Resolución Quirúrgica para Un Caso de Polisinusitis de Origen Odontogénico / Surgical Resolution for A Case of Polysinusitis of Odontogenic Origin

La celulitis orbitaria es una patología grave que está asociada con sinusitis paranasal. Éstas suelen presentar edema periorbitario, dolor, y movimiento extraocular restringido. La mayoría de los casos presentan pronóstico favorable, asociado a terapia antibiótica o drenaje quirúrgico. Las celulitis de origen odontogénico representan 2 a 5 % de todos los casos; se caracterizan por una diseminación del proceso infeccioso desde los ápices de las raíces, infectando al seno maxilar, llegando a la órbita a través de la fisura orbitaria inferior o a través de un defecto en el piso de la órbita. En el presente estudio se reporta el caso de un paciente masculino de 28 años que consulta por aumento de volumen periorbitario izquierdo con 4 días de evolución, posterior a exodoncia de segundo molar superior izquierdo. Al examen extraoral presenta aumento de volumen izquierdo con eritema periorbitario, proptosis ocular ipsilateral con visión conservada, y salida de líquido purulento por fosa nasal izquierda. En los exámenes de laboratorio e imagenológicos se pesquisa compromiso de seno maxilar, etmoidal y esfenoidal, decidiendo su hospitalización y manejo quirúrgico en tres tiempos operatorios, los cuales permiten acceso a pared anterior del seno maxilar y a espacio pterigoideo. Dentro de los diagnósticos de celulitis orbitaria pueden incluir reacciones alérgicas, conjuntivitis o herpes. Se excluyeron los diagnósticos mencionados debido a que no se observaron alteraciones dermocutáneas periorbitarias. Por el contrario, el compromiso unilateral, movimiento ocular alterado y doloroso indica que el cuadro abarcaba espacios profundos. La infección de senos paranasales posterior a una exodoncia es una complicación poco frecuente. Un diagnóstico temprano adecuado disminuye la morbilidad y mortalidad de esta condición. Debemos estar alertas a complicaciones posteriores en procedimientos realizados, tener conocimiento en diagnóstico y manejo de posibles evoluciones tórpidas en pacientes.

Orbital cellulitis is a serious pathology that is associated with paranasal sinusitis. These medical conditions usually present with periorbital edema, pain, and restricted extraocular movement. Most cases have a favorable prognosis, associated with antibiotic therapy or surgical drainage. Cellulitis of odontogenic origin represents 2 to 5 % of all cases. They are characterized by a spread of the infectious process from the apices of the roots, infecting the maxillary sinus, reaching the orbit through the inferior orbital fissure or through a defect in the floor of the orbit. The present study reports the case of a 28-year-old male patient, who consulted for a volume increase in left periorbital volume with 4 days of evolution, after extraction of the upper left second molar. Extraoral examination showed left volume increase with periorbital erythema, ipsilateral ocular proptosis with preserved vision, and discharge of purulent fluid from the left nostril. The laboratory and imaging tests showed compromise of the maxillary, ethmoid and sphenoid sinus deciding on hospitalization and surgical management in three operative times, which allow access to the anterior wall of the maxillary sinus and the pterygoid space. Diagnoses of orbital cellulitis may include allergic reactions, conjunctivitis, or herpes. These diagnoses were excluded because no periorbital dermocutaneous alterations were observed. In contrast, unilateral involvement, impaired eye movement, and pain indicate that the condition involved deep spaces. Paranasal sinus infection after tooth extraction is a rare complication. An early diagnosis adequately decreases the morbidity and mortality of this condition. We must be alert to subsequent complications in procedures performed, have knowledge in diagnosis and management of possible torpid evolutions in patients.

Efectividad del uso transoperatorio de solución electrolizada de superoxidación para la prevención de infecciones postoperatorias en cirugía de terceros molares / Effectiveness of the trans-operative use of electrolyzed superoxidation solution for the prevention of post-operative infections in third molar surgery

La cirugía de terceros molares es uno de los procedimientos más realizados dentro de la práctica odontológica, generalmente conlleva la prescripción de fármacos, incluidos antibióticos indicados para prevenir la aparición de procesos infecciosos. La resistencia antimicrobiana es considerada como un problema de salud pública a nivel mundial, por lo que el uso de antibióticos debe ser cauteloso. La solución electrolizada de súperoxidación ha demostrado tener efectos bactericidas, virucidas y ha sido utilizada para la prevención y el tratamiento de procesos infecciosos. El objetivo del presente estudio fue demostrar la efectividad de dicha solución en la prevención de infecciones posteriores a la cirugía de terceros molares. Se realizó un estudio aleatorizado, ciego, prospectivo en 20 pacientes utilizando un diseño split mouth, en donde cada paciente fue sujeto control y experimental, en el grupo control se irrigó durante el procedimiento con solución de súperoxidación y no se prescribió antibiótico posterior, mientras que en el grupo control se irrigó con solución fisiológica y se prescribió antibiótico posterior. Se realizaron 40 cirugías en 20 pacientes utilizando en cada paciente ambas terapéuticas. Se analizó el dolor postoperatorio, inflamación y presencia de infección. El dolor y la inflamación fueron ligeramente superiores en el grupo experimental al tercer día; sin embargo, al séptimo día los resultados fueron similares. No se presentó ningún caso de infección postoperatoria. El uso de solución de súperoxidación transoperatoria puede ser una herramienta muy útil en la prevención de infecciones postoperatorias posterior a cirugía de terceros molares en pacientes sanos en cirugías con dificultad leve a moderada (AU)

