Incidence of dry socket, alveolar infection, and postoperative pain following the extraction of erupted teeth.

AIM: The aim of this study was to determine the incidence of dry socket, alveolar infection, and postoperative pain following the routine extraction of erupted teeth. METHODS AND MATERIALS: Using a questionnaire, this prospective cross-sectional study evaluated 357 consecutive surgeries in which 473 erupted teeth were extracted by dental students under rigorous control of microbiologic contaminants during a 22-month period. The subject sample consisted of 210 (58.8%) male patients ranging in age from 11 to 79 years (mean 41 +/- 16.3). The most prevalent self-reported ethnicity was Caucasian (78.2%). The questionnaire consisted of 60 questions directed to the patient and to the dental student who performed the surgical procedure. The questionnaires were completed before and within seven days after the surgery to obtain outcomes data. Forty-five questionnaires were excluded due to lack of information, inconsistencies, or lack of contact with the patient; however, none had indications of alveolar infection or dry socket. The data were analyzed using descriptive statistics, chi-square tests (x(2)), and an odds ratio (OR) as appropriate at the critical level of significance, set at p<0.05 (x(2)) or p<0.01 (x(2), with the Monte Carlo simulation). RESULTS: The observed incidence was 0.6% (two cases each) for both alveolar infection and dry socket. Higher pain levels and pain persisting longer than two days were observed with more traumatic surgeries, or associated with postoperative complications. Smoking was found to be statistically associated with the development of postoperative complications. CONCLUSION: The incidence of alveolar infection, dry socket, and severe pain were very low for the routine extraction of erupted teeth. Severe pain that persists for more than two days can represent a sign of a postoperative complication such as dry socket. CLINICAL SIGNIFICANCE: Dental extraction is part of the dentists' daily work and intercurrences like dry socket, infection, and pain can occur. This manuscript reports the incidence of these occurrences and search for its predisposing factors.

Viability and collagen secretion by fibroblasts on titanium surfaces with different acid-etching protocols.

BACKGROUND: From the consolidation of surface treatments of dental implants and knowledge on the cellular mechanisms of osseointegration, studies have highlighted the importance of a connective tissue seal against the implant to prevent contamination from the oral environment and consequent biofilm formation. OBJECTIVE: This in vitro study aimed to evaluate whether different titanium surface treatments using acid solutions promoted an increase in collagen secretion, proliferation, and viability of fibroblasts. MATERIAL AND METHODS: Commercially pure grade-4 titanium disks (6 × 2 mm) were treated with different acid solutions (hydrochloric, nitric, and sulfuric) for 20 and 60 min, respectively, obtaining mean surface roughness of 0.1 to 0.15 µm and 0.5 to 0.7 µm. Human fibroblasts were seeded onto different surfaces and assessed after 24 h, 48 h, and 72 h for cell proliferation and viability using Trypan blue staining and MTT, respectively, as well as the secretion of type I collagen on to such surfaces using ELISA. Machined titanium surfaces were used as controls. Data were statistically analyzed using one-way ANOVA and Fisher's LSD test for multiple comparisons, adopting a significance level of 5%. RESULTS: No significant difference was observed in cell proliferation for the different surfaces analyzed. Cell viability was significantly lower on the machined surface, after 48 h, when compared to the groups treated with acid for 20 or 60 min, which did not differ from each other. The expression of type I collagen was lowest on the acid-treated surfaces. CONCLUSION: The results showed that the acid treatment proposed did not promote fibroblast proliferation and viability nor favor type I collagen synthesis.

Severely resorbed mandible treated by soft tissue matrix expansion (tent pole) grafts: case report.

The functional rehabilitation for severely resorbed mandibles has been a challenge for dentists and oral surgeons. We present a 2-year follow-up case of severely resorbed mandibles successfully treated by soft tissue matrix expansion and cranial bone graft with nonremovable screw-retained acrylic resin prosthesis supported by 4 dental implants.

Rehabilitation of a Severely Resorbed Posterior Mandible with 4-mm Extra-Short Implants and Guided Bone Regeneration: Case Report with 3-year Follow-up.

Alveolar bone resorption has been a major challenge for implant placement in regions limited by anatomical structures. New alternatives have been introduced with the inclusion of extra-short implants in dentistry. The association of guided bone regeneration (GBR) with the use of extra-short implants might be a viable alternative for regions with limited bone height. This case report aimed to present the rehabilitation of a patient with severe mandibular bone resorption in the posterior region. The association of GBR with the use of extra-short implants was a viable alternative after a 3-year follow-up.

