Mucosal Quality Research Articles

Dental restorative materials and special consideration for the elderly

With the global population aging, the oral health of elderly individuals faces unique challenges, particularly concerning dental caries. Root caries, in particular, have become a growing concern due to the significant number of retained teeth in older adults. This review delves into the frequency of root caries among older individuals and examines the limitations of existing dental restorative materials, including amalgam, glass ionomer cement, and light-cured composite resin, in meeting the unique requirements of the elderly. It underscores the urgent necessity for improving the antibacterial, bonding, remineralization, strength, and durability characteristics of these materials. Additionally, the study discusses factors related to aging, treatment planning, and special considerations in geriatric dental care. The review also delves into the challenges associated with providing dental care to elderly individuals, including depression, postural hypotension, prescribed drugs, delayed healing, adaptive potential, mucosal quality, and poor plaque control. Moreover, it addresses the role of xerostomia, bruxism, and certain medical conditions in exacerbating dental issues in the elderly. It also introduces novel anticariogenic restorative materials, such as antimicrobial materials, remineralization materials, and self-healing/low-shrinkage materials, highlighting their potential to improve oral health in older individuals.

Risk Characteristics of Peri-Implant Infections: A Retrospective Evaluation in a University Consultation Setting

Peri-implantitis is a common biological complication in dentistry. The aim of the present study was to retrospectively analyze risk characteristics in a group of patients referred to a university-based consultation for peri-implantitis. In all, 190 initial cases from 2010 to 2019 were evaluated and descriptively summarized. The evaluation included various parameters such as periodontitis, smoking and oral hygiene status, implant position, type of prosthetic restoration and retention, mucosal quality, and further anamnestic and clinical findings related to the potential risk of developing peri-implantitis. Peri-implantitis was diagnosed in 83% of the cases, with peri-implant mucositis alone in 16% of cases; furthermore, 38% of the patients were diagnosed with active/instable periodontitis, while 14% had stable periodontitis. Residual cement was considered as a potential co-factor of peri-implant inflammation in 43% of cases. Suboptimal implant positioning was found in 19% of patients. Peri-implantitis or peri-implant mucositis was present in about one-third of patients in the absence of smoking and periodontitis factors. Of note, 6% showed no identifiable risk factors. Factors related to an increased risk of peri-implantitis should be taken into consideration when planning implant treatment. Adequate prosthetic implant position, restoration, and cleanability remain important for long-term success.

Endoscopic Closure of Septal Perforations

ObjectiveThe management of septal perforations is a challenge for the surgeon. A wide variety of surgical techniques have been described, with different approaches. There is no scientific evidence to support a particular approach. The objective of this review is to present a practical guide on the technique of choice for each case of septal perforation. DiscussionInspection of the nasal mucosa, the size of the perforation, the location and especially the osteo-cartilaginous support, are the pillars of a successful surgery. For the sliding or rotating flaps of the mucosa of the septum it is essential to know in advance if the elevation of the mucopericondrio or mucoperiosteo of the septum is possible, otherwise the use of these flaps would not be indicated. The flaps of the lateral wall or nasal floor are the alternative. The pericranial flap may be indicated in total or near total perforations. ConclusionThe remnant of the nasal septum and status of osteo-cartilaginous support are the determining factors in the management of septal perforations. Each case should be evaluated individually and the approach chosen according to the size and location of the perforation, mucosal quality, personal history, previous surgery and the experience of the surgeon.

Cierre endoscópico de las perforaciones septales

ObjectiveThe management of septal perforations is a challenge for the surgeon. A wide variety of surgical techniques have been described, with different approaches. There is no scientific evidence to support a particular approach. The objective of this review is to present a practical guide on the technique of choice for each case of septal perforation. DiscussionInspection of the nasal mucosa, the size of the perforation, the location and especially the osteo-cartilaginous support, are the pillars of a successful surgery. For the sliding or rotating flaps of the mucosa of the septum it is essential to know in advance if the elevation of the mucopericondrio or mucoperiosteo of the septum is possible, otherwise the use of these flaps would not be indicated. The flaps of the lateral wall or nasal floor are the alternative. The pericranial flap may be indicated in total or near total perforations. ConclusionThe remnant of the nasal septum and status of osteo-cartilaginous support are the determining factors in the management of septal perforations. Each case should be evaluated individually and the approach chosen according to the size and location of the perforation, mucosal quality, personal history, previous surgery and the experience of the surgeon.

Inhaled Corticosteroids: Hazardous Effects on Voice—An Update

Inhaled corticosteroids (ICS) have become the prevalent treatment in asthmatics. Hazards to voice are under-recognized. A total of 38 patients with voice complaints associated with the use of ICS were assessed by 79 strobovideolaryngoscopy (SVL) examinations, 24 single and 14 multiple SVL. Hoarseness and dysphonia were the primary reasons for referral. The ICS initially used most frequently was Advair Diskus (fluticasone propionate and salmeterol-inhalation powder-[IP]) in 22 patients, followed by Flovent (fluticasone propionate inhalation aerosol-pressurized metered-dose inhaler-[PMDI]) in 11. Duration of ICS usage varied from 2 weeks to 4-5 years. Higher dosage and frequency of use exacerbated problems. Hazards to voice previously unrecognized by real-time indirect mirror or fiberoptic laryngoscopy were identified by meticulous attention to SVL abnormalities. There was essentially no difference in occurrence of abnormalities whether analyzed from the perspective of the initial 38 or all 79 examinations. These included abnormal mucosal wave symmetry/periodicity (76-63%), phase closure (74-63%), glottic closure (63-59%), mucosal wave amplitude/magnitude (50-35%), supraglottic hyperactivity (39-25%), mucosal quality (34-34%), and glottic plane (10-5%). Candidiasis of the larynx was infrequently observed. Fluticasone ICS were a cause of steroid inhaler laryngitis, and the best treatment was their avoidance or cessation. Further prospective studies ideally might include SVL documented as a pretherapy baseline and then repeated in each ICS patient who developed hoarseness/dysphonia.

Principes généraux de la chirurgie des lèvres

A successful lip reconstruction gives a shape illusion and re-establishes physiological function. We must be able to respect static and dynamic function and the axiom “use of lip to repair lip defect”. Local flaps provide optimal tissue to replace the lip in the surrounding structures, to respect aesthetic subunits and commissural function, to give a neuro-muscular continuity respecting fibers direction and mucosal quality. If extra-labial tissue is necessary, the use of the same principles enables the best compromise in shape and function as possible.