Effect of Occlusal Adjustment on Postoperative Pain after Root Canal Treatment: A Randomized Clinical Trial.

The aim of this prospective, randomized, clinical study was to analyze the influence of occlusal adjustment on the prevalence of postoperative pain after endodontic treatment. Seventy-eight patients, diagnosed with symptomatic irreversible pulpitis with indication for endodontic treatment, were selected to participate in the study. The participants were randomized and divided into two groups: in the occlusal adjustment group (OAG), endodontic treatment was performed with subsequent occlusal adjustment. In the control group (CG), endodontic treatment was performed without occlusal adjustment. Treatments were performed by the same operator. Pain occurrence and intensity were recorded on two scales: the verbal rating scale (VRS) and numerical rating scale (NRS). Pain assessment was carried out by a second examiner, blinded to the experiment, 6, 24 and 72 h after endodontic treatment. Data were analyzed using Mann-Whitney, chi-squared, and Fisher's exact tests. In the occlusal adjustment group, 71.1% reported postoperative pain and 67.5% reported pain in the control group. At the 6-hour assessment, 21 individuals reported pain in the occlusal adjustment group and 24 in the control group (p=0.672). At the 24-hour assessment, 18 and 19 individuals reported pain (p=0.991) and at the 72-hour assessment, 8 and 4 reported pain (p=0.219), respectively. Occlusal adjustment did not influence the prevalence of postoperative pain of endodontically treated teeth with symptomatic irreversible pulpitis.

Effect of occlusal adjustment on postoperative pain after root canal treatment: a randomized clinical trial

Abstract The aim of this prospective, randomized, clinical study was to analyze the influence of occlusal adjustment on the prevalence of postoperative pain after endodontic treatment. Seventy-eight patients, diagnosed with symptomatic irreversible pulpitis with indication for endodontic treatment, were selected to participate in the study. The participants were randomized and divided into two groups: in the occlusal adjustment group (OAG), endodontic treatment was performed with subsequent occlusal adjustment. In the control group (CG), endodontic treatment was performed without occlusal adjustment. Treatments were performed by the same operator. Pain occurrence and intensity were recorded on two scales: the verbal rating scale (VRS) and numerical rating scale (NRS). Pain assessment was carried out by a second examiner, blinded to the experiment, 6, 24 and 72 h after endodontic treatment. Data were analyzed using Mann-Whitney, chi-squared, and Fisher's exact tests. In the occlusal adjustment group, 71.1% reported postoperative pain and 67.5% reported pain in the control group. At the 6-hour assessment, 21 individuals reported pain in the occlusal adjustment group and 24 in the control group (p=0.672). At the 24-hour assessment, 18 and 19 individuals reported pain (p=0.991) and at the 72-hour assessment, 8 and 4 reported pain (p=0.219), respectively. Occlusal adjustment did not influence the prevalence of postoperative pain of endodontically treated teeth with symptomatic irreversible pulpitis.

Resumo O objetivo deste estudo prospectivo, randomizado e clínico foi analisar a influência do ajuste oclusal na prevalência de dor pós-operatória após o tratamento endodôntico. Setenta e oito pacientes, diagnosticados com pulpite irreversível sintomática com indicação de tratamento endodôntico, foram selecionados para participar do estudo. Os participantes foram randomizados e divididos em dois grupos: no grupo de ajuste oclusal (GAO), foi realizado tratamento endodôntico com posterior ajuste oclusal. No grupo controle (GC), o tratamento endodôntico foi realizado sem ajuste oclusal. Os tratamentos foram realizados pelo mesmo operador. A ocorrência e a intensidade da dor foram registradas em duas escalas: a escala de classificação verbal (VRS) e a escala de classificação numérica (NRS). A avaliação da dor foi realizada por um segundo examinador, cego para o experimento, 6, 24 e 72 horas após o tratamento endodôntico. Os dados foram analisados utilizando testes de Mann-Whitney, qui-quadrado e exato de Fisher. No grupo de ajuste oclusal, 71,1% relataram dor pós-operatória e 67,5% relataram dor no grupo controle. Na avaliação de 6 horas, 21 indivíduos relataram dor no grupo de ajuste oclusal e 24 no grupo controle (p=0,672). Na avaliação de 24 horas, 18 e 19 indivíduos relataram dor (p=0,991) e, na avaliação de 72 horas, 8 e 4 relataram dor (p=0,219), respectivamente. O ajuste oclusal não influenciou a prevalência de dor pós-operatória após o tratamento endodôntico em dentes com pulpite irreversível sintomática.

Effect of photobiomodulation therapy on postoperative pain after endodontic treatment: a randomized, controlled, clinical study.

OBJECTIVE: The aim of this prospective, randomized, clinical study was to assess the effect of photobiomodulation therapy (PBM) with low-level laser irradiation (LLLI) on postoperative pain after endodontic treatment. MATERIALS AND METHODS: Sixty patients, diagnosed with irreversible pulpitis in lower molar teeth, participated in the study. All treatments were performed by a single operator. Participants were randomly divided into two groups: in the experimental group (EG), endodontic treatment was performed with a reciprocating system, immediately followed by PBM with LLLI; and only endodontic treatment was performed in the control group (CG). Postoperative pain was assessed by a second examiner, who was blinded, using two scales: verbal rating scale (VRS) and numerical rating scale (NRS). Assessment was carried out at 6, 12, and 24 h after treatment. Data were analyzed using chi-squared, Fisher's exact, Mann-Whitney tests, ordinal, and non-parametric regression analyses. RESULTS: For the prevalence of pain, the difference between the groups was significant for the evaluations performed after 6 h (p = 0.04) and 24 h (p = 0.02). The difference after 24 h remained significant after stratification by sex and extrusion of filling material. Increased pain intensity was associated with extrusion of root canal filling material to the periapical region in the two scales used. CONCLUSION: The effect of PBM therapy after endodontic treatment showed a significant decreasein prevalence of postoperative pain. CLINICAL RELEVANCE: The PBM reduces the prevalence of postoperative pain and may benefit patients who need endodontic treatment.