Predicting Pain After Tooth Extraction: Pain Prediction Index.

AIMS: To identify relevant variables that may predict pain after routine extraction of erupted teeth, to construct a Pain Prediction Index (PPI) based on these variables, and to verify how these variables are related by using valid structural equation modeling (ie, path analysis). METHODS: This study was designed as an observational prospective study for postoperative memory of pain after dental extraction of erupted teeth. Data from a total of 781 surgical procedures related to dental extractions were included. Pain was self-reported by the patients and was evaluated by a verbal category scale (VCS) on the seventh postoperative day. The database was searched for predictive variables that were significantly (P < .05) associated with postoperative pain. RESULTS: Pain was scored by patients as none in 65.4% of cases (511); light in 22.9% (179); moderate in 11% (86); and severe in 0.6% (5). Seven predictive variables were strongly related to postoperative pain: gender (female); age (younger than 33); number of extracted teeth (three); surgical technique (surgical flap, ostectomy, or teeth sectioning); number of local anesthetic cartridges (more than three); time in surgery (greater than 25 minutes); and any surgical complications. These variables were used to compose the PPI. The retained PPI classified 66.3% of the patients correctly for both pain and no pain; however, when more than three points were scored on the PPI, it correctly predicted pain in 55.6% of cases. CONCLUSION: The present study identified seven predictive variables that were strongly related to postextraction pain and documented that the PPI could correctly predict pain in the majority of patients.

Impact of Dentofacial Deformity on Quality of Life: Age and Gender Differences Evaluated Through OQLQ, OHIP and SF36.

OBJECTIVES: The aim of this study was to verify the impact of dentofacial deformity on quality of life and explore gender and age differences. MATERIAL AND METHODS: The impact of dentofacial deformity (DD) on quality of life was evaluated through questionnaires; Short Form Health Survey (SF36), Oral Health Impact Profile Questionnaire (OHIP), Orthognathic Quality of Life Questionnaire (OQLQ) and a single question answered by a Visual Analogue Scale. RESULTS: Significant differences between male and female patients were observed in domains of OQLQ (oral function, P = 0.006; awareness of facial deformity, P = 0.018; and facial aesthetics, P < 0.001) and OHIP (physical pain, P = 0.006; psychological discomfort, P = 0.007; psychological disability, P = 0.006; and handicap, P = 0.01). CONCLUSIONS: The impact of dentofacial deformity was more pronounced in female Brazilian population. Age of patients with dentofacial deformity produced impacts over quality of life in different ways and according to the applied questionnaire and the interaction between age and gender may also produce different impacts in patients with dentofacial deformity. The domains of Orthognathic Quality of Life Questionnaire, Oral Health Impact Profile Questionnaire and Short Form Health Survey showed unaccepted distances in the pattern of answer rising doubts of their ability to assess quality of life as a generic and broad concept. There is a necessity to create a single quality of life instrument capable to measure impacts with sensitivity and specificity and from a generic concept to condition-specific health problem.

Clinical evaluation of anodized surface implants submitted to a counter torque of 25 ncm after 60 days of osseointegration: study in humans.

INTRODUCTION: Decreasing the time needed for osseointegration has always been a big challenge for modern implantodontics. The main factor which helps to decrease the time needed for osseointegration is the newly developed surfaces being used, as well as their microstructures, in relation to their osseoinductive properties. The aim of this work is to clinically evaluate the osseointegration of the implants when using The anodized surfaces in humans, following a 60 days-period of osseointegration. METHODOLOGY: Forty-Five implants were placed in different kinds of bones, according to the technique recommended by the manufacturer. Those implants were opened after 60 days of osseointegration. The success of evaluation was made through assessing the counter torque resistance of 25 Ncm. The implants which could withstand the applied torque were considered osseointegrated. RESULTS: Of the forty-five implants made in different kinds of bones, only one failed to present osseointegration, resulting in a success rate of 97.7 %. CONCLUSIONS: With this methodology it was possible to conclude that anodized surface implants present primary osseointegration after 60 days of healing, after which they can function normally.

Comparative, Histological and Histomorphometric Analysis of Three Anorganic Bovine Xenogenous Bone Substitutes: Bio-Oss, Bone-Fill and Gen-Ox Anorganic.

