Frequency of osteonecrosis in bisphosphonate users submitted to dental procedures: A systematic review.

OBJECTIVE: To determine the frequency of osteonecrosis of the jaw in bisphosphonate users submitted to dental procedures. METHODS: This systematic review searched the sources: MEDLINE, EMBASE, Web of Science, Scopus, and Virtual Health Library, with no restriction on language or publication date. Reviewers, in pairs and independently, selected the studies, extracted their data, and assessed the risk of bias. Meta-analyses were pooled using the DerSimonian and Laird random effects model. RESULTS: A total of 27 studies (5391 participants) were included. The most reported bisphosphonates were zoledronate (n = 17 studies) and alendronate (n = 19) for treating cancers (n = 11) and osteoporosis (n = 16), respectively. Twelve studies were of low methodological quality. The frequency of osteonecrosis was 2.7% (95% CI: 0.9-5.2%) and proved higher for intravenous [6.9% (0.7-17.3%)] than oral [0.2% (0.9-5.2%)] bisphosphonate use. No association between longer treatment duration and greater frequency of osteonecrosis was observed. CONCLUSIONS: Higher frequency of osteonecrosis was observed in intravenous bisphosphonate users submitted to dental extraction. Further studies collecting more detailed information on the bisphosphonates used and of greater methodological rigor are warranted to confirm these findings and better inform prescribers, dental surgeons, and other professionals on risks of bisphosphonate use in this patient group.

Comparison of piezosurgery and conventional rotary instruments in schneider's membrane sinus lifting: A pilot randomized trial.

BACKGROUND: The present study aimed to evaluate and compare the postoperative effects of the piezoelectric device and conventional rotary instruments in Schneider's membrane sinus lifting procedure. MATERIAL AND METHODS: Twenty patients requiring bilateral maxillary bone graft augmentation in the posterior maxillary region were selected. Piezoelectric surgery was performed on one side and conventional surgery with a rotary diamond bur on the other. Postoperative pain, swelling, edema, and mouth opening were evaluated at one hour and two and seven days after the procedures. All variables were submitted to Friedman or Wilcoxon tests at a 5% significance level. RESULTS: The comparison between groups showed that postoperative pain after one hour and two days was significantly lower (p< 0.05) in the piezoelectric device group. Regarding the edema, the results of both techniques were similar at all times assessed (p> 0.05). Piezosurgery was statistically associated (p< 0.05) with greater mouth opening only at the 48-hour evaluation. CONCLUSIONS: Osteotomy with a piezoelectric device causes less pain and greater mouth opening postoperatively compared with the conventional technique. Key words:Piezosurgery, sinus lift, edema, pain, rotative instruments.

Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis.

OBJECTIVES: There is a lack of evidence about the use of local anaesthetics (LAs) in patients with cardiovascular diseases (CVD) in dental procedures. Thus, this study evaluated the safety of using LA with vasoconstrictor to determine the risk of cardiovascular events in patients with CVD. DESIGN: Systematic review and meta-analysis. METHODS: We have searched in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid), Healthstar (via Ovid), CINAHL, Web of Science and ClinicalTrials.gov for randomised controlled trials (RCTs) up to January 2020. We have included RCTs involving adults with CVD within two groups: intervention group with LA with vasoconstrictor and control group with LA without vasoconstrictor. The primary outcomes assessed were death, mortality by a specific cause, stroke, acute myocardial infarction, hospitalisation, pain, bleeding and arrhythmias. The secondary outcomes were ST segment depression, anxiety, adverse effects and changes in haemodynamic parameters. The data were pooled using random effects meta-analyses and the confidence in the estimates was verified using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Ten RCTs (n=478 participants) were included. Most of them had a high risk of bias. There were more cases of pain and bleeding in groups without vasoconstrictor. Meta-analysis demonstrated a decrease in the systolic blood pressure with the use of LA with vasoconstrictor (standard mean difference -0.95, 95% CI -1.35 to -0.55) after procedure. Overall, for the other outcomes assessed there was no statistical difference. The quality of evidence was considered low according to the GRADE profile. CONCLUSIONS: The results suggest that the use of LA with vasoconstrictors (epinephrine in low doses) is safe in patients with some types of CVD. However, the low quality of evidence demonstrated that literature needs further studies in order to confirm these results. PROTOCOL REGISTRATION: PROSPERO (CRD42016045421).

Bleeding Risk in Patients Using Oral Anticoagulants Undergoing Surgical Procedures in Dentistry: A Systematic Review and Meta-Analysis.

The management of patients who undergo dental surgical procedures and receive oral anticoagulant therapy requires particular attention due to the risk of bleeding that may occur during the procedure. Bleeding rates in these trans- or post-operative patients tend to be unpredictable. The aim of this study was to conduct a systematic review in order to assess the risk of bleeding during and after performing oral surgery in patients administered oral anticoagulants compared with a group that discontinued anticoagulant therapy. For the purposes of this review, we searched the databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid), and the Virtual Health Library (VHL) from inception of the database to December 2018. The primary outcome was defined as the occurrence of local bleeding during and after oral surgical procedures. Four reviewers, independently and in pairs, screened titles and abstracts for full-text eligibility. Data regarding participant characteristics, interventions, and design and outcomes of the included studies were extracted. The data were pooled using random-effects meta-analyses and described as risk ratios (RRs) with a 95% confidence interval (95% CI). The confidence for the pooled estimates was ascertained through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and the protocol of this review was recorded in PROSPERO (CRD42017056986). A total of 58 eligible studies were identified, of which three randomized controlled trials were included in the meta-analysis, covering a total of 323 adult participants, among whom 167 were taking anticoagulants at the time they underwent dental surgery. Of these patients, 14.2% had reported bleeding. The risk of bleeding was found to be one to almost three times greater in patients taking warfarin compared with patients who discontinued the use of anticoagulant during the trans-operative period (RR = 1.67, 95% CI = 0.97 to 2.89) and in the post-operative period (RR = 1.44, 95% CI = 0.71 to 2.92), although the quality of evidence was very low. The results indicate that there is no evidence that the use of anticoagulants eliminates the risk of bleeding during surgical dental procedures.

