Medicina Oral, Patología Oral y Cirugía Bucal (Internet)

Delayed contact sensitivity on the lips and oral mucosa due to propolis-case report

We report a rare case of a patient who was referred to the Department of Oral medicine in Zagreb, Croatia. The patient was 20 years old, otherwise healthy and not taking any medication. She presented with irregular erosions partially covered with pseudomembranes that involved both lips and retrocomissural mucosa. Discrete erosion was also noticed on her lower lingual gingiva in the area 42. She reported a propolis solution self-medication for treatment of recurrent aphthous ulcers. After ten days of propolis application, lip and oral lesions developed. Patch test to propolis was proven. We highlight the fact that some folk medicine medications, such as propolis, although being known for many decades to be helpful in various conditions, in some individuals might lead to unwanted side-effects due to its antigenic potential. Additionally, every colleague, during the differential diagnosis of the oral lesions must bear in mind unwanted reactions to folk medicine products.

Follicular adenomatoid odontogenic tumor: immunohistochemical study

El tumor odontogénico adenomatoide (TOA) es una infrecuente lesión odontogénica benigna, que aparece en pacientes jóvenes, generalmente mujeres en la segunda década de la vida, a menudo como una lesión radiolúcida de aspecto quístico unilocular, en asociación a un diente, usualmente canino, no erupcionado. A pesar de haberse denominado también adenoameloblastoma o tumor ameloblástico adenomatoide, el TOA es una lesión benigna con una muy baja tendencia a la recidiva, mostrando una morfología muy peculiar (apariencia basaloide con estructuras glanduliformes, calcificaciones esferulares, presencia de material amiloide) que facilitan su reconocimiento histológico. Se presenta un análisis clínico-patológico de un TOA de tipo folicular de maxilar inferior, en asociación a la inclusión de un canino inferior izquierdo, en una paciente pediátrica de 9 años. El estudio inmunohistoquímico realizado muestra algunos datos previamente no referidos. A pesar de existir distintos tipos celulares en el TOA se observo una universal inmunorreactividad para p63, demostrando el carácter basal de los distintos elementos que lo constituyen. En concordancia con su benignidad y con su baja tasa de recidiva existe una escasa actividad proliferativa (2-3% de núcleos marcados por el antígeno Ki-67), estando la proliferación reducida a pequeños nódulos de células epiteliales (AE1-3 +) de núcleos elongados o fusiformes; de otra parte la mayor incidencia en pacientes de sexo femenino no puede ser explicada en base a la existencia de una hormonodependecia tumoral dada la ausencia de expresión de receptores hormonales (RE y RPg).

Adenomatoid odontogenic tumor (AOT) is an uncommon benign odontogenic lesion that affects young patients, with female predominance, mainly in second decade, showing a radiolucent unilocular image associated with an unerupted tooth, usually a canine. In spite of previous and confusing denominations, such as adenoameloblastoma or adenomatoid ameloblastic tumor, AOT is a benign tumor with a very low rate of recurrence, that show a peculiar morphological picture (basaloid appearance with glandular-like structures, calcifying areas, and amiloid-like material) that allow its histopathological recognition. We present a clinicopathological analysis of a case of follicular AOT affecting the mandible in a 9 years-old female patient associated with unerupted lower left canine. Immunohistochemical study showed some data previously unrecognised. All cellular types that composed AOT showed nuclear positivity for p63 indicating a basal characterization in the different cellular components. According to its benign character and low potential for recurrence, AOT revealed a scant proliferative activity (2-3% nuclei showed Ki-67 positivity) limited to some epithelial nodules (AE1-3 +) of fusiform appearance. Absence of reactivity for hormonal receptors (RE and RPg) excluded a possible hormonodependence in AOT that could explain the observed female predominance.

