Objective: The use of local anesthetics associated to vasoconstrictor agents in dentistry is thoroughly justified and is widely extended, but we cannot ignore the fact that anesthetic infiltration poses risk of complications throughout the dental treatment period. The objective of the present review is to document the reported effects the use of the local anesthetics most widely employed in dentistry, with or without association to vasoconstrictor agents may have in patients with any sort of cardiopathy.
Study Design: We have searched for randomized clinical trials on the assessment of the cardiovascular effects of local anesthetics used in dentistry, without limits as regards age or sex, conducted in patients with any type of cardiopathy which were published during the last decade and were index-linked in Cochrane, Embase and Medline.
Results: We have found six randomized clinical trials index-linked in Medline and Cochrane in the past ten years. These trials compare different types of anesthetics: lidocaine 2%, mepivacaine 2%, prilocaine 2% , associated or not to different vasoconstrictor concentrations such as adrenaline or felypressin. The cardiopathies affecting the patients included in the different trials range from hypertension, ischemic heart disease, arrythmias, chronic coronary disease to heart transplantation.
Conclusions: The use of anesthetics associated to vasoconstrictor agents is justified in the case of patients with cardiopathies (once we get over the period in which any type of dental manipulation is contraindicated) and in controlled hypertensive patients. In any case, we must be very careful with the choice and execution of the anesthetic technique, being it possible to use a dose between 1.8 and 3.6 ml, on a general basis. Further studies are necessary to establish the effects of these drugs on severe hypertensive patients or in patients with other more advanced cardiopathies.
Key words:Vasoconstrictor agents, epinephrine/adverse effects, local anesthetics, dental restoration, oral surgery, cardiovascular diseases, coronary arteriosclerosis, heart disease, hypertension, arrhythmias, coronariopathy.
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Keywords:Lower dental nerve Anatomy Cone bean computed tomography Bone graft of mandibular body a b s t r a c t Aim: The aim of this study was to determine the reliability of cone beam computed tomography to locate and take measurements of the mandibular canal, as well as the vestibular bone wall, in the planning of the bone graft surgery in the mandibular body.Material and methods: A total of 11 mandibles from fresh cadavers were studied (22 hemimandibles, half of them with teeth). A CBTC and a surgical procedure for the lateralization of the lower dental nerve were performed with the aim of measuring the thickness of the vestibular table and the mandibular canal (MC) or lower dental nerve at 5, 15, and 25 mm from the most posterior position of the mentonian hole.
Results:The results obtained in the study indicate that CBTC, being the best diagnostic tool currently available, still appears to be unreliable when compared to actual results. This discrepancy is a mean of 1.15 mm as regards the thickness of the vestibular bone wall that covers the MC, and a mean of 0.3 mm in relation to the thickness of the lower dental nerve.Discussion: It is important to know and assess these discrepancies in view of the multitude of surgical procedures that can be performed in this area, and in the vicinity of the lower dental nerve.Padrós E, et al. Fiabilidad del uso de la tomografía computarizada de haz cónico en la localización y medida del conducto mandibular en la planificación de técnicas quirúrgicas en el cuerpo mandibular. Rev Esp Cir Oral Maxilofac. 2015. http://dx.Discusión: Conocer y valorar estas discrepancias es importante dada la multitud de procedimientos quirúrgicos que se pueden realizar en esta zona, y la vecindad con el nervio dentarioinferior.bajo la licencia CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Diagnóstico y tratamiento de las periimplantitis. Actualización en el diagnóstico clínico y en el tratamiento de las periimplantitis Diagnóstico y tratamiento de las periimplantitis. Actualización en el diagnóstico clínico y en el tratamiento de las periimplantitis GARCÍA-CALDERÓN
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