Post-traumatic trigeminal neuropathy. A study of 63 cases.

INTRODUCTION: Trigeminal neuropathy is most often secondary to trauma. The present study explores the underlying causes and the factors that influence recovery. MATERIAL AND METHODS: A retrospective case study was made involving 63 patients with trigeminal neuropathy of traumatologic origin, subjected to follow-up for at least 12 months. RESULTS: Fifty-four percent of all cases were diagnosed after mandibular third molar surgery. In 37 and 19 patients the sensory defect was located in the territory innervated by the mental and lingual nerve, respectively. Pain was reported in 57% of the cases, and particularly among the older patients. Regarding patient disability, quality of life was not affected in three cases, while mild alterations were recorded in 25 subjects and severe alterations in 8. Partial or complete recovery was observed in 25 cases after 6 months, and in 32 after one year. There were few recoveries after this period of time. Recovery proved faster in the youngest patients, who moreover were the individuals with the least pain. CONCLUSION: Our patients with trigeminal neuropathy recovered particularly in the first 6 months and up to one year after injury. The older patients more often suffered pain associated to the sensory defect. On the other hand, their discomfort was more intense, and the patients with most pain and the poorest clinical scores also showed a comparatively poorer course.

Analysis of the peri-implant microbiota in 90 dental implants and its relationship to crevicular fluid volume.

OBJECTIVE: To evaluate the presence within the peri-implant sulcus of Tannerela forsythia (Tf), Porphyromonas gingivales (Pg), Treponema denticola (Td) and Aggregatibacter actinomycetemcomitans (Aa), and relate these bacteria to the peri-implant crevicular fluid volume (PICFV). MATERIAL AND METHOD: A prospective and cross-sectional clinical case series study was made. For the measurement of crevicular fluid, use was made of the Periotron® 8000 (Proflow Incorporated. New York, USA), measuring the volume in Periotron units (PU). For the detection of periodontopathogenic bacteria we used the IAI-PadoTest 4.5 (IAI Inc., IAI Institute, Zuchwil, Switzerland) - a system for the detection of Tf, Pg, Td and Aa based on the use of RNA arrays. RESULTS: We included 34 patients (19 females and 15 males) with a mean age of 56.4 years. Of these subjects, 30.8% were smokers and 69.2% non-smokers. Out of a total series of 213 implants, we analyzed the crevicular fluid and microbiota in 90 implants. A total of 16.5% of the implants presented mucositis, while 83.5% were in healthy peri-implant conditions. The microbiological study revealed the presence of Tf in 17.1% of the implants, Pg in 9.3%, Td in 13.6%, in Aa in none of the implants. The mean Periotron reading was 93.4 PU (range 12-198 PU). A statistically significant (p<0.05) relationship was observed between PICFV and the total percentage bacteria (Tf, Pg and Td) - with a strong association between the Td levels and smoking (p<0.01). In the implants with mucositis, the concentration of Pg and Td was greater. CONCLUSIONS: In the implants studied, the subgingival peri-implant microbiota was characterized by low levels of Pg, Tf, Td, and none of the patients proved positive for Aa. These bacteria showed a positive correlation to crevicular fluid volume, and a statistically significant relationship was observed between Td and smoking.

Apical surgery of a maxillary molar creating a maxillary sinus window using ultrasonics: a clinical case.

AIM: To describe a method of carrying out apical surgery of a maxillary molar using ultrasonics to create a lateral sinus window into the maxillary sinus and an endoscope to enhance visibility during surgery. SUMMARY: A 37-year-old female patient presented with tenderness to percussion of the maxillary second right molar. Root canal treatment had been undertaken, and the tooth restored with a metal-ceramic crown. Radiological examination revealed an apical radiolucency in close proximity to the maxillary sinus. Apical surgery of the molar was performed through the maxillary sinus, using ultrasonics for the osteotomy, creating a window in the lateral wall of the maxillary sinus. During surgery, the lining of the sinus was exposed and elevated without perforation. The root-end was resected using a round tungsten carbide drill, and the root-end cavity was prepared with ultrasonic retrotips. Root-end filling was accomplished with MTA(®) . An endoscope was used to examine the cut root face, the prepared cavity and the root-end filling. No intraoperative or postoperative complications were observed. At the 12-month follow-up, the tooth had no clinical signs or symptoms, and the radiograph demonstrated progressing resolution of the radiolucency. KEY LEARNING POINTS: When conventional root canal retreatment cannot be performed or has failed, apical surgery may be considered, even in maxillary molars with roots in close proximity to the maxillary sinus. Ultrasonic sinus window preparation allows more control and can minimize perforation of the sinus membrane when compared with conventional rotary drilling techniques. The endoscope enhances visibility during endodontic surgery, thus improving the quality of the case.

Relationship between oral surgical and endodontic procedures and episodic cluster headache.

OBJECTIVE: We sought to evaluate the possible relationship between oral surgery and endodontic procedures and the subsequent appearance of cluster headache (CH) in 54 patients. STUDY DESIGN: This study included 54 patients diagnosed and treated for episodic CH. The characteristics of pain, the extractions, and the endodontic procedures performed in the same or a contralateral quadrant were recorded and analyzed by using the chi-square test. RESULTS: Prior tooth extraction or endodontics had been performed in the pain-affected quadrant in 58% of cases and in the contralateral quadrant in 33%. The differences between quadrants were statistically significant. After the onset of pain, extractions were performed in the affected quadrant in 44% of patients. CONCLUSIONS: Although the appearance of pain after dental extraction could suggest a relationship between damage to the nerve supply and the development of CH, the possibility that dental extraction and endodontics may have been performed in response to CH-related pain must also be taken into account. With respect to the differential diagnosis of pain, it is easy for CH to be misdiagnosed as dental pulp pain.

Trigeminal neuralgia associated to basilar artery dolichoectasia.

A case of trigeminal neuralgia attributed to basilar artery dolichoectasia is described. Underlying vascular malformations and tumors of the cerebellopontine angle can be detected in patients with trigeminal neuralgia by means of noninvasive techniques such as computed tomography and magnetic resonance imaging; such diagnostic tools are therefore indicated in patients with trigeminal neuralgia to discard possible central nervous disorders.

Cluster headache and cocaine use.

We present 3 patients who had episodes of orofacial pain compatible with cluster headache, the differential diagnosis being established with pulp pain of dental origin. Cocaine inhalation triggered pain in the premolar zone of the upper jaw, followed by spread of pain to the periorbital region on the same side. The pain episodes were very intense and lasted between 30 and 120 minutes. The patients presented conjunctival injection and lacrimation of the affected eye during these episodes. The crises were always unilateral. In one patient, pain shifted sides from one crisis to another within the same symptomatic or cluster period, affecting the side through which the drug was inhaled. Pain usually appeared 1 to 2 hours after cocaine consumption, though it disappeared 5 to 10 minutes after again inhaling the drug. None of our patients acknowledged cocaine consumption at the first visit; drug inhalation was only admitted at subsequent visits, once a degree of confidence had been established with the physician.