Structural and functional salivary disorders in type 2 diabetic patients

La diabetes mellitus tipo 2 es el desorden metabólico más frecuente, siendo además causante de una importante morbi-mortalidad. En estos pacientes se han descrito alteraciones estructurales de la parotida (sialosis) que podrían comportar modificaciones en la composición salivar, así como un incremento de patología dental y periodontal. Objetivos: establecer las alteraciones bioquímicas de la saliva y su posible correlación con los hallazgos morfológicos. Diseño del estudio: se realizo un estudio clínico de 33 pacientes, 17 de ellos con diabetes tipo 2. Se recogieron muestras de saliva para análisis bioquímico y suero para control metabólico. Resultados: en la saliva de los pacientes diabéticos encontramos un incremento de la urea y las proteínas totales, así como una reducción de la microalbumina. La glucosa salivar estaba solo aumentada en los diabéticos con mal control metabólico. Los síntomas de xerostomía se detectaron en el 76,4% de los casos y las lesiones dentales y periodontales en el 100% de los pacientes. Conclusión: estos desordenes bioquímicos en la saliva de los pacientes con diabetes tipo 2 se pueden correlacionar con las alteraciones estructurales descritas previamente.

Diabetes mellitus type 2 is the most common metabolic disorder and it causes an important morbimortality. The structural modifications in the parotid gland (sialosis) had already been described in these patients and could result in variations in the salivary composition, as well as an increase in periodontal and dental pathology. Objectives: to compare the biochemical findings in the saliva and to correlate these biochemical disturbances with the morphologic findings previously described. Patients and methods: clinical information were gathered about 33 patients, 17 had type 2 diabetes. Samples of whole saliva were obtained for biochemical analysis and serum samples to determine metabolic control. Results: in the diabetics saliva we found urea and total proteins increased and reduced levels of microalbumina. Salivary glucose was only augmented in patients with poor metabolic control. Clinical symptoms of xerostomia were present in 76,4% and dental and periodontal disease in 100%. The parotid gland was characterised by the presence of small acini, lipid intracytoplasmic droplets, as well as adipose stroma infiltration. The acinar cytoqueratins expression was heterogeneous and very positive in the hyperplasic ducts. Conclusions: these biochemical disorders in the saliva of the type 2 diabetic patients would be related with the structural changes previously observed in parotid glands.

Immunohistochemical evaluation of metallothionein in palatal mucosal cells of mice treated with 4NQO

Objective: Metallothionein (MT) may play a preventive role in various carcinogenic process. 4NQO is an alkaline compound and potent mutagen that causes the formation of DNA adducts. The purpose of this study was to evaluate the immunoexpression of MT in palatal cells of mice submitted to the carcinogen 4NQO. Study design: C57BL/6 mice received applications of 4NQO to palate for periods of 8, 16, 20 and 24 weeks (experimental group). A control group received only applications of propylene glycol for the same periods. Subsequently animals of experimental and control groups were sacrificed and the palate was histologically analysed and MT immunohistochemistry performed. Results: Although morphological atypical features were scant, the expression of MT was higher in the experimental group in comparison to controls. There was an amplified induction of MT expression in oral epithelium of mice treated by 4NQO. Conclusion: These results suggest that MT may act as an endogenous defensive factor against 4NQO in early phases of oral carcinogenesis.

Multiple oral fibropapillomatosis as an initial manifestation of Cowden Syndrome: Case report

El síndrome de Cowden es una infrecuente enfermedad hereditaria englobada dentro de las poliposis gastrointestinales de tipo hamartomatoso. Se caracteriza por asociar anomalías cutaneomucosas y por la extraordinaria tendencia a desarrollar neoplasias malignas, principalmente de mama y tiroides. La importancia de un diagnóstico precoz del síndrome y de un adecuado screening tumoral en pacientes con lesiones papilomatosas cutaneomucosas, nos va a permitir adelantarnos en el diagnóstico de patologías con enorme morbimortalidad asociada en caso de una detección tardía. Presentamos el caso de una paciente diagnosticada de síndrome de Cowden tras consultar por lesiones papilomatosas labiales de largo tiempo de evolución y tratada posteriormente de cáncer de mama y riñón en estadios iniciales. El correcto diagnóstico de una patología banal de mucosa oral, nos ha permitido actuar de manera muy precoz frente a la patología neoplásica asociada a dicha enfermedad.

