A retrospective cohort study of pulp prognosis in luxated permanent teeth: a competing risk analysis.

AIM: The present retrospective cohort study aimed to evaluate luxated permanent teeth for pulp prognosis and risk factors. METHODOLOGY: Case records and radiographs of 224 patients, involving 427 luxated permanent teeth, referred for treatment at the Dental Trauma Center-School of Dentistry, Universidade Federal de Minas Gerais, (DTC-SD-UFMG) from 2014 to 2022, were assessed for pulp prognosis classified as vitality, necrosis and pulp canal obliteration (PCO). A competing risk survival analysis estimated the hazards of the three outcomes, and the effect of demographic, clinical and treatment variables was tested using a cause specific Cox regression model. RESULTS: Pulp vitality was found in163 teeth (38.2%), pulp necrosis in 120 teeth (28.1%) and 55 teeth (12.9%) developed PCO. Pulp vitality decreased in the presence of concomitant crown fractures (HR 0.38 95% CI [0.2-0.8] p = 0.006). The risk of pulp necrosis (HR 0.62 95% CI [0.4-0.96] p = 0.03) was lower in cases with open apices but increased with concomitant crown fractures (HR 4.0 95% CI [2.6-6.1] p = 0.001) and intrusions (HR 2.3 95% CI [1.2-4.1] p = 0.007). Lateral or extrusive luxations (HR 3.0 95% CI [1.3-6.9] p = 0.001) and open apices (HR 2.4 95% CI [1.2-4.7] p = 0.01) showed higher rates of PCO. CONCLUSION: Type of luxation, the diameter of the apical foramen, and the presence of concomitant crown fractures were main determinants of pulp prognosis after luxation injuries in permanent teeth. CLINICAL RELEVANCE: Pulp prognosis after tooth luxation is dependent on the presence and direction of tooth displacement together with infection control. CLINICAL TRIAL REGISTRATION: Not applicable.

Prevalence of dental, oral, and maxillofacial traumatic injuries among domestic violence victims: A systematic review and meta-analysis.

BACKGROUND/AIMS: Domestic violence (DV) encompasses a series of abusive behaviors, perpetrated in a family environment, against individuals of all ages and genders. Injuries to the head, neck, and face are frequent findings among victims of abuse, negatively impacting their quality of life. Although oral and maxillofacial injuries (OMFI) and traumatic dental injuries (TDI) are commonly diagnosed among DV victims, their prevalence is still unknown. This systematic review was aimed to assess the prevalence of OMFI and TDI among victims of DV. METHODS: The protocol of the review was registered in PROSPERO (CRD42023424235). Literature searches were performed in eight electronic databases, up to August 7th, 2023. Observational studies published in the Latin-roman alphabet and reporting the prevalence of OMFI and/or TDI were included. The Joanna Briggs Institute's critical appraisal tool, checklist for prevalence studies, was used for quality assessment. Results were presented as qualitative and quantitative syntheses. RESULTS: Seventeen studies, totaling 12,375 victims of domestic violence, were included. Meta-analyses showed an overall prevalence of 29% (95% CI: 15%-48%, I2 = 99%) and 4% (95% CI: 1%-10%, I2 = 98%) for OMFI and TDI, respectively. Higher pooled prevalence for OMFI (41%, 95% CI: 13%-46%, I2 = 99%) was demonstrated in samples with only women. OMFI was less prevalent (20%) among DV victims under 18, while TDI was lower among adults (1%). Hospital samples presented higher pooled prevalence of OMFI (32%), and forensic data from fatal victims presented higher prevalence of TDI (8%). CONCLUSION: The overall prevalence of OMFI and TDI in DV victims was 29% and 4%, respectively. Women victims of DV presented higher rates of OFMI (41%) and TDI (6%).

Prevalence of traumatic dental injuries in emergency dental services: A systematic review and meta-analysis.

