Temporalis Muscle Changes Following Botulinum Toxin A Injections in Masseter Hypertrophy Patients: A Randomized Triple-Blinded Trial.

BACKGROUND: This study aimed to elucidate the effects of botulinum toxin A (BoNT-A) treatment for patients diagnosed with masseter hypertrophy on the temporalis muscle, with a particular focus on assessing alterations in muscle thickness, electromyographic (EMG) activity, and the development of muscle pain. METHODS: The present randomized triple-blinded clinical trial enrolled 26 female participants aged between 25 and 50 years complaining about masseter hypertrophy. Participants received 75U of BoNT-A (abobotulinumtoxinA) in both masseter muscles and after three months were randomized to receive a second treatment session of saline solution (S-BoNT-A) or BoNT-A (M-BoNT-A). Longitudinal assessments included temporalis muscle thickness through ultrasound, EMG activity, subjective pain, and masseter prominence severity after one, three, and six months of the first injection session. Muscle thickness, EMG, and subjective pain were analysed using two-way ANOVA with repeated measures and post hoc Sidak test, and for masseter prominence severity, Friedman and Mann-Whitney tests were used. RESULTS: Regarding inter-group comparisons, a higher muscle thickness (p < 0.02) and a higher EMG activity (p < 0.01) were found in the M-BoNT-A group at the 6-month follow-up. For subjective pain assessments, inter-group comparisons showed a higher prevalence of painful regions in M-BoNT-A group at the 6-month follow-up (p < 0.02). No significant differences were found in masseter prominence severity at the 6 months assessment between groups. CONCLUSION: BoNT-A treatment for masseter hypertrophy lead to structural and functional changes in the temporalis muscle, presenting higher changes after multiple injections of this treatment. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparative study of arthrocentesis with concentric-needle cannula with classic concentric needle: A randomized single-blind controlled clinical trial.

This study aimed to assess and compare the efficacy of two distinct single-puncture techniques in temporomandibular joint (TMJ) arthrocentesis for managing disk displacement without reduction (DDwoR). Sixty patients with DDwoR were randomly and blindly assigned to two treatment groups (n = 30 each): group 1 - TMJ arthrocentesis with the classic concentric needle; and group 2 - TMJ arthrocentesis with the concentric needle-cannula system. The following variables were recorded and compared across the groups: patient's pain perception (visual analog scale - VAS, 0-10); maximal interincisal distance (MID, mm); facial edema (FE, presence or absence); and operation duration (OP, minutes). Patients in group 2 presented significantly lower values of VAS score and presence of FE (p < 0.05) when examining the data at 24 and 48 h after the arthrocentesis. They also showed an increase in MID values (p = 0.024) after 6 months. With regard to OP, no significant difference was observed between the groups. Performing a single-puncture TMJ arthrocentesis using a concentric needle-cannula system significantly reduced the patients' pain perception, and mitigated the presence of facial edema during the immediate postoperative period (at 24 and 48 h). Furthermore, it resulted in a notable increase in the MID after 6 months.

Orientações de manutenção e higienização de prótese fixa total implantossuportada: revisão de literatura / Guidelines for maintenance and cleaning of implantssupported total fixed prosthesis: literature review