Clinical evaluation of two dexamethasone regimens in the extractions of impacted third molars-a randomized clinical trial.

PURPOSE: The aim of the present study was to compare two therapeutic protocols of dexamethasone for the prevention of postoperative swelling, pain, and other complications after the extraction of impacted third molars, in a prospective, randomized, crossover, double-blinded clinical trial. METHODS: Fifty patients with symmetrical impaction of third molars were randomly assigned to two different protocols of dexamethasone for each side. Patients underwent two sessions performed at a 21-day interval. In group 1, patients took 8 mg of dexamethasone orally 1 h before the procedure, and in group 2, 4 mg dexamethasone orally 1 h before and 24 h after the procedure. Surgery duration, volume of local anesthetics, surgical technique, and rescue medication were standardized. Postoperative pain was evaluated using a visual analog scale (VAS) at predefined times: before operation; immediately after; 1, 2, 4, and 12 h; and 1, 2, 3, and 7 days after operation. The patients were also instructed to take notes of the number of rescue medication tablets taken. Edema and mouth opening were clinically evaluated before surgery and in the postoperative period (second and seventh postoperative days). RESULTS: There were no significant differences between groups for VAS scales (p = 0.5048), but the use of rescue medication was significantly lower in group 1 (p = 0.006). None statistically significant differences (p > 0.05) were observed between groups in any of the time points for all measurements of edema. However, the mouth opening limitation (DIINC) was bigger (p = 0.0069) for group 1 at 2 days. CONCLUSION: Pre-emptive use of different dexamethasone regimens had a beneficial effect against pain, edema, and mouth opening limitation, especially when administered at an 8 mg concentration, which suggests that this protocol may also be efficient for more invasive surgery.

Effectiveness and safety of oral sedation in adult patients undergoing dental procedures: protocol for a systematic review.

INTRODUCTION: The management of anxious patients undergoing dental procedures is still a challenge in clinical practice. Despite a wide variety of drugs for oral sedation in adult patients, there are relatively few systematic reviews that compare the effectiveness and safety of different drugs administered via this route. Thus, this study will evaluate the effectiveness and safety of oral sedation with benzodiazepines and other agents to patients undergoing dental surgical procedures. METHOD/DESIGN: We will conduct a systematic review and, if appropriate, a meta-analysis of randomised controlled clinical trials that will evaluate the use of conscious sedation administered orally to adult patients undergoing oral surgery. The search will be conducted using electronic databases, such as the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid), CINAHL (via Ovid), Lilacs (SciELO) and Capes database, without restriction of languages or date of publication. Primary outcomes include anxiety, sedation, treatment satisfaction, pain and adverse effects. Secondary outcomes include vital parameters (heart rate, respiratory rate and blood pressure) and patient cooperation during intervention. A team of reviewers will independently assess each citation for eligibility and in duplicates. For eligible studies, the same reviewers will perform data extraction, risk of bias assessment and determination of the overall quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation classification system. ETHICS AND DISSEMINATION: The evidence gathered from this study should provide dental surgeons with knowledge on the effectiveness and safety of oral sedation in adults requiring dental surgical procedures. This in turn should contribute towards the decision-making process in dental practice, minimising the risks of anxiety and ineffective pain control in clinical procedures, as well as possible side effects. Ethics approval is not required in protocols for systematic reviews. The systematic review will be published in a peer-reviewed journal and presented at conferences. PROSPERO REGISTRATION NUMBER: CRD42017057142.

Strategy to control occupational risk for Hepatitis B: impact on the vaccination and seroconversion rates in dentistry students / Estratégia para controle do risco ocupacional de Hepatite B: impacto nas taxas de vacinação e soroconversão de alunos de odontologia

ABSTRACT Objective: To describe the development of a dentistry school strategy in order to reduce the occupational risk related to hepatitis B. Methods: The academic registration documents of 242 students entering the institution between the years 2006 and 2013, were evaluated, among which were of copies of the updated vaccination cards and anti-HBs serologic testing. Demographic variables and others related to the vaccination status of hepatitis B and seroconversion were considered. Results: One hundred percent of the students were found to be vaccinated, and 87.2% had vaccination records of three doses. The results of anti-HBs tests proved seroconversion in 91.3% of the students. From 2011, the dental school was able to institutionalize the follow-up behavior of the students who had anti-HBs non-reactive. Of the twenty individuals whose serology was negative, nine students (45% of the total and all of the 2011-2013 class) were followed-up and repeated the basic vaccination and anti-HBs test; eight seroconverted and one was considered a non-responder, increasing the percentage of immune students to 95%. Eleven (55%) had other unregistered behavior or the documents analyzed showed no data on them. Conclusion: The procedure of following-up the registration in vaccination records required by the Biosafety Committee of the institution was shown to be effective in reducing the occupational risk of hepatitis B among the students.