Third molar surgery is one of the most performed procedures in dental practice, generally involving the prescription of drugs including antibiotics indicated to prevent the onset of infectious processes. Antimicrobial resistance is considered a public health problem worldwide, so the use of antibiotics should be cautious. The electrolyzed super oxidation solution has been shown to have bactericidal and virucidal effects and has been used for the prevention and treatment of infectious processes. The objective of the present study was to demonstrate the effectiveness of said solution in the prevention of infections after third molar surgery. A randomized, blind, prospective study was conducted in 20 patients using a split mouth design where each patient was a control and experimental subject, in the control group they were irrigated during the procedure with super oxidation solution and no subsequent antibiotic was prescribed. while the control group was irrigated with physiological solution and a subsequent antibiotic was prescribed. Forty surgeries were performed on 20 patients using both therapies in each patient. Postoperative pain, inflammation and presence of infection were analyzed. Pain and inflammation were slightly higher in the experimental group on third day, however on seventh day the results were similar. There were no cases of postoperative infection. The use of trans operative super oxidation solution can be a very useful tool in the prevention of postoperative infections after third molar surgery in healthy patients undergoing surgeries with mild to moderate difficulty.(AU)

Efficacy of Buccal Infiltration with or without Palatal Injection for Posterior Maxillary Teeth Extraction - A Split-Mouth Randomized Trial

ABSTRACT Objective: To evaluate the feasibility of posterior maxillary teeth extraction buccal infiltration with or without the use of palatal injection. Material and Methods: A total of 70 patients underwent extraction of bilateral maxillary posterior teeth under 2% lignocaine hydrochloride with 1:2,00000 adrenaline infiltration in this single-centric split-mouth randomized trial. The test side was administered with a buccal infiltration of 2 mL of anesthetic alone. An extended waiting period of 10 minutes was given before the commencement of the procedure. A standard protocol was followed for the control side. A single operator performed all extractions. Results: A total of 140 posterior maxillary teeth were extracted. Patients marked pain perception on a visual analogue scale in three different instances. During the administration of injections for the test side, the pain score was less than that of the control side and was statistically significant. The overall pain during the extraction procedure was comparable and statistically insignificant. The overall success of the method was 90%. Conclusion: Extraction of posterior maxillary teeth was feasible with a single buccal infiltration without palatal injection in most cases using an extended waiting period. Dentists can attempt extraction without palatal injections with optimal success. However, the alternate technique could be used when there is a necessity for rescue palatal anesthesia.

Relación entre la presión arterial y el control de la hemorragia post-exodoncia en pacientes bajo tratamiento con warfarina / Relationship between blood pressure and hemorrhage control post exodontia in patients under warfarin treatment

Objetivo: Determinar la relación entre el nivel de pre- sión arterial (PA) y la hemorragia post-exodoncia aplicando medidas de hemostasia local en pacientes bajo tratamiento con warfarina. Materiales y métodos: Este estudio se realizó sobre 30 pacientes (15 hombres y 15 mujeres) bajo tratamiento anti- coagulante oral (TACO) con warfarina. Los pacientes concu- rrían al programa de TACO del Hospital y Centro de Referen- cia de Salud El Pino (HEP y CRS). Se les realizaron una o dos extracciones dentales (n=38) sin suspensión del anticoagulan- te oral a pacientes que tuvieran un coeficiente internacional normalizado (INR) del día menor o igual a 3. Se aplicaron medidas de hemostasia local con gasa compresiva y/o sutura en 30 de las extracciones dentales. Los procedimientos quirúr- gicos fueron llevados a cabo en el Servicio Dental del CRS y HEP. Se registraron las siguientes variables: 1) PA previa a la exodoncia, 2) PA a los 30 minutos, 3) Presencia o ausencia de hemorragia a los 30 minutos post-exodoncia y 4) PA y presen- cia o ausencia de hemorragia a las 24 horas post-exodoncia. Se estudió la relación entre el nivel de PA y la hemorragia post-exodoncia. Resultados: De todos los pacientes evaluados, ninguno presentó hemorragia post-exodoncia en los distintos momen- tos de evaluación, independientemente de cuál fuera su PA. No se encontraron efectos de la variable PA ­considerando valores de PA sistólica (PAS) por debajo de 140 mmHg y de PA diastólica (PAD) menores a 90 mmHg- en relación con la hemorragia post-exodoncia. Conclusión: De acuerdo con los resultados obtenidos en este estudio, la presión arterial con PAS <140 mmHg y PAD <90 mmHg no es un factor que influya en el sangrado post-exodoncia en pacientes bajo tratamiento con warfarina con ≤3 (AU)

