Comparison of the efficacy of different techniques to seal the alveolus during alveolar ridge preservation: Meta-regression and network meta-analysis.

AIM: To evaluate the efficacy of different techniques to seal the alveolus (flap advancement [FA], open healing with barrier [OHB], and open healing without barrier [OHNB]) during alveolar ridge preservation (ARP) in terms of horizontal ridge width resorption. MATERIALS AND METHODS: Randomized trials of at least 2 months duration comparing at least two techniques to seal the alveolus against each other or against spontaneous healing (SH) were eligible. Searches were conducted in MEDLINE via PubMed, EMBASE, Scopus, and Cochrane Central. Conventional meta-analysis, meta-regression, and network meta-analysis (NMA) were conducted, with clinical and tomographic ridge width changes as outcomes. Predictive intervals (95% PI) were reported. RESULTS: Twenty-two studies were included, accounting for 52 study arms. Meta-regression identified that the socket sealing technique and publication year explained the observed heterogeneity. NMA showed that FA and OHB led to significantly lower ridge resorption than SH, resulting in 1.18 mm (95% PI 0.21-2.13) and 1.10 mm (95% PI 0.49-1.69) wide alveolar ridges, respectively. No significant difference between OHNB and SH was found (0.46 mm, 95% PI -0.70 to 1.64). The treatment with the largest probability for ARP was FA (52.7%), followed by OHB (39.1%) and OHNB (8.2%). CONCLUSIONS: FA and OHB are efficacious techniques to seal the alveolus during ARP.

What is the relapse after Le Fort I maxillary advancement in cleft lip and palate patients? A systematic review.

Le Fort I osteotomy is the most common procedure for maxillary advancement in cleft patients, and a significant relapse is expected in the postoperative period. This study purpose is to evaluate the maxillary relapse and associated factors in cleft lip and palate (CLP) patients submitted to standard Le Fort I advancement. This systematic review sought studies in PubMed, SCOPUS, and Cochrane and included papers that evaluated the maxillary relapse with at least 1-year postoperative period. The quality assessment was adapted following PRISMA statement. The initial electronic search found 345 papers, and the final selection included 10 studies. In total, 275 CLP patients were evaluated 198 had unilateral CLP and 41 had bilateral CLP. Isolated maxillary advancement was performed in 166 patients, while 109 had bimaxillary surgery. The mean relapse in horizontal and vertical plane was 1.2 mm (19.7%) and 1.0 mm (29.4%), respectively. In conclusion, a relapse after maxillary advancement in patients with CLP is expected, being higher in vertical plane. Patients with UCLP and those who underwent bimaxillary surgery had a higher relapse rate. Due to the miscellaneous data and methodologies, future prospective clinical trials should apply rigorous selection of CLP patients sample and methods for variable analysis to obtain more accurate results.

Comparison Between Hand and Sonic/ Ultrasonic Instruments for Periodontal Treatment: Systematic Review with Meta-Analysis.

AIMS: To systemically review the literature on the effect of hand and sonic/ultrasonic instruments used for the non-surgical treatment of periodontitis. MATERIALS AND METHODS: Five databases were searched for randomized clinical trials that compared the results of periodontal treatment using hand and sonic/ultrasonic for nonsurgical periodontal treatment. Four meta-analyses were performed, using the calculated mean differences (MD) between baseline and 3-months or 6-months after periodontal treatment for clinical attachment level (CAL), and probing pocket depth (PPD). RESULTS: Eighteen studies were included. All included studies showed significant improvement, in at least one periodontal parameter, in both tested periodontal therapies. The sonic/ultrasonic instruments spend significantly less time in comparison to manual instrumentation. At both 3- and 6-months after periodontal therapy, no statistically significant differences were detected for CAL gain between therapies (MD; 95%CI: 0.05; -0.21-0.30 and -0.23; -0.59-0.12). Similarly, no statistically significant differences were detected for PPD reduction between therapies at 3-months of follow-up (MD; 95%CI: -0.03; -0.34-0.28). After 6-months, the PPD reduction was 0.21 (95%CI: -0.43-0.00, p=0.05). CONCLUSION: Similar results may be expected for the periodontal treatment performed with hand and sonic/ultrasonic instruments. However, further studies with lower risk of bias are warranted.

