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Blended Intensive Programmes (BIP's) represent a valuable tool for gathering knowledge and summarising the latest trends in medicine and dentistry. Blended education has been found, even before the COVID-19 pandemic, to increase the level of education and stimulate effective learning for postgraduate healthcare professionals. Interprofessional education is critical for preparing students to enter the health workforce, where teamwork and collaboration are important competencies. This article outlines the key points of the Blended Intensive Programme's implementation in dental education organised by Wroclaw Medical University in Poland. BIP involved professors from 12 universities or research institutions from Europe and South America and 28 participants from 8 countries. The course was taught remotely and in person. In addition, it included a visit to the university and practical classes with artificial simulation and practice in dentistry. A structured questionnaire enabled measuring the evaluation of students' perception of the COVID-19 education before and after the pandemic. The European Region Action Scheme for the Mobility of University Students (ERASMUS) was fundamental to carrying out the BIP with the participation of several countries, allowing the exchange of knowledge, assessing the impact of the pandemic on dental universities, and strengthening international collaborations and the future project of research, education and clinical assistance. We conclude that hybrid teaching programmes broaden the learning spectrum in dental studies by allowing transnational and interdisciplinary approaches that make students aware of the importance of their work within the framework of the general health approach, as this differs from country to country.
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Aprendizaje , Pandemias , Humanos , Curriculum , Estudiantes , Educación en OdontologíaRESUMEN
External apical root resorption in permanent teeth is a multifactorial process influenced by a variety of local and systemic factors. This report describes a case of multiple and severe apical root resorptions in a patient with Turner syndrome. The condition was discovered in a young female with Turner syndrome after 30 months of orthodontic treatment with fixed appliance. The purpose of this report is to present reports by other authors on the potential causes of the increased risk of tooth resorption in patients with Turner syndrome and to share insights derived from its course, highlighting the implications and lessons learned. Patients with Turner syndrome are not ideal candidates for orthodontic treatment. Prior to commencing orthodontic treatment, it is essential to carefully consider the potential benefits of the therapy compared to the risk associated with exacerbating root resorption. In the case of Turner syndrome patients, where there is an elevated risk of such complications, a thorough analysis should be conducted to determine whether the expected benefits of the treatment outweigh the potential hazards to the patient's dental health.
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A Chitosan is a copolymer of N-acetyl-D-glucose amine and D-glucose amine that can be easily produced. It is a polymer that is widely utilized to create nanoparticles (NPs) with specific properties for applications in a wide range of human activities. Chitosan is a substance with excellent prospects due to its antibacterial, anti-inflammatory, antifungal, haemostatic, analgesic, mucoadhesive, and osseointegrative qualities, as well as its superior film-forming capacity. Chitosan nanoparticles (NPs) serve a variety of functions in the pharmaceutical and medical fields, including dentistry. According to recent research, chitosan and its derivatives can be embedded in materials for dental adhesives, barrier membranes, bone replacement, tissue regeneration, and antibacterial agents to improve the management of oral diseases. This narrative review aims to discuss the development of chitosan-containing materials for dental and implant engineering applications, as well as the challenges and future potential. For this purpose, the PubMed database (Medline) was utilised to search for publications published less than 10 years ago. The keywords used were "chitosan coating" and "dentistry". After carefully selecting according to these keywords, 23 articles were studied. The review concluded that chitosan is a biocompatible and bioactive material with many benefits in surgery, restorative dentistry, endodontics, prosthetics, orthodontics, and disinfection. Furthermore, despite the fact that it is a highly significant and promising coating, there is still a demand for various types of coatings. Chitosan is a semi-synthetic polysaccharide that has many medical applications because of its antimicrobial properties. This article aims to review the role of chitosan in dental implantology.