OBJECTIVES: This study aimed to perform a systematic review and meta-analysis regarding the prevalence of traumatic dental injuries (TDI) in emergency dental services. METHODS: Seven electronic and two grey literature databases were searched, up to December 2021, for studies that reported the TDI prevalence among dental emergencies. The Joanna Briggs Institute critical appraisal checklist for prevalence studies, and The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach were used to assess the risk of bias and quality of evidence respectively. The R software was used to perform a proportion meta-analysis on a random-effects model to estimate the pooled prevalence and respective 95% CI. RESULTS: From a total of 1476 studies identified after excluding duplicates, 38 met the inclusion criteria, and another five were identified through hand searching, summing 43 included observational studies with a total sample of 209099 individuals searching for emergency dental care. The overall pooled prevalence of TDI was 15.4% (95% CI: 11%-21%, I² = 100%). Paediatric dental emergency services and age group from 0 to 21 years presented the highest prevalence, 29% (95% CI: 22%-38%, I² = 99.5%) and 24% (95% CI: 15%-35%, I² = 98%) respectively. CONCLUSIONS: The overall pooled prevalence of TDI in emergency dental services was 15.4%, and 24% in the age group under 21 years. Considering the impact of prompt and correct emergency care in the long-term prognosis of TDI, such knowledge is relevant to organize emergency healthcare and support public policies in this area.

Expression of matrix metalloproteinases 2 and 9 in replanted teeth with external root resorption: A cross-sectional study.

OBJECTIVE: To evaluate matrix metalloproteinase (MMP) expression in replanted permanent teeth with external root resorption (ERR). DESIGN: The present cross-sectional study included 42 patients with replanted permanent teeth, presenting with progressive forms of ERR, and referred for extraction according to the rehabilitation treatment plan or due to root fractures. The control group consisted of 12 healthy premolars, from 5 patients with good periodontal health and no radiographic evidence of root resorption, referred for extraction for orthodontic reasons. Root fragments were processed soon after extraction, and the supernatant was collected to measure matrix metalloproteinase 2/tissue inhibitor of metalloproteinase 2 (MMP-2/TIMP-2) and matrix metalloproteinase 9/tissue inhibitor of metalloproteinases 2 (MMP-9/TIMP-2) complexes through a double-ligand enzyme-linked immunosorbent assay (ELISA). RESULTS: Case groups with external inflammatory root resorption (EIRR) or external replacement root resorption (ERRR) showed significantly higher levels of MMP-2/TIMP-2 and MMP-9/TIMP-2 complexes than the control group. Additionally, comparisons between the case groups demonstrated that the MMP-2/TIMP-2 complex also had significantly higher levels in the ERRR group (p < 0.001). CONCLUSIONS: Our results suggest that MMP-2 and MMP-9 participate in the pathobiology of both types of ERR. In addition, the higher levels of MMP-2/TIMP-2 complex in the ERRR group support common modulation mechanisms with physiological bone turnover.

Pulp healing in immature replanted permanent teeth: A competing risk analysis.

BACKGROUND/AIM: Tooth displacement during avulsion causes total rupture of the pulp's neurovascular supply. Revascularization and pulp healing may occur in immature teeth, which gives rise to the recommendation that root canal treatment may not be required. The aim of this study was to evaluate the prognostic factors for the pulp's response after replantation of young permanent teeth. METHODS: Records from 117 patients with 133 replanted permanent immature teeth were reviewed, and pulp outcomes were classified as healing (hard tissue deposition on the dentinal walls followed by narrowing of the pulp lumen or ingrowth of bone-like tissue inside the pulp canal) or non-healing (pulp necrosis with infection). The effect of clinical and demographic co-variates on the hazards of both outcomes was assessed performing a competing risk model. RESULTS: Pulp necrosis with infection was diagnosed in 78.2% of the teeth, and healing was observed in 12.8% of the teeth. A total of 12 teeth (9.0%) were censored due to prophylactic removal of the pulp or severe external root resorption caused by eruption of adjacent canines. The cs-Cox model demonstrated that the hazards of pulp healing increased in teeth with extra-alveolar periods <15 min (csHR: 7.83, 95% CI 1.76-34.80, p = .01), while the hazards of pulp necrosis with infection decreased (csHR: 0.31, 95% CI: 0.10-0.92, p = .04). Teeth replanted with Moorrees' stages 4 and 5 of root development had higher hazards of pulp necrosis with infection than teeth with stage 2 of root development (csHR: 2.23, 95% CI 1.11-4.50, p = .03; csHR: 2.89, 95% CI: 1.40-5.95; p = .01). CONCLUSIONS: Pulp healing rarely occurred after replantation of young permanent teeth being associated with short extra-alveolar periods <15 min. Early stages of root development decreased the hazards of pulp necrosis with infection.

