Clinical performance and patient-related outcome measures of digitally fabricated complete dentures: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: The demand to streamline workflow while increasing patient comfort and satisfaction in the manufacturing of removable complete dentures (CDs) is growing, and computer-aided design and computer-aided manufacturing (CAD-CAM) technology has gained prominence. However, a systematic review and meta-analysis of the clinical performance and patient-related outcome measures (PROMs) of digitally fabricated complete dentures is lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to determine whether digitally fabricated CDs improve the clinical performance and PROMs compared with conventionally fabricated CDs. MATERIAL AND METHODS: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and was registered at the International Prospective Register of Systematic Reviews (CRD42023433909). This review aimed to address the question "Do digitally fabricated CDs improve clinical performance and PROMs compared with conventional CDs?" Two independent authors conducted electronic searches up to September 2023. Denture base retention and patient satisfaction were analyzed through the continuous outcome evaluated by mean difference and standard deviation, with 95% confidence intervals. The risk of bias in each study was assessed using the Risk of Bias In Non-randomized Studies of Interventions and the Risk of Bias based on the Cochrane risk of bias tool for randomized trials. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation. RESULTS: A total of 1505 articles were found during the search, and 16 were included in this review. The main outcomes were grouped into clinical performance (retention, adaptation or fit, clinician's denture quality assessment, masticatory efficiency, and occlusal force) and PROMs (patient satisfaction, oral health related quality of life, final choice, and willingness-to-pay). In terms of denture base retention, between conventional CDs and printed CDs analyzes, conventional CDs exhibited better retention (P=.02), but no significant difference was found between the conventional CDs and milled CDs (P=.20). In terms of patient satisfaction, no statistically significant difference was found between the manufacturing methods of digitally fabricated CDs (printed CD, P=.55; milled CD, P=.08). CONCLUSIONS: Digitally fabricated CDs showed similar or better clinical performance than conventional CDs, and different types of digital manufacturing processes for complete dentures did not influence PROMs.

The Effect of Advanced Platelet-Rich Fibrin in Tissue Regeneration in Reconstructive and Graft Surgery: Systematic Review.

This systematic review answered the guiding question using the PICO system: "What are the effects of advanced platelet-rich fibrin (A-PRF) on alveolar ridge preservation and tissue gain in reconstructive and jaw graft surgery?" Searches were performed in the PubMed|MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, and LILACS|bvs databases. In total, 573 articles were found in the initial search, and 564 were evaluated after the removal of duplicates, of which 5 randomized controlled trials met the eligibility criteria and were included 2 studies investigated the effect of A-PRF on the preservation of the bone ridge, 1 study evaluated the tissue repair after tooth extraction with A-PRF, 1 evaluated the peri-implant gap filling with A-PRF-xenograft mixture, and other the A-PRF on the treatment of alveolar osteitis. Advanced-PRF preparation protocol varied between the included studies from 8 to 13 minutes of centrifugation, at 1300 RPM (200 g ). The use of A-PRF provided greater dimensions of height and more favorable maintenance of the ridge profile, probing depth, and gingival margin level after extraction. Advanced-PRF also increased bone density, vital bone, epithelial healing, and control of postoperative pain and swelling after tooth extraction and in the treatment of alveolar osteitis.

Muscle activity between dentate and edentulous patients rehabilitated with dental prostheses: A systematic review.

