Postoperative pain and edema control following different protocols of preemptive analgesia in the surgical removal of impacted third molars: A triple-blind parallel randomized placebo-controlled clinical trial.

This randomized controlled clinical trial aimed to evaluate the preemptive effects of acetaminophen, ibuprofen, ketoprofen, nimesulide or dexamethasone on postoperative pain and edema in the surgical removal of impacted third molars. Participants underwent bilateral surgeries at 2 different times and were randomly given the test drug or placebo (split-mouth). Postoperative pain, edema and rescue medication were evaluated at different times. Study power was >80% for the observed effect size in the crossover repeated measures design. Differences between test drug and placebo were the response variable. Generalized Estimation Equation models were adjusted for each outcome. Sample comprised 5 groups (n = 20 each). Ibuprofen and nimesulide showed higher overall effects on pain scores over time, with no differences between them (p = 0.557). Acetaminophen showed significantly lower overall effects in edema control over time, when compared to other test drugs, that showed similar effects. Lower quantity of rescue medication were also observed for ibuprofen and nimesulide, with no differences between them (p = 0.999). Ibuprofen and nimesulide showed beneficial overall preemptive effects. Hence, in the decision-making process for preemptive analgesia in impacted third molar surgeries, ibuprofen and nimesulide should be considered on a case-by-case basis as the drugs of choice.

Toxicity of Carnoy's solution toward human keratinocytes: an in vitro study

Abstract: The present study aimed to characterize the chemical elements and cytotoxicity of Carnoy's solution (CS) by comparing two different trademarked products (one Brazilian [NCS] and another imported [ICS]) using inductively coupled plasma mass spectrometry (ICP-MS) and human keratinocyte (HaCaT) cultures. For performing ICP-MS, the solutions were diluted according to calibration curves, and the chemical elements were analyzed with a spectrometer. HaCaT cells were exposed to CS concentrations ranging from 0.10% to 20% for 3 or 5 min. Cell viability was evaluated immediately (T0), 24 h (T1), and 7 days (T2) after exposure to CS using 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyl-tetrazolium bromide (MTT) reduction assay. Data were analyzed using a t-test for ICP-MS and analysis of variance followed by Tukey's post-hoc test for MTT assay, both considering statistical significance at p<0.05. ICP-MS results revealed that ICS presented significantly lower concentrations of 12 chemical elements than NCS. The results of MTT assay revealed that at T0, ICS was more cytotoxic than NCS regardless of the time of exposure (p < 0.05). At T1, the only difference between the groups was at a concentration of 0.10% after 5 min of exposure. At T2, at a concentration of 0.5%, ICS resulted in a significant reduction in cell viability compared to NCS (p < 0.05). Thus, the results showed that ICS was more cytotoxic than NCS. Collectively, our findings suggest that the individual compositions of different CS formulations should be investigated.

Two-stage technique in third molar autotransplantation: case report / Técnica de dois estágios no autotransplante de terceiro molar: relato de caso

ABSTRACT Tooth autotransplantation is an option for treating patients presenting early tooth loss. The teeth most commonly removed are the first molars, and their absence could lead to several oral health problems in patients. This transplant technique consists of the transposition and repositioning of a tooth from one area to another, in the same patient. Dental implants have high success rates, but tooth autotransplantation is less complex and less expensive, because the patient's own tooth is used. In the context of dental rehabilitation, tooth transplantation is focused on re-establishing masticatory function and esthetics. Success rates are variable, but in the majority of cases they exceed 80%. This article aims to report the case of a patient who underwent autotransplantation of the maxillary left third molar into the maxillary right first molar position. The surgical procedure was performed on two stages. After a 3-year clinical and radiographic follow-up period, a satisfactory result was achieved with the transplanted tooth presenting a healthy pulp and periodontal tissues, reestablishing the patient's function and esthetics.

RESUMO O transplante dentário autógeno (autotransplante dentário) é uma opção de tratamento para pacientes que perdem dentes precocemente. Os elementos mais comumente extraídos são os primeiros molares permanentes e a falta dos mesmos pode acarretar em diversos agravos para a saúde bucal do paciente. O autotransplante dentário consiste na transposição cirúrgica e reposicionamento de um elemento dentário, de um local da boca para outro, no mesmo indivíduo. O tratamento com implantes possui elevado índice de sucesso, mas o transplante apresenta maior praticidade e menor custo, uma vez que utiliza um órgão do próprio paciente. Assim, como a reabilitação protética, tem como função o restabelecimento da mastigação e estética. As taxas de sucesso são variáveis, mas em sua maioria ultrapassam os 80%. O presente trabalho relata o caso clínico de uma paciente submetida ao transplante do germe dental do elemento 28 para o alvéolo do elemento 16. O ato cirúrgico foi realizado com a técnica de dois estágios e após o acompanhamento clínico e radiográfico de três anos, obteve-se um resultado satisfatório e o elemento transplantado apresentou saúde pulpar e periodontal, restabelecendo a função e a estética à paciente.