Cowden syndrome is a rare hereditary disease included within hamartoma-type gastrointestinal polyposis. It is characterised by associated mucocutaneous anomalies and by the extraordinary tendency to develop malignant neoplasia, mainly in the breast and thyroid. Early diagnosis of the syndrome and adequate tumoral screening in patients with mucocutaneous papillomatosis make it possible to make an earlier diagnosis of associated pathologies which have great morbidity when detected late. We present the case of a patient diagnosed with Cowden syndrome after consultation for labial papillomatous lesions of long evolution who was subsequently treated for breast and kidney cancer in initial stages. The correct diagnosis of a banal pathology of oral mucosa made it possible for us to take early action against the neoplastic pathology associated with this disease.

Helicobacter pylori in the dental plaque: Is it of diagnostic value for gastric infection?

Aim: The aim of the present study was the assessment of association of helicobacter pylori of dental plaque and stomach in a more homogenous population and also to determine the diagnostic value of dental plaque for gastric infection. Materials and Methods: Based on the results of Rapid urease test (RUT) on specimens from gastric antrum, 88 patients with symptoms of dyspepsia were assigned into two groups of infected and non-infected with helicobacter pylori. Supragingival plaque samples were collected from mandibular first and second molar area using and sterile curette and were investigated using RUT. Statistical analysis of data was performed using chi-square test and independent t-test. Results: H.pylori was detected in 34.1 % of dental plaque specimens. The prevalence of helicobacter pylori infection in dental was 31.8 % and 36.4 % in patients with and without gastric infection (P=0.6). Also the interaction of age and infection was not significant but the prevalence of H. pylori both in the dental plaque and the stomach of male patients was higher than female patients. Conclusion: there is not any significant association between the helicobacter pylori of the dental plaque and the stomach. Also the dental plaque can not be used as a primary diagnostic aid for gastric infection.

Hamular Bursitis and its possible craniofacial referred symptomatology: Two case reports

El diagnostico del dolor craneofacial esta condicionado al manejo interdisciplinario por lo confuso de su presentación especialmente en la ausencia de signos únicos y objetivos. La bursitis es una entidad patológica recientemente notificada en la zona hamular y que debe ser vinculada al diagnostico por exclusión en desordenes temporomandibulares (DTM) y patologías de oído, nariz y garganta, debido a la sintomatología similar a la de otras condiciones que afectan la región de cabeza y cuello. La bursitis del proceso hamular es un patología dolorosa que puede fácilmente ser confundida con neuralgia del glosofaríngeo o del trigémino que genera gran incomodidad en la orofaringe con sintomatología heterotopica referida y patrón ipsilateral a cara. Esta patología en estados crónicos puede ser responsable de la amplificación del dolor percibido por efecto de excitación central. En este reporte se presentan dos casos clínicos de Bursitis Hamular y su manejo terapéutico conservador. El reconocimiento de la inflamación de la bursa del tendón del músculo tensor del velo palatino suministra al especialista una herramienta más en el manejo del dolor craneofacial.

The diagnosis of craniofacial pain is conditioned by the interdisciplinary management of its presentation especially in the absence of unique and objective signs. Bursitis is a pathological entity recently found in the hamular area and should be included in the diagnosis for exclusion of temporomandibular disorders (TMD), ear-nose-throat pathologies, due to the similar symptomatology to other head and neck conditions. The hamular process bursitis is a painful condition that can easily be confused with glosopharinge or trigeminal neuralgia that generates an uncomfortable feeling in the oropharinge with ipsilateral referred - heteretopic - symptomatology to the head. This pathology, in chronic states, can be responsible for the amplification of the pain perceived by the central excitation effect. In this report are presented two clinical cases of hamular bursitis and its conservative therapeutic management. The recognition of the inflammation of the bursa of the tensor veli palati muscle supplies the specialist with another tool in the management of craniofacial pain.