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Quitosano , Humanos , Quitosano/farmacología , Materiales Biocompatibles , Odontología , Antibacterianos/farmacología , Polímeros , Aminas , GlucosaRESUMEN
BACKGROUND: Temporomandibular disorders (TMD) pose a serious health problem that can have a negative effect on patients' lives, impair work performance, and result in work absences and restrictions in daily activities. OBJECTIVES: The aim of this observational, cross-sectional study was to evaluate the level of satisfaction with life among Polish patients with TMD and to assess the influence of pain severity on this parameter. A secondary goal was to investigate sleep quality within this patient group and explore its relationship with pain. MATERIAL AND METHODS: A total of 219 patients from the Outpatient Clinic for Temporomandibular Disorders at the University Dental Polyclinic in Wroclaw, Poland, participated in this study. These individuals underwent a clinical examination using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) protocol and completed 2 validated questionnaires, namely the Satisfaction With Life Scale (SWLS) and the Pittsburgh Sleep Quality Index (PSQI). Furthermore, the patients were assessed for the severity of masseter muscle pain (MMP) and temporal muscle pain (TMP), and the average pain in these muscles (AMP) was calculated. Subsequently, a statistical analysis was performed on the collected data. RESULTS: The group of patients with average satisfaction with life exhibited significantly higher levels of MMP (p = 0.025) and AMP (p = 0.044) as compared to the high-satisfaction group. Regarding sleep quality, 50.23% of the patients experienced poor sleep quality. Poor sleep quality was found to be statistically associated with higher levels of TMP (p = 0.032) and AMP (p = 0.028). Moreover, women demonstrated significantly worse sleep quality as compared to men (p = 0.002). The findings indicate that PSQI has a greater impact on SWLS than vice versa. CONCLUSIONS: Due to a large number of TMD patients experiencing poor sleep quality and the associated reduced life satisfaction, these parameters should be considered as influential factors that modify the management of patients with TMD.
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Calidad del Sueño , Trastornos de la Articulación Temporomandibular , Adulto , Masculino , Humanos , Femenino , Polonia , Dimensión del Dolor , Estudios Transversales , DolorRESUMEN
BACKGROUND: The COVID-19 pandemic has spread very rapidly around the world. Various regional and national lockdowns were imposed to control the spread. Meanwhile, vaccine development and population vaccination were the next steps for pandemic control. Workers in the dental field, both dentists and dental assistants, however, were close to the sources of aerosol generated during dental procedures and thus were the group of workers the most exposed to COVID-19 infection. The aim of our study was to monitor the immune response before and after the vaccine in a high-risk population, composed by dental professionals. METHODS: A clinical prospective study was carried out among dental professionals at the Academic Dental Polyclinic, Wroclaw Medical University (Wroclaw, Lower Silesia region, Poland). Blood samples were collected at an interval of one year - March/April 2020, before the vaccination against COVID-19, and April 2021, after the vaccination. The analysis was performed on serum with four different methods: qualitative, semi-quantitative, and quantitative IgG count for SARS-CoV-2, and SARS-CoV-2 neutralizing antibodies. RESULTS: A total of 42 healthy adult volunteers participated in the study. The results showed a statistically significant difference (p < 0.05) in antibody levels before and after vaccination (1st and 2nd measurement) for each test method. The tests that were used affected the results and the test that showed the strongest relationship with the result was the Qualitative test. CONCLUSIONS: Dental professionals are the adult working population most at risk for COVID-19. Monitoring SARS-CoV-2-status-related seropositivity can provide useful information occupational risk factors for dental professionals.
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COVID-19 , Adulto , Humanos , Estudios Prospectivos , COVID-19/epidemiología , COVID-19/prevención & control , Pandemias , SARS-CoV-2 , Control de Enfermedades Transmisibles , Vacunación , Inmunoglobulina G , Anticuerpos Antivirales , OdontólogosRESUMEN
Three-dimensional printing has become incorporated into various aspects of everyday life, including dentistry. Novel materials are being introduced rapidly. One such material is Dental LT Clear by Formlabs, a resin used for manufacturing occlusal splints, aligners, and orthodontic retainers. In this study, a total of 240 specimens, comprising two shapes (dumbbell and rectangular), were evaluated through compression and tensile tests. The compression tests revealed that the specimens were neither polished nor aged. However, after polishing, the compression modulus values decreased significantly. Specifically, the unpolished and nonaged specimens measured 0.87 ± 0.02, whereas the polished group measured 0.086 ± 0.03. The results were significantly affected by artificial aging. The polished group measured 0.73 ± 0.05, while the unpolished group measured 0.73 ± 0.03. In contrast, the tensile test proved that the specimens showed the highest resistance when the polishing was applied. The artificial aging influenced the tensile test and reduced the force needed to damage the specimens. The tensile modulus had the highest value when polishing was applied (3.00 ± 0.11). The conclusions drawn from these findings are as follows: 1. Polishing does not change the properties of the examined resin. 2. Artificial aging reduces resistance in both compression and tensile tests. 3. Polishing reduces the damage to the specimens in the aging process.