RESUMO Objetivo: Descrever a experiência de uma Faculdade de Odontologia para redução do risco ocupacional relacionado à hepatite B. Métodos: Foram avaliados os documentos de cadastro acadêmico dos 242 alunos com ingresso na instituição entre os anos de 2006 a 2013, dos quais faziam parte cópias da carteira de vacinação atualizada e do teste sorológico anti-HBs. Variáveis demográficas e relacionadas à situação vacinal da hepatite B e de soroconversão foram consideradas. Resultados: Verificou-se que 100% dos discentes foram vacinados, sendo que para 87,2% havia registro de vacinação em três doses. Os resultados do anti-HBs comprovaram a soroconversão em 91,3% dos alunos. Dos 20 indivíduos, cuja sorologia foi negativa, 9 alunos (45% do total e todos das turmas de 2011 a 2013) foram acompanhados e repetiram o esquema básico de vacinação e o teste anti-HBs, sendo que 8 soroconverteram e 1 foi considerado não respondedor, elevando a frequência de alunos imunes para 95%. Os 11 (55%) restantes não tiveram conduta registrada ou não havia dados sobre os mesmos nos documentos analisados. Conclusão: A conduta de acompanhamento vem mostrando-se efetiva para reduzir o risco ocupacional da hepatite B entre os alunos.

Bleeding risk in patients using oral anticoagulants submitted to surgical procedures in dentistry: a systematic review protocol.

INTRODUCTION: The management of patients undergoing oral surgical procedures using anticoagulants raises concerns regarding the risk of bleeding. Bleeding rates in those patients during or after oral surgical procedures are uncertain. The aim of this study will be to determine the bleeding rate during and after oral surgeries in patients using anticoagulants. METHODS AND ANALYSIS: A systematic review will be conducted and if appropriate, a meta-analysis of randomised clinical trials evaluating the bleeding risk during and after oral surgical procedures in patients using anticoagulants were selected. The literature search will be conducted using electronic databases, such as the Cochrane Central Register of Controlled Trials, MEDLINE (via Ovid), Embase (via Ovid), Cumulative Index to Nursing and Allied Health Literature (via Ovid), LILACS (SciELO) and CAPES database, without restriction of languages or date of publication. The primary outcome will be the occurrence of local bleeding rate during and after oral surgical procedures, and as secondary outcome, the following complications will be considered: implant failure, healing problems and infections. Groups of two independent reviewers will select the titles and abstracts for full-text eligibility. For eligible studies, the same reviewers will perform data extraction, bias risk assessment and determination of the overall quality of evidence for each of the outcomes using the Grading of Recommendations Assessment, Development and Evaluation classification system. Meta-analysis and subgroup analyses will be conducted, to all outcomes, if appropriate. ETHICS AND DISSEMINATION: The systematic review will be published in a peer-reviewed journal, and brief reports of the review's findings will be released directly to the intended audience. The results will help dentists in the decision-making process to minimise the risk of bleeding in patients using anticoagulants in their clinical practice. PROSPERO REGISTRATION NUMBER: CRD42017056986.

Evaluation of two amoxicillin protocols for antibiotic prophylaxis in implant placement surgeries / Avaliação de dois protocolos de amoxicilina para profilaxia antibiótica em cirurgias de instalação de implantes

ABSTRACT Objective The aim of this study was to evaluate the effectiveness of two amoxicillin protocols for antibiotic prophylaxis in implant placement surgeries. Methods A clinical study was performed with 66 volunteers of both genders (mean 51,9 ± 2,5 years) that met the inclusion criteria and were randomly assigned into 2 groups: Group 1 (n=35) - oral administration of amoxicillin (2g) 1 hour before the surgical procedure and Group 2 (n=31) oral administration of amoxicillin (2g) 1 hour before the surgical procedure and 500mg every 8 hours during 7 days after the surgeries. The following clinical parameters were evaluated: adverse reactions, pain and implants failure. The pain was evaluated in the surgery day (before, immediately after and at night), 24h, 48h, 72h and one week after the surgery and other clinical parameters were evaluated in daily appointments until the third postoperative day, 7 days and three months after the surgeries. Data were analyzed and statistical significance was 5%. Results Adverse reactions (headache, diarrhea, stomachache and nauseas) and implant failure occurred only in G2 (4 volunteers and 3 implants, respectively). Regarding pain, higher values for G2 on "at the night (p=0.0043), 24h (p=0.0013), 48h (p=0.0187) e 72h (p=0.0445) were observed. Conclusion The present study showed that a single dose of amoxicillin was effective in antibiotic prophylaxis in implant placement surgeries, suggesting that the use of amoxicillin in the postoperative period did not bring additional benefit.

RESUMO Objetivo Avaliar a eficácia de dois protocolos de amoxicilina em cirurgias para instalação de implantes. Métodos Foi realizado um estudo clinico com 66 voluntários de ambos os gêneros (idade média 51,9±2,5 anos) que atenderam aos critérios de inclusão e que foram distribuídos por sorteio em 2 grupos: Grupo 1 (n=35) - amoxicilina (2g) por via oral 1h antes da cirurgia e Grupo 2 (n=31) - amoxicilina (2g) por via oral 1h antes da cirurgia e 500mg a cada 8 horas durante 7 dias. Os parâmetros avaliados no pós-operatório foram ocorrência de reações adversas, dor e perda de implantes. A dor foi avaliada no dia da cirurgia (antes, imediatamente após e à noite), 24h, 48h, 72h e 1 semana após as cirurgias, e os demais parâmetros foram avaliados em consultas diárias até o terceiro dia pós-cirúrgico, 7 dias e 3 meses após as cirurgias. Os resultados foram submetidos à análise estatística com nível de significância de 5%. Resultados Reações adversas (cefaleia, diarréia, dor estomacal e náusea) e perda de implantes ocorreram apenas em G2 (4 voluntários e 3 implantes, respectivamente), e em relação à dor foram observados valores maiores para G2 nos tempos "à noite (p=0,0043), 24h (p=0,0013), 48h (p=0,0187) e 72h (p=0,0445). Conclusão Os dados sugerem que a dose única de amoxicilina (2g) foi eficaz na profilaxia antibiótica para cirurgias de implantes, e que a amoxicilina no período pós-operatório não proporcionou benefício adicional.