Incidence of oral sinus communications in 389 upper third molar extraction

Introducción. La incidencia de las comunicaciones bucosinusales (CBS) tras la extracción del tercer molar superior no se conoce con exactitud. Objetivos. El objetivo de este estudio fue identificar la incidencia de las CBS tras la extracción de 389 cordales superiores realizadas durante el año 2003 en el Máster de Cirugía Bucal e Implantología Bucofacial de la Universidad de Barcelona. Material y método. Se registraron diversas variables con el fin de determinar la relación de la extracción del tercer molar con la incidencia de las CBS: la edad y el sexo del paciente, la angulación del cordal, la técnica quirúrgica y la sospecha radiológica de proximidad con el seno maxilar. Resultados. Únicamente el 5.1% (IC 95%: 2.2-7.3%) de las extracciones quirúrgicas de los cordales superiores provocaron una CBS. El riesgo de producir una CBS fue similar en todos los grupos de edad, y aumentó con la profundidad de inclusión del tercer molar, la complejidad de la técnica quirúrgica y al efectuar ostectomía.

Introduction. The incidence of oral sinus communications (OSC) following the extraction of an upper third molar remains uncertain. Objectives. The purpose of this study was to determine the incidence of OSC following the extraction of 389 consecutive upper third molars during 2003 in the Master of Oral Surgery and Orofacial Implantology (Barcelona University, Spain). Patients and method. Different variables were recorded, including patient age, sex, molar angulation, surgical technique and radiological sinus proximity, to determine the relation between third molar extraction and the incidence of OSC. Results. Only 5.1% (95% CI: 2.2-7.3%) of the upper molar surgical extractions produced OSC, the risk of which was found to be similar in all age groups and increased with the depth of third molar inclusion, the complexity of the surgical technique and the performance of an ostectomy.

Retrospective study of 145 supernumerary teeth

Objetivo: El presente estudio retrospectivo pretende describir la distribución de los dientes supernumerarios en una población de pacientes que acuden a una Unidad ambulatoria de Cirugía Bucal. Introducción: Los dientes supernumerarios y la hiperodoncia múltiple se asocian normalmente con diferentes síndromes como el de Gardner o con fisuras faciales; sin embargo, pueden aparecer en pacientes sin ningún tipo de patología. Su prevalencia oscila entre el 0,5 y el 3,8% en la dentición permanente y entre el 0,35 y el 0,6% en la decidua. Pacientes y método: Para ello, se revisaron 36.057 historias clínicas de pacientes que acudieron a nuestro Servicio entre septiembre de 1991 y marzo de 2003. Se recogieron los siguientes datos: edad, sexo, número de dientes supernumerarios extraídos, localización, morfología y tipo de diente supernumerario. El número de pacientes incluidos en el estudio fue de 102. Resultados: De los 147 dientes supernumerarios descubiertos en la cavidad bucal, se extrajeron un total de 145. El grupo más frecuente fue el de los mesiodens (46,9%), seguido por los premolares supernumerarios (24,1%) y los cuartos molares supernumerarios o distomolares (18%). El 74,5% de los dientes supernumerarios se localizaban en el maxilar superior y un 46,9% de los dientes supernumerarios se localizaban en palatino/lingual. La morfología heteromórfica aparecía en dos tercios de los dientes supernumerarios, siendo la más frecuente la conoide. El 29,7% de los dientes supernumerarios producían la inclusión de los dientes permanentes, siendo el mesiodens el que la producía con mayor frecuencia. Conclusiones: Los mesiodens producen con elevada frecuencia la retención de los incisivos permanentes, que erupcionan espontáneamente después de la extracción de los dientes supernumerarios, si tienen espacio suficiente en la arcada y conservan la fuerza eruptiva. Los premolares supernumerarios tienen normalmente morfología eumórfica y son un hallazgo radiológico casual, al no producir ningún tipo de sintomatología.