Prevalência de lesões traumáticas dentoalveolares em serviços odontológicos de urgência: revisão sistemática e meta-análise / Prevalence of traumatic dentoalveolar injuries in emergency dental services: systematic review and meta-analysis

As lesões traumáticas dentoalveolares (LTDA) consistem em lesões de natureza múltipla e aguda decorrentes de impactos abruptos sobre os dentes e suas estruturas de suporte. Em todo o mundo, estas lesões têm uma alta prevalência relatada e representam grande parte da procura por serviços de emergência odontológicos. No entanto, informações sobre a prevalência de LTDA dentro dos serviços odontológicos emergenciais ainda são dispersas e fragmentadas. Este estudo objetivou revisar a literatura de forma sistemática e sintetizar as informações disponíveis sobre esta prevalência através de meta-análise, conforme descrito no protocolo registrado no PROSPERO sob o código CRD42021243537. A busca bibliográfica foi realizada em sete principais bases de dados em saúde: PubMed; Embase; LILACS; LIVIVO; ScienceDirect; Scopus e Web of Science. E outras duas bases da literatura cinzenta: Google Acadêmico e OpenGrey. A partir da estratégia PICOS, a seguinte pergunta específica para a revisão foi definida: "Qual a prevalência de LTDA nos serviços odontológicos de urgência?". Foram incluídos estudos que apresentaram a prevalência de LTDA em serviços odontológicos emergenciais, publicados em alfabeto latino-romano. Foram excluídos resumos, revisões, relatos-de-caso, protocolos, opiniões de especialistas, cartas, pôsteres e publicações nas quais a versão do texto completo não pôde ser acessada. Estudos conduzidos em clínicas especializadas em traumatismos dentários e em condições extremas, tais como cenários de guerra e desastres ambientais, também foram excluídos. De 2464 estudos identificados pela busca bibliográfica, 1476 restaram após a exclusão de duplicatas. Destes, 1329 foram excluídos pela leitura do título e resumo. Dos 147 estudos remanescentes, 38 foram selecionados após a leitura do texto completo e outros 5 trabalhos foram incluídos através da busca manual pelas referências das publicações selecionadas. O ano de publicação dos 43 estudos variou de 1984 a 2021. A maioria dos trabalhos (30) apresentou risco de viés moderado de acordo com o checklist para estudos de prevalência do Joanna Briggs Institute. Foram observadas prevalências que variaram de 1,9% a 69,1% sendo que a prevalência global, para os 43 estudos incluídos, foi de 15,4% (11%-21%, i2=100%, IC:95%). Quando considerada a análise de subgrupos, a prevalência foi de 22% (13%-33%, I2 = 100%, IC:95%) para os estudos que avaliaram a faixa etária entre 0 e 21. A mesma prevalência de 29% (22%- 38%, I2=99.5%, IC:95%) foi observada para os estudos conduzidos em serviços odontopediátricos de urgência. Considerando-se que o atendimento emergencial é determinante do prognóstico das LTDA em longo prazo, o conhecimento da prevalência destas lesões entre as emergências odontológicas é fundamental para organizar estes serviços e subsidiar políticas públicas nesta área.