Emergency aesthetics: a report of integrated rehabilitation / Emergência estética: um relato de reabilitação integrada

The aesthetic and functional rehabilitation of patients with dental trauma may involve several specialties and treatment options. Rises the subject from a case where a female patient, 12 years, complaining of suffering humiliation due to anterior teeth fractured. Patient reported to have fallen to the ground, and 2 years over time the teeth were darkening and fracturing. She had pain localized, stimulated by chewing and palpation. Clinical examinations showed that there was an inadequate hygiene, gingivitis, crown fractures, impaired vitality of the elements 11, 21 and 22 and gingival hyperplasia. In periapical radiographs, it was possible to verify enough remaining tooth structure, but requiring surgery to increase the clinical crown to expose the cervical end of the preparation and ensure it does not invade the biological space.The therapeutic conduct adopted was: periodontal surgery to increase the clinical crown of all the upper anterior teeth and a new gingival contour; endodontic treatments on the elements 11, 21 and 22; cementing intracanal fiberglass pins on each element, and coronary reconstruction with resin compound. To support in the restorative procedure was performed a waxing gradually in a model and obtained a silicone matrix addition. During the treatment guidelines were given about oral hygiene and also motivational. After 60 days of periodontal surgery and 30 days of definitive restorative procedure, was checked an improvement of her oral hygiene and gingival health. The follow up of 12 months showed no changes in the restoration.

A reabilitação estética e funcional de pacientes com traumatismo dentário pode envolver diversas especialidades e opções de tratamento. Levanta-se o tema a partir de um relato de caso cujo paciente do gênero feminino, 12 anos, queixava-se de sofrer humilhação decorrente de dentes anteriores fraturados. Paciente relatava ter caído da própria altura, há 2 anos e com o tempo os dentes foram escurecendo e fraturando. Apresentava dor localizada, estimulada pela mastigação e palpação. Ao exame clínico, observou-se higienização inadequada, gengivite, fraturas coronárias, comprometimento da vitalidade pulpar dos elementos 11, 21 e 22 e hiperplasia gengival. Ao exame radiográfico periapical, foi possível verificar suficiente remanescente dental, necessitando porém de cirurgia de aumento de coroa clínica para expor o término cervical do preparo e garantir que este não invadisse o espaço biológico. A conduta terapêutica adotada foi: cirurgia periodontal para aumento de coroa clínica de todos os dentes anteriores superiores e recontorno gengival; tratamentos endodônticos dos elementos 11, 21 e 22; cimentação intracanal de pinos de fibra de vidro em cada elemento; e reconstrução coronária com resina composta. Para auxiliar no procedimento restaurador foi realizado o enceramento progressivo em modelo e obtido uma matriz de silicone de adição. Durante o tratamento foram realizadas orientações de higiene bucal e motivação. Após 60 dias da cirurgia periodontal e 30 dias do procedimento restaurador definitivo, foi verificado melhora da higiene e saúde gengival.

Planejamento reverso na correção de sorriso gengival / Reverse planning on the correction of gummy smile

Este trabalho objetiva destacar a importância do planejamento reverso para correção de sorriso gengival. Levanta-se o tema a partir de um relato de caso, com o diagnóstico de erupção passiva alterada. O tratamento de escolha foi o aumento de coroa clínica no sextante superior anterior com planejamento reverso. O planejamento reverso consiste na confecção de um guia cirúrgico que possui diversas funções, tais como definir plano e arquitetura gengival para as incisões iniciais, estabelecer referência para osteoplastia e determinação da posição do zênite, e ainda simular o resultado esperado. Assim, é possível avaliar o impacto do tratamento proposto e, além disso, o paciente pode interagir e avaliar os resultados esperados. Para a confecção do guia cirúrgico executou-se moldagem com silicone de adição Adsil®, objetivando copiar fielmente os detalhes anatômicos dos dentes e gengivas. O modelo foi confeccionado em gesso especial e, aplicando os princípios estéticos de zênites sobre o modelo, foi realizado o enceramento das faces vestibulares até a área cervical a ser removida. A prensagem do guia foi feita com resina acrílica, não diferindo dos passos de prensagem de uma prótese total. Foi realizada a cirurgia e após 45 dias observou-se que o resultado almejado foi alcançado sem necessidade de cirurgias adicionais. Conclui-se que o planejamento reverso confere ao procedimento alto grau de precisão e previsibilidade

This paper aims to highlight the importance of reverse planning to the correction of gummy smile which is raised from a case report. With the diagnosis of altered passive eruption, the choosen treatment was the increase of the clinical crown in the upper anterior sextant with reverse planning. The reverse planning consists in preparing a surgical guide that has many functions, such as plan and gingival architecture for initial incisions, act as a reference to osteoplasty and to the position of the zenith and to simulate the expected results. Thus, it is possible to assess the impact of the proposed treatment and, moreover, the patient caninteract and evaluate the possible outcome. To prepare the surgical guide, it was used polysiloxane Adsil ®, to copyfaith fully the anatomic details of teeth and gums. The model was made of special plaster and applying the principles of esthetic zenith on the model, the waxing of the buccal faces was performed until the cervical area to be removed. The pressing of the guide was made with acrylic resin, not differing from the steps of pressing of a denture. Surgery was performed, and after 45 days it was observed that the desired results were achieved without the need for additional surgeries. It can be concluded that the reverse planning gives to the procedure a high degree of precision and predictability