P <0.01). Significant associations were also found between MBL and placement of implants in regenerated sites (P <0.001) and between MBL and a previous history of periodontitis (P <0.05). When the sample is evaluated only in selected implants (one per patient, n = 67), significant differences appear to relate only to the MBL with the placement of implants in regenerated bone sites (P <0.001)., Conclusions: Osteoporosis (as evaluated by MCI) does not pose a risk for the development of greater MBL. Parameters adversely affecting the development of increased MBL are a previous history of periodontitis and especially the placement of implants at sites of bone regeneration.

Case Report: A 46-year-old man with severe hemophilia A, stage A2 HIV infection and chronic hepatitis C genotype 1A, for whom the treatment plan included implant-supported prostheses in 2 mandibular edentulous sections. The protocol followed included factor VIII replacement concentrate and oral antifibrinolytic therapy. The right mandibular section was fitted with 3 Straumann implants (Ø 4.1 mm, length 10 mm), and the left mandibular section received 2 implants of the same characteristics. The patient showed no postoperative complications. After implant placement, the patient attended scheduled review appointments. After a 3-month period of osseointegration, the prosthesis was fitted., Conclusions: Although, in this case, the treatment proved successful 2 years postrehabilitation and the protocol used seems safe and effective, long-term prospective studies are needed to evaluate the implant success rate in these patients.

Objective: This article reports a case of severe generalized aggressive periodontitis and subsequent collapse of the occlusion in a psychiatric patient, treated by an extremely conservative orthodontic-periodontal-prosthodontic treatment., Summary: A woman presented with severe anterior proclination caused by severe periodontal disease and Angle's class II molar malocclusion. The patient wanted to preserve her teeth and rejected the idea of implant treatment. This case report demonstrates that combining periodontal therapy, orthodontic treatment, and prosthodontics (through a decision-making system with a proper interdisciplinary coordination) can greatly improve function and the esthetic result. Comprehensive periodontal treatment took place before other intervention, and periodontal maintenance and follow-up throughout the treatment and after played a crucial role.

Objectives: The aim of the present study is to compare cardiovascular safety profiles of two dental anesthetics: articaine versus two standard mepivacaine solutions used during etiological periodontal treatment in cardiovascular patients., Study Design: Using a cross-over study design, ten cardiovascular patients were randomly assigned to dental treatment with 1.8 mL of a local anesthetic injected on each quadrant of the mouth: Articaine (40 mg with Epinephrine 0.5 mg % and 40 mg with Epinephrine 1mg %) or Mepivacaine (30 mg and 20 mg with Epinephrine 1mg %). A computer programme enabled continuous longitudinal data collection: O2 saturation, blood pressure (BP) and heart rate (HR)., Results: No severe clinical side effects were observed. During the treatment period, we observed statistically significant differences as regards HR between injections with and without adrenalin (p< 0.039) and as regards systolic (p< 0.046) and diastolic (p < 0.046) blood pressure during the stabilization period. In both cases, the parameters under study increase. Age, gender, jaw treated, treatment duration and the rest of cardiovascular variables did not affect the results. None of the patients underwent ischemic alterations or any other complication derived from the treatment or the anesthesia., Conclusions: According to the results of our study, dental anesthetics with standard concentrations of Epinephrine seem to alter HR and BP. Although no cardiac ischemic alterations or any other cardiovascular complications have been observed, we must be cautious with the administration of anesthetics containing vasoconstrictors in patients with cardiovascular diseases.

Objective: The purpose of this study was to analyze craniofacial characteristics from lateral head profile radiographs of patients with cri-du-chat (CdC) syndrome., Study Design: The craniofacial morphology of 10 CdC patients was evaluated using standard cephalometric methods, measuring 39 craniofacial variables on cephalometric x-ray images., Results: The principal characteristics were skeletal class II malocclusion, caused by mandibular retrognathism, dental biprotrusion, and a small upper airway. Additionally, 70% of patients had a steep palatal plane angle; the cranial base angle was flattened, also in 70% of patients., Conclusions: Results indicated that the deletion of 5p had an impact on the cranial base, maxilla, mandible, and upper airway, causing distinctive features to become apparent through irregular growth., (Copyright © 2010 Mosby, Inc. All rights reserved.)

Objective: The purpose of this study was to determine the type and characteristics of the interventions, indications of dental treatment and procedures performed to patients treated under general anesthesia (GA) by pediatric dentistry residents, during the 1997-1999 period., Method: A sample of 57 hospital records of patients treated as part of the Special Pediatric Course at the Puerto Rico Pediatric Hospital were reviewed. Statistical analysis was done using the chi-square test for inferences on proportions., Results: MR patients made up 59.7% and NMR patients made up 40.3% of the sample studied. Ages ranged from 2 to 35 years with a mean age of 11 years (SD=8.54). MR patients were classified into 7 categories: mental retardation (38.2%), cerebral palsy (14.7%), epileptic (5.9%), mental syndromes (26.9%), hydrocephalic (5.9%), autism (5.9%) and others (2.9%). The NMR were classified into 5 categories: early childhood caries (65.2%), cardiac patients (8.7%), maxillofacial anomalies (4.3%), organic syndromes (13.1%) and others (8.7%). The dental procedures performed were: dental extractions 84%(MR) and 68% (NMR), restorative procedures 87.3%(MR) and 12.7%(NMR). Oral prophylaxis was performed in 76.8%, fissure sealants in 10.7% and topical fluoride applications in 21.8%., Conclusion: Dental extraction was a frequently performed procedure in both groups. The prevalence of exodontia and restorative procedures indicates the need to design and implement prevention programs for special pediatric patients.

Cardiovascular diseases represent one of the main causes of death in developed societies. These diseases are not only important because of the mortality they generate, but also due to the high number of affected persons under treatment that the health systems of different countries have to support. Hence, the early detection of risk factors triggering these diseases has been seen as the most effective mechanism to prevent them. Over the last few years periodontal pathology has been more or less related to the suffering of cardiovascular diseases. This fact could be of great clinical and epidemiological relevance owing to the actual considerable prevalence of periodontal diseases. In the present review, the clinical and physiopathological factors which scientifically support this association are analyzed,reaching the conclusion that further studies are needed to have the proof that said association represents a determinate risk factor for the suffering of cardiovascular diseases.

The European Higher Education Space (EHES) is a project to harmonize all the European University systems in order that all of them will posses a homogeneous structure of undergraduate, graduate and post graduate studies. The time period established to implement this project is year 2010. The present paper describes the establishment of a new career degree model in Spain, the degree in Dentistry that started twenty years ago. Also it has been stated the number of the present Departments and Schools, the access system to Public University Schools of Spain, the evaluation system, and which are the new mechanisms incorporated in the Spanish University system to implement this integration to the EHEE. This is the moment to design the new master guidelines to obtain homogeneous career degrees that may imply more accessibility and mobility of students and professionals.

The present study reviews and updates the indications for general anesthesia in dental practice. An earlier number of this same journal published the bases and indications for dental management under general anesthesia. The present issue will review the materials and installations required for applying such anesthetic procedures, and addresses the basic working protocol for this particular health care discipline.

Advances in medical science have increasingly extended human life expectancy, thereby increasing the number of risk patients who require dental treatment under conditions of maximum safety. On the other hand, a part of the population presents physical or mental impairments which preclude minimum cooperation with the dental professional to ensure treatment with the necessary guarantees. Dentists and stomatologists must therefore consider the possibility of performing general anesthesia in these special patients, as the only way to ensure adequate dental treatment.