Facial sensibility of patients with trigeminal neuralgias.

OBJECTIVES: Idiopathic trigeminal neuralgia (ITN) is an excruciating shock-like paroxysmal pain restricted to the trigeminal area of innervation, with discrete loss of sensibility (thermal, tactile and painful). Trigeminal postherpetic neuralgia (PHN) is a neuropathic pain at the trigeminal territory that persists after Herpes zoster infection, which also is associated to sensorial compromise. The objective of this study was to evaluate the somesthetic facial sensibility (pain, thermal and tactile) and to compare the findings between PHN and ITN. METHODS: 18 patients with PHN and 26 patients with ITN were diagnosed by the IASP criteria. They were evaluated with a systematic approach, which included mechanical, thermal (cold and warm) and painful stimuli. RESULTS: We found statistical significance at the ophthalmic branch of PHN in pain (p=0.001), tactile (p=0.002), cold (p=0.016) and warm (p=0.013); in ITN, the maxillary branch had higher threshold with pinpricks (p=0.016) and the mandibular branch had higher tactile threshold. CONCLUSIONS: The trigeminal area affected by the disease had the higher sensorial losses (ophthalmic branch in PHN and maxillary/mandibular branches in ITN). PHN patients had losses in large and small fibers; therefore, ITN patients had the losses mostly in large fibers, which support different peripheral neural mechanisms for these neuropathic diseases.

Regeneração óssea guiada em defeitos extensos pós-exodontias utilizando membrana exposta ao meio bucal / Guided bone regeneration after tooth extraction using membrane exposed to the oral environment. Case reports

Este artigo traz dois casos clínicos de pacientes que apresentaram defeitos ósseos extensos após exodontias. Os defeitos foram protegidos com barreira regenerativa de polipropileno, exposta ao meio bucal, a qual foi removida uma semana após a cirurgia. Nenhum tipo de biomaterial foi usado para preencher o defeito a ser reparado, apenas sangue. A literatura científica enfatiza a importância de manter as dimensões do rebordo alveolar depois de extrações dentárias, principalmente visando a colocação de implantes osseointegráveis. Entretanto, nem sempre se consegue um rebordo que permita a estabilidade do implante, ou boa estética, principalmente em casos quando há defeitos ósseos extensos. Os casos apresentados mostram que no período avaliado foi possível conseguir a preservação de um rebordo alveolar que deu condições de inserção de implantes e que também favoreceu a estética. O uso da técnica de regeneração óssea guiada através de barreira de polipropileno e que fique exposta ao meio bucal é viável e reduz a morbidade de cirurgias mais traumáticas.

This article presents two cases of patients who had advanced bone defects after dental extraction. The defects were covered with a polypropylene membrane, exposed to the oral environment, which was removed one week after surgery. The scientific literature emphasizes the importance of maintaining the dimensions of the alveolar ridge after tooth extraction, mainly targeting the placement of dental implants. However, extensive bone defects oftentimes prevent an alveolar ridge that enables the stability of the implant or good esthetics, particularly in those cases. The cases presented showed that during the period evaluated it was possible to achieve preservation of alveolar ridge providing conditions for implant placement, which also favored the aesthetic result. The use of guided bone regeneration technique with a polypropylene barrier exposed to the oral environment is feasible and reduces the morbidity during traumatic surgeries.