Traumatic dental injuries (TDI) consist of multiple and acute injuries resulting from abrupt impacts on teeth and their supporting structures. These injuries have a high prevalence reported worldwide and represent a large part of the demand for emergency dental services. However, information on the TDI prevalence rate within emergency dental services is still scattered and fragmented. This study aimed to systematically review the literature and synthesize the information available on this prevalence through meta-analysis, as described in the protocol registered in PROSPERO under code CRD42021243537. A bibliographic search was performed in seven health databases: PubMed; Embase; LILACS; LIVIVO; ScienceDirect; Scopus; and Web of Science. And two other grey literature bases: Google Scholar and OpenGrey. Based on the PICOS strategy, the following specific question for the review was defined: What is the prevalence of TDI in emergency dental services? Studies showing the TDI prevalence rate in emergency dental services, published in the Latin- Roman alphabet, were included. Abstracts, reviews, case reports, protocols, expert opinions, letters, posters, and publications in which the full-text version could not be accessed were excluded. Studies conducted in clinics specializing in dental trauma and in extreme conditions, such as war scenarios and environmental disasters, were also excluded. Of 2464 studies identified by the literature search, 1476 remained after excluding duplicates. Of these, 1329 were excluded by reading the title and abstract. Of the remaining 147 studies, 38 were selected after reading the full text and another 5 works were included through a manual search for the references of the selected publications. The year of publication of the 43 studies ranged from 1984 to 2021. Most studies (30) had a moderate risk of bias according to the Joanna Briggs Institute's checklist for prevalence studies. Prevalence rates ranging from 2% to 69% were observed and the overall prevalence, for the 43 studies included, was 15.4% (11%- 21%, i2=100%, CI:95 %). For subgroup analysis, the prevalence of 22% (13%-33%, I2=100%, CI: 95%) was observed for studies that evaluated the age group between 0 and 21. A prevalence of 29% (22%-38%, I2=99%, CI: 95%) was observed for studies conducted in emergency paediatric dental services. Considering that emergency care is a determinant of TDI's long-term prognosis, knowledge of the prevalence of these injuries among dental emergencies is essential to organize these services and support public policies in this area.

Urbanization increases carbon concentration and pCO2 in subtropical streams.

Urbanization growth may alter the hydrologic conditions and processes driving carbon concentrations in aquatic systems through local changes in land use. Here, we explore dissolved carbon concentrations (DIC and DOC) along urbanization gradient in Santa Catarina Island to evaluate potential increase of CO2 in streams. Additionally, we assessed chemical, physical, and biotic variables to evaluate direct and indirect effects of urbanization in watersheds. We defined 3 specific urbanization levels: high (> 15% urbanized area), medium (15-5% urbanized area), and low (< 5% urbanized area) urbanization. The results showed that local changes due to growth of urban areas into watersheds altered the carbon concentrations in streams. DOC and DIC showed high concentrations in higher urbanization levels. The watersheds with an urban building area above 5% showed pCO2 predominantly above the equilibrium with the atmosphere. These findings reveal that local modifications in land use may contribute to changes in global climate by altering the regional carbon balance in streams.

Pre-Emptive Effect of Dexamethasone and Diclofenac Sodium Associated With Codeine on Pain, Swelling, and Trismus After Third Molar Surgery: A Split-Mouth, Randomized, Triple-Blind, Controlled Clinical Trial.

