Bone Density of the Midpalatal Suture After Surgically Assisted Rapid Maxillary Expansion: A Retrospective Cohort Study.

OBJECTIVES: To evaluate the bone density in the midpalatal suture after 10 months of surgically assisted rapid maxillary expansion (SARME) with the separation of the maxilla into 2 segments. METHODS: Sixty multislice computed tomography (MCT) from 20 patients undergoing SARME were analyzed in 3 periods of time (1 MCT per patient on each occasion): (1) 1 week before surgery, (2) postsurgery immediately after completing the expander activation, and (3) 10 months after the expander activation. On all occasions, the bone density was measured in Hounsfield units on MCT scans in axial and coronal sections, in the anterior (A1), middle (A2), and posterior (A3) regions of the midpalatal suture. RESULTS: The mean percentage values of bone density in Hounsfield units, from the 10-month postactivation period to preoperative in the A1, A2, and A3 regions were 68.38%, 38.21%, and 55.90%, respectively, in the axial norm, and 64.06%, 36.81%, and 55.50% in coronal norm (A1 = A3>A2), with no significant difference in the tomographic cuts (P >0.05). There was no correlation between patient age or amount of expansion in the expander and bone density. CONCLUSIONS: The bone density in the midpalatal suture 10 months after SARME is lower than preexpansion. A denser new bone formation along the suture concentrates closer to the extremities rather than in the central region. Although the maturation of the new bone formation in the midpalatal suture is lower 10 months after SARME, it appears to be sufficient for satisfactory clinical results, regardless of patient age or the amount of expansion in the expander.

Is dipyrone effective as a preemptive analgesic in third molar surgery? A pilot study.

PURPOSE: Studies on preemptive analgesia in maxillofacial surgery have shown several controversial clinical results, mainly due to the absence of a methodological standard, besides a wide variety of studied drugs. This study intended to answer the following hypothesis: Is the administration of dipyrone preemptively capable of decreasing trans- and postoperative pain in the third molar surgical extraction? METHODS: A pilot prospective double-blind placebo-controlled study was carried out with 25 patients submitted to the third molar surgical extraction at two moments, one side in each intervention. Dipyrone (1 g) was preemptively administered (study group) for the extraction of two third molars on the same side and, in a second surgical procedure, dipyrone (1 g) was administered in the immediate postoperative period (control group). Evaluated variables were the amount of anesthetic, pain perceived through the visual analogue scale (VAS) in transoperative and immediate postoperative periods, and over 12-h investigation period, analgesic consumption, duration of surgery, and time to rescue analgesia. RESULTS: The results were submitted to Student's t test and statistical differences were observed in transoperative (p < 0.05) and immediate postoperative (p < 0.01) periods, while the other studied variables did not present statistical differences. CONCLUSION: The preemptive administration of dipyrone decreased the perception of transoperative and immediate postoperative pain when compared to its use after surgery only.

Oral dexamethasone decreases postoperative pain, swelling, and trismus more than diclofenac following third molar removal: a randomized controlled clinical trial.

PURPOSE: The aim of this study was to compare the anti-inflammatory potential of two pharmacotherapy protocols based on the parameters of pain, trismus, and swelling, after extraction of third molars. METHODS: Thirty patients selected with symmetrical impaction of third molars were submitted to surgical procedures in both sides in different times. For one group, dexamethasone was used for 3 days, and for another group diclofenac sodium was also used for the same period. The main variables analyzed were the visual analogue pain scale (VAS), but others were also analyzed such as swelling and trismus, which were submitted to statistical analysis. RESULTS: The results had no difference regarding the length of procedures (p = 0.986) and the pain in the immediate and 4-h postoperative period (p = 0.723 and 0.541). The rescue analgesic consumption was higher (p < 0.05) when using the protocol with diclofenac sodium. The variables mouth opening (p < 0.05) and swelling (p < 0.05) were significantly better when using the protocol with dexamethasone in the postoperative period. CONCLUSIONS: Medical protocol with the use of dexamethasone in the postoperative period was more effective in controlling pain, trismus, and swelling, after the extraction of third molars, when compared to diclofenac sodium.

Comparação da latência anestésica de Articaína, Lidocaína, Levobupivacaína e Ropivacaína através de 'Pulp Tester' / Comparison of the anesthetic latency of Articaine, Lidocaine, Levobupivacaine and Ropivacaine, through "Pulp Tester"