BACKGROUND: Adequate muscle activity is important for the success of oral rehabilitation: it maintains the integrity of the stomatognathic system and is responsible for chewing movements needed to break, crush and grind food. OBJECTIVE: To compare muscle activity using electromyography (EMG) while clenching or chewing soft and/or hard foods among individuals with natural dentition (ND) and edentulous patients rehabilitated with dental prostheses. METHODS: This review was conducted until March, 2023, and the research question was "Is the muscle activity of edentulous patients rehabilitated with dental prostheses similar to that of dentate individuals?" A search strategy was conducted in PubMed/MEDLINE, The Cochrane Library, Web of Science, Lilacs, Embase and manual journal searches. RESULTS: Ten studies were included in the analysis. Most of them reported that individuals with ND had significant higher muscle activity (clenching or chewing) than complete dentures (CD) users. However, no difference was observed between patients with full mouth implant-supported fixed dental prosthesis (ISFDP) and ND. Additionally, two studies compared patients with mandibular ISFDP with maxillary CD and individuals with ND and found no differences; however, one study concluded that patients with ISFDP with CD (maxillary or mandibular) had lower muscle activity than individuals with ND. Only one study reported a higher muscle activity in patients with full-mouth ISFDP than in individuals with ND. CONCLUSIONS: Bimaxillary CD users had lower muscle activity than individuals with ND. During rehabilitation, the muscle activity of patients with full-mouth ISFDP and mandibular ISFDP with maxillary CD is similar to individuals with ND.

Photodynamic therapy in the treatment of denture stomatitis: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Photodynamic therapy is widely used in dentistry, but limited evidence exists regarding its effectiveness in treating denture stomatitis. High resistance to antifungals has been reported, and photodynamic therapy could be an alternative treatment. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate whether photodynamic therapy is effective in reducing denture stomatitis. MATERIAL AND METHODS: A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and recorded in the prospective register of systematic reviews (PROSPERO) (CRD42020205589) to answer the population, intervention, control, outcome (PICO) question: "Is photodynamic therapy effective in the treatment of denture stomatitis when compared with the use of antifungal agents?" Electronic searches were performed in databases PubMed/MEDLINE, Cochrane library, and Web of Science for articles published until February 2021 by using the following terms: (denture stomatitis OR oral candidiasis) AND (low-level light therapy OR laser therapy OR lasers OR photodynamic therapies OR photochemotherapy) AND (antifungal drugs OR antifungal agents OR antimicrobial OR treatment). Clinical trials and randomized clinical trials, studies in the English language, and studies comparing antifungal agents with photodynamic therapy were included. RESULTS: In total, 5 articles were selected for the qualitative analysis and 3 for the meta-analysis. No significant difference was detected between antifungal therapy and photodynamic therapy in the reduction of colony-forming units on the palate. In a subgroup analysis, a significant difference was found in the reduction of colony-forming units on the palate at 15 days and at the denture surface at 30 days. CONCLUSIONS: Photodynamic therapy is effective in the treatment of denture stomatitis, but after 30 days and 15 days, the antifungals demonstrated better performance.

Does the use of conventional complete dentures influence taste perception? A systematic review.

STATEMENT OF PROBLEM: Although conventional complete dentures are widely used, a systematic review of their influence on wearers' taste perception is lacking. PURPOSE: The purpose of this systematic review was to determine whether conventional complete dentures influence the taste perception of edentulous patients. MATERIAL AND METHODS: This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42022341567), and the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed. The guiding question was: "Does the use of complete dentures influence the taste perception of edentulous patients?" Two reviewers searched articles in the PubMed/MEDLINE, Scopus, Cochrane Library, and https://clinicaltrials.gov databases up to June 2022. The risk of bias in each study was assessed using the risk of bias in nonrandomized studies of interventions and the risk of bias based on the Cochrane risk of bias tool for randomized trials. The certainty of evidence was assessed using grading of recommendations, assessment, development, and evaluation (GRADE). RESULTS: A total of 883 articles were found with the search, and 7 were included in this review. Various changes in taste perception were identified in some of these studies. CONCLUSIONS: The use of conventional complete dentures can influence the perception of the 4 primary tastes (sweet, salty, sour, and bitter) of edentulous patients, which may negatively interfere with the perception of flavor.

Do Computerized Delivery Systems Promote Less Pain and Anxiety Compared to Traditional Local Anesthesia in Dental Procedures? A Systematic Review of the Literature.

