Use of Photobiomodulation to Reduce Postoperative Pain, Edema, and Trismus After Third Molar Surgery: A Systematic Review and Meta-Analysis.

PURPOSE: Third molar extraction can cause surgical trauma, which is associated with pain, edema, trismus, and functional limitations. The aim of the present systematic review was to investigate the effects of photobiomodulation (PBM) following the extraction of impacted mandibular third molars. METHODS: An electronic search was conducted in 10 databases from inception up to October 2021 and the grey literature, with no restrictions regarding language or year of publication. Randomized controlled clinical trials (RCT) were included. Studies that were not RCTs were excluded. Reviewers independently analyzed titles and abstracts, followed by full-text analysis. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The exposure variable was the use of PBM and the outcomes were pain, edema, and trismus. Meta-analysis was performed using a random-effects model. The estimate was calculated considering standardized mean differences (SMD) and respective 95% confidence intervals (CI) obtained for each outcome on the first, second, third and seventh postoperative days. The level of evidence was assessed using the GRADE approach. RESULTS: The search resulted in the 3,324 records. Thirty-three RCTs were included in the systematic review and 23 of these were included in the meta-analyses. The studies involved a total of 1,347 participants (56.6% female and 43.4% male) between 16 and 44 years of age. A greater reduction in pain was found in the PBM group compared to the control group on the third postoperative day (SMD: -1.09; 95% CI: -1.63; -0.55; P < .001; low certainty). Edema was discretely lower in the PBM group on the second postoperative day (SMD: -0.61; 95% CI: -1.09; -0.13; P < .001; low certainty) and trismus was discretely lower in the PBM group on the seventh postoperative day (SMD: 0.48; 95% CI: 0.00; 0.96; P < .001; very low certainty). CONCLUSION: The evidence of the effect of PBM regarding the control of pain, edema, and trismus following third molar extractions is low or very low.

Predictors associated with malocclusion in children with and without sleep disorders: a cross-sectional study

Abstract The aim of the present study was to investigate predictors of malocclusion in Brazilian schoolchildren eight to ten years of age based on a causal directed acyclic graph model. A cross-sectional study was conducted with 739 schoolchildren eight to ten years of age. Parents/guardians provided information on sleep disorders of the child (Sleep Disturbance Scale for Children) and family characteristics (Family Adaptability and Cohesion Evaluation Scale). The diagnosis of malocclusion was performed by four trained examiners using the Dental Aesthetic Index. Control variables were selected using a directed acyclic graph. Descriptive analysis was performed, followed by robust logistic regression analysis for complex samples (α = 5%). The following variables were associated with malocclusion in the final model: sleep disorders (OR = 2.61; 95%CI: 2.43-2.86), mouth breathing (OR = 1.04; 95%CI: 1.02-1.99), non-nutritive sucking habits (OR = 2.45; 95%CI: 2.37-4.85), and obesity (OR = 1.54; 95%CI: 1.02-2.33). Sociodemographic characteristics, family functioning, and premature tooth loss did not remain associated with malocclusion. Sleep disorders, mouth breathing, sucking habits, and obesity are predictors of malocclusion in schoolchildren eight to ten years of age.

Evaluation of the association between self-reported sleep bruxism and chronotype and sleep quality among dental students / Avaliação da associação entre cronotipo, qualidade do sono e autorrelato de bruxismo do sono entre estudantes universitários de Odontologia

ABSTRACT Background Sleep bruxism (BS) is defined as involuntary jaw movements characterized by grinding and clenching teeth. Objective To verify the association between chronotype, sleep quality, and self-reporting of BS in dental students. Method A cross-sectional study was conducted with 214 undergraduate dental students at a public university in northeast Brazil. The participants answered the Munich Chronotype Questionnaire for the identification of chronotype and another questionnaire regarding daily aspects to collect information about sleep quality, self-reported sleep bruxism, the use of sleeping pills, snoring, concentration during daily activities and energy upon waking. Results The prevalence of self-reported sleep bruxism was 11.0%. In the final model, the eveningness chronotype (OR = 23.00; 95% CI: 2.36-223.84, p = 0.007), habitual snoring (OR = 3.12; 95% CI: 1.31-7.39, p = 0.01) and low energy upon waking in the morning (OR = 2.37; 95% CI: 1.96-5.58, p = 0.040) were associated with self-reported sleep bruxism. Conclusion The evening chronotype, presence of snoring, and low energy when waking up in the morning influenced self-reporting of sleep bruxism among undergraduate dental students.