A evolução dos tratamentos em implantodontia possibilitou uma mudança nos tratamentos reabilitadores para pacientes edêntulos, tornando possível a colocação de próteses fixas, que proporcionam maior qualidade de vida para estes pacientes. Para que estas próteses tenham bom desempenho e longevidade satisfatórios é essencial que se mantenha um padrão adequado de higienização bucal e manutenção profissional. Assim, o objetivo deste trabalho foi realizar uma revisão de literatura a respeito dos principais recursos disponíveis para higienização e manutenção das próteses totais fixas sobre implante (protocolo de Branemark), tanto nos cuidados domiciliares dos pacientes quanto no atendimento profissional do cirurgião dentista. Foi realizada uma busca eletrônica, não sistemática, nas bases de dados Lilacs, Pubmed/Medline, Scielo e ScienceDirect, cruzando-se os seguintes descritores: "Higiene Oral"; "Implantes Dentários"; "Implantação Dentária"; "Manutenção"; "Prótese Dentária Fixada por Implante" e "Prótese Dentária". Foram consultados artigos de revisão de literatura, revisão sistemática, meta-análise, estudos clínicos randomizados, além de livros pertinentes ao assunto, publicados no período de 1995 a 2022.Verificou-se na literatura disponível que os principais instrumentos indicados para uso domiciliar são escova dental, fio dental, escova interdental, irrigador oral, dentifrício e enxaguatório. No atendimento profissional em consultório odontológico deve ser dispendida atenção especial às instruções passadas ao paciente e também fazer o possível para motivar e encorajar o seu engajamento na rotina de higienização, além do acompanhamento periodontal, possíveis substituições de parafusos e instalação de placa oclusal estabilizadora, quando necessário. Manter uma higiene oral adequada é essencial para o sucesso das próteses fixas sobre implantes e o cirurgião dentista desempenha um papel crucial não apenas ao realizar o acompanhamento periódico do paciente, mas também ao sugerir os instrumentos mais apropriados, instruir sobre a higiene oral adequada e motivar o paciente a manter a saúde bucal satisfatória(AU)

The evolution of treatments in implantology has enable a change in rehabilitation treatments for edentulous patients, making it possible to place fixed prostheses that provide a better quality of life for these patients. In order to ensure good performance and satisfactory longevity, it is essential to maintain an appropriate standard of oral hygiene and professional maintenance. Thus, the objective of this work was to conduct a literature review on the main resources available for cleaning and maintenance of complete fixed prostheses on implants (Branemark protocol), both in the patients' home care and in the professional care provided by the dentist. A nonsystematic electronic search was carried out in the Lilacs, Pubmed/Medline, Scielo, and ScienceDirect databases, crossing the following descriptors: "Oral Hygiene"; "Dental Implants"; "Dental Implantation"; "Maintenance"; "Dental Prosthesis, ImplantSupported"; and "Prosthodontics". Literature review articles, systematic reviews, meta-analyses, randomized clinical studies, and relevant books on the subject published from 1995 to 2022 were consulted. The literature available indicates that the main instruments recommended for home care are toothbrush, dental floss, interdental brush, oral irrigator, toothpaste, and mouthwash. In the professional dental office, special attention should be given to the instructions given to the patient, as well as to motivate and encourage their engagement in the hygiene routine, in addition to periodontal monitoring, possible screw replacements, and installation of an occlusal splint when necessary. Maintaining adequate oral hygiene is essential for the success of fixed prostheses on implants, and the dentist plays a crucial role, not only in providing periodic patient follow-up, but also in suggesting the most appropriate instruments, instructing on adequate oral hygiene, and motivating the patient to maintain satisfactory oral health(AU)

The benefits of performing temporomandibular joint arthrocentesis with catheters and a vacuum pump: A randomized control trial.

This study aims to compare the effectiveness of two different techniques of double puncture arthrocentesis with and without the addition of catheters and a vacuum pump for management of temporomandibular joint (TMJ) disc displacement without reduction (DDWOR). A total of 48 patients with DDWOR were randomly and blindly allocated into two treatment groups (N = 24): Group 1, TMJ arthrocentesis with the addition of catheters and a vacuum pump to the second needle; Group 2, TMJ arthrocentesis without any addition device. The following variables were registered and compared between groups: patient's pain perception (visual analogue scale [VAS; 0-10]); maximal interincisal distance [MID; mm]; joint effusion (JE, presence or absence); facial edema (FE; presence or absence); and the operation duration (OP; minutes). Patients in Group 1 presented with significantly lower VAS scores (p < 0.001) and presence of FE (p = 0.03) in the post-operative period, also an increase in MID values (p = 0.026), and a reduction in JE (p = 0.022) after 3 months. Besides that, in this group, the procedure was performed significantly faster (p < 0.001). Performing arthrocentesis with the addition of a vacuum pump makes the procedure faster and yields better results in terms of pain, facial swelling, mouth opening and joint effusion.

