A triple-blind randomized clinical trial of different associations between dexamethasone and non-steroids anti-inflammatories for preemptive action in third molar extractions.

The aim of this study is to evaluate the preemptive analgesic effects of dexamethasone (DEX) alone or combined with non-steroidal anti-inflammatory drugs (NSAIDs) in third molar surgeries. The subjects were divided into five groups (n = 20 teeth/group); subjects received only 8 mg of dexamethasone 1 h before the surgical procedure (DEX group), or in combination with etodolac (DEX + ETO), ketorolac (DEX + KET), ibuprofen (DEX + IBU), loxoprofen (DEX + LOX). Paracetamol 750 mg was provided as the number of rescue analgesics (NRA). Salivary PGE2 expression was measured preoperatively and at 48 h. Edema and Maximum mouth opening (MMO) were measured postoperatively at 48 h and 7 days. A visual analog scale (VAS) was performed postoperatively at 6, 12, 24, 48, 72 h, and 7 days. Salivary expression of PGE2 showed a decrease only for the DEX group. Edema and MMO and NRA consumption showed no significant differences among the groups (P > 0.05). The VAS showed a significantly lower pain perception at 6 h after the surgery for the DEX + ETO and DEX + KET groups (P < 0.05). The combination of DEX and NSAIDS should be considered for preemptive acute postsurgical pain management in third molar surgery. In some drug associations such as dexamethasone 8 mg + NSAIDS (ETO and KET) in the pre-operative time, only a few rescue analgesics are necessary.

Comparative Evaluation of Bone Repair with Four Different Bone Substitutes in Critical Size Defects.

This study evaluated the osteoconductive potential of four biomaterials used to fill bone defects. For this, 24 male Albino rabbits were submitted to the creation of a bilateral 8 mm calvarial bone defect. The animals were divided into four groups-bovine hydroxyapatite, Bio-Oss® (BIO); Lumina-Bone Porous® (LBP); Bonefill® (BFL); and an alloplastic material, Clonos® (CLN)-and were euthanized at 14 and 40 days. The samples were subjected to histological and histometric analysis for newly formed bone area. Immunohistochemical analysis for Runt-related transcription factor 2 (Runx2), vascular endothelial growth factor (VEGF), and osteocalcin (OC) was performed. After statistical analysis, the CLN group showed greater new bone formation (NB) in both periods analyzed (p < 0.05). At 14 days, the NB showed greater values in BIO in relation to LBP and BFL groups; however, after 40 days, the LBP group surpassed the results of BIO (p < 0.001). The immunostaining showed a decrease in Runx2 intensity in BIO after 40 days, while it increased for LBP (p < 0.05). The CLN showed increased OC compared to the other groups in both periods analyzed (p < 0.05). Therefore, CLN showed the best osteoconductive behavior in critical defects in rabbit calvaria, and BFL showed the lowest osteoconductive property.

Alveolar bone dynamics in osteoporotic rats treated with raloxifene or alendronate: confocal microscopy analysis.

In this study, the characteristics of the alveolar bone of rats with induced osteoporosis were examined. Thirty-two rats were divided into four groups according to the induction of osteoporosis and drugs administered: OG, osteoporotic rats without treatment (negative control); SG, rats which underwent sham surgery ovariectomy (SHAM); alendronate (AG), osteoporotic rats treated with alendronate; and RG, osteoporotic rats treated with raloxifene (RG). On the 8th day after ovariectomy and SHAM surgeries, drug therapy was started with AG or RG. On the 52nd day, 20 mg/kg calcein was administered to all of the rats, and on the 80th day, 20 mg/kg alizarin red was administered. Euthanasia was performed on the 98th day. The bone area marked by fluorochromes was calculated and data were subjected to two-way ANOVA test and Tukey's post-hoc test (p < 0.05). The comparison of the induced osteoporosis groups showed no statistically significant differences in bone turnover only between RG and SG (p = 0.074) and AG and OG (p = 0.138). All other comparisons showed significant differences (p < 0.001). The largest bone turnover was observed in RG and SG groups. RG was the medication that improved the dynamics of the alveolar bone of rats with induced osteoporosis, resembling that of healthy rats.