RESUMO Introdução O bruxismo do sono (BS) é definido como movimentos involuntários da mandíbula caracterizados por ranger e apertar os dentes. Objetivo Verificar se o cronotipo e a qualidade do sono estão associados ao autorrelato de BS em graduandos de Odontologia. Método Um estudo transversal com 214 estudantes de uma universidade pública do Nordeste do Brasil. Os participantes responderam ao Morningness-Eveningness Questionnaire para identificar os cronotipos e outro questionário sobre aspectos diários em que foram coletadas informações sobre qualidade do sono, autorrelato de bruxismo do sono, uso de pílulas para dormir, ronco, concentração nas atividades diárias, energia ao acordar. Resultados A prevalência de autorrelato do bruxismo do sono foi de 11,0%. No modelo final, o cronotipo noturno (OR = 23,00; 95% IC: 2.36-223.84, p = 0,007), o hábito de roncar (OR = 3,12; 95% IC: 1.31-7.39, p = 0,01) e o baixo nível de energia ao acordar pela manhã (OR = 2,37; 95% IC: 1.96-5.58, p = 0,04) estiveram associados com o autorrelato de BS. Conclusão O cronotipo noturno, a presença do ronco e a baixa energia ao se levantar pela manhã influenciaram o autorrelato de bruxismo do sono entre os estudantes de graduação em Odontologia.

Mandibular canal bifurcation and trifurcation: case report from a finding obtained through cone beam computed tomography / Bifurcação e trifurcação do canal mandibular: relato de caso a partir de um achado em tomografia computadorizada de feixe de cone

Aim: This case report aims to demonstrate a rare mandibular canal (MC) variation, presenting right trifurcation and left bifurcation through Cone-Beam Computed Tomography (CBCT). Case report: A 26-year-old female patient with no systemic disorders was referred for surgical removal of the lower third molars due to the presence of painful symptoms. CBCT was requested to evaluate the relationship between third molars and the mandibular canal and to guide the surgical planning. Tomographic volume was analyzed through the Sidexis software (Sirona Dental Systems, Bernsheim, Germany). During the analysis of tomographic sections, it was possible to observe the presence of bilateral MC variations. Bifurcation of the right MC and trifurcation of the left MC were observed. Conclusion: The present report highlighted the importance of CBCT for the diagnosis of anatomical changes, such as MC trifurcation.

Objetivo: Este relato tem por objetivo descrever uma rara variação do canal mandibular (CM) apresentando trifurcação direita e bifurcação esquerda, por meio da Tomografia Computadorizada de Feixe Cônico (TCFC). Relato do caso: Paciente do sexo feminino, 26 anos de idade, sem comprometimento sistêmico, foi encaminhada para remoção cirúrgica dos terceiros molares inferiores devido a presença de sintomatologia dolorosa. Foi solicitada uma TCFC para avaliar a relação entre terceiros molares e o canal mandibular, para orientar o planejamento cirúrgico. O volume tomográfico foi analisado por meio do software Sidexis (Sirona Dental Systems, Bernsheim, Alemanha). Durante a análise dos cortes tomográficos, foi possível observar a presença de variações do CM bilateralmente. Observou-se bifurcação do CM direito e trifurcação do CM esquerdo. Conclusão: O presente relato destacou a importância da TCFC para o diagnóstico das alterações anatômicas, como a trifurcação do canal mandibular.

Signs of the proximity of third molar roots to the mandibular canal: an observational study in panoramic radiographs.

The objectives of this study were to assess the relationship between mandibular third molars and the mandibular canal, establishing which radiographic signs are most prevalent in predicting contact between these structures, and to associate these signs and the proximity with the position of the third molar according to the classifications of Pell & Gregory and Winter. A retrospective, cross-sectional observational study was carried out on panoramic radiographs. From a dataset of 3289 images, a convenience sample of 1548 panoramic radiographs with a total of 2639 third molars was selected for evaluation. The inclusion criteria were patients of both sexes who had at least 1 totally formed mandibular third molar that was adjacent to a second molar. Radiographs were excluded if they were of poor quality or revealed evidence of cystic or tumoral processes or extensive caries. Seven radiographic signs were used to determine if there was contact between the third molar and mandibular canal. A proximity to the mandibular canal was verified for 1677 (63.5%) of 2639 third molars. The most frequent radiographic signs of proximity were darkened roots (767 teeth [29.1%]) and discontinuity of the mandibular canal (757 teeth [28.7%]). Third molar/mandibular canal proximity was found significantly more frequently in female patients and in patients aged 24 years and younger (P < 0.001). The tooth positions most frequently associated with proximity between the third molar and the mandibular canal were position C (highest point of the third molar located at or below the cervical margin of the second molar) and the mesioangular position (long axis of the third molar angled mesially toward the second molar).