Aim: To establish the relationship between blood pres- sure (BP) level and post-exodontic hemorrhage by applying local hemostasis measures in patients under warfarin treat- ment. Materials and methods: This study was conducted in 30 patients (15 men and 15 women) under oral anticoagu- lant (OAC) treatment with warfarin. The patients attended the TACO program of the "Hospital y Centro de Referencia de Salud el Pino (HEP y CRS)". One or two dental extractions (n=38) were performed in the patients that had an INR low- er or equal to 3, without suspending the oral anticoagulant treatment, applying local hemostasis measures with compres- sive gauze and/or suture in 30 of the extractions. The surgical procedure was carried out in the Dental Department of the CRS and HEP. The following variables were registered: 1) BP prior to extraction, 2) BP after 30 minutes, 3) presence or absence of hemorrhage after 30 minutes post-exodontia and 4) BP and presence or absence of hemorrhage 24 hours post-exodontia. The relation between BP level and post-exo- dontic bleeding was studied. Results: Considering all the examined patients, none of them presented post-exodontic hemorrhage at any of the dif- ferent moments of evaluation, regardless of their BP level. No effect of the BP variable ­considering a range of systolic BP SBP) below 140 mmHg and a diastolic BP (DBP) under 90 mmHg- was found in relation to post-exodontic hemorrhage. Conclusion: According to the results obtained in this study, blood pressure with SBP <140 mmHg and DBP <90 mmHg is not an influential factor in post-exodontic bleeding in patients under warfarin treatment with ≤3 (AU)

Increased Expression of RUNX2 and ALP Resulting from a Combination of Propolis Extract and Bovine Bone Graft in Socket Preservation Material

Abstract The aim of this study was to determine the inductive effect of a combination of propolis and BBG extract on RUNX2 and ALP expression in the tooth extraction sockets of Cavia cobaya. Fifty- six Cavia cobaya were divided into four groups: polyethylene glycol (PEG), propolis extract + PEG, BBG + PEG, and propolis extract + BBG + PEG. The lower left incisor was extracted, and the socket subsequently filled with material according to the specific group of which the subject was a member. The subjects were sacrificed on the 14th and 30th days. Immunohistochemical staining was carried out under a light microscope at 400x magnification. Statistical analysis was then carried out by means of One-Way ANOVA and Tukey HSD tests. The mean number of RUNX2 and ALP expressions in each group was significantly different. The highest number of RUNX2 and ALP expressions occurred in the propolis + BBG + PEG group on the 30th day, while the lowest expressions were observed in the control group on the 14th day. A combination of propolis and BBG extract at a concentration of 2% of active substance effectively increases the expression of RUNX2 and ALP in preserving the tooth extraction sockets of Cavia cobaya.

Remoción diferida de un tercer molar superior impulsado a la región infratemporal / Deferred removal of a third upper molar driven to the infratemporal region

La cirugía de los terceros molares retenidos puede ser considerada una intervención de rutina para el cirujano bucomaxilofacial. Como todo procedimien-to quirúrgico, puede presentar complicaciones intra y postoperatorias. Las más frecuentes son el dolor, edema, trismus, hemorragia y fracturas de las piezas dentarias a extraer, o de las tablas óseas. Pero tam-bién se pueden presentar otras complicaciones ines-peradas, como la impulsión o desplazamiento de la pieza dentaria a espacios anatómicos vecinos, entre los que podemos encontrar al espacio pterigomandi-bular, la celda submaxilar, el seno maxilar, el espacio infratemporal, según se trate de terceros molares retenidos inferiores o superiores. En el presente ar-tículo, se describe una situación clínica de un tercer molar superior, que fue accidentalmente impulsado a la región infratemporal, y removido en una segunda cirugía realizada 3 semanas después del primer in-tento de exodoncia. Se analizan también los estudios preoperatorios para su correcto diagnóstico, y las maniobras clínicas e instrumentales tendientes a po-sibilitar su remoción minimizando las complicaciones intra y postquirúrgicas (AU)

Surgery of retained third molars can be considered a routine intervention for the oral surgeon. Like any surgical procedure, it can present intra and posto-perative complications. The most frequent are pain, edema, trismus, hemorrhage and fractures of the teeth to be extracted or of the bone tables. But other unexpected complications can also occur, such as the impulsion or displacement of the tooth to neighbo-ring anatomical spaces, among which we can find the pterygomandibular space, the submaxillary cell, the maxillary sinus, the buccal space, the infratemporal space and the lateral pharyngeal space, depending on whether they are lower or upper retained third mo-lars. In this article, the clinical case of a third upper molar is described, which was accidentally driven to the infratemporal region, which was removed in a second surgery performed 3 weeks after the first attempt at exodontics. It should be noted the impor-tance of diagnostic imaging as an indispensable com-plement to the correct location of the displaced tooth and its subsequent removal (AU)

Evaluating the risk factors of inferior alveolar nerve injury following removal of the mandibular third molars / 中华口腔医学杂志

Objective: To evaluate the risk factors of inferior alveolar nerve injury (IANI) after surgical removal of the mandibular third molars (M3) and present a new risk scoring system to predict the probability of IANI. Methods: Patients who underwent extraction of M3 in the Stomatology Hospital, Zhejiang University School of Medicine from April 2017 to December 2019 were involved. The investigators enrolled a sample composed of 949 mandibular third molars. Prediction model was used for univariate and multivariate analysis of gender, age, M3, inferior alveolar canal (IAC), and the contact between M3 and IAC, to assess the risk factors of IANI. Combined with the risk factors determined by the outcomes of prediction model, the risk scoring system was constructed. The diagnostic performance of each cut-off score was examined to conduct a risk stratification of IANI risk scores. The predictive ability and reliability of the model were evaluated. Results: In prediction model, twenty nine cases (4.4%, 29/664) experienced postoperative IANI. Number of root (P<0.01), depth of impaction (P<0.05), contact between M3 and IAC (P<0.01) and their contact position (P<0.05) were statistically significant as contributing risk factors of IANI. Specifically, the incidence of temporary IANI was higher in those who aged under 25 years (P<0.001), while female suffer more permanent injury (P<0.05). Based on the IANI risk scoring system, patients were stratified into low-risk, middle-risk and high-risk groups at cutoff scores of 3 and 4. The area under the receiver operator characteristic curve of the risk scoring system were 0.81 [95%CI (0.70-0.90), P=0.002] and 0.80 [95%CI (0.68-0.92), P=0.007] towards good discrimination. Conclusions: Age, gender, number of root, depth of impaction, and contact between M3 and IAC were risk factors of IANI. IANI risk scoring system might help in preoperative assessment, recognition of high-risk cases and decision-making to reduce IANI.

