RESUMO
BACKGROUND: The aim of the present study was to investigate pain perception and anxiety within the context of surgery for the placement of mandibular block bone and to evaluate the causality effect between theses variables. MATERIAL AND METHODS: A total of 13 patients were recruited for the study and were submitted to mandibular autogenous block bone surgery. Demographic data were collected and the anxiety level was determined using the State-Trait Anxiety Inventory (STAI). The STAI was administered on the day of surgery and on the 14th postoperative day. Pain was determined using the visual analogue scale (VAS) and limitation of daily activities and postoperative symptoms were also reported. Data were analyzed using parametric tests (α=0.05) and cross-lagged analysis was performed to verify a causality effect. RESULTS: Few patients reported interference with daily activities or the presence of postoperative symptoms. A significant association of bad breath/taste with STAI-State was detected on the 14th postoperative day. No evidence of causality between STAI and VAS was detected. CONCLUSIONS: The patient's self-evaluation indicates that the pain and anxiety level felt during treatment was not directly associated with the clinical aspects of the surgical procedure or with postoperative activities/symptoms limitations. Key words:Anxiety pain, questionnaires, autogenous bone block, treatment, outcomes.
RESUMO
O objetivo desse estudo foi avaliar a condicao ossea, a dor e a ansiedade em individuos submetidos a cirurgia de enxerto osseo autogeno tridimensional em mandibula posterior, provenientes da linha obliqua externa. Foram mensuradas altura e largura do enxerto osseo, volume e qualidade ossea da regiao receptora, antes e apos a instalacao do enxerto em dois momentos, por meio de softwares e imagens tomograficas. Adicionalmente obteve-se o auto relato dos pacientes por meio de questionarios de ansiedade (IDATE T-E) e a percepcao de dor (EVA) durante o tratamento e pos-operatorio de 14 dias. Algumas variaveis clinicas de interesse do tratamento cirurgico, limitacao das atividades diarias, bem como sintomas pos-operatorios foram coletadas respectivamente: durante, e no posoperatorio de 14 dias. Tratou-se de estudo de coorte quasi-experimental prospectivo, de amostra nao-probabilistica contando com 15 individuos selecionados. O estudo foi dividido em quatro etapas. A primeira etapa consistiu na selecao e recrutamento da amostra e requisicao de exames complementares. Na segunda etapa, foi realizado o enxerto de tecido conjuntivo proveniente do palato, 3 meses antes da cirurgia de enxerto osseo e obtida a tomografia inicial. Na terceira etapa, foram aplicados questionarios pre e pos-operatorios, e realizadas as cirurgias de enxerto osseo autogeno tridimensional. Na quarta e ultima etapa, realizou-se a aplicacao de questionarios e tomografias posoperatorios, e analise estatistica dos dados. Os resultados da analise linear da area receptora nos diferentes momentos da avaliacao apresentaram diferenca significante, resultando em ganho medio osseo final de 0,3mm (}1,3). para largura, e 1,7 mm (}0,94) para altura, a analise fractal nao foi observada diferenca significativa para a trabeculagem ossea entre os diferentes momentos de avaliacao. No entanto, pode-se verificar diferenca significativa entre os resultados do volume osseo da area receptora inicial em relacao ao final, com ganho em volume osseo de 3,412 mm3 (} 1,55), taxa de 71,6%. A reabsorcao media do volume do enxerto obteve-se taxa de 14,4%, correspondendo a media de 0,688 mm3 (}1,48). Nao houve associacao significativa entre a maioria das atividades diarias/sintomas pos-operatorios e percepcao da dor, bem como entre caracteristicas clinicas e os niveis de ansiedade (IDATE), na terceira etapa do estudo (P>0.05). Como excecao pode-se verificar associacao significativa entre halitose e IDATE-Estado, na terceira etapa (P=0.014). Nao foi observada diferenca significante entre os niveis de ansiedade (IDATE) obtidos entre os 3 momentos de avaliacao (P>0.05). A analise de correlacoes cruzadas nao apresentou relacao de causalidade entre as respostas de ansiedade-estado e percepcao de dor (P>0.05). Houve apenas uma correlacao positiva (P=0.044) entre a percepcao de dor no dia da cirurgia e IDATE-T no pos-operatorio de 14 dias. Concluiu-se que a reconstrucao de defeitos verticais de mandibulas posteriormente atroficas pela tecnica tridimensional, proporcionou adequada cicatrizacao com baixas complicacoes e minima reabsorcao ossea, favorecendo ganho osseo vertical. A autoavaliacao do paciente parece indicar que o nivel de dor e ansiedade se manifestou durante o tratamento, no entanto pode nao estar diretamente associado ao procedimento cirurgico. Nao foi possivel provar a causalidade que a dor prediz a ansiedade dos pacientes neste tratamento.(AU)
The aim of this study was to evaluate the bone condition, pain and anxiety in individuals submitted to three-dimensional autologous bone graft surgery in the posterior mandible from the external oblique line. Bone graft height and width, bone volume and quality of the recipient region were measured before and after the graft installation in two moments, through software's and tomographic images. Additionally, self-report of the patients was obtained through an anxiety questionnaire (IDATE T-S) and pain perception (VAS) during the treatment and 14 days postoperative. Some clinical variables of interest in the surgical treatment, limitation of daily activities, as well as postoperative symptoms were collected, respectively, during, and in the postoperative period of 14 days. This is a prospective, almost experimental, cohort study of a non-probabilistic sample with 15 selected individuals. The study was divided into four stages. The results of the linear analysis of the receptor area at the different moments of the evaluation showed a significant difference, resulting in a mean bone gain of 0.3 mm (} 1.3). for width, and 1.7 mm (} 0.94) for height, the fractal analysis did not observe a significant difference for bone trabeculation between the different moments of evaluation. However, a significant difference could be observed between the results of the bone volume of the initial recipient area in relation to the final one, with gain in bone volume of 3,412 mm3 (} 1,55), a rate of 71.6%. The average resorption of the graft volume obtained a rate of 14.4%, corresponding to the mean of 0.688 mm3 (} 1.48). There was no significant association between the majority of daily activities / postoperative symptoms and pain perception, as well as between clinical characteristics and levels of anxiety (STD), in the third stage of the study (P> 0.05). As an exception, a significant association between halitosis and IDATE-Estado can be observed in the third stage (P = 0.014). No significant difference was observed between the levels of anxiety (IDATE) obtained between the 3 moments of evaluation (P> 0.05). Crosscorrelation analysis did not present a causal relationship between anxiety-state responses and pain perception (P> 0.05). There was only a positive correlation (P = 0.044) between the perception of pain on the day of surgery and the IDATET in the postoperative period of 14 days. It is concluded that the reconstruction of vertical defects of posterior atrophic mandibles by the three-dimensional technique, provided adequate healing with low complications and minimal bone resorption, favoring vertical bone gain. The self-assessment of the patient seems to indicate that the level of pain and anxiety manifested during the treatment, however it may not be directly associated with the surgical procedure. It was not possible to prove the causality that the pain predicts the anxiety of the patients in this treatment.(AU)