Comparison of the Effectiveness of Different Methods for Pain Reduction During Injection Procedures in the Frontalis Muscle.

BACKGROUND: Forehead aesthetic injections are a well-known source of discomfort, and many analgesic non-invasive techniques have been proposed to ameliorate pain. However, no study has compared all these techniques for aesthetic purposes. Therefore, this study aimed to compare the effectiveness of topical cream anesthesia, vibratory stimulus, cryotherapy, pressure, and even no intervention, on pain during and immediately after injection, when considering aesthetic injections in the forehead. METHODS: Seventy patients were selected and had their foreheads divided into 5 parts, which received four different analgesic techniques, and one control zone was added. A numeric rating scale was used to assess pain, two direct questions were asked to evaluate patients' preference and discomfort with the techniques, and the adverse events were quantified. The injections were performed in the same sequence, with three minutes of rest between them and in a single session. Comparisons among analgesic methods for pain relief were performed by the one-way analysis of variance (ANOVA), considering a significance level of 5%. RESULTS: No significant differences were found among the analgesic methods, and between the methods and the control zone, both during and immediately after the injections (p > 0.05). The preferred method for pain relief was the use of topical anesthetic cream (47%), while the most uncomfortable technique was manual distraction (pressure) (36%). Only one patient reported an adverse event. CONCLUSIONS: No analgesic method to diminish pain was superior to the others or was better than no method. Nevertheless, the topical anesthetic cream was the preferred technique, causing less discomfort. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Botulinum toxin type A and acupuncture for masticatory myofascial pain: a randomized clinical trial

Abstract BoNT-A has been widely used for TMD therapy. However, the potential benefits compared to dry needling techniques are not clear. Objective this study aimed to compare the immediate effects of botulinum toxin type A (BoNT-A) injections and Acupuncture in myofascial temporomandibular disorders (TMD) patients. Methodology 54 women were divided into three groups (n=18). AC patients received four sessions of traditional acupuncture, being one session/week during 20-min. BoNT-A patients were bilaterally injected with 30U and 10U in masseter and anterior temporal muscles, respectively. Moreover, a control group received saline solution (SS) in the same muscles. Self-perceived pain was assessed by visual analog scale, while pressure pain threshold (PPT) was verified by a digital algometer. Electromyographic evaluations (EMG) of anterior temporal and masseter muscles were also measured. All variables were assessed before and 1-month after therapies. The mixed-design two-way repeated measures ANOVA and Tukey's post-hoc tests were used for analysis, considering a=0.05. Results Self-perceived pain decreased in all groups after one month of therapy (P<.001). BoNT-A was not better than AC in pain reduction (P=0.05), but both therapies were more effective in reducing pain than SS (P<0.05). BoNT-A was the only treatment able to improve PPT values (P<0.05); however, a severe decrease of EMG activity was also found in this group, which is considered an adverse effect. Conclusion after one month of follow-up, all therapies reduced the self-perceived pain in myofascial TMD patients, but only BoNT-A enhanced PPT yet decreased EMG.

Oral behaviors, bruxism, malocclusion and painful temporomandibular joint clicking: is there an association?