PURPOSE: We aimed to compare the effect of dexamethasone, 8 mg, and diclofenac sodium, 50 mg, associated with codeine, 50 mg, on the control of pain, swelling, and trismus after extraction of impacted third molars. MATERIALS AND METHODS: Fifteen healthy patients with a mean age of 22.8 years (SD, 12.62 years) received a single oral dose of either drug 1 hour before each surgical procedure (left and right teeth). At 24, 48, and 72 hours after surgery, swelling was determined by use of linear measurements on the face and trismus was determined by maximal mouth opening. Postoperative pain was self-recorded by the patients using a numerical rating scale at 24-hour intervals for a period of 72 hours. Data analysis involved descriptive statistics and Shapiro-Wilk, Wilcoxon, and paired t tests (P < .05). RESULTS: Dexamethasone controlled pain (P = .016) and edema (P = .08) within 48 hours better than diclofenac sodium associated with codeine. No statistically significant differences were found between drugs regarding trismus and consumption of rescue analgesics (acetaminophen). CONCLUSIONS: The results of this study suggest that pre-emptive administration of dexamethasone, 8 mg, showed better control of pain and swelling in bilateral extractions of third impacted mandibular molars.

Preemptive Effect of Dexamethasone in Third-Molar Surgery: A Meta-Analysis.

The aim of the present study was to assess the effectiveness of preemptive dexamethasone in surgery of the lower third molars and to compare it with other oral anti-inflammatories. An electronic search was conducted for preemptive effects related to lower third-molar surgery in 3 separate databases. The variables pain, swelling, and trismus were assessed. Meta-analysis was used to calculate the pooled effect measures for mean and standard deviation values (95% confidence interval [CI]). Seven split-mouth clinical trials were selected. Two studies were included in the meta-analysis. Three studies showed a low risk of bias; 2 studies exhibited a moderate risk and 2 a high risk of bias. Dexamethasone was better than nonsteroidal anti-inflammatories for preemptive effectiveness. Meta-analysis for swelling confirmed better results for dexamethasone than for methylprednisolone after 2 days (95% CI = -1.28 to -0.38), 4 days (95% CI = -1.65 to -0.71), 7 days (95% CI = -1.42 to -0.71), and overall (95% CI = -1.25 to -0.72). Dexamethasone was better than methylprednisolone for mouth opening after 4 days (95% CI = 0.18 to 1.07). There is insufficient evidence through meta-analysis to conclude that dexamethasone is better than other nonsteroidal anti-inflammatories or methylprednisolone as a preemptive analgesic. The results of this meta-analysis suggest that dexamethasone is more effective than methylprednisolone for swelling and trismus.

Oral Health-Related Quality of Life Before and After Treatment of Dentin Hypersensitivity With Cyanoacrylate and Laser.

BACKGROUND: The aim of this longitudinal study is to verify changes in the oral health-related quality of life of patients 180 days after treatment of dentin hypersensitivity (DH) with laser and cyanoacrylate. METHODS: This clinical, controlled, randomized, double-masked trial used a split-mouth design, and quadrants were randomized to receive either laser or cyanoacrylate treatments. All patients received both treatments. The study included 62 patients aged 12 to 60 years (mean: 31.4 years) in whom a total of 432 teeth were treated. Quadrants were randomly distributed into two groups: cyanoacrylate (n = 218 teeth) or laser (n = 216 teeth) treatment. DH was evaluated with air and cold stimuli at 24 hours, 30, 90, and 180 days after treatment. The Oral Health Impact Profile (OHIP-14) questionnaire was applied at baseline and 180 days after treatment. RESULTS: There were statistically significant differences in the following OHIP-14 subscales before and after treatment: physical pain (P = 0.002), psychologic discomfort (P <0.001), psychologic disability (P = 0.003), social disability (P = 0.01), and total score (P <0.001). At the end of the study, 80.6% of participants reported an improvement in their condition. CONCLUSION: There was a reduction in the impact of DH on the quality of life of study participants after interventions with laser and cyanoacrylate.

O uso da regeneração óssea guiada em implantes orais

Um dos grandes empecilhos na implantodontia é a ausência de tecido ósseo tanto no plano vertical quando no plano horizontal. No entanto, com a regeneração óssea guiada é possível em alguns casos atenuar o problema. O principal obstáculo para a regeneração óssea é a formação mais rápida de tecido conjuntivo, quando comparada osteogênese...