Introdução: Um conhecimento profundo dos anestésicos odontológicos, como o tempo de latência da droga, pode assegurar o êxito do controle da dor no trans e no pós-operatório. Objetivo: Comparar a latência entre quatro soluções anestésicas, ou seja, o tempo entre o início da deposição do anestésico local e o momento em que seus efeitos tornam-se perceptíveis. Entretanto, isso não está relacionado com o êxito do controle da dor no trans e no pós-operatório (profundidade da anestesia). Material e Método: Foi realizado um estudo duplo cego, cruzado e randomizado, com 30 pacientes voluntários submetidos a quatro procedimentos em intervalos de uma semana, a partir de bloqueio do alveolar superior posterior. No segundo molar a ser tratado, foi utilizado o 'pulp tester' em intervalos de 2 minutos, considerando a insensibilidade da polpa quando da ausência de resposta após dois testes consecutivos de 80muV, chegando ao máximo de 10 minutos e determinando, assim, o período de latência do anestésico. Os dados foram submetidos aos testes T-student, de Friedman e de Kruskal-Wallis (p<0,05). Resultado: Não houve diferenças estatisticamente significativas (p=0,8327) entre as soluções anestésicas. Para todas estas, a mediana foi 2 minutos. Não houve, ainda, diferenças significantes entre os gêneros em relação à idade (p=0,4545), bem como entre os valores, quando se tentou observar a influência do gênero nos valores de latência (p=0,6754). Conclusão: Sendo os tempos médios de latência idênticos, a escolha da droga dependerá da duração do procedimento cirúrgico-odontológico a se realizar, além da necessidade ou não de analgesia pós-operatória. .

Introduction : A thorough knowledge of dental anesthetics, like the lag time of the drug, can ensure the success of pain control during and after surgery. Objective : Comparing the latency time of 4 anesthetics, in other words, the time between the deposition of the local anesthetic and when its effects become noticeable. However, this is not related with the successful pain control during and after surgery (depth of anesthesia). Material and Method : We conducted a double-blind, crossover, randomized study with 30 volunteers underwent 04 procedures in one-week intervals from the posterior superior alveolar block. In the second molar being treated, the pulp tester was used at intervals of 02 minutes, considering the insensitivity of the pulp when there is no response after two consecutive tests of 80muV, peaking at 10 minutes thus determining the latency period of the anesthetic. The data were submitted to t-student test, Friedman test and Kruskal-Wallis test (p<0.05). Result : There were no statistically significant differences (p=0.8327) between the anesthetics. In all cases the median was 2 minutes. Still, there were no significant differences between genders in relation to age (p=0.4545), as well as between the values when it attempted to observe the influence of gender in latency values (p=0.6754). Conclusion : Since the average lag time was identical, the choice of the drug will depend on the duration of the oral surgery and the necessity of postoperative analgesia. .

Avaliação do grau de ansiedade dos pacientes antes de cirurgias orais menores / Evaluation of the degree of anxiety patients before minor oral sugery

Introdução: Medo e ansiedade são comuns a pacientes que requerem tratamento odontológico e, em se tratando de procedimentos cirúrgicos, a ansiedade pode tornar-se um fator complicador, a partir do momento em que a alteração dos sinais vitais do paciente pode gerar situações de emergência. Objetivo: Avaliar o grau de ansiedade pré-operatória dos pacientes submetidos a cirurgias orais, identificando qual procedimento cirúrgico causa mais ansiedade nos pacientes e qual o momento cirúrgico causador de maior ansiedade. Material e Método: Foram selecionados 200 pacientes que iriam se submeter a cirurgias bucais nos ambulatórios do Departamento de Odontologia da Universidade Federal de Sergipe. No dia da cirurgia, os pacientes respondiam à escala EAD, tendo sido avaliadas a frequência cardíaca (FC) e a pressão arterial sanguínea (PA), considerados dados basais dos parâmetros físicos empregados para a avaliação da ansiedade pré-operatória. Resultado: Não houve diferenças estatisticamente significantes (Kruskal-Wallis, p=0,6933) entre os tratamentos em relação à ansiedade. A correlação de Spearman (rS) entre os valores obtidos para a ansiedade e os valores de pressão arterial e frequência cardíaca revelou-se fraca (rS<0,2), embora significativa (p<0,05) entre os resultados. A anestesia foi o momento que produziu maior ansiedade (Kruskal-Wallis, p<0,05), em relação aos demais momentos. Conclusão: A ansiedade teve influência no aumento da frequência cardíaca e da pressão arterial sistólica, tornando-se importante o seu controle pelo cirurgião-dentista para evitar complicações no decorrer da cirurgia.

Introduction: Fear and anxiety are common in patients who require odontological treatment. During surgical procedures, anxiety can become a complicating factor from the moment in which the change of patient’s vital signs can generate emergency situations. Objective: Evaluate the degree of preoperative anxiety of patients submitted to oral surgery, to identify which surgical procedure causes more anxiety in patients and also which surgical moment is causing greater anxiety. Material and Method: 200 patients were selected for oral surgery at the clinics of the Department of Dentistry, Federal University of Sergipe. On the day of surgery, patients answered the EAD scale and their heart rate (HR) and blood pressure (BP) were evaluated. These data served as baseline of the physical parameters used in the evaluation of preoperative anxiety. Result: Statistically, there were no significant differences (Kruskal-Wallis test, p=0.6933) between treatments regarding anxiety. The Spearman correlation (rS) between the values obtained for anxiety, blood pressure levels and heart rate showed a weak correlation (rs <0.2), although significant (p<0.05) between the results. The anesthesia was the moment that produced greater anxiety (Kruskal-Wallis test, p<0.05) compared to the other moments. Conclusion: Anxiety has a connection with the increase of the heart rate and systolic blood pressure. This fact makes very important its control by the surgeon-dentist meaning to avoid complications through the surgery.