Abstract The present cross-sectional case-control study aimed to determine if there is an association between specific oral behaviors, sleep bruxism (SB), awake bruxism (AB), and painful temporomandibular joint (TMJ) clicking. Ninety individuals were dived into three groups; Group 1 (n = 30): painful TMJ clicking; Group 2 (n = 30): painless TMJ clicking; and Group 3 (n = 30): control group. The following clinical data were studied: oral behaviors (unilateral chewing, gum chewing, nail biting, foreign objects biting, leaning with jaw against the hand, and sleeping in a position that pressures the jaw), SB, AB (including the frequency in 10 days, evaluated by ecological momentary assessment), and malocclusions investigated based on clinical inspections (anterior open bite, posterior cross-bite, abnormal overbite/overjet, occlusal guidance, mediotrusive and/or laterotrusive interferences, retruded contact position to maximum intercuspation slide, missing posterior teeth). All statistical tests (Kolmogorov-Smirnov, chi-square, and one-way ANOVA) were performed with a 5% significance level. Group 1 had the highest frequency of and a significant association with leaning with jaw in the hand, sleeping position that pressures the jaw, gum chewing, nail biting, and AB (p<0.05). Gum chewing, nail biting, and AB were associated with Group 2 only when compared to Group 3 (p<0.05). No significant difference among groups was found for other behaviors (unilateral chewing and foreign objects biting), SB, and all malocclusions (p>0.05). It can be concluded that patients with painful TMJ clicking had a higher frequency of and a significant association with some specific harmful behaviors and AB.

Oral Rehabilitation With Dental Implants and the Importance of a Preventive Evaluation for Osteonecrosis of the Jaws Associated With Medications.

Osteonecrosis of the jaw is a possible oral complication resulting from antiresorptive therapies, such as bisphosphonates (Bfs). Although the etiology is not entirely clear, it has been shown to be dependent on several factors, with the traumatic stimulation caused by the placement of teeth implants indicated as one of the predisposing factors to this pathology. The indications and preventive methods for performing these procedures have been questioned, making it essential to determine the proper protocols. Thus, the present study aims to discuss the risks of the development of osteonecrosis in patients undergoing dental implant surgery who use Bfs as well as to discuss related local and systemic factors and possible methods for preventing this side effect. The study also aims to present a clinical case of an osteopenic patient who used Bfs and underwent rehabilitation through implants according to specific protocols, which resulted in successful treatment.

The effectiveness of microwave disinfection in treating Candida-associated denture stomatitis: a systematic review and metaanalysis.

OBJECTIVE: To evaluate the effectiveness of microwave disinfection in treating Candida-associated denture stomatitis (CADS). MATERIALS AND METHODS: The PubMed/MEDLINE, Embase, and Scopus databases were searched for reports on randomized clinical trials (RCTs) published in English until May 2020 (PROSPERO CRD42020192062) that evaluated the treatment of CADS by using microwave disinfection. The main outcomes were the improvement of clinical signs and/or the decrease in the residual yeast present on the dentures and palatal mucosa. The mean differences, standard deviations, risk ratio, and 95% confidence interval were calculated by using the random-effects model. Heterogeneity was assessed by using Cochran's Q test and I2 values. The level of significance was set at α = 0.05. RESULTS: Five RCTs with 245 participants were included. The descriptive investigations demonstrated that microwave disinfection was as effective (p > 0.05) as 0.2% chlorhexidine, 0.02% sodium hypochlorite, and topical nystatin (100.000 IU/mL), and was superior to topical miconazole in treating CADS. The metaanalysis did not show a statistical difference between microwave disinfection and nystatin (100.000 IU/mL) treatment in terms of mycological counts, cure, and recurrence rates (p > 0.05). CONCLUSION: Microwave disinfection showed comparable results with those of conventional therapies for treating CADS. In addition, treatment with 650 W for 3 min once a week for 14 days had better cost-effect results, indicating both the prevention and treatment of CADS. CLINICAL RELEVANCE: Our findings provide evidence regarding the treatment of CADS using microwave disinfection, and also indicating the best cost-effective option for this treatment modality.