PURPOSE: The aim of this study is to assess whether the use of computerized devices to deliver local anesthesia results in less pain and anxiety compared to traditional anesthesia in adult dental procedures. METHODS: This review was registered at PROSPERO (CRD 42021265046), based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and was structured according to the PICO strategy. The studies were selected based on eligibility criteria, and data were collected by 1 author and reviewed by another. RESULTS: Nine of the 10 studies included were randomized controlled trials. Differences related to pain and anxiety were observed, which favored computerized techniques; however, caution should be exercised when interpreting these results due to differences in assessment methods. The studies used different local anesthetics, including 2% lidocaine, 4% articaine, or 3% mepivacaine with epinephrine diluted 1:80,000 to 1:200,000. A total of 560 patients were evaluated. CONCLUSIONS: Computerized anesthesia devices yielded better results than conventionally delivered anesthesia after qualitative evaluation. Nevertheless, conventional anesthesia is widely used, safe, and effective. Due to the heterogeneity among the included studies, it is strongly recommended that new randomized clinical trials using well-defined methodologies be performed to improve the quality of evidence regarding this topic.

Rehabilitation with dental prostheses and its influence on brain activity: A systematic review.

STATEMENT OF PROBLEM: The consequences of edentulism depend on its complexity and are far-reaching, but limited evidence regarding its association with neurologic health is available. PURPOSE: The purpose of this systematic review was to establish the relationship between oral prosthetic rehabilitation and the regional increase in brain activity. MATERIAL AND METHODS: This systematic review was registered in the International Prospective Register of Systematic Reviews (CRD42021262247), and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. Randomized clinical trials, prospective studies comparing the brain activity of patients rehabilitated with and without the use of dental prostheses, and studies that analyzed the human brain by using noninvasive techniques were used as inclusion criteria. The risk of bias in each study was assessed by using the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I). RESULTS: The search was carried out in the PubMed/MEDLINE, Embase, Cochrane Library, and https://clinicaltrials.gov databases up to June 2021. After a search conducted by 2 reviewers, 8 articles were included in the review. A regional increase in blood flow and regional cerebral activity during dental prosthesis use was identified in the studies. CONCLUSIONS: A positive association was found between the different types of prosthetic rehabilitation and brain function. Prostheses may preserve and restore neurological health.

Patient-reported outcome measures and prosthetic events in implant-supported mandibular overdenture patients after immediate versus delayed loading: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Immediately loaded mandibular overdentures are clinically acceptable treatment options that have gained popularity because their use shortens the treatment duration. However, whether the immediate loading of dental implants can match the prosthetic events, satisfaction, and quality of life of delayed loading is still unclear. PURPOSE: The purpose of this systematic review and meta-analysis was to compare the prosthetic events, satisfaction, and quality of life of immediate versus delayed loading implants in patients rehabilitated with mandibular overdentures. MATERIAL AND METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered at The International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021258187). Electronic searches were carried out by 2 independent reviewers in the PubMed/MEDLINE, Cochrane Library, and Web of Science databases up to May 2021. Only randomized clinical trials and prospective studies with at least 10 participants that compared immediate versus delayed loading were selected. A meta-analysis was performed by using the RevMan 5 software program for complications and maintenance outcomes. RESULTS: Seven articles were included in the qualitative analysis, and 4 were included in the quantitative analysis. The meta-analysis demonstrated no significant difference between immediate and delayed loading for prosthetic complications (RR=1.71; 95% CI=0.67-4.37; I2=85%, P=.27) or maintenance (RR=1.92, 95% CI=0.44-8.28; I2=94%, P=.38). CONCLUSIONS: Although the prosthetic complications and maintenance were more likely to favor the delayed loading group, available evidence showed no statistical difference for prosthetic complications and maintenance between immediate loading and delayed loading in mandibular overdentures.

Does nocturnal use of a complete denture interfere with the degree of obstructive sleep apnea? A systematic review and meta-analysis.