Early Osseointegration Events on Neoss® ProActive and Bimodal Implants: A Comparison of Different Surfaces in an Animal Model.

BACKGROUND: Cell interactions, adherence, and osseointegration at the bone-implant interface can be directly influenced by the surface properties of the titanium implant. PURPOSE: To characterize osseointegration of Neoss® implants with conventional (control group) and hydrophilic (test group) surface treatments. MATERIALS AND METHODS: Six Labrador dogs received Neoss implants with conventional and hydrophilic surfaces. The bone-implant interfaces were evaluated 1 and 4 weeks after implantation, and osseointegration was evaluated using histological, histomorphometric, fluorescence, and resonance frequency analyses. The surfaces were also subjected to topographic and hydrophilicity analyses. RESULTS: The topographic analyses revealed increased surface roughness in the test group compared with the control group (surface area roughness 0.42 and 0.78 µm, respectively, for control and test group surfaces; p ≤ .05). The wettability values were higher in the test group (contact angles 67.2° and 27.2° for the control and test group surfaces, respectively; p ≤ .05). Implants in the test group also exhibited better stability, more bone-implant contact, and increased bone area compared with implants in the control group. CONCLUSION: Neoss implants in the test group improved bone formation in the early stages of osseointegration compared with implants in the control group.

Treatment of circumferential defects with osseoconductive xenografts of different porosities: a histological, histometric, resonance frequency analysis, and micro-CT study in dogs.

BACKGROUND: Finding the most effective method of minimizing the gap effect in alveolar crest remodeling constitutes a clinical challenge for immediate implant technique. PURPOSE: To evaluate the effectiveness of osseoconductive xenografts with different porosities in the crestal bone region, with and without guided bone regeneration, over immediate implant installation. MATERIALS AND METHODS: Five bone defects (6 mm in diameter/4 mm depth) were prepared on one side of the mandibles of twelve dogs. Implants of 3.3 × 10 mm were installed on the mesial side of each defect, providing a 2.7-mm distal gap. Defects were randomly filled with autogenous bone, coagulum, a deproteinized bovine bone mineral (DBBM) block, a DBBM sponge, or DBBM granules. The same procedures were performed on the opposite side after 8 weeks. Collagen membranes were used to cover the defects on half of the sides. The animals were sacrificed after 8 weeks. The outcomes were evaluated by histology, histomorphometric analysis, resonance frequency analysis, and micro-CT analysis. RESULTS: The histomorphometry showed the DBBM sponge to provide similar bone formation to autogenous bone at 8 weeks without a membrane. The coagulum rendered better bone formation at 16 weeks (membrane) (p < .05). The DBBM block exhibited the poorest results between treatments (8 and 16 weeks, with or without membrane). Micro-CT analysis revealed increasing bone surface values in sites with DBBM granules, followed by the DBBM sponge (8 weeks without membrane) and autogenous bone at 8 weeks with membrane (p < .05). Porosity analysis of the biomaterials showed the highest number, volume, and surface area of closed pores in DBBM granules. The DBBM block presented the highest volume of open pores, open porosity, and total porosity. CONCLUSIONS: The high-porosity block (DBBM block) failed to provide greater bone repair within the defect. Biomaterials with lower porosity (DBBM sponge and granules) showed similar or higher bone formation when compared with autogenous bone.

Short-term evaluation of grafts fixed with either N-butyl-2-cyanocrylate or screws.

