ABSTRACT
BACKGROUND: This study aimed to evaluate the gene expression of cyclooxygenases (COXs) in an oral model of preemptive analgesia. MATERIAL AND METHODS: Gingival tissue was collected during extraction of lower third molars from a randomized, triple-blind, split-mouth and placebo-controlled study. The eligible patients were randomly sorted to receive a single dose either of ibuprofen 400mg, or etoricoxib 120 mg or a placebo, one hour prior to surgery. The temporal course of RNAm was evaluated for COX-1 and -2 by means of a quantitative polymerase chain reaction in real time (RT-qPCR) at time zero and 30 minutes after the surgical procedure began, and it was correlated with clinical parameters (pain and maximum mouth opening). RESULTS: There was a significant increase in COX-1 expression between T0 and T30 in ibuprofen (p=0.004) and etoricoxib (p=0.010) groups. As regards COX-2, there were increases from T0 to T30 in all groups (placebo, p=0.012; ibuprofen, p<0.001; etoricoxib, p<0.001). All groups showed a significant decrease in COX-2:COX-1 ratio from T0 to T30 (placebo, p=0.013; ibuprofen, p<0.001; etoricoxib, p=0.047). Experimental groups showed a significant correlation between COX-1 and COX-2 levels and clinical pain parameters. CONCLUSIONS: The present preemptive analgesia study concludes that COX-2 RNAm induction was directly linked to third molar-related tissue inflammation and that the relation between COX-1 and COX-2 levels were inversely proportional to the preemptively administered nonsteroidal anti-inflammatory drugs COX-2 selectivity. Key words:Preemptive analgesia, dental extraction, cyclooxygenases, real-time polymerase chain reaction.
ABSTRACT
BACKGROUND: This study aimed to review translational studies focusing on third molar removal surgeries through a systematic analytical approach. MATERIAL AND METHODS: A PROSPERO-registered systematic review (CRD42017060455) was conducted following the PRISMA statement to summarize current knowledge on gene expression in third molar surgeries. A search was performed in PubMed's Medline and Scopus databases, without date or language restrictions, using the logical expression {[(Third molar) OR (preemptive) OR (cyclooxygenase inhibitors) OR (acute inflammation) AND (gene expression)]}. RESULTS: All studies included in the analysis evaluated gene expression in a third molar extraction model, using the preemptive analgesia methodology in seven investigations. The sample analyzed was obtained from gingival tissue biopsy (n=4), blood (n=1), transudate (n=1) and gingival tissue biopsy/transudate (n=1). There were differences with respect to evaluated genes, drug protocol, sample studied, and method for evaluating gene expression. CONCLUSIONS: Third molar surgeries were found to be associated with different COX-related gene expression patterns. Although inflammatory events following the surgical procedure are associated with COX isoforms, data from preemptive analgesia studies are scarce, especially from studies correlating gene expression and clinical parameters. In the future, from a clinical perspective, identifying the molecular targets of a drug based on individual gene expression may be helpful to delineate specific third molar, surgery-related, preemptive analgesia protocols
Subject(s)
Humans , Molar, Third/surgery , Clinical Protocols , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Gene Expression , Postoperative Complications/prevention & controlABSTRACT
Objetivo: apresentar um caso clínico de levantamento de seio maxilar, utilizando biomaterial e instalação de implante imediato e discutir alguns fatores importan-tes para o sucesso desse tipo de tratamento. Relato de caso: Paciente do sexo masculino, 65 anos de idade, procurou o Serviço de prótese sob implante e implan-todontia com o objetivo de reabilitar área edêntula na região do dente 15 com implante. No exame de ima-gem foi observado pouca altura óssea remanescen-te para realização do implante na região. Diante das características do caso, foi proposta para o paciente a realização do levantamento de seio com a utilização de enxerto ósseo particulado (biomaterial) simultâneo à colocação de implante na área, visando uma reabili-tação mais rápida do paciente. Atualmente, o pacien-te encontra-se com 12 meses de pós-operatório, com reabilitação final concluída, bons resultados estético e funcional foram conseguidos. Os exames de imagem apresentam total incorporação do implante ao leito re-ceptor e ao enxerto realizado após 1 ano de acompa-nhamento. Considerações Finais: Pode-se concluir que a instalação de implante imediato após a realização do levantamento do seio maxilar, é um procedimento viá-vel, quando bem indicado, e que proporciona ao pa-ciente uma diminuição do tempo de tratamento.