Lateral and apical root resorption in teeth orthodontically moved into edentulous ridge areas

ABSTRACT Objective: The present study aimed at comparing the external lateral root resorption (ELRR) and external apical root resorption (EARR) between teeth moved through the atrophic edentulous ridge and those undergoing the usual orthodontic movement. Methods: Fifty-four premolars were evaluated, where 27 of them had been moved toward the edentulous ridge (Group 1) and 27 from the same patient, had not been translated, which comprised the control group (Group 2). ELRR was evaluated by 0-3 scores and EARR was evaluated by 0-4 scores, before and after movement. Measurements were compared by Kruskal-Wallis and Student-Newman-Keuls tests. Results: ELRR increased statistically only in the Group 1 (p< 0.05). After orthodontic treatment, it was observed that almost 56% (n = 15) of teeth in Group 1 presented scores 2 and 3, while Group 2 presented scores 2 and 3 in about 11% (n= 3) of the teeth. EARR increased in both groups after orthodontic movement, however, statistically analyses showed no significant differences between groups (p> 0.05). Conclusions: Orthodontic movement into the atrophic edentulous ridge is subject to a greater lateral external root resorption.

RESUMO Objetivo: O presente estudo teve como objetivo comparar a reabsorção radicular lateral externa (RRLE) e a reabsorção radicular apical externa (RRAE) em dentes movimentados sobre o rebordo edêntulo atrófico e naqueles submetidos à movimentação ortodôntica usual. Métodos: Foram avaliados 54 pré-molares, sendo 27 deles movimentados em direção ao rebordo edêntulo (Grupo 1) e 27 (dos mesmos pacientes) não transladados, que compuseram o grupo controle (Grupo 2). A RRLE foi avaliada por meio de escores de 0 a 3, e a RRAE foi avaliada por meio de escores de 0 a 4, antes e depois do tratamento. As medidas foram comparadas por meio dos testes de Kruskal-Wallis e de Student-Newman-Keuls. Resultados: O escore da RRLE aumentou estatisticamente apenas no Grupo 1 (p< 0,05). Após o tratamento ortodôntico, observou-se que quase 56% (n = 15) dos dentes do Grupo 1 apresentaram escores 2 e 3, enquanto o Grupo 2 apresentou escores 2 e 3 em cerca de 11% (n = 3) dos dentes. O escore da RRAE aumentou em ambos os grupos após a movimentação ortodôntica; entretanto, as análises estatísticas não mostraram diferenças significativas entre os grupos (p> 0,05). Conclusões: Dentes submetidos à movimentação ortodôntica sobre rebordo edêntulo atrófico estão sujeitos a uma maior reabsorção radicular externa lateral.

Role of inflammatory and pain genes polymorphisms in temporomandibular disorder and pressure pain sensitivity.

OBJECTIVE: The aim of this study was to assess the correlation of inflammatory and pain genes polymorphisms with the presence of temporomandibular disorder (TMD) patients and with pressure pain sensitivity. DESIGN: Data was collected from 268 consecutive subjects at Bauru School of Dentistry. Subjects aged younger than 20 years, with dental and neuropathic pain, sinusitis, cognitive and neurologic disorder were excluded. Included subjects were evaluated using the Research Diagnostic Criteria for Temporomandibular disorders and divided into two groups: TMD cases and healthy controls. Groups were submitted to pressure pain threshold (PPT) test for the temporomandibular joint, anterior temporalis and masseter muscles and genotyped for Val158Met, IL6-174, IL-1ß-3954 and TNFA-308. Student's t-test and Pearson chi-square test were used to comparisons between groups. A linear multiple regression was used to evaluate the influence of genetics variables on the PPT and a bivariate analysis was used to assesses the influence of genetics variables on pain sensitivity below the PPT cut off of the structures in TMD group. RESULTS: TMD group showed significantly lower PPT values for all structures when compared with control group (p < 0.001). SNP IL6-174 predicted higher pain sensitivity in the temporomandibular joint (p < 0.005) and in anterior temporalis muscle (p < 0.044) and SNP Val158Met in the masseter muscle (p < 0.038); when TMD group was divided according to PPT cut-off values the SNP Val158Met influenced increase pain sensibility in the masseter muscle. CONCLUSION: TNFA-308 was associated with TMD and SNP IL6-174 and SNP Val158Met influenced pain sensitivity of patients with TMD.