INTRODUCTION: Anorganic bovine xenogenous grafts show the best performance as bone substitutes in implantodontics. Bio-Oss is the world's most widely used and investigated anorganic bone substitute. This article compares two anorganic bovine bone substitutes (Bone-Fill and Gen-Ox anorganic) with Bio-Oss. MATERIALS AND METHODS: Eight New Zealand rabbits were implanted with 4 titanium cylinders randomly filled with Bio-Oss, Bone-Fill, Gen-Ox anorganic or a blood clot. Four animals were sacrificed after 8 weeks; 12 weeks later, the remaining four were sacrificed. The contents of the cylinders were removed, cut and stained with HE before they were evaluated with an optical microscope. The samples were submitted to histomorphometry for analysis. RESULTS: The bone formation with Bio-Oss at 8 weeks was 8.43 mm(2); at 12 weeks, it was 9.32 mm(2). The bone formation with Bone-Fill at 8 weeks was 7.24 mm(2); at 12 weeks, it was 9.01 mm(2). The bone formation with Gen-Ox anorganic at 8 weeks was 2.78 mm(2); at 12 weeks, it was 3.02 mm(2). The bone formation with the blood clot at 8 weeks was 0.65 mm(2); at 12 weeks, it was 0.63 mm(2). CONCLUSION: Following this model, Bone-Fill was comparable to Bio-Oss and superior to Gen-Ox and blood clot.

Comparative study of immediately inserted dental implants in sinus lift: 24 months of follow-up.

OBJECTIVES: The primary aim of this study is to evaluate the success rate of immediately inserted dental implants in sinus lift and the secondary aim is to assess the reliability of performing simultaneous surgery for sinus lift, grafting and implant placement in situations of very low residual bone heights (<4 mm) in the posterior maxillae. MATERIALS AND METHODS: A series of consecutive patients who sought dental implant rehabilitation were included in this study. The sinus lift cases were selected and divided into two groups based on the maxillary alveolar height, ≥4 mm of radiographically measurable bone height (Group 1) and < 4 mm of bone height (Group 2). RESULTS: A total of 13 implants were installed in Group 1, whereas 8 implants were installed in Group 2. The success rate for dental implants in the sinus lifts reached 95.2% after a period of 24 months of evaluation, at 100% for Group 1 (bone height ≥ 4 mm) and 87.5% for Group 2 (bone height with < 4 mm). Besides the differences between the percentages of success, statistical differences were not reached when the groups were compared (Fisher's exact test, P = 0.38). CONCLUSIONS: Despite the limitations of this study, including its low number of participants, the results indicate that simultaneous surgery for sinus lifting, grafting and dental implants in posterior maxillae with very low bone heights (<4 mm) can be performed safely, although with lower success rates than found in patients with higher residual bone heights (>4 mm).

A single dose of amoxicillin and dexamethasone for prevention of postoperative complications in third molar surgery: a randomized, double-blind, placebo controlled clinical trial.

BACKGROUND: The aim of this study was to assess the efficacy of a single prophylactic dose of amoxicillin and/or dexamethasone in preventing postoperative complications (PC) after a surgical removal of a single mandibular third molar (M3). METHODS: This study is a randomized, placebo controlled clinical trial. Four groups were included: Group 1 (G1) included a prophylactic dose of 2 g of amoxicillin and 8 mg of dexamethasone; Group 2 (G2) included a prophylactic dose of 2 g of amoxicillin and 8 mg of placebo; Group 3 (G3) included a prophylactic dose of 8 mg of dexamethasone and 2 g of placebo and; Group 4 (G4) placebo. RESULTS: Fifty patients were included. It was observed one case of alveolar infection (2%) and two of alveolar osteitis (4%) resulting in three PC (6%). No statistical differences were observed between therapeutic groups for development of PC, trismus, pain and edema. The use of antibiotics showed an absolute risk reduction (ARR) for PC development of 3.52% and the number needed to treat (NNT) was 29. CONCLUSION: Prophylactic antibiotics and corticoid in a single dose regimen did not bring any benefit on M3 surgeries.