Remoção de dente deslocado para o seio maxilar / Removing the tooth displaced to the maxilar sinus

Os seios paranasais auxiliam na termorregulação do ar inspirado, acrescentam ressonância à voz e tornam a estrutura esquelética facial mais leve. O seio maxilar exibe proximidade com a cavidade bucal, o assoalho da órbita, a cavidade nasal e as raízes dos elementos dentários da maxila. Quando um dente é deslocado para o seio, a técnica de Caldwell-Luc pode ser utilizada, pois fornece acesso direto ao seio e à boa visualização. Assim, esse relato tem como objetivo apresentar o caso clínico de uma paciente cujo dente foi deslocado acidentalmente para o seio maxilar, após tentativa de exodontia, o qual foi removido por meio da técnica de Caldwell-Luc. Contudo, ratifica-se a importância do conhecimento anatômico a fim de prevenir acidentes e complicações relacionados às cirurgias maxilares... (AU)

The paranasal sinuses aid in the thermoregulation of the inspired air, adds resonance to the voice and makes the facial skeletal structure lighter. The maxillary sinus exhibits proximity to the buccal cavity, floor of the orbit, nasal cavity and the roots of dental elements of the maxilla. When a tooth is moved to the breast, the Caldwell-Luc technique can be used as it provides direct access to the breast and good visualization. Thus, this report aims to present the clinical case of a patient whose tooth was accidentally moved to the maxillary sinus after attempted exodontia, which was removed by the Caldwell Luc technique. However, the importance of anatomical knowledge is confirmed in order to prevent accidents and complications related to maxillary surgeries... (AU)

External root resorption of second molars caused by impacted third molars: an observational study in panoramic radiographs / Reabsorção radicular externa de segundos molares ocasionadas por terceiros molares impactados: estudo observacional em radiografias panorâmicas

Objective: This research investigate the presence of external root resorption (ERR) in second molars caused by impacted third molars in panoramic radiographs, relating to the position of third molars according to classification of Winter, Pell and Gregory. Material and method: A cross-sectional, retrospective study using panoramic radiographs obtained from January 2014 to December 2015. The inclusion criterion was the presence of a second molar adjacent to an impacted third molar. Data were analyzed using descriptive and inferential statistics. Pearson's Chi-Square Test and Fisher's Exact Test (p≤0.05) were performed. Result: The sample consisted of 584 panoramic radiographs, 356 (60.95%) of women, and 228 (39.05%) of men, the mean age was 25.31 years. The prevalence of ERR was 12.5%, and the group of 14-24 year olds was the most affected (p = 0.46). The presence of ERR was statistically higher in the mandible (42.1%) with p=0.01. The ERR located in the cervical (57.1%) and medium (58.8%) thirds was proportionally higher in the teeth with B2 (p=0.02) and mesio-angular positions (p=0.26). Conclusion: The prevalence of ERR in second molars, caused by impacted third molars, was shown to be similar to results found in the literature, with no gender preference, this affects young patients, occurring frequently in mandible teeth, and presents greater severity in the cervical and middle thirds. The B2 and mesio-angular positions were more prone to ERR.

Objetivo: Esta pesquisa investigou a presença de reabsorção radicular externa (RRE) em segundos molares ocasionada pelos terceiros molares impactados em radiografias panorâmicas, relacionando com a posição dos terceiros de acordo com a classificação de Winter e de Pell e Gregory. Material e método: Um estudo transversal, retrospectivo, por meio de radiografias panorâmicas obtidas no período de janeiro de 2014 a dezembro de 2015. Adotou-se como critério de inclusão, a presença um segundo molar adjacente a um terceiro molar impactado. Os dados foram analisados por meio de estatística descritiva e inferencial. Foram realizados o Teste Qui-Quadrado de Pearson e Teste Exato de Fisher (p≤0,05). Resultado: A amostra foi composta por 584 radiografias panorâmicas, sendo 356 (60,95%) do gênero feminino e 228 (39,05%) do masculino, a média de idade foi de 25,31 anos. A prevalência de RRE foi de 12,5%, e a faixa etária de 14-24 anos foi mais acometida (p=0,46). A presença de RRE foi estatisticamente maior na mandíbula (42,1%) com p=0,01. As RRE localizadas nos terços cervical (57,1%) e médio (58,8%) foram proporcionalmente maiores nos dentes nas posições B2 (p=0,02), e mesioangular (p=0,26). Conclusão: A prevalência de RRE em segundos molares causada por terceiros impactados se mostrou estar de acordo com a média existente na literatura mundial, sem predileção por gênero, acometendo mais pacientes jovens, frequentemente ocorre nos dentes da mandíbula e apresenta um maior grau de severidade no terço cervical e médio. As posições B2 e mesioangular apresentaram maior propensão à RRE.