Arthrocentesis with different irrigation volumes in patients with disc displacement without reduction: One-year follow-up.

Objective: This study evaluated the clinical efficacy of arthrocentesis when varying the irrigation volume in patients with disc displacement without reduction (DDWOR). Methods: Thirty DDWOR patients were equally divided into two groups: G1 (50 mL) and G2 (200 mL). Information was compared for pain, the maximum interincisal distance (MID), protrusion, and right and left laterality. Results: Arthrocentesis was able to reduce the pain and increase the MID, protrusion, and both laterality values significantly one year after the procedure (p < 0.001) in both groups. However, comparisons between the groups revealed no significant difference (p > 0.05). Furthermore, changes in volume did not affect the arthrocentesis results (p = 0.626, odds ratio = 1.625; 95% confidence interval = 0.230-11.461). Conclusion: Arthrocentesis techniques using 50- and 200-mL irrigation volumes were both effective, with no significant differences between techniques observed after one year of follow-up.

Temporomandibular joint morphology does not influence the presence of arthralgia in patients with disk displacement with reduction: a magnetic resonance imaging-based study.

OBJECTIVE: The aim of this study was to compare, by using magnetic resonance imaging (MRI), temporomandibular joint (TMJ) morphology between patients with disk displacement with reduction (DDWR) with or without arthralgia and a control group and to identify which factors are associated with the concomitant presence of arthralgia in DDWR patients. STUDY DESIGN: In this investigation, 36 TMJ MRIs were divided into 3 groups. Group 1 (n = 12) comprised patients with DDWR and arthralgia; group 2 (n = 12) comprised patients with DDWR without arthralgia; and group 3 (n = 12) was the control group. Disk and mandibular condyle morphologies; articular eminence morphology and inclination; size of the mandibular fossa; joint space size; joint effusion; bone marrow of the mandibular condyle; and the relative signal intensity of retrodiscal tissue were evaluated. RESULTS: Fisher's exact test and 1-way analysis of variance (ANOVA) revealed no significant differences (P > .05) between groups for any variable. Logistic regression analysis showed that no anatomic variables were related to the concomitant presence of arthralgia in patients with DDWR (P > .05). CONCLUSIONS: As evaluated on MRI scans, no significant differences in the anatomic characteristics of the TMJ were detected between DDWR patients with or without concomitant arthralgia and the control group. There were no factors associated with the concomitant presence of arthralgia in patients with DDWR.

Botulinum toxin-A injections as therapy for chronic painful post-traumatic trigeminal neuropathy: case report / Injeções de toxina botulínica-A como terapia para dor neuropática trigeminal pós-traumática crônica: relato de caso

Painful post-traumatic trigeminal neuropathy (PTTN) involves spontaneous and evoked pain, of moderate to severe intensity, continuous and described as burning or shooting. The first line treatment is pharmacological. However, botulinum toxin - A (BoNT-A) can be used when medications cannot control pain. This article describes the use of BoNT-A in a case of PTTN refractory to conventional pharmacological treatment. A 44-year-old male patient presented with an 8-years history of pain in the lower left second molar region. Pain was burning, lasting for seconds, with multiple pain episodes per day. Diagnosis hypothesis was PTTN. After no improvement with conventional pharmacological treatment, injections of BoNT-A were elected. Somatosensory assessment showed a significant reduction in visual analog scale for touch, cold and pinprick sensitivity. Likewise, patient's impression of change in pain significantly improved after BoNT-A injections. Our results suggest that BoNT-A could be used as a treatment for PTTN refractory to conventional treatments. (AU)