Factors affecting the stability of maxillary extraction site closure

ABSTRACT Introduction: A side effect observed in cases treated with extractions is the instability of orthodontic space closure. Objective: The aim of this study was to investigate the influence of gingival invagination, presence of third molars and facial pattern, on the stability of orthodontic space-closure in the maxillary arch. Methods: Ninety-nine subjects (41 male and 58 female) with Class I malocclusion treated with four premolars extraction were evaluated. Extraction sites reopening and gingival invaginations were evaluated in scanned dental models in the posttreatment and 1-year posttreatment stages (mean age 16.1 years). Third molars presence was evaluated at 1-year posttreatment panoramic radiographs, and the facial pattern (SN.GoGn) was evaluated in the initial lateral headfilms. Multiple logistic regression analysis was used to estimate the influence of the aforementioned independent variables on the frequency of extraction space reopening. Results: Space reopening was observed in 20.20% of the subjects 1-year post-debonding. Gingival invaginations were present in 25.73% of quadrants after debonding and in 22.80% 1-year posttreatment. The mean pre-treatment SN.GoGn was 35.64 degrees (SD=5.26). No significant influence was observed of the three independent variables on the instability of extraction site closure. Conclusions: The presence of gingival invaginations, third molars and facial growth pattern do not seem to influence maxillary extraction sites reopening.

RESUMO Introdução: Um efeito colateral observado nos casos tratados com extrações é a instabilidade do fechamento ortodôntico do espaço. Objetivo: O objetivo do presente estudo foi investigar a influência da invaginação gengival, da presença de terceiros molares e do padrão facial na estabilidade do fechamento ortodôntico dos locais de extração na arcada superior. Métodos: Noventa e nove indivíduos (41 homens e 58 mulheres) com má oclusão de Classe I tratados com extração de quatro pré-molares foram avaliados. A reabertura dos locais de extração e as invaginações gengivais foram avaliadas nos modelos dentários digitalizados nos estágios pós-tratamento e um ano pós-tratamento (idade média de 16,1 anos). A presença dos terceiros molares foi avaliada em radiografias panorâmicas de um ano pós-tratamento, e o padrão facial (SN.GoGn) foi avaliado nas radiografias laterais iniciais. Análise de regressão logística múltipla foi utilizada para estimar a influência das variáveis independentes citadas na frequência de reabertura do espaço de extração. Resultados: A reabertura do espaço foi observada em 20,20% dos sujeitos um ano após a remoção do aparelho. Invaginações gengivais estiveram presentes em 25,73% dos quadrantes após a remoção do aparelho e em 22,80% após um ano pós-tratamento. O SN.GoGn pré-tratamento médio foi de 35,64 graus (DP = 5,26). Não foi observada influência significativa das três variáveis independentes sobre a instabilidade do fechamento do local de extração. Conclusões: A presença de invaginações gengivais, terceiros molares e padrão de crescimento facial não parece influenciar na reabertura dos locais de extração maxilar.

The influence of flap design on patients' experiencing pain, swelling, and trismus after mandibular third molar surgery: a scoping systematic review

Abstract Third molar removal surgery usually comes accompanied by postoperative discomfort, which could be influenced by the surgical approach chosen. This scoping systematic review aimed at compiling the available evidence focused on the influence of flap design, including envelope flap (EF), triangular flap (TF), and modified triangular flap (MTF), on postoperative pain, swelling, and trismus, as primary outcome measures, and any result mentioning healing promotion or delay, as secondary outcome measure, after mandibular third molar extraction surgery. An electronic search, complemented by a manual search, of articles published from 1999 to 2020 was conducted in the Medline (PubMed), EMBASE and Web of Science databases including human randomized controlled trials, prospective, and retrospective studies with at least 15 patients. The risk of bias of the included studies was assessed either with the Cochrane's Risk of Bias tool or with the Newcastle-Ottawa scale. Every step of the review was performed independently and in duplicate. The initial electronic search recovered 2102 articles. After applying the inclusion criteria, 12 articles were included. For patient's perceived postoperative pain, TF and MTF frequently reported better results than EF. For swelling, the literature is divided, despite a trend favoring EF. For trismus, data showed that its occurrence is mostly associated with the duration of the surgery rather than with the chosen flap. For healing, the limited data is inconclusive. Finally, randomized studies showed a high risk of bias, whereas nonrandomized studies were mostly of good quality and low risk of bias. Although there was no clear consensus regarding the influence of different flap designs for third mandibular molar extraction on postoperative clinical morbidities; the surgeon's experience, estimated surgical difficulty, molar position and orientation, and surg ery duration should be considered when choosing among the different flap designs.