Simplificando o tratamento de paciente em uso de rivaroxabana através da cirurgia guiada ­ relato de caso / Simplifying treatment for patient using rivaroxaban through guided surgery ­ case report

O número de pacientes em tratamento com anticoagulantes necessitando de tratamento odontológico cresceu consideravelmente nos últimos anos. Dessa forma, os clínicos que trabalham com Implantodontia devem estar preparados para esses pacientes e possíveis complicações. O presente estudo objetiva fazer um relato de caso sobre o manejo clínico de paciente de 70 anos de idade com histórico de hemorragia severa associada ao uso do anticoagulante rivaroxabana, mostrando como o uso da cirurgia guiada pode simplificar e viabilizar reabilitações com implantes dentários em pacientes com essa condição. Para isso, foi realizado escaneamento intraoral e planejamento virtual em software específico para instalação de dois implantes Straumann em região posterior direita, onde já havia sido realizado um levantamento de seio maxilar. O procedimento cirúrgico transcorreu de forma rápida e sem complicações, com alta aceitação por parte do paciente, que recebeu a reabilitação protética final aproximadamente 3 meses após a instalação dos implantes. Concluiu-se que a cirurgia guiada é uma excelente alternativa para reduzir morbidade e risco de hemorragia em pacientes fazendo uso de rivaroxabana (AU).

The number of patients receiving anticoagulants requiring dental treatment has increased considerably in recent years. Thus, clinicians working with Implantology should be prepared to treat these patients and possible complications. This study aims to present a case report on the clinical management of a 70-year-old patient with a history of severe hemorrhage associated with the use of rivaroxaban anticoagulant, showing how the use of guided surgery can simplify and enable rehabilitation with dental implants in patients with this condition. In order to do this, we performed intraoral scan and virtual planning in specific software for the placement of two Straumann implants in the right posterior region, where a maxillary sinus lift had already been performed. The surgical procedure was performed quickly and without complications, with high acceptance by the patient, who received the final prosthetic rehabilitation approximately 3 months after implant placemenet. It is concluded that guided surgery is an excellent alternative to reduce morbidity and risk of hemorrhage in patients taking rivaroxaban (AU).

Variações anatômicas do canal mandibular e forame mentual avaliadas através de tomografia computadorizada de feixes cônicos / Anatomical variations of the mandibular canal and mental foramen measured by cone beam computed tomography

Este estudo investigou as variações anatômicas do canal mandibular (CM) e do forame mentual (FM) em uma população do sul do Brasil utilizando exames de tomografia computadorizada de feixes cônicos (TCFC). Exames de 99 pacientes (198 hemimandíbulas) foram avaliados quanto à presença e localização de canais mandibulares duplos (CMD), presença e extensão de alça anterior do CM, presença de forame mentual acessório (FMA), e a relação entre FMA e CM. Em adição às estatísticas descritivas, o teste de Qui-quadrado e o teste Exato de Fisher compararam a ocorrência de variações anatômicas para cada lado da mandíbula e para o gênero dos pacientes. CMD foram encontrados em 63 hemimandíbulas (32,48%) e a maioria foi classificada como canal vestíbulo-lingual. Alça anterior do CM foi detectada em 14 hemimandíbulas (7%) com comprimento médio de 1,87±0,56 mm. FMA foi encontrado em apenas duas hemimandíbulas (1,1%) e um FMA estava em relação com o CM. O teste de Qui-quadrado não mostrou relação entre variações anatômicas e lado da mandíbula. Entretanto, a presença de CMD foi relacionada de forma estatisticamente significativa com o gênero masculino. CMD foi observado em um percentual significativo da população estudada e ocorreu mais em homens. Entretanto, outras variações anatômicas avaliadas através de TCFC não foram associadas de forma significativa com nenhuma outra variável abordada, sugerindo que essas variações não são prevalentes na população estudada (AU).