Unsatisfactory glycemic control in type 2 Diabetes mellitus patients: predictive factors and negative clinical outcomes with the use of antidiabetic drugs

ABSTRACT Many factors can interfere with glycemic control in patients with type 2 diabetes mellitus and this patient group has an increased risk of experiencing drug-related negative outcomes (DNO). The aim of this study was to identify the predictive factors of unsatisfactory glycemic control and DNO in this group of patients. A cross-sectional study was conducted collecting data from prescriptions and interviews with 100 patients of the Endocrinology Clinic of the Hospital Complex of Sorocaba, São Paulo, Brazil. Variables associated with unsatisfactory glycemic control were determined and the DNO associated with antidiabetic drugs identified. Age (<65 years) (OR=4.09), family history of diabetes (OR=3.24), use of combined therapy to treat diabetes (2-4 antidiabetic drugs) (OR=5.13) and presence of DNO (OR=5.92) were found to be predictive factors for poor patient glycemic control. DNO were observed in 49% of the patients and were caused predominantly by ineffectiveness in patients with poor glycemic control (p<0.05). There was no significant difference between groups (satisfactory and unsatisfactory glycemic control) for DNO caused by safety issues (p>0.05). Characterization of the profile of patients with uncontrolled diabetes and of aspects associated with drug treatment can contribute to the planning of interventions to improve patient care

Evaluation of blood glucose in type II diabetic patients submitted to local anesthesia with different vasoconstrictors / Avaliação da glicemia de pacientes diabéticos submetidos à anestesia local com diferentes vasoconstritores

ABSTRACT Objective: In the dental clinic, the use of local anesthetics containing vasoconstrictors in diabetic patients are still controversial raising some doubts. Thus, the objective of this randomized crossover clinical trial was to evaluate blood glucose, pulse oximetry and heart rate of type 2 diabetic patients when submitted to local anesthesia using prilocaine 3% associated to felypressin 0,03UI / ml (G1) and 2% lidocaine associated to epinephrine 1: 100,000 (G2). Methods: The sample consisted of 20 compensated type 2 diabetic patients (both genders) who were taking oral hypoglycemic drugs. The volunteers underwent two periodontal sessions (scaling) and one of the solutions tested was used in each visit. The cited parameters were evaluated at three different times: before the procedure (T1), 10 minutes after anesthesia (T2) and after 20 minutes (T3). Results: Regarding the blood glucose levels, no statistically significant difference was found in different times between G1 and G2 (p> 0.05). Similarly, regarding pulse oximetry and heart rate, no statistically significant differences were observed in intervals assessed between groups (p> 0.05), presenting values within normal limits. Conclusion: Considering the vasoconstrictors and the volume of anesthetic solution used, the results suggest that the evaluated vasoconstrictors do not alter significantly blood glucose, pulse oximetry and heart rate in compensated type 2 diabetic patients.

RESUMO Objetivo: Na clínica odontológica, o uso de soluções anestésicas locais contendo vasoconstritores em pacientes diabéticos ainda sucita algumas dúvidas. Desta forma, o objetivo deste ensaio clínico cruzado e randomizado foi avaliar de forma comparativa a glicemia, oximetria de pulso e frequência cardíaca de pacientes portadores de diabetes tipo II quando submetidos à anestesia local com prilocaína 3% com felipressina 0,03UI/ml (G1) e lidocaína a 2% com epinefrina 1:100.000 (G2). Métodos: Foram selecionados 20 indivíduos diabéticos do tipo II, compensados, sem distinção de gênero, que faziam uso de hipoglicemiantes orais. Os voluntários foram submetidos a duas sessões de instrumentação periodontal, sendo administrada uma das soluções testadas em cada consulta. Os parâmetros citados foram avaliados em três momentos distintos: antes do procedimento (T1), 10 minutos após a anestesia (T2) e após 20 minutos (T3). Resultados: Para os valores de glicemia não houve diferença estatisticamente significante nos diferentes tempos entre G1 e G2 (p>0,05). Da mesma forma, em relação à oximetria de pulso e frequência cardíaca, não foram observadas diferenças estatisticamente significativas nos intervalos avaliados entre os grupos (p>0,05), com valores dentro da normalidade. Conclusão: Considerando a concentração dos vasoconstritores e o volume das soluções anestésicas empregadas, os resultados sugerem que os vasoconstritores avaliados não alteram de forma significativa a glicemia, oximetria de pulso e frequência cardíca de adultos portadores de diabetes tipo II compensados.

Clinical evaluation of different epinephrine concentrations for local dental anesthesia / Avaliação clínica da epinefrina em diferentes concentrações para anestesia local odontológica

BACKGROUND AND OBJECTIVES: Clinical trials comparing lidocaine associated to different epinephrine concentrations are scarce. This study aimed at comparing cardiovascular parameters, anesthetic efficacy and level of discomfort during the injection of two 2% lidocaine solutions associated to 1:100,000 or 1:200,000 epinephrine. METHODS: Participated in this cross-sectional double blind study 30 patients (24.3±4.7 years) who were submitted to anamnesis, vital signs evaluation and baseline threshold measurement of right upper canine tooth. In each clinical session, with 15 days interval, 1.8mL of one of the anesthetic solutions were administered. Anesthetic efficacy was measured with electric stimulation and vital parameters were evaluated in three periods: 5 minutes before, during and soon after anesthesia. At the end of each session, the visual analog scale was applied to evaluate injection pain sensitivity, which was repeated 24h later. RESULTS: All volunteers had satisfactory pressure levels to carry out the trial. There has been no statistically significant differences in systolic blood pressure (p=0.33), diastolic blood pressure (p=0.1505), heart rate (p=0.9464) and oxygen saturation (p=0.9297) considering each local anesthetic solution in each moment (during and after anesthesia). Formulations of 2% lidocaine with 1:100,000 and 1:200,000 epinephrine have shown no statistical differences for all anesthetic parameters (p>0.05). CONCLUSION: Considering the volume used in this study, decreased epinephrine concentration on lidocaine solution has not affected its clinical efficacy and has not influenced cardiovascular parameters. .