Clinical evaluation of single and repeated sessions of photobiomodulation with two different therapeutic wavelengths for reducing postoperative sequelae after impacted mandibular third molar surgery: a randomized, double-blind clinical study

Abstract The effects of the number of photobiomodulation (PBM) sessions on the postoperative inflammatory process remain controversial. The current literature comparing single and repeated PBM sessions is limited. Objective This study aimed to compare the effects of single and repeated PBM sessions, applied at two different therapeutic wavelengths within the infrared spectrum, on postoperative inflammatory response after impacted third molar tooth extraction. Methodology This randomized, double-blind clinical study included 40 patients with bilateral impacted mandibular third molars (80 teeth). The patients were divided into two groups each including 20 subjects (40 teeth) to receive either single-session laser at 810 nm (20 teeth) and 940 nm (20 teeth) immediately after the surgery or repeated laser sessions at 810 nm (20 teeth) and 940 nm (20 teeth) (immediately after the surgery and on postoperative Day 1). Lasers at 940 nm (power density 0.5 Watt/cm2, energy density 4 J/cm2 for a time until the cumulative energy on the device screen reaches 50 J from 0 J, in continuous mode, spot size 2.8 cm2) and at 810 nm (power density 0.14 Watt/cm2, energy density 4 J/cm2, for 30 seconds, in continuous mode, spot size 2.1 cm2) were applied intra- and extra-orally. Pain, swelling, and trismus were evaluated postoperatively. Results No significant differences were determined between the groups on the evaluated parameters (p>0.05). Conclusion Within the study limitations, in PBM, the effects of 810 nm and 940 nm and those of single and repeated applications were similar regarding pain, swelling and trismus. Immediate postoperative PBM could be preferred to repeated applications performed by point application within a 24-hour period.

Cuerpo extraño (fragmento de amalgama intraóseo) de la mandíbula: informe de caso / Foreign body (intraosseous bone fragment) of the mandible: report of a case

Un cuerpo extraño es un objeto o una estructura que se incluye accidental o intencionalmente en la intimidad de los tejidos orgánicos de un individuo. Puede desencadenar importantes procesos inflamatorios/ infecciosos, dependiendo de su naturaleza, requiriendo en la mayoría de los casos su extracción quirúrgica, con el fin de evitar daños al paciente. Este trabajo tiene como objetivo informar un caso de cuerpo extraño (fragmento de amalgama) incluido iatrogénicamente en la exodoncia de un molar inferior derecho en un paciente que, después de 8 años, optó por hacerse un implante en el área y descubrió la inclusión de este material, siendo necesaria su extracción quirúrgica para la posterior colocación del implante dental en la región. Los autores destacan la necesidad de realizar una minuciosa inspección y toilette de la caja alveolar en el acto de la exodoncia, para evitar incluir cuerpos extraños en el sitio quirúrgico y evitar así, una nueva intervención en el área (AU)

Foreign body is an object or structure included accidentally or intentionally in the intimacy of the organic tissues of individuals. They can trigger important inflammatory / infectious processes, depending on its nature, requiring its surgical removal in most cases, to prevent damage to the patient. This study aimed to report a case of a foreign body (fragment of amalgam) iatrogenically included in extraction of a right lower molar in a patient who, after 8 years, opted to have an implant in the area and discovered the inclusion of this material, requiring its surgical removal for subsequent placement of a dental implant in the region. The authors highlight the need to perform a thorough inspection and toilet of the alveolar box in the act of extraction, to avoid including foreign bodies in the surgical site, avoiding further intervention in the area (AU)

Relação da exodontia de terceiros molares e a ocorrência de parestesia do nervo alveolar inferior: uma revisão narrativa / Relationship of third molar extraction and occurrence of lower alveolar nerve paresthesia: a narrative review

Terceiros molares inferiores podem apresentar uma estreita relação com o nervo alveolar inferior, aumentando as chances de lesão durante o ato cirúrgico. Objetivo: descrever a relação entre a exodontia de terceiros molares e a ocorrência da parestesia do nervo alveolar inferior. Revisão de literatura: cirurgia para exodontia de dentes terceiros molares é o procedimento mais frequentemente realizado entre as cirurgias bucais e, como todo tipo de cirurgia, possui riscos e acidentes e/ou complicações que podem acometer os pacientes tal como a parestesia. Esta é uma condição que altera a sensibilidade de determinada área e pode ocorrer em consequência de traumas diretos ao nervo ou pela compressão deste, devido a hematoma e edema, levando a desconforto e incômodo. Considerações finais: é importante o profissional cirurgião-dentista atentar para o planejamento correto, criterioso e fazer uso de exames complementares, a fim de precaver possíveis complicações durante o ato cirúrgico. Caso a parestesia aconteça, podem ser utilizados tratamentos medicamentosos, a laser ou cirúrgicos, com resultados em longo prazo positivos e reversão do caso.(AU)

Lower third molars may present a close relation with the inferior alveolar nerve increasing the chances of injury during the surgical act. In view of this, this literature review aims to describe the relationship between the extraction of molars third and the occurrence of inferior alveolar nerve paresthesia. Paresthesia is a condition that alters the sensitivity of a certain area and can occur as a result of direct trauma to the nerve or compression of the nerve due to hematoma and edema. It leads to discomfort and discomfort, and it is important for the professional to attend to the correct, judicious planning and to make use of complementary exams. If paraesthesia occurs, medical, laser or surgical treatments are used, with positive long- -term results and reversal of the case. (AU)