A neuropatia trigeminal pós-traumática dolorosa (PTTN) envolve dor espontânea e evocada, de intensidade moderada a grave, contínua e descrita como queimante ou lascinante. O tratamento de primeira linha é farmacológico. No entanto, a toxina botulínica - A (BoNT-A) pode ser usada quando os medicamentos não conseguem controlar a dor. Este artigo descreve o uso da BoNT-A em um caso de PTTN refratário ao tratamento farmacológico convencional. Paciente de sexo masculino, 44 anos, com 8 anos de dor na região do segundo molar inferior esquerdo. A dor foi descrita como queimante, com duração de segundos e com vários episódios por dia. A hipótese de diagnóstico foi PTTN. Após nenhuma melhora com o tratamento farmacológico convencional, as injeções de BoNT-A foram eleitas. A avaliação somatossensorial mostrou uma redução significativa na escala visual analógica para sensibilidade ao toque, frio e picada após BoNT-A. Da mesma forma, a impressão de mudança do paciente na dor melhorou significativamente após as injeções de BoNT-A. Nossos resultados sugerem que o BoNT-A poderia ser usada como tratamento para PTTN refratário a tratamentos convencionais. (AU)

Use of osseointegrated implants in the intermaxillary suture in a patient with microstomia: Case report with a 2-year follow-up.

AIM: To report the rehabilitation of a female patient, 40 years old, with a microstomia. CASE REPORT: The Z-plasty surgery was performed in the region of the labial commissure to increase the mouth opening. In the mandible, two implants were installed in the interforaminal region and an overdenture with bar/clip attachment system was made. The maxilla was atrophic, with the presence of two bone sites in the intermaxillary suture region: the first one anterior to the incisive foramen and the second one in the middle of the hard palate. Two implants were placed without a graft in those sites. The conventional maxillary denture was converted into an overdenture with ball attachments system. CONCLUSION: Based on the presented case, with a 2-year follow-up, it can be concluded the validity of the use of the techniques of surgeries to increase the mouth opening, implants in intermaxillary suture and overdentures as rehabilitation therapy for patients with microstomia.

Temporomandibular joint disc displacement with reduction: a review of mechanisms and clinical presentation

Abstract Disc displacement with reduction (DDWR) is one of the most common intra-articular disorders of the temporomandibular joint (TMJ). Factors related to the etiology, progression and treatment of such condition is still a subject of discussion. This literature review aimed to address etiology, development, related factors, diagnosis, natural course, and treatment of DDWR. A non-systematic search was conducted within PubMed, Scopus, SciELO, Medline, LILACS and Science Direct using the Medical Subjective Headings (MeSH) terms "temporomandibular disorders", "temporomandibular joint", "disc displacement" and "disc displacement with reduction". No time restriction was applied. Literature reviews, systematic reviews, meta-analysis and clinical trials were included. DDWR is usually asymptomatic and requires no treatment, since the TMJ structures adapt very well and painlessly to different disc positions. Yet, long-term studies have shown the favorable progression of this condition, with no pain and/or jaw locking occurring in most of the patients.

Double puncture versus single puncture arthrocentesis for the management of unilateral temporomandibular joint disc displacement without reduction: A randomized controlled trial.

PURPOSE: To compare the clinical efficacy of the conventional double puncture versus single puncture type 2 arthrocentesis for management of temporomandibular joint disc displacement without reduction (DDWOR). MATERIALS AND METHODS: Twenty-six patients with DDWOR were randomly and blindly allocated into two treatment groups (N = 13): Group 1, conventional double puncture arthrocentesis; Group 2, single puncture type 2 arthrocentesis. Data on gender, side of painful joint complaint, age (years), duration of joint pain (months), maximum interincisal distance (MID - mm), and pain intensity self-reported with a visual analog scale (VAS; 0-10) were collected. VAS scores and MID were measured before (baseline) and 6 months after arthrocentesis (final). RESULTS: Both techniques resulted in significantly reduced VAS scores and increased MID (p = 0.001) after 180 days. However, there were no statistically significant differences between techniques (p > 0.05). CONCLUSIONS: The two arthrocentesis methods tested were effective in reducing VAS scores and increasing MID in patients with DDWOR.