JUSTIFICATIVA E OBJETIVOS: Estudos clínicos comparando o uso da lidocaína associada a diferentes concentrações de epinefrina na odontologia são escassos. O objetivo deste estudo foi comparar parâmetros cardiovasculares, eficácia anestésica e grau de desconforto durante a injeção de 2 soluções de lidocaína a 2% associadas a epinefrina 1:100.000 ou 1:200.000. MÉTODOS: Trinta pacientes (24,3±4,7 anos) foram incluídos (estudo cruzado e duplamente encoberto) e submetidos a anamnese, avaliação de sinais vitais e mensuração do limiar basal do dente canino superior direito. Em cada sessão clínica, com intervalo de 15 dias, foram administrados 1,8mL de uma das soluções anestésicas. A eficácia anestésica foi mensurada com estímulo elétrico, e os parâmetros vitais foram avaliados em 3 períodos: 5 minutos antes, durante e logo após a anestesia. Ao final de cada sessão foi aplicada a escala analógica visual para avaliação da sensibilidade dolorosa da injeção, e repetida após 24h. RESULTADOS: Todos os voluntários apresentaram níveis pressóricos satisfatórios para realização do estudo. Não houve diferenças estatisticamente significativas entre os valores de pressão arterial sistólica (p=0,33), pressão arterial diastólica (p=0,1505), frequência cardíaca (p=0,9464) e saturação de oxigênio (p=0,9297) considerando cada anestésico local em cada momento (durante e após a anestesia). As formulações de lidocaína a 2% com epinefrina a 1:100.000 e 1:200.000 não apresentaram diferença estatística para todos os parâmetros anestésicos (p>0,05). CONCLUSÃO: Considerando o volume utilizado no presente estudo, a redução da concentração da epinefrina na solução de lidocaína não afetou sua eficácia clínica e não influenciou os parâmetros cardiovasculares. .

Evaluation of different types of polishing of composite resin surfaces after the removal of metal and ceramic brackets / Avaliação de diferentes tipos de polimento de superfície de resina composta após a remoção de bráquetes metálicos e cerâmicos

Avaliar a efetividade de diferentes métodos de polimento de superfície de resina composta após a remoção de bráquetes ortodônticos. Material e Métodos: 160 discos de resina composta foram confeccionados a partir de uma matriz de resina acrílica e divididos em 4 grupos, de acordo com o tipo de resina composta usada: G1- microparticulada (n = 40), G2- microhíbrida (n = 40), G3 nanohíbrida (n = 40), G4- nanoparticulada (n = 40). Metade das amostras foi submetida à termociclagem, com 2000 ciclos entre 5 ± 2 °C to 55 ± 2 °C, por um min cada. Metade de cada grupo o bráquete metálico Gemini™ (3MUnitek) e a outra metade o bráquete cerâmico Transcend™ (3M Unitek). A remoção dos bráquetes foi realizada em máquina de teste Universal (EMIC DL model 2000). Metade dos espécimes de cada subgrupo foi polido com pontas diamantadas e a outra metade com discos Sof-Lex. A média da rugosidade superficial dos discos de resina composta foi calculada usando-se um perfilômetro, antes da colagem dos bráquetes, após a remoção dos bráquetes, após a remoção dos excessos de resina e após o polimento. Resultados: O teste ANOVA mostrou que após a remoção dos bráquetes e após o polimento, a rugosidade superficial foi maior no grupo G2 (p < 0,05). Após a remoção dos bráquetes cerâmicos os grupos mostraram maior rugosidade superficial (p < 0,05). Não houve diferença estatisticamente significante na rugosidade entre os grupos termociclados e os tipos de polimento. Conclusão: A qualidade do polimento está sujeita ao tipo de resina utilizada. Os bráquetes cerâmicos induzem a uma maior rugosidade superficial após a remoção. Ambos tipos de polimentos usados foram efetivos...

To evaluate the effectiveness of different methods of composite resin polishing after the removal of orthodontic brackets. Material and Methods: 160 resin discs made from a matrix of acrylic resin were divided into 4 groups, according to the type of composite resin used: G1 - microfilled (n = 40), G2 - microhybrid (n = 40), G3 - nanohybrid (n = 40) and G4 - nanofilled (n = 40). One half of the samples was subjected to thermocycling, at 2000 cycles from 5 ± 2 ºC to 55 ± 2 ºC, for 1 min each. Half of each group of resins was bonded with Gemini™ metallic brackets (3M Unitek) and the other half with Transcend™ ceramic brackets (3M Unitek). The brackets were transferred to a universal testing machine (EMIC DL model 2000). Half of the specimens from each subgroup were polished with diamond burs and the other half with Sof-Lex discs. The average surface roughness of composite resin discs was measured, using a profilometer, before the bonding of brackets, after the removal of brackets, after removing the excess resin and after polishing. Results: After removal of brackets and after polishing, the surface roughness was greater in the microhybrid group (ANOVA, p < 0.05). After removal of ceramic brackets, the groups showed higher surface roughness (ANOVA, p < 0.05). There was no significant difference in roughness related to thermocycling and the type of polishing. Conclusion: The quality of the polish is subjected to the type of resin used. Ceramic brackets provided rougher surfaces after removal. Both types of polishing used are effective...