Objective: The goal of the present retrospective study is to describe the distribution of the supernumerary teeth in a population of patients that have been attended at the Public Clinic of the Department of Oral Surgery. Background: Supernumerary teeth and multiple hyperdontia are usually associated with different syndromes, such as Gardner syndrome, or with facial fissures; however, they can appear in patients without any pathology. Their prevalence oscillates to 0.5-3.8% in patients with permanent teeth and to 0.35-0.6% in patients with primary teeth. Patients and Methods: A total of 36,057 clinical histories of patients that were admitted at the clinic between September of 1991 and March of 2003 were revised. The following data were extrapolated: age, sex, number of extracted supernumerary teeth, localization, morphology and type of supernumerary teeth. Consequently, 102 patients were included into the present study. Results: Of the 147 supernumerary teeth identified in the oral cavities of patients 145 were extracted. The most frequent supernumerary teeth identified were mesiodens (46.9%), followed by premolars (24.1%) and fourth molars or distal molars (18%). As for location, 74.5% of the supernumerary teeth were found in the superior maxillary bone and 46.9% of the supernumerary teeth were present in the palatine/lingual area. Heteromorphology was found in two thirds of the supernumerary teeth, with conical shape being the most frequent. Finally, 29.7% of the supernumerary teeth had occlusion with permanent teeth, and mesiodens were the predominating type of supernumerary teeth that showed this feature. Conclusions: Mesiodens very frequently cause retention of permanent incisors, which erupt spontaneously after the extraction of supernumerary teeth, if there is sufficient space in the dental arch and if they conserve the eruptive force. Generally, supernumerary premolars are eumorphic and are casually discovered during radiological exam, if not producing any symptomology.

Stafne bone cavity: Magnetic resonance imaging

A case of Stafne bone cavity (SBC) affecting the body of the mandible of a 51-year-old female is reported. The imaging modalities included panoramic radiograph, computed tomography (CT) and magnetic resonance (MR) imaging. Panoramic radiograph and CT were able to determine the outline of the cavity and its three dimentional shape, but failed to precisely diagnose the soft tissue content of the cavity. MR imaging demonstrated that the bony cavity is filled with soft tissue that is continuous and identical in signal with that of the submandibular salivary gland. Based on the MR imaging a diagnosis of SBC was made and no further studies or surgical treatment were initated. MR imaging should be considered the diagnostic technique in cases where SBC is suspected. Recognition of the lesion should preclude any further treatment or surgical exploration.

A review of facial injuries due to dog bites

Bite injuries to the head and neck region can result in facial disfigurement with distressing physical and psychological consequences. This article reviewed the causes and management of facial bite wounds due to dog bites. A PUBMED search of the National Library of Medicine from 1995 to December 2005 was conducted. Keywords used in the search were facial wound, bite wound, dog bite. The results showed that the risk factors for dog attacks include: school-aged children, male, households with dogs, male dogs and certain breeds (german shepherds, bull terriers, blue/red heelers, dobermans and rottwellers). Early management of such complex injuries usually guarantees satisfactory outcome. Most of the cases involve a known dog (friends, neighbors) and family pet. Although animal bites are not the most accounted children injuries, deaths may a result of these attacks. Antibiotic therapy is indicated for infected bite wounds and fresh wounds considered at risk for infection, such as extremely large wounds, large hematoma, and cat bites, that appear be more infected than dog bites. Tetanus immunization status and the risk of rabies infection should be routinely addressed in bite wound management. Prevention strategies should be considered for preventing dog bites.