This study investigated the anatomical variations of the mandibular canal (MC) and mental foramen (MF) in a southern Brazilian population using cone beam computed tomography (CBCT). Exams of 99 patients (198 hemimandibles) were evaluated for the presence and location of double mandibular canals (DMC), the presence and extent of MC anterior loops, the presence of an accessory mental foramen (AMF), and the relationship between the AMF and the MC. In addition to descriptive statistics, Chi-squared and Fisher's exact tests compared the occurrence of anatomical variations to each side of the mandible and the gender of patients. DMC was found in 63 hemimandibles (32.48%) and most was classified as buccolingual canals. Anterior loops were detected in 14 hemimandibles (7%) and they averaged 1.87±0.56 mm in length. AMFs were found in only 2 hemimandibles (1.1%) and one AMF was related to the MC. Chi-square tests showed no relationship between the anatomical variations and the side of the mandible. However, DMC was significantly more common in men. DMC was observed in a significant percentage of the population and they occurred more frequently in men. However, others anatomical variations evaluated by CBCT were not significantly associated with any characteristic of the study population, suggesting that these are not prevalent variations in southern Brazilians (AU).

The Use of Antibiotics in Odontogenic Infections: What Is the Best Choice? A Systematic Review.

PURPOSE: Odontogenic infections are a common problem in dentistry, and their treatment often requires the use of antibiotics besides the removal of the source of infection, which frequently makes it more difficult for clinicians to make a decision regarding the choice of antibiotic. This study aimed to answer the following questions through the Patient, Intervention, Comparison, Outcome (PICO) format: When should antibiotics be used in dental infections (DIs)? Which are the most effective drugs? How long should antibiotics be administered? MATERIALS AND METHODS: This was a systematic review using the PubMed, Scopus, and Cochrane databases without restriction as to the period researched. The variables analyzed in each article were the number of odontogenic infections in each study, type of study, surgical intervention performed, antibiotics administered, statistical differences between groups studied, and patients' evolution after treatment. RESULTS: The search included 1,109 articles. After the full reading of 46 articles, 16 were included in the final review and 30 were excluded. A sample of 2,197 DI cases was obtained, in which 15 different antibiotics were used, with a 98.2% overall cure rate. CONCLUSIONS: The studies showed that antibiotics were prescribed only in situations of regional and/or systemic body manifestations. In the case of DIs, once drainage has been performed and/or the cause of infection has been removed, all antibiotics tested are equally effective with respect to clinical cure, and the choice of antibiotics is not as successful as the local intervention treatment procedure. When the real need for antibiotic therapy is detected, antibiotics should be used for the shortest time possible until the patient's clinical cure is achieved.

Combinação de técnicas para clareamento dentário em dentes vitalizados / Combined technique for tooth bleaching of vital tooth

O objetivo deste artigo é descrever o clareamento de dentes vitais utilizando uma combinação de técnica caseira e de consultório. Foi utilizado peróxido de hidrogênio a 35% para a técnica de consultório em combinação com a técnica caseira utilizando peróxido de hidrogênio a 16%. A paciente foi monitorada quanto à mudança de cor dos dentes, de acordo com a escala Vitapan 3D-Master. Concluiu-se que, desde que bem planejado e com correto diagnóstico, a combinação de técnicas clareadoras é uma excelente opção de tratamento estético e conservador para clareamento de dentes com alteração de cor.

The aim of this paper was to describe a vital tooth bleaching employing a combination of in-office and at-home techniques. We used a 35% hydrogen peroxide for the in-office technique combined to home bleaching using hydrogen peroxide at 16%. The patient was monitored for teeth color change, according to the Vitapan 3D-Master scale. It was concluded that, with proper planning and diagnosis, the combination of bleaching techniques is an excellent option for aesthetic and conservative treatment of teeth chromatically altered.