Preemptive use of anti-inflammatories and analgesics in oral surgery: a review of systematic reviews.

Objectives: This review of systematic reviews evaluated the effectiveness and safety of the preemptive use of anti-inflammatory and analgesic drugs in the management of postoperative pain, edema, and trismus in oral surgery. Materials and methods: The databases searched included the Cochrane Library, MEDLINE, EMBASE, Epistemonikos, Scopus, Web of Science, and Virtual Health Library, up to March 2023. Pairs of reviewers independently selected the studies, extracted the data, and rated their methodological quality using the AMSTAR-2 tool. Results: All of the 19 studies reviewed had at least two critical methodological flaws. Third molar surgery was the most common procedure (n = 15) and the oral route the most frequent approach (n = 14). The use of betamethasone (10, 20, and 60 mg), dexamethasone (4 and 8 mg), methylprednisolone (16, 20, 40, 60, 80, and 125 mg), and prednisolone (10 and 20 mg) by different routes and likewise of celecoxib (200 mg), diclofenac (25, 30, 50, 75, and 100 mg), etoricoxib (120 mg), ibuprofen (400 and 600 mg), ketorolac (30 mg), meloxicam (7.5, 10, and 15 mg), nimesulide (100 mg), and rofecoxib (50 mg) administered by oral, intramuscular, and intravenous routes were found to reduce pain, edema, and trismus in patients undergoing third molar surgery. Data on adverse effects were poorly reported. Conclusion: Further randomized clinical trials should be conducted to confirm these findings, given the wide variety of drugs, doses, and routes of administration used.

In vitro evaluation of the effectiveness of ProTaper universal rotary retreatment system for gutta-percha removal with or without a solvent.

INTRODUCTION: Effective removal of gutta-percha in endodontic retreatment is a significant factor to ensure a favorable outcome from failed procedures. The purpose of this study was to evaluate the efficacy of a nickel-titanium rotary instrument system with or without a solvent versus stainless steel hand files for gutta-percha removal. METHODS: Forty extracted human maxillary anterior teeth were prepared and filled. They were divided into 4 groups: Gates-Glidden and K-files, Gates-Glidden and K-files with chloroform, ProTaper Universal rotary retreatment system, and ProTaper Universal rotary retreatment system with chloroform. The operating time was recorded. The teeth were longitudinally sectioned and photographed. The images were analyzed and the filling remnants were quantified by using the IMAGE TOOL software. RESULTS: With Kruskall-Wallis test, statistical analysis showed that there was no significant difference between the techniques in regard to the amount of the endodontic filling remnants (P < .05); however, the ProTaper Universal rotary retreatment system was faster than the hand files (P < .05). CONCLUSIONS: All of the techniques proved helpful for the removal of endodontic filling material, and they were similar in material remaining after retreatment, but the ProTaper Universal rotary retreatment system without chloroform was faster.

Efetividade de técnicas manual e rotatória na desobturação de canais radiculares, com ou sem o uso de solventes / Effective techniques and manual rotation in the root canal removal procedure, with or without the use of solvents

Apesar do alto índice de sucesso do tratamento endodôntico, algumas vezes há necessidade de reintervenção decorrente da presença de sinais e/ou sintomas. Nestes casos, é de suma importância a remoção do material obturador presente, onde podem estar aderidos microrganismos. Independente da técnica, sabe-se que há dificuldade na remoção de todo o material obturador presente. Novas técnicas e instrumentos são desenvolvidos com objetivo de alicerçar tal procedimento. Também, existe um pressuposto que o uso de solventes pode resultar em facilidade na remoção do material presente, porém com remanescente obturador junto às paredes do canal. O objetivo deste estudo foi verificar "in vitro" a efetividade, quanto à capacidade de remoção de material obturador e o tempo, de técnicas manual e rotatória, com ou sem solvente, na desobturação de canais radiculares. Após instrumentação e obturação com guta-percha e cimento endodôntico Endofill®, 40 dentes unirradiculares humanos extraídos, que ficaram em 100% de umidade a 37oC por 30 dias, simulando a situação clínica, foram divididos aleatoriamente em quatro grupos de acordo com a técnica de desobturação, todos auxiliados pelo microscópio operatório (12,5X): grupo I - limas manuais; grupo II - limas manuais mais clorofórmio; grupo III - sistema ProTaper Universal® D para retratamento; e grupo IV - sistema ProTaper Universal® D para retratamento mais clorofórmio. O tempo efetivo de desobturação foi mensurado. Os dentes foram clivados longitudinalmente, fotografados e através do software IMAGE TOOL 3.00, as imagens foram analisadas e a área de material obturador remanescente foi mensurada. Após análise estatística através do teste de Kruskall-Wallis (p<0,05), verificou-se que não houve diferença significativa entre as técnicas quanto ao remanescente de material obturador no canal radicular. Porém, quanto ao tempo, houve diferença estatisticamente significante, sendo o grupo III o mais efetivo .

Despite the high rate of success of endodontic treatment, sometimes there is need for reintervention because of the presence of signs and / or symptoms. In these cases, it is important to remove the endodontic filling which can be adhered microorganisms. Regardless of the technique, it is known that there is difficulty in complete removal of the root canal filling material. New techniques and instruments are developed in order to build such a procedure. Also, there is an assumption that the use of solvents can result in the removal of material easier, but with remnants of dissolved gutta-percha adhered at the walls of the canal. The purpose of this “in vitro”study was to evaluate the efficacy of stainless steel hand files versus nickel-titanium rotary instruments, with or without solvent, for endodontic filling removal from root canals. After instrumentation and filling with gutta-percha and Endofill® sealer, 40extracted human maxillary anterior teeth which remained in 100% humidity and 37oC for 30 days, simulating the clinical situation, were randomly divided into four groups according to the technique of root canal filling removal, all aided by the microscope surgery (12.5 X): Group I - hand files; group II - hand files with chloroform; group III -ProTaper Universal® D rotary retreatment system; group IV - ProTaper Universal® D rotary retreatment system with chloroform. The operating time was recorded. Theteeth were longitudinally sectioned and photographed. The images were analyzed and the root canal fillings remnants were quantified with the computer software IMAGE TOOL 3.00. The statistical analysis (Kruskall-Wallis) (p <0.05) showed that there was no significant difference between the techniques concerning the amount ofthe endodontic fillings remnants. But the group III was significantly faster than the other groups (AU).