Comparação da força de atrito entre bráquetes autoligados e bráquetes convencionais com diferentes ligaduras / Comparison of friction among self-ligating brackets and conventional brackets with different ligadures

O objetivo do presente trabalho foi comparar a força máxima, força de atrito estática e dinâmica existente entre bráquetes de aço inoxidável autoligados passivos da marca EasyClip® (Aditek®), bráquetes de aço inoxidável convencionais Morelli® (Dental Morelli®) ligados com ligaduras elastoméricas convencionais (Dental Morelli®) e com ligaduras elastoméricas não convencionais com desenhos “8” e “88” (Tecnident®). Foi utilizado um dispositivo que permite a movimentação de deslize do fio (aço inoxidável 0,019 X 0,025 polegadas - Morelli®) de forma perpendicular aos slots dos bráquetes alinhados, sem nenhuma possível interferência externa. Uma máquina de testes universal (EMIC DL2000) foi utilizada para o tracionamento dos fios e transformação em dados computadorizados. Esses dados foram transformados e submetidos aos testes de Kolmogorov & Smirnov, e ao teste de Bartlett, depois submetidos às análises não paramétricas Kruskal-Wallis e SNK. Nesse estudo, bráquetes autoligados e bráquetes convencionais com elásticos não convencionais “8” e “88” reduzem o atrito na mecânica de deslize em relação aos módulos elastoméricos convencionais (P<.05).

The aim of the present work was to compare maximum force, static and dynamic friction forces between three different types of brackets: passive stainless steel self-ligating brackets from EasyClip® (Aditek®), conventional Morelli® stainless steel brackets (Dental Morelli®) ligated with conventional elastometric ligatures (Dental Morelli®), and with nonconventional elastomeric ligatures “8” and“88” (Tecnident®). A device that allows the slippage of the wire (stainless steel 0.019 X 0.025 inches - Morelli®) perpendicular to the slots of the aligned brackets with no external interference. A universal testing machine (EMIC DL2000) was used to traction the wire and convert it intocomputerized data. These data were submitted to Kolmogorov & Smirnov tests and to Bartlett test, and then to Nonparametric Tests-Kruskal-Wallis and SNK tests. In the present study it was observed that selfligated brackets and conventional brackets with nonconventional “8” and “88” elastics reduce the friction of sliding mechanics when compared to conventional elastometric modules (P<.05).

Evaluation of effects of two dexamethasone formulations in impacted third molar surgeries / Avaliação dos efeitos de duas formulações de dexametasona em cirurgias de terceiros molares inclusos

BACKGROUND AND OBJECTIVES: Submucosal dexamethasone injection directly in the surgical area has been used in different dental procedures, but there are still few studies evaluating its efficacy as compared to oral route for impacted third molar surgeries. So, this study aimed to evaluate postoperative pain, edema and trismus after impacted third molar surgeries using oral or submucosal local injection of dexamethasone. METHODS: This was a prospective, controlled, crossover and randomized study involving 36 patients with indication of lower third molar surgeries, who were randomly distributed in two groups: group A - submucosal local injection of dexamethasone (4mg/1mL) after local anesthesia, and group B - oral dexamethasone tablet (4mg) one hour before procedure. Edema and trismus were clinically evaluated in the postoperative period and in the 1st, 2nd, 3rd and 7th postoperative days. Patients were oriented to record pain intensity in the visual analog scale in periods zero (preoperative), 1h, 2h, 4h, 12h, 1 day, 2 days and 3 days and one week after surgery. Data were submitted to statistical analysis with significance level of 5%. RESULTS: There were no significant differences in surgical time with regard to operated sides (p=0.4). Edema and trismus values were not statistically different between observed groups (p>0.05). Mean pain values recorded in the visual analog scale were not statistically different between groups and patients have not reported major postoperative discomfort and had no need to prolong analgesic medication (p>0.05). CONCLUSION: Both dexamethasone administration routes were effective to control pain, edema and trismus after lower third molar surgeries, presenting similar results...

JUSTIFICATIVA E OBJETIVOS: A utilização da injeção submucosa de dexametasona diretamente na área cirúrgica tem sido realizada em vários procedimentos odontológicos, mas ainda são escassos os estudos que avaliaram a sua eficácia em comparação com a via oral para exodontias de terceiros molares inclusos. Desta forma, o objetivo do presente estudo foi avaliar a dor, edema e trismo no pós-operatório de cirurgia de terceiros molares inclusos utilizando-se dexametasona, por via oral, ou por injeção local submucosa. MÉTODOS: Estudo prospectivo, controlado, cruzado e randomizado envolvendo 36 pacientes com indicação cirúrgica de terceiros molares inferiores que foram divididos em dois grupos: grupo A injeção local submucosa de dexametasona (4mg/1mL) após a anestesia local e grupo B - 1 comprimido de dexametasona (4mg), por via oral, uma hora antes do procedimento. Edema e trismo foram avaliados clinicamente no pré-operatório, 1º, 2º, 3º e 7º dia de pós-operatório. Os pacientes foram orientados a registrar a intensidade de dor na escala analógica visual nos períodos zero (pré-operatório), 1h, 2h, 4h, 12h, 1 dia, 2 dias, 3 dias e uma semana após as cirurgias. Os dados obtidos foram submetidos a análise estatística com nível de significância de 5%. RESULTADOS: Não revelaram diferenças significativas no tempo cirúrgico em relação aos lados operados (p=0,4). Os valores de edema facial e trismo não demonstraram diferenças estatisticamente significativas entre os grupos observados (p>0,05). Os valores médios de dor registrados na escala analógica visual não mostraram diferença estatística significativa entre os grupos e os pacientes não relataram grande desconforto pós-operatório...