BACKGROUND: The impact of a complete denture on obstructive sleep apnea is not well understood. Therefore, this study aimed to evaluate the relationship between nighttime use of complete dentures and obstructive sleep apnea and determine if wearing a complete denture during sleep changes the degree of obstructive sleep apnea. METHODS: This systematic review followed the notification items for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was recorded in the International Prospective Registry of Systematic Reviews (PROSPERO) under number CRD42020183167. An electronic search in the PubMed/MEDLINE, Scopus, and Cochrane Library databases for articles published until September 2020 was conducted. The search strategy used the terms (complete denture OR denture OR edentulous OR edentulism) AND (quality of sleep OR sleep OR apnea OR obstructive sleep apnea). Only prospective, retrospective, controlled, and randomized clinical studies of patients wearing complete dentures, studies comparing sleep with and without the prosthesis, and studies in which patients were diagnosed with obstructive sleep apnea by polysomnography were included in the review. RESULTS: In total, four articles were selected for the qualitative and quantitative analyses. A total of 144 patients, with an average age of 60 years, were studied. The meta-analysis showed that there was no statistical difference in the apnea-hypopnea index between using and not using the prosthesis during sleep. CONCLUSIONS: The use of complete dentures during sleep does not influence the degree of obstructive sleep apnea.

Evolution of Hematological Parameters in Patients Undergoing Orthognathic Surgery With a View to Hospital Discharge: A Prospective Study.

BACKGROUND: The length of hospital stays of patients undergoing orthognathic surgery depends on related local and systemic factors. Hematological changes resulting from orthognathic surgery, followed up in the postoperative period until hospital discharge, have neither yet been established for specific cases, nor for normal situations. This study aimed to describe the hemodynamic parameters of patients undergoing orthognathic surgery, considering a prediction of hospital discharge. A prospective analytical study was carried out on a sample of convenience for this purpose. METHODS: The erythrogram, leukogram, and platelet count were assessed 24 and 72 hours after surgery and compared with preoperative values. Intraoperative volume loss was also assessed. Inferential statistical analyses were performed as analysis of variance or Friedman test, paired Wilcoxon test, Mann-Whitney test, and 2-tailed Spearman correlation. RESULTS: The red blood cell count (mean ±â€Šstandard deviation [median]); (4.60 ±â€Š0.24 [4.56]), hemoglobin (12.82 ±â€Š1.03 [12.75]), hematocrit (39.51 ±â€Š3.47 [39.60]), and red cell distribution with (32.60 ±â€Š0.88 [33.05]) were higher preoperatively (P < 0.001). Mean corpuscular volume (83.87 ±â€Š5.63 [83.10]), mean corpuscular hemoglobin (27.50 ±â€Š1.47 [28.00]), leukocytes (6262.00 ±â€Š1448.36 [6380.00]). The volume loss varied between 463.87 and 752.13 mL (608.00 ±â€Š144.13 [630.00]). CONCLUSIONS: The results of the hematological evaluations corroborate the expectation of standard discharge from the hospital, with reflected changes resulting from volume loss and intense postoperative inflammatory response, even under the anti-inflammatory pharmacological effect.

Surgical Management of Odontogenic Infection in Sturge-Weber Syndrome: Report of a Case.

ABSTRACT: Surgical management of odontogenic infections in Sturge-Weber Syndrome is challenging, due to the risk of massive bleeding and difficulty to achieve hemostasis. The authors describe the use of preoperative vascular embolization for oral surgery in a 29-year-old patient. The authors highlight the importance of hemostatic agents and primary wound closure and the role of vascular embolization as a potential tool for preventing hemorrhage in these cases.

Surface roughness of acrylic resins used for denture base after chemical disinfection: A systematic review and meta-analysis.