Osteonecrose dos Maxilares Associada ao uso de Bisfosfonatos / Osteonecrosis of the Jaws Associated with the use of Bisphosphonates

Os bifosfonatos são uma classe de medicamentos, que têm por função a inibição da atividade dos osteoclastos, interferindo na remodelação e no turnover ósseo. São indicados para retardar a metástase óssea em algumas condições malignas, como em mielomas múltiplos, câncer de mama e próstata, e outras condições benignas, como no tratamento da doença de Paget e da osteoporose. Desde 2003, estudos têm associado a osteonecrose avascular dos ossos maxilares ao uso dos bifosfonatos. Dentre os mecanismos de ação dos bifosfonatos, podemos citar a sua atividade antiosteoclástica e antiangiogênica, que altera o metabolismo ósseo, inibindo a reabsorção óssea e diminuindo o turnover ósseo. As exposições ósseas maxilo-mandibulares ocorrem após procedimentos cirúrgicos odontológicos ou, menos comumente, após o uso de próteses apoiadas na fina mucosa de revestimento ósseo da cavidade bucal. O tratamento da osteonecrose associada aos bifosfonatos (OAB) é bastante variado, controverso e desafiador, visto que nenhum tratamento efetivo tem sido proposto até o momento. O objetivo desse relato de caso é descrever a ocorrência de áreas de exposição óssea mandibular em um paciente que fez uso do ácido zolendrônico (Zometa®) bem como apresentar a abordagem terapêutica realizada que resultou em completo recobrimento mucoso das áreas ósseas expostas... (AU)

Biphosphonates are a class of drugs whose function is the inhibition of osteoclast activity, interfering in remodeling and bone turnover. They are indicated to delay bone metastases in some malignancies such as multiple myeloma, prostate cancer and other benign conditions such as in the treatment of Paget's disease and osteoporosis. Since 2003, studies associate avascular osteonecrosis of the jaws to the use of bisphosphonates, especially intra venous. Among the mechanisms of action of bisphosphonates are their osteoclastic and antiangionenic activity which alters bone metabolism, inhibiting bone resorption and reducing bone turnover. Maxillo-mandibular bone exposures occur after surgical dental procedures or less commonly after the use of prostheses supported on thin bone lining mucosa of the buccal cavity. The treatment of osteonecrosis associated with biphosphonates (OAB) is quite varied, controversial and challenging, since no effective treatment has been proposed until this moment. The purpose of this case report is to describe the occurrence of areas of mandibular bone exposure in a patient with history of use of Zolendronic Acid (Zometa) and present the therapeutic approach undertaken which resulted in full mucous covering of the exposed bony áreas... (AU)

Pain control in third molar surgery / Control del dolor en cirugía de tercer molar

The sensation of pain at the surgical site may be increased and persist for long periods after the noxious stimulus has been removed. Post-operative pain from the extraction of impacted molar may cause serious discomfort to the patient resulting in considered moderate to severe in intensity. Analgesia for this surgical procedure is related to the use of nonsteroidal anti-inflammatory drugs, steroids, analgesics of central and peripheral actions used in combination or individually. The aim of this review is to show an update about the use and the physiological bases for indications of the analgesic therapy in third molar surgery.

La sensación de dolor en el sitio quirúrgico puede ser mayor y persistente por largos periodos de tiempo después de que el estímulo nocivo ha sido retirado. El dolor postoperatorio desde la extracción de un molar impactado puede causar molestias moderadas o severas en intensidad. La analgesia para estos procedimientos son relacionadas con el uso de fármacos antiinflamatorios no esteroidales, esteroides, analgésicos de acción central y periféricos utilizados en combinación o individualmente. El objetivo de esta revisión es mostrar una puesta al día en el uso y las bases fisiológicas para la indicación de terapia analgésica en cirugía de tercer molar.

Tratamento odontológico prévio a transplante de células tronco-hematopoiéticas: um relato de caso / Dental treatment prior to hematopoietic stem cell transplant: a case report

O linfoma é uma neoplasia malígna que se desenvolve nos gânglios linfáticos e uma possível abordagem terapêutica para esta doença é o transplante de medula óssea. Sob condições de imunossupressão, todo foco infeccioso pode ser ativado e, em função disto, toda infecção ativa em pacientes pré-transplantes de células hematopoiéticas deve ser erradicada previamente, para prevenir ou reduzir riscos de complicações sistêmicasnestes pacientes. Objetivo: Relatar um caso de atendimento odontológico a um paciente com necessidade premente de transplante de células tronco-hematopoiéticas, acometido de Linfoma não-Hodgkin.