Recurrent pyogenic granuloma associated with port-wine stain: a case report / Granuloma Piogênico recorrente associado à Mancha Vinho do Porto: um relato de caso

O granuloma piogênico (GP) é um processo proliferativo não neoplásico. Este termo entretanto, é equivocado, uma vez que não está relacionado a qualquer infecção, não contém pus e não é um verdadeiro granuloma. A ocorrência do GP recorrente associado a lesões vasculares na pele, tais como manchas de vinho do porto, tem sido descrita na literatura. Paciente do gênero masculino com 23 anos de idade foi atendido na Universidade Federal do Maranhão apresentando uma lesão com características de granuloma piogênico na vestibular do primeiro molar, associada à mancha vinho do porto. O diagnóstico foi confirmado através de biopsia excisional e análise histopatológica. Devido à recorrência da lesão após a abordagem cirúrgica, injeções intralesionais de corticoides foram realizadas três vezes. Após dois anos de acompanhamento, não houve recorrência. Pode-se concluir que, apesar da alta prevalência de recorrência do granuloma piogênico, injeções intralesionais com corticoides podem ser uma alternativa ao tratamento cirúrgico convencional.

Pyogenic granuloma (PG) is a non-neoplastic proliferative lesion. This term, however, is a misconception, since it is not related to any infection, does not contain pus and it is not a true granuloma. The occurrence of recurrent PG associated with vascular lesions on the skin, such as port-wine stains, has been described in the literature. A 23 years old male patient was attended in the Federal University of Maranhão presenting a lesion with pyogenic granuloma characteristics in the buccal side of the first molar associated with port-wine stain. The diagnosis was confirmed per an excisional biopsy, along with histopathologic analysis. Due to the recurrence of the lesion after the surgical approach, intralesional corticosteroid injections was performed three times. After two-years no signs of recurrence could be observed. In conclusion, despite of the high prevalence of Pyogenic Granuloma recurrence, intralesional corticosteroid injections may be an alternative option to conventional surgical treatment.

Does pregabalin improve sleep disorders in fibromyalgia? / A pregabalina melhora os distúrbios do sono na fibromialgia?

ABSTRACT BACKGROUND AND OBJECTIVES: Fibromyalgia is a chronic generalized pain syndrome accompanied by somatic symptoms, mainly represented by sleep disorders. Pregabalin is the main agent among pharmacological treatments. CONTENTS: An electronic search was performed in the databases Lilacs, Pubmed/Medline, Scielo and ScienceDirect. The keywords used in English and Portuguese were "fibromyalgia"; "sleep disorder", "treatment"; "pregabalin"; "medicine"; "fibromialgia"; "distúrbios do sono", "tratamento"; "pregabalina"; "fármacos". Only articles of literature review, systematic review, meta-analysis and randomized clinical studies published between October 1992 and May 2018 were included. CONCLUSION: Pregabalin is efficient and safe in the management of sleep disorders in patients with fibromyalgia because it reduces the number of awakenings and increases sleep duration.

RESUMO JUSTIFICATIVA E OBJETIVOS: A fibromialgia é uma síndrome de dor generalizada crônica, acompanhada de sintomas somáticos, representados principalmente por distúrbios do sono. Dentre os tratamentos farmacológicos, a pregabalina é o principal representante. CONTEÚDO: Foi realizada uma busca eletrônica nas bases de dados Lilacs, Pubmed/Medline, Scielo e ScienceDirect, cruzando-se os seguintes descritores em língua inglesa e portuguesa: "fibromyalgia"; "sleep disorder", "treatment"; "pregabalin"; "medicine"; "fibromialgia"; "distúrbios do sono", "tratamento"; "pregabalina"; "fármacos". Foram incluídos somente artigos de revisão de literatura, revisão sistemática, meta-análise e estudos clínicos randomizados publicados no período de outubro de 1992 a maio de 2018. CONCLUSÃO: A pregabalina é eficiente e segura no manuseio dos distúrbios do sono em pacientes com fibromialgia, pois diminui o número de despertares e aumenta o tempo de duração do sono.