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BACKGROUND: Three-dimensional (3D) printing technology has brought much innovation to medicine and has been successfully adopted in many areas of dentistry. Although 3D printing techniques are being increasingly used, their advantages and disadvantages still need to be investigated, particularly with regard to the materials used in dentistry. Dental materials should be biocompatible and non-cytotoxic, and have sufficient mechanical integrity in the oral environment in which they are intended for use. OBJECTIVES: The present work aimed to identify and compare the mechanical properties of three 3D-printable resins. The materials included IBT Resin, BioMed Amber Resin and Dental LT Clear Resin. The Formlabs Form 2 printer was used. MATERIAL AND METHODS: A tensile strength test was performed on 10 specimens of each resin. Tensile modulus was measured on 2-millimeter-thick dumbbell-shaped specimens, 75 mm in length and 10 mm in width. The 10 specimens of each resin were mounted between the grips of a universal testing machine (Z10-X700). RESULTS: The results showed that BioMed Amber specimens cracked easily, yet no deformation was observed. The amount of force used to test the tensility of the specimens was the lowest for IBT Resin, while it was the highest for Dental LT Clear Resin. CONCLUSIONS: IBT Resin was the weakest material, whereas Dental Clear LT Resin was the strongest.
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Ámbar , Odontología , HumanosRESUMEN
Currently, 3D print is becoming more common in all branches of medicine, including dentistry. Some novel resins, such as BioMed Amber (Formlabs), are used and incorporated to more advanced techniques. The aims of the study were to check whether or not polishing and/or artificial aging influences the properties of the 3D-printed resin. A total of 240 specimens of BioMed Resin were printed. Two shapes (rectangular and dumbbell) were prepared. Of each shape, 120 specimens were divided into four groups each (with no influence, after polishing only, after artificial aging only, and after both polishing and artificial aging). Artificial aging took place in water at the temperature of 37 °C for 90 days. For testing, the universal testing machine (Z10-X700, AML Instruments, Lincoln, UK) was used. The axial compression was performed with the speed of 1mm/min. The tensile modulus was measured with the constant speed of 5 mm/min. The highest resistance to compression and tensile test were observed in the specimens that were neither polished nor aged (0.88 ± 0.03 and 2.88 ± 0.26, respectively). The lowest resistance to compression was observed in the specimens that were not polished, but aged (0.70 ± 0.02). The lowest results of the tensile test were observed when specimens were both polished and aged (2.05 ± 0.28). Both polishing and artificial aging weakened the mechanical properties of the BioMed Amber resin. The compressive modulus changed much with or without polishing. The tensile modulus differed in specimens that were either polished or aged. The application of both did not change the properties when compared to the polished or aged probes only.
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Three-dimensional printing is finding increasing applications in today's world. Due to the accuracy and the possibility of rapid production, the CAD/CAM (computer-aided design/computer-aided manufacturing) technology has become the most desired approach in the preparation of elements, especially in medicine and dentistry. This study aimed to compare the biomechanical properties, fractal dimension (FD), and texture of three selected materials used for 3D printing in dentistry. Three biomaterials used in 3D printing were evaluated. The materials were subjected to the compression test. Then, their mechanical features, FD, and texture were analyzed. All the tested materials showed different values for the studied properties. The only statistically insignificant difference was observed for the force used in the compression test. All three materials showed differences in width and height measurements. The difference in the decrease between the compression plates was also significant. For Dental LT Clear, the mean value was 0.098 mm (SD = 0.010), while for BioMed Amber it was 0.059 mm (SD = 0.019), and for IBT it was 0.356 mm (SD = 0.015). The nominal strain also differed between the materials. IBT had the highest mean value (7.98), while BioMed Amber had the smallest (1.31). FD analysis revealed that Dental LT Clear did not show differences in the structure of the material. The other two materials showed significant changes after the compression test. Texture analysis (TA) revealed similar results: BioMed Amber resin showed significantly less pronounced texture changes compared to the other two materials. BioMed Amber also showed the most stable mechanical properties, whereas those of IBT changed the most. Fractal analysis revealed that IBT showed significant differences from the other two materials, whereas TA showed that only Dental LT Clear did not show changes in its texture after the compression test. Before the compression, however, BioMed Amber differed the most when bone index was taken into account.