Fibrina rica em plaquetas e piezocirúrgico em comparação com instrumento rotatório convencional e coágulo em cirurgia de terceiros molares inferiores impactados: relato de caso

Objetivo: avaliar os resultados pós-operatórios em cirurgias de terceiros molares inferiores impactados com um desenho split mouth. Em um dos lados, foi utilizada fibrina rica em plaquetas (PRF) e piezocirúrgico, no lado oposto, foi realizada osteotomia rotatória convencional e coágulo. Foram avaliados a relação entre as duas técnicas de osteotomia, o tempo cirúrgico e a gravidade das sequelas no pós-operatório, incluindo dor, edema, trismo e reparo. Relato de caso: este trabalho apresenta um relato de caso clínico como projeto-piloto de uma série de casos clínicos. Os terceiros molares inferiores indicados para extração, foram pareados pela classificação de Pell e Gregory, sendo divididos em: grupo A (hemiarco direito), utilizando o piezocirúrgico e PRF, e grupo B (hemiarco esquerdo), seguindo os padrões tradicionais com brocas rotatórias e coágulo. As exodontias foram realizadas em um único momento pelo mesmo cirurgião-dentista. O piezocirúrgico, comparado à técnica convencional, demonstrou menor dor pós-operatória pela escala de VAS, além de diminuir o número de analgésicos consumidos e reduzir significativamente o trismo após 72 horas da cirurgia. Em contrapartida, o seu tempo cirúrgico foi superior ao da técnica convencional. Considerações finais: conclui-se que o uso de piezocirúrgico e PRF obteve melhores resultados nas condições pós-operatórias com relação a dor, edema e reparo. Porém, o tempo cirúrgico foi maior que a osteotomia convencional e coágulo. Sendo assim, o presente estudo mostrou que a piezocirurgia e a utilização combinada de PRF têm efeitos positivos nos resultados pós-operatórios, após a exodontia de terceiro molar impactado.

Glucose levels and hemodynamic changes in patients submitted to routine dental treatment with and without local anesthesia.

OBJECTIVE: The aim of this study was to (1) observe the extent to which hemodynamic and glucose measurements change in patients submitted to a dental procedure with and without a local anesthetic and a vasoconstrictor (LAVA; 2% mepivacaine with adrenaline 1100,000) and (2) correlate those parameters with the patients' anxiety levels. METHOD: This was an unblinded, random, prospective, and observational study with paired groups. Patients were evaluated during two different consultations during which they either did or did not receive a local anesthetic/vasoconstrictor. RESULTS: Thirty-seven patients ranging in age from 18 to 45 years (mean 30.4 ± 5.5 years) were evaluated. Hemodynamic parameters, including systolic blood pressure, diastolic blood pressure, heart rate, and glucose levels, did not change significantly in healthy patients, regardless of whether a LAVA was administered during the dental treatment. CONCLUSION: The patients' anxiety statuses neither varied significantly nor showed any correlation with the studied hemodynamic parameters and glucose levels, regardless of whether local anesthetics were used.

Cisto de retenção mucoso em mucosa sinusal e levantamento de seio maxilar / Mucosal retention cyst and maxillary sinus lifting: a case report

A técnica de levantamento de seio maxilar é a opção mais utilizada para tratamento das deficiências em altura na região posterior da maxila. Algumas patologias apresentam aumento na dificuldade de execução da técnica, podendo contraindicar temporariamente o procedimento. Uma das alterações mais frequentes na região é a presença de cistos de retenção mucosos (mucoceles de seio maxilar). Apesar de normalmente serem de fácil diagnóstico em imagens, seu comportamento clínico de diminuição ou regressão espontânea pode mascará-los, levando a diagnósticos incorretos. Os autores relataram um caso em que as imagens tomográficas demonstravam pequena imagem hiperdensa na cavidade sinusal, porém, sem evidências de mucocele sinusal. Apresentam também a condução do caso após o diagnóstico transcirúrgico.

The technique of sinus lifting is one of the most indicated to treat height defIciencies in posterior maxilla. Some pathologies can counterindicate temporarily the procedure. Mucous retention cyst (MRC) are frequent inside the maxillary sinus. Although easy to detect on images, its clinical bahavior can lead to an incorrect diagnosis. The present paper aims to report a case which images were showing a small hyperdense image in the right maxillary antrum, but without evidences of MRC. The solution after transurgical diagnosis is also presented.