OBJECTIVE: This study aimed to systematically review the literature regarding the surface roughness of polymethylmethacrylate (PMMA) for denture bases, disinfected with different chemical agents and analyse the outcomes of the included studies. BACKGROUND: Various chemical disinfection protocols to clean the removable dental prosthesis are reported in the literature, however systematic reviews analysing the outcomes in the surface roughness of the PMMA are lacking. METHODS: The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) checklist was used to structure this systematic review. The inclusion criteria were as follows: clinical trials, in vitro studies, studies in English and studies comparing the effects of chemical disinfection products on the surface roughness of PMMA. An electronic search was performed in the following databases: PubMed/MEDLINE, Scopus and Web of Science.; we also conducted a manual search for articles published in specific journals of dental prostheses and dental materials. RESULTS: Thirteen in vitro studies in this systematic review and meta-analysis. According to the meta-analysis, the effects of 0.5% (P = .32; MD: 0.06; CI: -0.05 to 0.17; heterogeneity: P < .00001; I2  = 92%) and 1% NaOCl solutions (P = .27; MD: 0.01; CI: -0.01. to 0.03; heterogeneity: P = .03; I2  = 55%) did not statistically differ between the groups studied. Effects of alkaline peroxide were statistically significant (P = .0009; MD: 0.01; CI: 0.01-0.02; heterogeneity: P = .004; I2  = 65%), suggesting that it promotes deterioration of the PMMA surface. CONCLUSION: The alkaline peroxide, when used as a disinfectant, generated changes on the surface roughness of PMMA and should be used with caution; however, NaOCl, even at different concentrations, caused fewer changes on the surface of the denture base.

Evaluation of IL-6 levels and +3954 polymorphism of IL-1ß in burning mouth syndrome: A systematic review and meta-analysis.

This study evaluated IL-6 salivary levels as well as the +3954 polymorphism of IL-1ß in patients with burning mouth syndrome and healthy individuals, through case-control studies. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We conducted this research in PubMed/MEDLINE, Cochrane Library and Web of Science databases. The risk of bias was measured based in the Newcastle-Ottawa Scale. Researches with a group of patients with burning mouth syndrome and a control group in which the presence of the +3954 polymorphism of IL-1ß and/ or IL-6 salivary levels through non-stimulated saliva were evaluated to detect if this interleukin concentrations are increased in patients and if the polymorphism is a risk factor for this syndrome. We identified seven studies with total of 440 participants, 229 patients with burning mouth syndrome and 211 healthy controls, ages 24-84 years old. The female gender was predominant. Patients in the majority of studies did not present increased levels of IL-6 and the +3954 polymorphism of IL-1ß is not a risk factor for this syndrome. A few studies researched biomarkers in this pathology and more investigations are required not only to identify salivary levels and the polymorphism evaluated, but also other interleukins and polymorphisms in order to clarify the etiopathogenesis of this syndrome as well as for propose new diagnostic methods and treatments.

Is Single-Puncture TMJ Arthrocentesis Superior to the Double-Puncture Technique for the Improvement of Outcomes in Patients With TMDs?

PURPOSE: Arthrocentesis is a common treatment for temporomandibular joint disorders. Although modifications of the standard double-puncture technique have been described, no consensus has been reached regarding which is the best. The aim of the present study was to compare the outcomes of the single- and double-puncture arthrocentesis techniques (SPT and DPT, respectively). MATERIALS AND METHODS: A systematic review following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines was performed. Two independent reviewers conducted electronic searches in the MEDLINE/PubMed, Cochrane Library, and Scopus databases for relevant studies reported up to January 2019. Studies comparing type I SPT (only 1 cannula) or type II SPT (2 soldered cannulas) to conventional DPT were considered. Data regarding the maximal mouth opening (MMO), joint pain, and operative time were extracted for the meta-analysis. In the case of statistically significant heterogeneity (P < .10), a random effects model was used to assess the significance of the treatment effects. Otherwise, a fixed effects model was used. The included randomized controlled trials (RCTs) were assessed for methodologic quality using the Cochrane Collaboration tool. RESULTS: Nine studies were included for qualitative synthesis. Two were suitable for quantitative synthesis per outcome. The meta-analysis did not find any differences between SPT and DPT in relation to the MMO. However, in relation to joint pain, the results slightly favored the use of DPT. No differences in operative time were found between type I SPT and DPT (P = .49). CONCLUSIONS: The present study found no differences between the SPT and DPT in relation to the MMO, and no difference was found in operative time between the DPT and type I SPT. Because of the heterogeneity between studies, it might be interesting to conduct more homogeneous RCTs to elucidate which technique results in better clinical outcomes.