Avaliacão do uso da amoxicilina em, diferentes períodos no tratamento de abscessos dentoalveolares / Evaluation ot use of amoxicillin in different periods for the treatment of dentaolveolar abscess

O objetivo foi avaliar a eficácia da amoxicilina em diferentes periodos (3 e 7 dias) no tratamento coadjuvante de abscessos dentoalveolares após realização de drenagem. Foram avaliados 20 voluntários divididos em 2 grupos (n=10): G1 - 19 de amoxicilina, antes do procedimento de drenagem e 500mg de 8/8h por 3 dias; G2 - 1 9 de amoxicilina antes do procedimento e 500mg de 8/8h por 7 dias. Foram avaliados o edema, dor, febre, supuração e trismo, e os voluntários tiveram acompanhamento clínico diário. O edema foi avaliado em duas medidas (Tragus a Asa do Nariz e Tragus a Comissura Labial). A abertura bucal e o edema foram avaliados antes da drenagem, 1, 2, 3 e 7 dias após. Para a avaliação de dor foi utilizada a escala analógica visual (EAV) antes e nos intervalos O, 1 h, 2h, 4h, 12h, 1 dia, 2 dias, 3 dias e 1 semana após. Os resultados fora m su bmetidos à a ná I ise estatística (Kruska II-Wa II is), com n ivel de sig n ificâ ncia de 5%. Quanto aos parâmetros clínicos avaliados, não foram observadas diferenças estatisticamente significantes entre os grupos [p>0,05), e nenhum dos voluntários apresentou complicações no período do pós-atendimento. Concluiu-se que, após a intervenção clínica, a eficácia da amoxicilina nos períodos avaliados foi similar na amostra avaliada

The aim of this study was to compare the use of amoxicillin for different time intervals (3 and 7 days) for treatment of acute dentoalveolar abscesses after performing drainage. Twenty volunteers were divided into two groups (n = 10): G 1 - The volunteers received 1 9 of amoxicillin before the drainage procedure, and 500mg of amoxicillin every 8 hours for 3 days; G2 - The volunteers received 19 of amoxicillin before the drainage procedure, and 500mg of amoxicillin every 8 hours for 7 days. For each patient followed-up, acute infectious conditions were investigated, and pain, edema, fever, suppuration and trismus were evaluated. To evaluate pain was used a visual analog scale [VAS) in the intervals O, 1 h, 2h , 4h , 12 h , 1,2 and 3 days and 1 week after the drainage. The results were submmited to statistical analysis [Kruskal - Wallisl. with a significance levei of 5 %. There was no statistically significant difference between the groups considering the parameters evaluated [p>0.05). None of the volunteers had complications in the post clinical care assessed. It was concluded that after clinical intervention, the effectiveness of the use of amoxicillin in periods of 3 and 7 days was similar in the evaluated volunteers

Staining of esthetic brackets by plaque disclosing solutions

AIM: To evaluate the staining of esthetic orthodontic brackets by plaque disclosing solutions. METHODS: Two types of brackets manufactured by GAC/DENTSPLY(r) were evaluated: ceramic (n=30) and polycarbonate (n=30). The brackets were divided into 6 groups. Two control groups (n=6) were immersed in absolute ethanol: GI - ceramic brackets and GII - polycarbonate brackets. Four experimental groups (n=12) were immersed in different plaque disclosing solutions: GIII (ceramic brackets) and GIV (polycarbonate brackets) were immersed in Replak(r); GV (ceramic brackets) and GVI (polycarbonate brackets) were immersed in Replasul "S"(r). Relative quantitative analysis of the influence of plaque disclosing tablets on bracket staining was performed using reflectance spectrophotometry of stain deposition. Exploratory analysis of the data was performed using Analysis of Variance (ANOVA) in a 2x2 factorial setup (bracket x immersion) with additional treatments (controls). RESULTS: The results demonstrated that the ceramic brackets presented the highest amount of staining when Replasul "S"(r) was used (pd"0.05). However, when Replak(r) was used, no statistically significant difference was found in comparison with the control group (p>0.05). For polycarbonate brackets, staining was detected for both disclosing solutions (p>0.05). CONCLUSIONS: The disclosing solutions caused stain formation on polycarbonate brackets and, under the tested conditions, use of Replak(r) on ceramic brackets did not cause staining...

Amoxicillin administrations and its influence on bone repair around osseointegrated implants.

PURPOSE: The objective of this study was to evaluate the influence of 4 different amoxicillin administration protocols on osseointegration of dental implants. MATERIALS AND METHODS: Thirty-five Wistar rats received an implant in the right tibia and were divided into 5 groups (n = 7): the control group (G1), a group that received a single dose of amoxicillin suspension (40 mg/kg) hour before surgery (G2), a group that received amoxicillin suspension 1 hour before surgery and a 10-mg/kg dose every 12 hours for 3 days (G3), a group that received amoxicillin suspension 1 hour before surgery and a 10-mg/kg dose every 12 hours for 5 days (G4), and a group that received amoxicillin suspension 1 hour before surgery and a 10-mg/kg dose every 12 hours for 7 days (G5). The animals were sacrificed by anesthesia overdose 28 days after implant placement. The samples were retrieved for bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) analyses. RESULTS: BIC analysis indicated 3 different statistical groups: G1 plus G2, G3, and G4 plus G5. There was no statistical difference between G1 and G2 or between G4 and G5. G3 presented lower values, with statistical difference for G1 plus G2 and G4 plus G5. Also, a statistical difference was found between G1 plus G2 and G4 plus G5. For BAFO evaluation, no statistical difference was found for the experimental groups. CONCLUSION: The results of this study suggest that prolonged use of amoxicillin might have a negative effect on bone formation around implants.