PURPOSE: N-butyl-2-cyanoacrylate (NB-Cn) is an alternative method for onlay graft fixation and might be efficient for preserving the graft volume. Our aim was to analyze the gene expression and mineralized tissue variations of calvarial bone grafting fixed in the mandible with either NB-Cn or a titanium screw (TiS). MATERIALS AND METHODS: New Zealand rabbits had bilateral calvarial grafts fixed at both sides of the mandible with either NB-Cn or a TiS. The rabbits were sacrificed at 4 and 8 days, and micro-computed tomography analysis was performed. For molecular analysis, the gene expression of interleukin-6, interleukin-10, and tumor necrosis factor-α was assessed. Quantification using real-time polymerase chain reaction was performed. Statistical analysis was performed using the paired Student t test (P < .05). RESULTS: Bone graft fixation with NB-Cn promoted superior volume and density preservation. The percentage of mineralized tissue at the center portion and border of the graft was very similar (NB-Cn, 50.6% ± 8.3% and 50.3% ± 10.6%, respectively) and superior than in the TiS group (32.5% ± 3.5% and 33.8% ± 6%, respectively). Genes from the NB-Cn group were upregulated compared with those in the TiS group at the initial phases of bone healing (4 days), with the profile reversed at the 8-day point. At day 8, the osteoclastogenesis-related genes were upregulated in the TiS group. CONCLUSIONS: Onlay bone grafts fixed with screws induced more inflammation during the initial remodeling process than did NB-Cn. The differences in the incorporation into the host bed suggest that the use of adhesives for graft fixation will promote superior volume and density preservation.

Tratamento de fraturas indesejáveis durante cirurgia ortognática: relato de dois casos clínicos / Treatment of undesirable fractures during ortognatic surgery: report of two clinical cases

O presente trabalho tem como objetivo relatar dois casos clínicos de fraturas indesejáveis durante a osteotomia sagital do ramo mandibular. Em ambos os casos após detecção das fraturas indesejáveis, prosseguiu-se com a separação total dos cotos proximais e distais, bloqueio intermaxilar e fixação interna rígida com placas e parafusos do sistema 2.0. No pós-operatório de 18 meses os pacientes não apresentaram défices sensoriais e mantiveram relação oclusal estável. No acompanhamento radiográfico não se notou mudanças de posicionamento das placas e parafusos, bem como havia bom posicionamento dos côndilos nas suas respectivas cavidades articulares. Houve muitas modificações da Osteotomia sagital do ramo mandibular desde a técnica proposta por Trauner e Obwegeser (1957), e também diferentes modalidades de tratamento foram apresentadas 57 na literatura para o tratamento das fraturas indesejáveis. No presente artigo os autores demonstraram duas modalidades de tratamento com bons resultados pós-operatórios.

We report two cases of unfavorable segment fracture during a sagittal split osteotomy procedure. In both cases, the undesirable fractures were conducted until its stabilization and fixation with bone plates and screws. The radiographic follow up period are demonstrated without alterations to the screws and plates planned position, with good occlusal relationship and no sensorial deficit. There have been many modifications of the Sagittal Split Osteotomy technique since Tauner and Obwegeser proposed it in 1957, with different treatment modalities been shown in specific literature to solve the bad split situation. In this paper the authors demonstrated two of these techniques with good post-operative results.

Enucleação de fibroma cemento-ossioficante extenso em maxila: relato de caso clínico / Enucleation of fibroma cemento-ossioficante full in the jaw: a case report

Os tumores ósseos benignos dos maxilares possuem características semelhantes entre si, tais como o crescimento lento, assintomático ecapazes de causar a expansão do osso cortical adjacente. Entre ver o comportamento clínico e a conduta terapêutica para este tipo de tumor.

Benign osseous tumors of the maxillaries have similar characteristics among them selves, such as the slow, asymptomatic growth and being able to cause expansion of the adjacent cortical bone. Amongst these, the cemento-ossifying fibroma has a rare incidence, with predilection for females and more frequent localization in the mandible. This case-report aims to describe the clinical behavior and the therapeutic conduct for this type of tumor.

Enucleação de ameloblastoma mandibular multicístico / Multicystic enucleation of mandibular ameloblastoma

Ameloblastomas são tumores benignos, localmente invasivos e altamente recidivante. É um tumor odontogênico, caracterizado pela proliferação do epitélio ameloblástico em um estroma fibroso. O presente trabalho relata um caso de ameloblastoma mandibular, em que foi realizada a enucleação total com escarificação marginal e reconstrução por meio de placa e parafusos de titânio.

Ameloblastomas are benign tumors with locally invasive characteristics and high recurrence episodes. It is an odontogenic tumor characterized by fibrous epithelium ameloblastic proliferation into the stromal tissue. This paper presents a case of mandibular ameloblastoma, enucleation and mandibular reconstruction with titanium plate and screws.