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(1) Background: In recent years, 3D printing has become a highly popular tool for manufacturing in various fields such as aviation, automobiles, plastics, and even medicine, including dentistry. Three-dimensional printing allows dentists to create high-precision models of teeth and jaw structure, and enables them to develop customized tools for patients' treatment. The range of resins used in dentistry is quite large, and this branch is developing rapidly; hence, studies comparing different resins are required. The present study aimed to compare the mechanical properties of two chosen resins used in dentistry. (2) Materials and methods: Ten specimens each of two types of 3D-printable resins (BioMed Amber and IBT, developed by Formlabs) were prepared. The samples were printed on a Formlabs Form 2 3D printer according to ISO standards. Samples for the compression test were rectangular in shape (10 ± 0.2 mm × 10 ± 0.2 mm × 4 ± 0.2 mm), while the samples used for the tensile test were dumbbell shaped (75 mm long, with 10 mm end width and 2 mm thickness). Tensile and compression tests of both materials were performed in accordance with the appropriate ISO standards. (3) Results: The BioMed Amber resin was more resistant to compression and tensile forces, thus implying that the resin could withstand higher stress during stretching, pulling, or pushing. The IBT resin was less resistant to such loads, and failure of this material occurred at lower forces than those for Biomed Amber. An ANOVA test confirmed that the observed differences were statistically significant (p < 0.001). (4) Conclusions: Based on the properties of both materials, the IBT resin could be better used as a tray for placing orthodontic brackets through an indirect bonding technique, while the BioMed Amber resin would be more useful as a surgical guide for placing dental implants and mini-implants. Further potential fields of application of the resins should be investigated.
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Cleft lip and cleft palate has one of the highest incidences in the malformations of the oral cavity, that varies between populations. The background underlying the issue of cleft lip and palate is multifactorial and greatly depends on the genetic factors and environmental factors. The aim of this nonsystematic narrative review is to present the cleft palate and or lip pediatric population as target for interdisciplinary treatment. The purpose of this narrative review is to sum up the modern knowledge on the treatment of patients with clefts, as well as to highlight the importance of the great need for cooperation between different dental specialists along with medical professionals such as oral surgeons, prosthodontists, orthodontists along with medical professions such as pediatricians, speech therapists and phoniatrics, and laryngologist.
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(1) The CAD/CAM technique exploiting 3D printing is becoming more and more popular in dentistry. The resins are used in all the dental specialties, including conservative dentistry, prosthodontics, surgery, and orthodontics. The interest in investigating the different properties of dental materials has been an aim of researchers. The purpose of the presented study was to compare the properties of two 3D-printable dental resins (both rigid, used for medical purposes). (2) Methods: Ten blocks of two-type shapes were printed on a printer designed for medical use. The tensile modulus and compression were investigated and compared. The axial compression test was performed according to the PN-EN ISO 604:2003 norm, while the tensile test was performed according to the PN-En ISO 527-1-2019 (E) norm. In the first test, the sample size of the perpendicular shape was 10 ± 0.2 mm × 10 ± 0.2 mm × 4 ± 0.2 mm and in the second it was 75 mm, the end width 10 mm, and the thickness 2 mm. (3) Results: The statistical analysis based on ANOVA tests showed that all the obtained results were statistically significant. Both of the examined materials had similar properties and were resistant and stable in shape. The tensile modulus and compression tests performed on them gave similar results. They also showed high durability to compression and tensility. (4) Conclusions: Both of the examined materials were durable and rigid materials. BioMed Amber was more resistant to compression, while Dental LT clear was more resistant in the tensility test. Although both resins had similar physical properties, it is still disputable whether the chosen materials could be used interchangeably.