Utilização do mini-implante no tratamento ortodôntico / Use of mini screw in the orthodontic treatment

Os mini-implantes foram introduzidos na prática ortodôntica como uma simples alternativa para a ancoragem absoluta. Eles podem ser implantes confeccionados especialmente para procedimentos ortodônticos ou para a simples fixação por osteotomia. A principal vantagem dos mini-implantes é o pequeno e variado tamanho, aumentando potencialmente os locais para a sua colocação, especialmente nas regiões inter-radicular/pararadicular, o que eliminou um problema da prática clínica visto que muitas vezes os ortodontistas encontravam dificuldades relacionadas com a perda de ancoragem, por dependerem da colaboração do paciente. A força ortodôntica é usualmente aplicada ao mini-implante imediatamente ou em curto tempo após sua colocação. Não se faz necessário um período de espera devido a sua estabilidade primária ser geralmente suficiente para sustentar uma força ortodôntica normal e devido ao desenvolvimento do mini-implante, os tratamentos se tornaram mais simples e rápidos. Este artigo objetiva abordar a utilização dos mini-implantes na Ortodontia, a aplicação de forças e aspectos referentes à estabilidade primária.

Mini-implants have recently been introduced as simple absolute anchorage alternatives in orthodonticts. They can be implants made especially for orthodontic procedures or simple osteotomy fixation svrews. The main advantage of mini-implants is their small size and the size variety, significantly increases the potential sites placement especially the interadicular/ pararadicular regions.The orthodontic load is usually applied to the mini-implant immediately or very early after placement. A waiting period is not necessary because its primary stability is generally sufficient to sustain normal orthodontic loading due to the development of minimplant the treatments became simpler and fast.This paper approaches a literature review will have as objective to the use of the mini-implants in orthodontics, application of forces and referring aspects to the primary stability.

Efeito comparativo entre a dipirona sódica e a dipirona sódica associada à cafeína no controle da dor pós-exodontia / Comparative effect of sodium dipyrone and sodium dipyrone associated to caffeine to control post-tooth extraction pain

BACKGROUND AND OBJECTIVES: Adequate postoperative pain control is a challenge among surgical specialties, in spite of recent advances in analgesic techniques and analgesics. Caffeine has been used as therapeutic adjuvant to potentiate analgesic efficacy of some drugs, however there are still no scientific investigation reports on the association with sodium dipyrone in the postoperative period of dental procedures. So, this study aimed at observing and comparing the efficacy of sodium dipyrone alone or in association with caffeine to control postoperative pain of dental procedures, considering hemodynamic parameters of patients as indicators of anxiety and pain during surgery. METHODS: This is a crossover and double-blind study involving 50 young and healthy patients (25 males and 25 females) referred for bilateral extraction of impacted mandibular third molars. Operated side, patient's gender and analgesic drug used were randomized. Visual analog scale scores were submitted to Friedman test (α = 0.05) to compare pain intensity at defined intervals (preoperative, immediate postoperative, 1, 2, 4 and 12 hours, 1, 2, 3 and 7 days after surgery). Blood pressure and heart rate were measured in the preoperative period, after anesthetic injection and in the postoperative period (Friedman test, (α = 0.05). RESULTS: Patients have referred mild pain in the first two postoperative days and there has been no statistically significant difference between the analgesic efficacy of sodium dipyrone alone or in association with caffeine in different evaluated intervals. Most cardiovascular changes were within normality, considering anxiety and stress induced by surgery. CONCLUSION: The therapeutic protocol proposed in this study has not shown statistically significant difference between sodium dipyrone associated or not to caffeine to control post-tooth extraction pain.

JUSTIFICATIVA E OBJETIVOS: O adequado controle da dor pós-operatória constitui um desafio entre as especialidades cirúrgicas, a despeito dos recentes avanços das técnicas de analgesia e dos analgésicos. A cafeína tem sido utilizada como adjuvante terapêutico para potencializar a eficácia analgésica de alguns fármacos, porém ainda não existe relatos de investigação científica da associação com a dipirona sódica em dor pós-operatória em procedimentos odontológicos. Dessa forma, o objetivo deste estudo foi observar e comparar a eficácia da dipirona sódica isolada e da dipirona sódica associada à cafeína no controle da dor pós-operatória em cirurgia dental, considerando os parâmetros hemodinâmicos dos pacientes como indicador de ansiedade e de dor durante a cirurgia. MÉTODOS: Estudo cruzado e duplo encoberto incluiu 50 pacientes jovens e saudáveis (25 homens e 25 mulheres) com indicação de exodontia bilateral de terceiros molares mandibulares impactados. O lado operado, o gênero do paciente e o fármaco analgésico usado foram randomizados. Os escores obtidos pela escala analógica visual foram submetidos ao teste de Friedman (α = 0,05) para comparação das intensidades dolorosas em intervalos definidos (pré-operatório, pós-operatório imediato, 1, 2, 4 12 horas, 1, 2, 3 e 7 dias após as cirurgias) e as alterações nos parâmetros de pressão arterial e frequên¬cia cardíaca foram mensurados no pré-operatório, após a injeção anestésica e no pós-operatório (teste de Friedman, α = 0,05). RESULTADOS: Os pacientes experimentaram dor leve nos dois primeiros dias de pós-operatório e não houve diferença estatisticamente significante entre a eficácia analgésica da dipirona sódica isolada e da dipirona sódica associada à cafeína nos diferentes intervalos medidos. A maioria das alterações cardiovasculares observadas estava dentro da normalidade, considerando a ansiedade e estresse induzido pela cirurgia...