Delayed alveolar bone repair and osteonecrosis associated with Zoledronic Acid therapy in rats: macroscopic, microscopic and molecular analysis

Abstract Objective This study aims to evaluate bone repair and the development of the medication related osteonecrosis of the jaw (MRONJ) associated with the use of zoledronic acid in Wistar rats. Methodology 48 male Wistar rats were divided into four groups: ZA, treated with intraperitoneal zoledronic acid, 0.6 mg/kg every 28 days, totaling five doses; control (C), treated with 0.9% sodium chloride; ZA-surgical (SZA) and C-surgical (SC), submitted to extraction of the right upper molars 45 days after the first application. Alveolar bone repair was evaluated by macroscopic and histological analysis. Protein expression evaluations were performed by qPCR. Results Macroscopic evaluation showed that 91.66% (11) of the animals in the SZA group and 41.66% (5) from the SC group presented solution of epithelium continuity (P<0.05). All animals in the SZA group and none in the SC group had bone sequestration. The area of osteonecrosis was higher in the SZA group than in the SC group (P<0.05). In molecular evaluation, the SZA group presented changes in the expression of markers for osteoclasts, with increased RANK and RANKL, and a decrease in OPG. Conclusion The results highlighted strong and evident interference of zoledronic acid in bone repair of the socket, causing osteonecrosis and delayed bone remodeling.

Adhesión Bacteriana en Hilo de Sutura de Seda Negra y Nylon Post Extracción Dental Simple: Ensayo Clínico Controlado / Bacterial Adhesion in Black Silk Suture Thread and Nylon Post Simple Dental Extraction: Controlled Clinical Trial

RESUMEN: El objetivo de este estudio fue comparar los hilos de sutura de seda negra y la sutura nylon con respecto a la adhesión bacteriana post extracción dental simple de piezas posteriores. El presente trabajo se desarrolló en la Clínica Odontológica y el Laboratorio de Microbiología de la Unidad de Ciencias Biomédicas y Biotecnología de la Universidad Privada Antenor Orrego (Trujillo, Perú), entre agosto y setiembre de 2014. Se trabajó con 19 unidades de muestreo para hilo de seda negra y 19 para nylon. El procedimiento de exodoncia para todos los pacientes fue estandarizado. Luego de la extracción, se procedió a suturar la herida quirúrgica, colocando dos puntos circunferenciales, uno con cada tipo de hilo. A los 7 días, los hilos fueron retirados y sometidos a análisis microbiológico. La adhesión bacteriana de los hilos de sutura seda negra y nylon fue comparada empleando el test de Wilcoxon. Además la adhesión bacteriana de cada hilo fue comparada con la adhesión en hilos estériles (control) empleando el test de Mann-Whitney para una p<0,005. Al comparar la adhesión bacteriana de ambos hilos, se encontró diferencia entre ellos (p=0,027), correspondiendo mayor adhesión al hilo de nylon. La adhesión bacteriana fue mayor en el hilo de sutura de nylon comparado con el hilo de sutura de seda negra.

ABSTRACT: The objective of the study was to compare black silk suture threads and nylon suture with respect to bacterial adhesion after simple dental extraction of posterior pieces. The present study was developed in the Clínica Estomatológica and the Laboratorio de Microbiología of the Unidad de Ciencias Biomédicas y Biotecnología de la Universidad Privada Antenor Orrego (Trujillo, Peru), between August and September 2014. We worked with 19 units sampling for black silk thread and 19 for nylon. The procedure of exodontia for all patients was standardized. After the extraction, the surgical wound was sutured, placing two circumferential points, one with each type of thread. After 7 days, the threads were removed and subjected to microbiological analysis. The bacterial adhesion of the black silk and nylon suture strands was compared using the Wilcoxon test. In addition, the bacterial adhesion of each strand was compared with the adhesion in sterile strands (control) using the Mann-Whitney test for p <0.005. When comparing the bacterial adhesion of both threads, a difference was found between them (p = 0.027), corresponding greater adhesion to the nylon thread. Bacterial adhesion was higher in nylon suture compared to black silk suture.

Assessment of intraoperative risk factors for surgical difficulty in surgical extraction of impacted mandibular third molar: a prospective study

The extraction of impacted third molars is among the most common surgical procedures carried out in the field of Oral and Maxillofacial Surgery. For proper planning of surgical extraction, espe-cially for impacted mandibular third molars the estimated level of surgical difficulty of the case is important. This study was conducted to evaluate the intraoperative risk factors contributing to surgical difficulty in extraction of impacted mandibular third molars and consequently the post-operative outcome. Here, we have undertaken a study in which the intraoperative variables were considered, to evaluate their contribution for surgical difficulty and postoperative complica-tions in surgical removal of 100 impacted mandibular third molars. Three variables were found significant associated with total surgical time intervention, i.e., surgeon's experience (p=0.006), Inter-incisal opening (p=0.032), and cheek flexibility (p=0.004). Total surgical time intervention for 'right side' was higher with 49.20 ± 17.94 minutes (p=0.691). Total surgical time intervention for 'gagging reflex present' was 50.21 ± 17.812 (p=0.674). Multiple linear regression shows that surgeon's experience was the only predictor (p<0.001). The surgical difficulty of impacted mandibular third molar are likely to depend on the intraoperative factors like Surgeon's time, surgeon's experience, check flexibility, and inter incisal mouth opening.