N. Pyogenic granuloma

Antibiotic prophylaxis in pediatric odontology: An update

La mayoría de las infecciones orofaciales tienen un origen odontogénico, son autolimitantes y drenan espontáneamente. Las bacterias que causan estas infecciones son generalmente saprofitas. Además los procedimientos odontológicos invasivos dan lugar a una bacteriemia transitoria. Cuando una lesión oral se contamina por una bacteria extrínseca deben administrarse la pauta antibiótica indicada, tan pronto como sea posible. En caso de pulpitis no suele estar indicado si la infección alcanza sólo al tejido pulpar o los tejidos inmediatamente adyacentes. En caso de dientes avulsionados, se aplicará antibiótico local junto con la administración de antibióticos sistémicos. El profesional debe conocer la severidad de la infección y el estado general del niño para considerar derivarlo al centro médico. En los pacientes cuyo sistema inmune está comprometido debe realizarse profilaxis siempre. Así como en los pacientes con problemas cardiacos asociados con endocarditis o catéteres vasculares o dispositivos protésicos. Los antibióticos administrados oralmente, efectivos ante infecciones odontogénicas es la Penicilina V asociada al ácido clavulánico. En caso de alergias, una alternativa, es la clindamicina. La mayoría de las infecciones agudas se resuelven en 3-7 días. En los últimos años, se tiende a reducir el uso general de antibióticos con propósitos preventivos o terapéuticos.

Most orofacial infections are of odontogenic origin, and are of a self-limiting nature, characterized by spontaneous drainage. The causal bacteria are generally saprophytes. On the other hand, invasive dental interventions give rise to transient bacteremia. When an oral lesion is contaminated by extrinsic bacteria, the required antibiotic treatment should be provided as soon as possible. In the case of pulpitis, such treatment is usually not indicated if the infection only reaches the pulp tissue or the immediately adjacent tissues. In the event of dental avulsion, local antibiotic application is advised, in addition to the provision of systemic antibiotics. The dental professional must know the severity of the infection and the general condition of the child in order to decide referral to a medical center. Prophylaxis is required in all immunocompromised patients, as well as in individuals with cardiac problems associated with endocarditis, vascular catheters or prostheses. Penicillin V associated to clavulanic acid and administered via the oral route is known to be effective against odontogenic infections. In the case of allergies to penicillin, an alternative drug is clindamycin. Most acute infections are resolved within 3-7 days. In recent years, the tendency is to reduce general antibiotic use for preventive or therapeutic purposes.

Telescopic crowns in adult case with lip and palate cleft: Update on the etiology and management

La fisura labiopalatina es una de las malformaciones congénitas craneofaciales más importantes a tener en cuenta por el odontólogo general debido a su alta incidencia y a su elevada repercusión en la cavidad oral. Sus causas se deben a factores genéticos y predominantemente a factores ambientales, haciendo su aparición ya en el período embrionario. El sexo masculino se encuentra más afectado, en una relación de 7:3. La asociación más frecuente es el labio leporino unilateral total con fisura palatina, que es el caso que nos atañe. Presentamos el caso de un varón de 20 años que acude a nuestra consulta demandando una solución estética a su situación dental. El tratamiento efectuado al paciente, así como una puesta al día en cuanto a la etiología y tratamiento en adultos de esta malformación es el motivo del presente artículo.

Lip and palatal clefts are among the most important congenital craniofacial malformations to be taken into account in general dental practice, due to their high incidence and important repercussions upon the oral cavity. The underlying causes are genetic and fundamentally environmental, and the disorders manifest as early as in the embryonic period. Males are predominantly affected, with a 7:3 ratio versus females. Our patient, a 20-year-old male, presented the most common association, i.e., total unilateral hare lip with palatal cleft. A description is provided of the treatment for his dental problem, together with an update on the etiology and management of adults with malformations of this kind.

Aesthetic dentistry: Chromatic appreciation in the clinic and the laboratory

La demanda estética en Odontología va en aumento, una de sus bases es la correcta selección del color de las restauraciones. El color es una cualidad que se ve modulada por una serie de factores ambientales e individuales que el clínico debe conocer. La valoración ocular del color, puede inducir a error de apreciación si no se sigue un protocolo correcto de iluminación, y técnica de observación los autores lo revisan, simplificándolo con un enfoque práctico. Recientemente, han aparecido instrumentos de medición del color que intentan corregir los defectos de la técnica convencional.

