Injury Risk Estimation in Mandible-Related Surgical Procedures: A CBCT Study Based on Vital Interforaminal Anatomical Structures.

The mandibular interforaminal region has been considered safe for surgical procedures; nevertheless, the risk of injury to neurovascular structures, such as the mental foramen (MF) and its related structures (anterior loop [AL] and lingual foramina [LF]) should not be overlooked. The study aimed to evaluate the relative risk of injury to these structures during surgical procedures in the anterior region of the mandible based on cone-beam computed tomography (CBCT) scans. A retrospective cross-sectional and observational study was performed on 250 CBCTs from adults (18-69 years) with dentate jaws. Linear measurements of the MF, AL, and LF were evaluated to estimate the risk of injury to these structures during chin-related surgical procedures. The most frequent distance between the base of the mandible (BM) and MF was 8 mm (30.2%). In addition, 20.4% of the CTs had 6 mm from the vestibular cortical bone to the LF. The commonly found measurement from LF to the apex of the nearest tooth was 7 mm (24.0%); 64.2% of the CTs showed a 2-mm distance between the most distal point of the dental implant site to the most anterior point of the AL. Safety distances for genioplasty techniques (MF to mandible base > 6 mm, 96.6% [CI 95%, 95.0%-98.2%]) were observed. Considering the 5-mm cut-off point between the lower limit of a hypothetical bone graft and the chin, 65.4% (CI 95%, 58.9%-71.9%) of CTs were within this distance. Regarding the safety margin of 8 mm, 85.6% (CI 95%, 80.8%-90.4%) were up to this value. This study found safety margins for genioplasty and chin bone grafting surgical techniques that adopt a 5-mm cut-off point. Further similar studies assessing other surgical methods and employing larger samples from different geographical origins may contribute to this field of investigation.

Systematic review and meta-analysis of lingual foramina anatomy and surgical-related aspects on cone-beam computed tomography: a PROSPERO-registered study.

PURPOSE: This study aimed to summarize the evidence regarding lingual foramen (LF) characteristics using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: A registered systematic review (#42,019,145,962) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. An electronic search without date or language restrictions was performed in five databases, including grey literature (Google Scholar and ProQuest). The Meta-Analysis of Statistics Assessment and Review Instrument was used to evaluate the selected studies. RESULTS: A total of 6641 articles were identified, and 26 studies (8255 CBCT scans) were selected after a three-step selection process. There was a female predominance, and age ranged between 10 and 93 years. A total of 4336 LFs were observed among men (n = 2042) and women (n = 2294). Of this LF-related sample, 43.5% of the studies were from Asia, followed by Europe (33.5%), North America (14%), and South America (9%). Different distances from the LF to the alveolar crest (11.04-20.4 mm), buccal (4.73-4.91 mm), and lingual (8.75 mm) cortices and the inferior border of the mandible (8.48-26.59 mm) were evaluated. CONCLUSION: In summary, this systematic review found that LF is an anatomical structure with a high prevalence among the included studies (greater than 90%), regardless of the population evaluated. The occurrence of at least one LF was the most common pattern.

Mental Foramen and Anterior Loop Anatomic Characteristics: A Systematic Review and Meta-analysis of Cross-sectional Imaging Studies.

INTRODUCTION: The present study aimed to review the epidemiologic, topographic, and morphometric aspects of the mental foramen (MF) and anterior loop (AL) on cone-beam computed tomographic imaging studies. METHODS: An International Prospective Register of Systematic Reviews (PROSPERO)-registered systematic review (CRD42018112991) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two reviewers independently performed data extraction from observational studies that evaluated MF and AL on 7 electronic databases. MedCalc (MedCalc Software bv, Ostend, Belgium) software was used to perform a meta-analysis with a 95% confidence level. RESULTS: Of 1545 articles, 66 met the inclusion criteria, totaling 14,233 patients from 5 continents, with a total of 6655 females and 5884 males (some studies did not report sex), with an age range between 8 and 89 years. The most prevalent shapes of MF were oval (48.72%) and circular (44.36%), and the most frequent horizontal positions were between premolars (43.66%) and in line with the long axis of the second premolar (43.12%). CONCLUSIONS: Based on the articles that assessed AL, the mean prevalence was 43.18%, with most studies reporting bilateral localization as the most prevalent.