The effectiveness of the cold therapy (cryotherapy) in the management of inflammatory parameters after removal of mandibular third molars: a meta-analysis

Introduction: Cold therapy (cryotherapy) is a common procedure recommended by dental surgeons after surgical removal of thirdmolars, which is an invasive intervention that often deals with an expressive inflammatory response. Objective: To investigate whether cryotherapy interferes with clinical outcomes such as pain, edema, and trismus in the postoperative period of mandibular third molar surgeries. Data Synthesis: An electronic search was conducted in the OVID, PubMed, VHL, Science Direct, Cochrane Library, and Web of Science databases, through March 2018. The eligibility criteria included clinical trials that evaluated the effect of cryotherapy in at least one of the following variables: pain, swelling, and trismus. Two independent reviewers assessed the studies. The methodological quality of each article was analyzed. The search strategy resulted in 1,088 articles. Following the selection process, 11 studies were included in the systematic review and 4 of them in the meta-analysis. High risk of bias was found in most of the studies according to the Cochrane Handbook assessment. Patients receiving cryotherapy had less edema than patients in the control group at second day follow-up (mean difference [MD]: -0.94; 95%CI [-1.49; -0.39]). There were no statistically significant results when comparing trismus between experimental and control group (MD: 0.43; 95%CI [-0.34;1.20]). There were insufficient available data to support influences in postoperative pain. Conclusions: Cryotherapy applied on thefirstday aftermandibular third molar removal can manage edema in the patients.Well-designed randomized clinical trials to test the efficacy of cryotherapy after surgical removal of third molars are needed to justify its indication (AU)

Treatment of bisphosphonate-related osteonecrosis using platelet-rich plasma: microtomographic, microscopic, and immunohistochemical analyses

Abstract The present study aimed to investigate the use of platelet-rich plasma (PRP) on tooth extraction sites in rats treated with bisphosphonates. Thirty Albinus Wistar male rats were administered 0.035 mg/kg zoledronic acid intravenously for 8 weeks, divided into four administrations with a 2-week interval between each application, after which their upper right central incisors were extracted to induce the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). The samples were divided into the following two groups: Group 1 (G1) underwent marginal resection of BRONJ followed by the use of PRP, while Group 2 (G2) underwent resection of BRONJ but without the use of PRP. The treatment groups were evaluated after 14, 28, and 42 days. Clinical, microtomographic, microscopic, and immunohistochemical (IHC) evaluations were performed. Microtomography results revealed no significant difference between the groups (p <0.05) in any time period. Histomorphometric analysis showed increased bone formation over time for both groups (p < 0.001). G1 demonstrated a greater amount of new bone formation than G2 at 28 and 42 days (p < 0.001), with G1 presenting greater vascularization and a slightly higher VEGF expression. For both groups, RANKL/OPG expression levels were sufficient as a parameter for indicating the rate of bone remodeling in a previously treated area of osteonecrosis groups. Taken together, our findings indicated that the use of PRP improves the resolution process of BRONJ.

Do premolar extractions necessarily result in a flat face? No, when properly indicated

Abstract The esthetic benefits are among the main goals of orthodontic treatment; therefore, tooth extractions have been avoided as a protocol for orthodontic treatment because they may impair the facial profile. The present article discusses aspects as the magnitude and response of soft tissue profile due to changes in incisor positioning, and the effect of different sequences of premolar extraction. One case report illustrates the subject, with favorable and stable esthetic and occlusal outcomes five years after orthodontic treatment with extraction of second premolars.

Resumo Os benefícios estéticos estão entre os principais objetivos do tratamento ortodôntico. Por isso, as extrações dentárias têm sido evitadas como protocolo de tratamento ortodôntico, pois podem prejudicar o perfil facial. No presente artigo, serão discutidos aspectos como a magnitude da resposta do perfil de tecidos moles em decorrência das mudanças na posição dos incisivos e os efeitos de diferentes sequências de extrações de pré-molares. Um caso clínico ilustrará o tema, com resultados estéticos e oclusais favoráveis e estáveis cinco anos após o tratamento ortodôntico com extrações de segundos pré-molares.

COX-2 Inhibitors in Dental Pain Management / Inhibidores de la COX-2 en el Tratamiento del Dolor Dental

ABSTRACT: Pain is a major symptom in many dental procedures. Studies show consistently that pain, including dental pain, is not effectively treated; management of pain is a critical and challenging component in dentistry. Improvement and efficacy on the treatment depends on knowing which treatments are the most effective. Knowing how well an analgesic works and its associated adverse effects is fundamental to clinical decision. The aim of this review is to provide information to the dentistry field on the treatment of dental pain specifically with COX-2 inhibitors providing a useful guide to dentist on controlling pain. Therefore, nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed analgesic agents in surgical outpatients. Major limitations of NSAIDs are their gastrointestinal (GI) adverse events (perforation, ulceration, and bleeding), impairment of hemostatic function, and renal failure (with long-term therapy). A new class of NSAIDs, COX2 selective inhibitors (Coxibs), have been developed with the aim of reducing the GI adverse events of traditional NSAIDs while maintaining their effective anti-inflammatory and analgesic properties.