Profile and costs associated with the use of osteosynthesis materials in victims of traffic accidents.

BACKGROUND/AIMS: Facial trauma arising from traffic accidents is one of the most prevalent injuries in urban trauma centers. The aim of this study was to evaluate the frequency, types, and costs associated with osteosynthesis material used in facial fractures of traffic accident victims seen at the Hospital da Restauração, Recife/PE, Brazil, from January to December 2014. MATERIALS AND METHODS: Data were collected from the medical records of hospitalized patients submitted to surgery under general anesthesia for the treatment of facial fractures during the period. The data were analyzed descriptively by calculating absolute frequencies, percentages, and means. Statistical analysis was performed using SPSS v.21.0. RESULTS: Among the patients, 73.1% were victims of motorcycle accidents that led to higher costs as they were the most prevalent injuries. Mandibular fractures were the most prevalent injury (53.5%). A total of 477 osteosynthesis materials were used, of which 76.51% were a 2.0-mm plate system, 15.51% were a 1.5-mm plate system, 3.14% were a 2.4-mm plate system, 3.77% titanium meshes, 0.83% lag screws, and 0.2% steel wires. The use of these materials for the treatment of facial fractures resulted in a cost of US $51.285,00 for the Brazilian public health system. CONCLUSION: The increase in the number of traffic accidents implies significant numbers of victims with facial fractures, as well as considerable costs associated with the use of osteosynthesis materials for public health services.

Updated Review of Traumatic Dislocation of the Mandibular Condyle Into the Middle Cranial Fossa.

PURPOSE: Traumatic dislocation of the mandibular condyle into the middle cranial fossa (DMCCF) is a rare event after maxillofacial trauma. Treatment may be performed with closed or open reduction (with or without craniotomy), and arthroplasty procedures might be necessary for long-standing cases. The aims of this study were to perform an integrative review of traumatic DMCCF cases reported in an electronic database and to report a case in which cerebrospinal fluid leakage occurred after open treatment. PATIENTS AND METHODS: The study was carried out in 2 phases. In the first part, an electronic search was undertaken in MEDLINE (via PubMed) in April 2018, with 52 articles being included. In the second, we report a case in which cerebrospinal fluid leakage occurred through the external auditory canal after open reduction of the mandibular condyle into the middle cranial fossa in a 22-year-old male patient, with a follow-up of 5 months. RESULTS: A total of 59 cases were included. Most patients were female patients (69%), the right condyle was mostly affected, and traffic accidents (53%) were the main etiology. Closed treatment was ideally performed within 2 weeks of intrusion. Open treatment was required for cases with 2 or more weeks of impaction. The types of open treatment were open reduction, condylectomy, condylotomy, and temporomandibular joint reconstruction with alloplastic implants. The glenoid fossa was reconstructed in 28 cases, and a temporalis muscle flap with or without bone grafts was the main choice. Despite the treatment option used, mandibular deviation during opening occurred in 41% of cases. Rare complications included persistent facial paralysis, persistent hearing loss on the affected side, increased cerebral contusion after reduction, and postoperative pneumocephalus. CONCLUSIONS: Cases of DMCCF require a multidisciplinary approach based on the expertise of both maxillofacial and neurologic surgeons. Close monitoring is extremely important to mitigate complications.

Surgical Management of Gunshot Injury to the Temporomandibular Joint.

One of the indications of the surgical approach of the temporomandibular joint is the presence of foreign body in its interior. However, joint handling offers risks, especially bleeding. In these cases, angiography and embolization of the arteries involved with the projectile play an important role in the prevention of complications. In this report, the authors describe a case of a 23-year-old male victim of firearm attack with comminuted fracture of the right mandibular condyle. The patient underwent angiography and prophylactic embolization of the arteries adjacent to the foreign body. A surgical procedure was performed to remove the projectile and bone fragments with the aid of the X-ray image intensifier, which resulted in the restoration of mandibular function, absence of joint pain, and satisfactory dental occlusion. This case shows the importance of auxiliary imaging methods for performing a safe surgical procedure for removal of ballistic and bony fragments from the interior of the temporomandibular joint.