Preemptive use of oral nonsteroidal anti-inflammatory drugs for the relief of inflammatory events after surgical removal of lower third molars: A systematic review with meta-analysis of placebo-controlled randomized clinical trials.

PURPOSE: To investigate the effectiveness of preemptive analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) for the relief of inflammatory events (pain, edema, and trismus) after surgical removal of third molars. MATERIALS AND METHODS: A two-phase PROSPERO-registered systematic review was conducted in accordance with the PRISMA statement. PubMed, Scopus, Web of Science, COCHRANE, LILACS, DOSS, and gray literature were searched using the following terms (MeSH) or their combinations: molar, third; anti-inflammatory agents, non-steroidal; analgesia; preoperative period; pain management. RESULTS: From a total of 2903 articles, 31 (n = 2184 subjects) were selected. All studies presented a low risk of bias but exhibited high heterogeneity in methodology. Ten studies were selected for the meta-analysis. Preemptive analgesia for removal of third molars reduced average pain scores, especially those 1 h and 6 h after surgery (n = 151, p < 0.001, 95% CI = -2.81 to -0.97), reduced the average consumption of medication, and decreased the number of patients requiring medication without affecting the average time for its first consumption. CONCLUSION: In summary, most NSAIDs showed good results for inflammatory events and reduced average pain scores and consumption of rescue medication. However, more homogeneous and well-delineated clinical studies are necessary to determine a possible association between NSAIDs and the relief of inflammatory events.

Atuação de um cirurgião-dentista residente em unidade de terapia intensiva de um hospital de referência em trauma: relato de experiência / Actuation of a dentistry resident in an intensive care unit of a trauma reference hospital: experience report

A Odontologia no ambiente hospitalar é responsável pelo diagnóstico e tratamento das alterações bucais em parceria com equipes multidisciplinares de alta complexidade ao paciente de Unidade de Terapia Intensiva (UTI). O objetivo deste estudo foi relatar a experiência de um profissional Cirurgião-dentista (CD) residente de uma Residência Multiprofissional atuando em um hospital de referência em trauma no município de Fortaleza durante o ano de 2015. O atendimento inicial era baseado no índice de prognóstico APACHE II e, em seguida exame clínico extra e intra-oral era realizado no leito do paciente com o objetivo de diagnosticar alterações patológicas. Os pacientes foram submetidos a procedimentos que incluíram desde a higienização oral com clorexidina 0,12% para prevenção da PAVM, bem como procedimentos odontológicos invasivos como exodontias, suturas e intervenções periodontais. Além disso, a busca ativa por lesões em cavidade oral realizada possibilitou o diagnóstico precoce e tratamento de alterações patológicas. Dessa forma, a presença do CD na equipe multiprofissional em UTI é de fundamental importância, visto que a manutenção da saúde bucal do indivíduo gera repercussão sistêmica na saúde geral dos indivíduos internados.

Dentistry in the hospital environment is responsible for the diagnosis and treatment of oral disorders in partnership with multidisciplinary teams of high complexity to the Intensive Care Unit (ICU) patient. The aim of this study was to report an experience of a Dentist resident of a Multiprofessional Residency working in a reference hospital in trauma in the city of Fortaleza during the year 2015. The initial care was based on the APACHE prognostic index II, and then extra and intraoral clinical examination was performed in the patient's bed in order to diagnose pathological alterations. Patients underwent procedures ranging from oral hygiene with 0.12% chlorhexidine for prevention of VAP, as well as invasive dental procedures such as exodontia, sutures and periodontal interventions. In addition, the active search for oral cavity lesions performed allowed the early diagnosis and treatment of pathological alterations. Thus, the presence of Dentist in the multiprofessional team in ICU has a fundamental importance, since the maintenance of the individual's oral health generates systemic repercussion in the general health of hospitalized patients.