RESUMEN: El dolor es un síntoma principal en muchos procedimientos dentales. Los estudios demuestran consistentemente que el dolor, incluido el dolor dental, no se trata de manera efectiva; el manejo del dolor es un componente crítico y desafiante en odontología. La mejora y la eficacia en el tratamiento depende de saber qué tratamientos son los más efectivos. Saber qué tan bien funciona un analgésico y sus efectos adversos asociados es fundamental para la decisión clínica. El objetivo de esta revisión es proporcionar información al campo de la odontología sobre el tratamiento del dolor dental específicamente con los inhibidores de la COX-2, proporcionando una guía útil para el control del dolor por parte del dentista. Por lo tanto, los fármacos antiinflamatorios no esteroideos (AINE) son los agentes analgésicos más comúnmente prescritos en pacientes ambulatorios quirúrgicos. Las principales limitaciones de los AINE son los eventos adversos gastrointestinales (perforación, ulceración y hemorragia), deterioro de la función hemostática e insuficiencia renal (con terapia a largo plazo). Una nueva clase de AINE, los inhibidores selectivos de la COX-2 (Coxibs), se han desarrollado con el objetivo de reducir los eventos adversos gastrointestinales de los AINE tradicionales mientras se mantienen sus propiedades antiinflamatorias y analgésicas efectivas.

Evaluation of the Bleeding Intensity of Patients Anticoagulated with Warfarin or Dabigatran Undergoing Dental Procedures / Avaliação da Intensidade de Sangramento de Procedimentos Odontológicos em Pacientes Anticoagulados com Varfarina ou Dabigatrana

Abstract Background: Thrombotic disorders remain one of the leading causes of death in the Western world. Dabigatran appeared as an alternative to warfarin for anticoagulation in the treatment of atrial fibrillation (AF). The risk associated with bleeding due to its use has been documented in several randomized clinical trials, but no large study has examined in detail the risk of bleeding during dental extraction and other dental procedures involving bleeding. Objective: To compare the intensity of bleeding in individuals taking dabigatran or vitamin K antagonist (warfarin) and undergoing dental procedures. Methods: Prospective, single-center, controlled study with one single observer. Patients diagnosed with nonvalvular AF, on warfarin or dabigatran, cared for at a cardiology referral center, and requiring single or multiple dental extractions, were evaluated up to seven days post-extraction. The following outcomes were assessed: bleeding time between the beginning and the end of suture and complete hemostasis; bleeding before the procedure, after 24 hours, 48 hours, 7 days, during and after suture removal (late); p<0.05 was defined as of statistical relevance. Results: We evaluated 37 individuals, 25 in the warfarin group and 12 in the dabigatran group. Age, sex, weight, height, blood pressure, color, schooling, family income and comorbidities were similar between the two groups. Regarding bleeding after 24 hours of the procedure, no one in the dabigatran group had bleeding, whereas 32% in the warfarin group had documented bleeding (p = 0.028). The other variables analyzed did not differ between the groups. Conclusions: This study suggests that, regarding dental extraction, there is no statistically significant difference in the intensity of bleeding of patients taking dabigatran as compared to those taking warfarin. Bleeding 24 hours after the procedure was less frequent among patients on dabigatran.

Resumo Fundamento: Distúrbios trombóticos permanecem como uma das principais causas de morte no mundo ocidental. A dabigatrana surgiu como alternativa à varfarina para a anticoagulação no tratamento da fibrilação atrial (FA). O risco associado a eventos hemorrágicos com a sua utilização foi documentado em vários ensaios clínicos randomizados, mas nenhum grande estudo analisou detalhadamente o risco de hemorragia durante a extração dentária e em outros procedimentos odontológicos que envolvam sangramentos. Objetivo: Em indivíduos submetidos a procedimentos odontológicos, avaliar a intensidade de sangramento com o uso de dabigatrana em comparação ao uso de anticoagulante oral antagonista da vitamina K (varfarina). Métodos: Estudo prospectivo, controlado, unicêntrico, observador único. Pacientes com diagnóstico de FA não valvar atendidos em um centro de referência em cardiologia e com indicação de anticoagulação que necessitavam de tratamento odontológico para exodontia única ou múltipla, estando em uso de varfarina ou dabigatrana e avaliados até sete dias pós-exodontia. Foram avaliados os efeitos sobre: tempo de sangramento entre o início e o fim da sutura e hemostasia completa; sangramento antes do procedimento, após 24 e 48 horas, 7 dias, durante e após a remoção da sutura (tardio), sendo considerado como estatisticamente significativo valor de p < 0,05. Resultados: Foram avaliados 37 indivíduos, sendo 25 no grupo varfarina e 12 no dabigatrana. Idade, sexo, peso, altura, pressão arterial, cor, escolaridade, renda familiar e comorbidades foram semelhantes nos dois grupos. Em relação ao sangramento 24 horas após o procedimento, ninguém do grupo dabigatrana apresentou sangramento, que esteve presente em 32% do grupo varfarina (p = 0,028). Não houve diferenças entre os grupos em relação às outras variáveis analisadas. Conclusões: Os dados deste estudo permitem sugerir que, em indivíduos submetidos a procedimento odontológico de exodontia, não há diferença estatisticamente significante na intensidade de sangramento em uso de dabigatrana em comparação ao uso de varfarina. Há uma menor frequência de sangramento 24 horas após o procedimento nos indivíduos em uso de dabigatrana.