Influence of Diabetes on the Survival Rate and Marginal Bone Loss of Dental Implants: An Overview of Systematic Reviews.

We aimed to conduct an analysis of the systematic reviews (SRs) in literature about the implant survival rate (ISR) and marginal bone loss (MBL) in diabetic and nondiabetic patients. This work was registered in The International Prospective Register of Systematic Reviews (CRD42018095314) and was developed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Library Handbook. A search was performed on PubMed, Cochrane, Scopus, Embase, and LILACS. The PICO (problem/patient/population, intervention/indicator, comparison, outcome) question was "Do the survival rates of dental implants and marginal bone loss differ between diabetic and nondiabetic patients?" A total of 130 articles were retrieved. After eliminating repetitions, 118 were reviewed. Finally, 6 SRs were included. All the reviews indicated that there is no effect of diabetes on the ISR; however, a negative effect of the disease can be observed in MBL. Analysis of the quality of the studies was performed using the assessment of SRs in dentistry (Glenny Scale) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2). Glenny Scale showed a moderate to high quality of the included studies. In contrast, AMSTAR 2 pointed out a critically low level for 4 studies, with no study fulfilling the criteria for high quality. It may be concluded that there is no effect of diabetes on the ISR; however, a negative effect of the disease can be observed on MBL.

Impacted maxillary third molar displaced to the infratemporal space: a critical review and case report.

The aim of the present study was to use the scientific evidence found in a critical literature review as a basis to discuss the displacement of maxillary third molars to the infratemporal fossa in terms of anatomical and demographic characteristics and the treatment protocols used. In addition, this article reports a new clinical case of third molar displacement in a 19-year-old man. For the literature review, the Cochrane, Medline, Lilacs, and BBO databases were searched for relevant key words, and the selected articles were classified in accordance with their level of evidence according to the Oxford Centre for Evidence-Based Medicine criteria. Twenty-two articles were found, but only 13 were considered relevant and met the criteria for inclusion in this review. All of the articles were classified as Level 6b for scientific evidence (case reports). The maxillary left third molar was more commonly displaced to the infratemporal fossa (69.23%) than was the right third molar. Most of the molars exhibited complete root formation (53.84%), were multirooted (69.23%), and had fused roots (53.84%). During the procedures for removal of the displaced molars, either general or local anesthetic agents were used. Surgical access for molar removal was almost always intraoral, and no permanent postoperative complications were recorded. The time from tooth displacement until attempted surgical removal ranged from immediately to 24 years after the displacement. Both general dentists and oral and maxillofacial surgeons were responsible for the displacements.

Application of Dexamethasone in the Masseter Muscle During the Surgical Removal of Lower Third Molars.

PURPOSE: The aim of the present study was to analyze the effect of the application of dexamethasone in the masseter muscle during third molar surgery. METHODS: This randomized, clinical trial used dependent samples and the split-mouth method. A sample of 30 patients, with impacted or semi-impacted third molars, as well as vertical and mesioangular positions of a similar surgical difficulty (on both sides), was subjected to 2 operations: an experimental operation and a control procedure, with a 30-day wash-out. The choice of which group would be experimental or control was random. The experimental group received 8 mg of dexamethasone, which was applied directly to the masseter muscle immediately after surgery. The control group did not receive corticosteroids. Seven and 15 days after the surgery, the patients were assessed in relation to their levels of pain, trismus, and edema. RESULTS: Concerning edema and trismus, there was a significant difference (P <0.05) between the control and experimental groups. As for the pain scale, no significant differences were found between the presence or absence of corticoids. CONCLUSION: The present study concluded that the application of dexamethasone in the masseter muscle effectively reduces edema and trismus, but does not affect pain.