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There is an ongoing search for novel disinfection techniques that are not only effective, cheap, and convenient, but that also do not have adverse effects on the properties of dental impressions. We compared the effects of various methods (UVC, gaseous ozone, commercial solution, and spray) on the dimensional change, tensile strength, and hardness of silicone impressions. Moreover, as a secondary aim, we performed a statistical comparison of the properties of nondisinfected addition (Panasil Putty Soft, Panasil monophase Medium, Panasil initial contact Light) and condensation silicones (Zetaplus Putty and Oranwash L), as well as a comparison of materials of various viscosities (putty, medium-bodied, and light-bodied). Our results revealed that addition silicones had higher dimensional stability, tensile strength, and Shore A hardness compared to condensation silicones. Both traditional (immersion and spraying) and alternative methods of disinfection (UVC and ozone) had no significant impact on the tensile properties and dimensional stability of the studied silicones; however, they significantly affected the hardness, particularly of Oranwash L. Our study demonstrated that, similarly to standard liquid disinfectants, both UVC and ozone do not strongly affect the material properties of most silicones. However, before recommendation, their usefulness for each individual material should be thoroughly evaluated.
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Desinfectantes , Ozono , Desinfección/métodos , Ensayo de Materiales , Siliconas , Propiedades de Superficie , ViscosidadRESUMEN
Effective disinfection of dental impressions is an indispensable requirement for the safety of dental personnel and patients. The ideal method should be not only effective but also convenient, cheap, and environmentally friendly. This study aimed to reliably evaluate the efficacy of ultraviolet C (UVC) radiation, gaseous ozone, and commercial liquid chemicals used for silicone dental impressions disinfection. These methods were applied to two types of elastomeric impression materials: condensation silicones and addition silicones of various consistency (putty, medium, and light). The antimicrobial effectiveness against Pseudomonas aeruginosa, Staphylococcus aureus, and Candida albicans was evaluated in vitro by counting colony-forming units (CFU) on the surface of samples. The one-way ANOVA with a Tukey HSD test or the Kruskal-Wallis with a Dunn's test was performed. The results obtained revealed the efficacy of the proposed methods for disinfection of both C-silicones and A-silicones in most of the studied groups. Only one material (Panasil initial contact Light) was not effectively disinfected after UVC irradiation or ozone application. In conclusion, the potential of each disinfection method should be evaluated separately for each material. Moreover, in further research, the possible influence of the proposed methods on the physical properties of the impression materials should be thoroughly investigated.
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Blood derivates, such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), are autogenous sources of many growth factors that are involved in the healing and regeneration of tissues, and for this reason, are used in dentistry treatments. This fact also contributes to the growing interest in these biomaterials in regenerative personalized medicine. The multitude of platelet-rich forms creates many possibilities for their use. This semi-systematic review describes and compares the methods of obtaining properties and potential uses of these materials in personalized treatments.
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The success of modern dental treatment is strongly dependent on the materials used both temporarily and permanently. Among all dental materials, polymers are a very important class with a wide spectrum of applications. This review aims to provide a state-of-the-art overview of the recent advances in the field of natural polymers used to maintain or restore oral health. It focuses on the properties of the most common proteins and polysaccharides of natural origin in terms of meeting the specific biological requirements in the increasingly demanding field of modern dentistry. The use of naturally derived polymers in different dental specialties for preventive and therapeutic purposes has been discussed. The major fields of application cover caries and the management of periodontal diseases, the fabrication of membranes and scaffolds for the regeneration of dental structures, the manufacturing of oral appliances and dentures as well as providing systems for oral drug delivery. This paper also includes a comparative characteristic of natural and synthetic dental polymers. Finally, the current review highlights new perspectives, possible future advancements, as well as challenges that may be encountered by researchers in the field of dental applications of polymers of natural origin.
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Productos Biológicos/farmacología , Polímeros/farmacología , Animales , Materiales Biocompatibles/farmacología , Humanos , Salud Bucal , Enfermedades Periodontales/tratamiento farmacológico , Regeneración/efectos de los fármacos , Ingeniería de Tejidos/métodosRESUMEN
The infection with a new type of virus - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - called coronavirus disease 2019 (COVID-19) was first described in December 2019, in Wuhan, China. Due to the gastrointestinal mucosa tropism of the virus, an attempt was made to describe the oral manifestations of the SARS-CoV-2 infection. Angiotensin-converting enzyme 2 (ACE2), which permits the attachment of the virus, is present also in the oral cavity. There are many symptoms in the oral cavity; among them, the most prevalent ones are dysgeusia (taste disorders), oral pain, the exacerbation of autoimmune diseases as well as the herpes simplex virus (HSV) and varicella zoster virus (VZV) infections. Ulcerations and aphthous stomatitis are also often mentioned. The research shows that there are many oral symptoms in COVID-19, but the coexistence with the main disease has not been fully stated and understood. There is still no clearance on whether the oral symptoms are the manifestations of the disease or occur due to the loss of the immune response. Therefore, further studies on this subject should be conducted.