Glucose levels and hemodynamic changes in patients submitted to routine dental treatment with and without local anesthesia

OBJECTIVE: The aim of this study was to (1) observe the extent to which hemodynamic and glucose measurements change in patients submitted to a dental procedure with and without a local anesthetic and a vasoconstrictor (LAVA; 2 percent mepivacaine with adrenaline 1100,000) and (2) correlate those parameters with the patients' anxiety levels. METHOD: This was an unblinded, random, prospective, and observational study with paired groups. Patients were evaluated during two different consultations during which they either did or did not receive a local anesthetic/vasoconstrictor. RESULTS: Thirty-seven patients ranging in age from 18 to 45 years (mean 30.4 ± 5.5 years) were evaluated. Hemodynamic parameters, including systolic blood pressure, diastolic blood pressure, heart rate, and glucose levels, did not change significantly in healthy patients, regardless of whether a LAVA was administered during the dental treatment. CONCLUSION: The patients' anxiety statuses neither varied significantly nor showed any correlation with the studied hemodynamic parameters and glucose levels, regardless of whether local anesthetics were used.

Tratamento da fratura de mandíbula atrófica associada reabilitação com implantes dentários – relato de caso / Treatment of atrophic mandible fracture combined to rehabilitation with dental implants – case report

O aumento da população idosa e o incremento da procura por tratamentos reabilitadores faz com que os profissionais dedicados a esta arte se depararem com a necessidade de reabilitação de mandíbulas atróficas e com o risco de sua fratura. A proposta deste trabalho foi apresentar o relato de um caso de tratamento de fratura de mandíbula atrófica. O caso foi tratado sob anestesia geral, com instalação de placa de fixação mandibular concomitante a instalação de 4 implantes cone morse para futura confecção de protocolo com desenho all on four. A técnica proporcionou adequada resolução para a fratura e proporcionou segurança para a futura reabilitação implantossuportada.

The increasing elderly population and increasing demand for rehabilitation treatments make professionals dedicated to this art faced with the need for rehabilitation of atrophic jaws and the risk of fracture. The purpose of this study was to present the case report of the treatment of atrophic mandible fractures. The patient was treated under general anesthesia, with installation of the mounting plate concomitant mandibular installing 4 morse taper implants for future preparation of protocol design on all four. The technique provided adequate resolution for fracture and provided security for the future rehabilitation implant.

Uso do transfer-control bone replacing system para realização de enxertos autógenos em bloco – apresentação de dois casos clínicos / Use of the transfer-control bone replacing system for autogenous bone block grafting: presentation of two clinical cases

Os enxertos em bloco de osso autógeno são a principal opção para ganhos em espessura em atrofias severas do rebordo. Apesar de ser considerado padrão-ouro, a técnica de remoção do enxerto ósseo aumenta a morbidade das reconstruções. O uso do Tranfer-Control Bone Replacing System apresenta uma excelente alternativa para estas reconstruções, pois permite uma perfeita adaptação do bloco removido ao seu leito receptor com menor morbidade em relação às técnicas convencionais. Este trabalho apresenta o relato de dois casos clínicos de diferentes pacientes para realização de enxerto ósseo autógeno em bloco com o sistema mencionado, removido da linha oblíqua externa, para ganho de espessura óssea para posterior reabilitação com implantes osseointegrados. Em ambos os casos, o bloco foi realizado na região do elemento 14, e o resultado obtido com a técnica permitiu a instalação dos implantes na posição desejada.

Autogenous bone block grafts are the main option for augmentation in severely atrophic areas. Despite being the gold standard, current techniques for bone removal increase local patient morbidity. The Transfer-Control Bone Replacing System represents an alternative technique because it allows for ideal adaptation of the harvested block to the receptor site with less morbidity when comparted to traditional techniques. This paper illustrates two clinical case reports where the use of the aforementioned system is made at the oblique external line to gain thickness before dental implant placement. in both cases, the bone block was grafted at the maxillary premolar region providing adequate sites for three-dimensional implant placement.

Avaliação do sucesso de levantamentos de seio maxilar utilizando osso autógeno particulado e Gen Ox inorgânico associados em partes iguais (1:1) / Success evaluation of the sinus lifting procedure with autogenous plus anorganic bovien bone (Gen Ox) in a 1: 1 ratio

A técnica do levantamento de seio maxilar permite a instalação de implantes em deficiências de altura na região posterior da maxial. Os autores apresentam 20 levantamentos de seio maxilar realizados com associação de osso autógeno e de osso xenógeno inorgânico bovino (Gen Ox).

The sinus lifting technique allows implant placement at posterior maxillary regions with defficient bone heights. The authors present 20 cases where the autogenous material was mixed with an anorganic bovine bone in a 1:1 ratio.