Aesthetic requirement in dentistry is getting more and more important every day. One of its basic principles is the correct selection of colour for the restorations. Colour is a quality which is modulated by a series of factors, environmental and individual, that the clinic must know. Colour measurement by the human eye can induce to an appreciation mistake if it doesnt follow a correct protocol of light conditions and observation technique, checked by the authors, simplifying it with a practical focusing. Colour measurement instruments have appeared recently, trying to correct the problems of conventional technique.

Oral health survey of the child population in the Valencia Region of Spain (2004)

Introducción (fundamento y objetivo): La finalidad de establecer una periodicidad sexenal para estudiar la evolución de salud oral infantil unido a importantes cambios demográficos asociados con la inmigración en la Comunidad Valenciana han motivado este trabajo. Material y método: Con una muestra seleccionada al azar de 509 niños de 6 años, 478 de 12 años y 401 de 15-16 años se ha realizado un estudio de corte transversal. Los exploraciones clínicas fueron realizadas por odontólogos calibrados (Kappa > 0.85). Resultados: La prevalencia de caries en dentición temporal a los 6 años es del 32% (Icod=1.08) y en dentición permanente es de 42.5% a los 12 años (ICAOD=1.07) y del 55.9% a los 15-16 años (ICAOD=1.84). Los niveles de caries en los niños inmigrantes son significativamente altos. La media de sextantes con sangrado fue de 0.16, de 1.58 y de 1.10, mientras que con cálculo fue de 0.15, 0.76 y 0.88 respectivamente. Conclusión: Los niveles de caries tanto en dentición temporal como permanente a los 6 y 12 años se mantienen estables, mientras que a los 15-16 años siguen descendiendo. Los niños inmigrantes, con altos niveles de caries, constituyen un grupo poblacional con importantes necesidades de tratamiento y de aplicación de programas preventivos.

Introduction (basis and objectives): The objectives of this study were to study the evolution of child oral health in the Valencia Region and establish a six-year interval for these surveys, at a time of major demographic changes associated with immigration into the region. Materials and Methods: A cross sectional study was conducted in a random sample of 509 children aged 6 years, 478 aged 12 years and 401 aged 15-16 years. The clinical examinations were performed by calibrated dentists (Kappa > 0.85). Results: Caries prevalence was 32% at 6 years of age (dft=1.08) in primary dentition and 42.5% at 12 years (DMFT=1.07) and 55.9% at 15-16 years (DMFT=1.84) in permanent dentition. Caries levels in immigrant children were significantly high. The mean numbers of sextants with bleeding were 0.16, 1.58 and 1.10 while the scores for sextants with calculus were 0.15, 0.76 and 0.88, respectively. Conclusions: Caries levels in both primary and permanent dentition have remained stable at 6 and 12 years of age and have continued to fall in the 15-16-year-old age group. Immigrant children have high caries levels and are a population group in serious need of treatment and prevention plans.

Periodontal regeneration in clinical practice

Siempre se ha considerado que el objetivo ideal de la terapia periodontal es la regeneración o restitución de los tejidos de soporte perdidos. Sin embargo, el intentar traducir este objetivo, en actuaciones clínicas concretas puede convertirse en una tarea tremendamente compleja y cuyos resultados disten mucho del objetivo inicial. La intención de este artículo es ofrecer una perspectiva general y actualizada de la regeneración periodontal que permita al clínico situarla dentro de la estrategia de tratamiento oral global. Para ello se revisa: el proceso de curación de la herida periodontal, los diferentes enfoques terapéuticos, la interpretación de los resultados, y por último, los factores que limitan las indicaciones de las técnicas de regeneración periodontal.

The regeneration or restitution of lost supporting tissue has always been considered the ideal objective of periodontal therapy. However, attempts to convert this intention into solid clinical practice can become tremendously complex, the results of which are very different from the original intention. The aim of this article is to offer an up-to-date, general perspective on periodontal regeneration, orienting the clinician within the global strategy for oral treatment. To this end, we revise the healing process of periodontal injury, the different therapeutic approaches, the interpretation of the results, and finally, limiting factors in periodontal regeneration.