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COVID-19 , Enfermedades de la Boca , COVID-19/complicaciones , Humanos , Enfermedades de la Boca/etiología , SARS-CoV-2RESUMEN
Temporomandibular disorders (TMD) have multifactorial and complex etiology. Regardless of their etiology, all those conditions may result in centrally mediated chronic muscle pain, myalgia, myofascial pain, myofibrotic contracture, myosistis, myospasm, headache and a variety of neck, shoulder, upper back and lower back pain. Biofeedback (BF) is one of methods that has been used for more than 50 years in rehabilitation to facilitate normal movement patterns after injuries. Some studies suggest that biofeedback may be an effective treatment option for patients with different muscle disorders. The aim of this study was to evaluate the efficiency of biofeedback in masticatory muscle activity management in the light of current medical literature. The authors followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines for this systematic review. The authors searched the MEDLINE, Scopus, Web of Science, CINAHL databases to identify relevant publications. Finally 10 papers were included. Most of the selected studies showed a significant correlation between biofeedback usage and reduction of masticatory muscle activity. By analyzing qualified studies, it can be concluded that biofeedback can be an effective tool in masticatory muscle activity management.
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Chitosan is a linear amino-polysaccharide and a natural polymer with a structure based on repetitive deacetylated and acetylated units randomly distributed. It is produced from chitin, one of the most common naturally occurring polysaccharides. Its numerous biomedical applications have been extensively described in the literature. It becomes more and more popular as a therapeutic agent and its use is constantly extended. Given its commonness, regenerative properties, easy chemical treatment, and biocompatibility, it might be used in the treatment of damaged oral cavity tissues. Due to its antimicrobial and regenerative-inducting properties as well as high biocompetency, chitosan is more and more frequently used in medicine and dentistry. It can be applied in all fields of dentistry including preventive dentistry, conservative dentistry, endodontics, surgery, periodontology, prosthodontics and orthodontics. Several data discussing the effectiveness of chitosan use on new bone formation are still inconclusive. The aim of the paper was to evaluate the applicability and biochemical impact of chitosan on oral health maintenance. Even though chitosan might find its adhibition in all dental specialities, it should still be considered as a potential allergen and thus further studies on this topic should be carried out.
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Quitosano/uso terapéutico , Especialidades Odontológicas , Quitosano/administración & dosificación , HumanosRESUMEN
BACKGROUND: Pain related to temporomandibular disorders (TMD) is a common problem in modern societies. The aim of the article is to present the concepts of TMD pain clinical management. METHODS: A survey was performed using the PubMed, SCOPUS and CINAHL databases for documents published between 1994 and 2014. The following search keywords were selected using MeSH terms of the National Library of Medicine in combination: TMD pain, TMD, TMJ, TMJ disorders, occlusal splint, TMD physiotherapy, TMJ rheumatoid disorders and TMJ surgery. Original articles and review papers which presented the clinical relevance and practical validity regarding the possibility of application in TMD management have been included. Authors have excluded articles without outstanding practical aspect and evidence-based background. A first selection was carried out by reviewing titles and abstracts of all articles found according to the criteria. After that the full texts of potentially suitable articles were assessed. In line with these criteria, among 11467 results the writers have included 66 papers. RESULTS: The most commonly reported conservative treatments are massage therapy and individually fabricated occlusal splints. In addition to massage, other popular methods include manual therapy and taping, warming/cooling of aching joints, and light and laser therapy. Drugs are also commonly used. In the most severe cases of the temporomandibular joint degeneration, surgical restoration of the joint is sometimes applied. CONCLUSIONS: The authors concluded that conservative treatment including counselling, exercises, occlusal splint therapy, massage, manual therapy and others should be considered as a first choice therapy for TMD pain because of their low risk of side effects. In the case of severe acute pain or chronic pain resulting from serious disorders, inflammation and/or degeneration pharmacotherapy, minimally invasive and invasive procedures should be considered.