The influence of electrical high-speed rotation on mandibular third molar surgeries: a prospective, randomized, split-mouth clinical and radiographic study.

The aim of this split-mouth randomized clinical trial was to evaluate the clinical outcomes (operative time, edema, trismus, and pain), the immediate histological effects, the alveolar repair (2 and 4 months), and the quality of life after the extraction of impacted third molars using high-speed pneumatic and electrical rotation. Sixteen patients underwent extraction of the two mandibular third molars with a minimum interval of 15 days. On one side of the participant's mouth, high-speed pneumatic rotation was used (Control Group-CG) while for the other side, high-speed electrical rotation was used (Study Group-SG). Statistical analysis included ANOVA repeated measures and Pearson correlations. SG group showed: shorter operative time (p = 0.019), less pain (p = 0.034), swelling (p < 0.001) and trismus (p = 0.025) on the 1st postoperative day; less pain (p = 0.034) and trismus (p = 0.010) on the 3rd postoperative day; less trismus (p = 0.032) on the 7th postoperative day; and better quality of life (p = 0.007). No differences were observed for peripheral bone damage or bone density of alveolar repair at 2 and 4 months between groups. Electric high-speed rotation provided better postoperative clinical parameters of pain, edema and trismus when compared with pneumatic high-speed rotation for mandibular third molar surgery.Trial registration: Brazilian Registry of Clinical Trials registration number RBR-4xyqhqm ( https://ensaiosclinicos.gov.br/rg/RBR-4xyqhqm ).

Comparison of suture and sutureless techniques on postoperative complications after third molar surgery: a systematic review.

OBJECTIVE: To compare, among patients undergoing third molar surgeries, whether the use or omission of sutures improves postoperative clinical parameters. METHOD: A systematic literature review was conducted to identify randomized clinical trials in humans. The steps of this review were conducted following the PRISMA protocol. The risk of bias assessment was performed using the revised Cochrane tool (RoB 2). The RevMan software was employed for meta-analyses, and the quality of evidence was evaluated using GRADE. RESULT: A total of seven articles were included in the systematic review; however, only one article quantitatively measured bleeding, rendering meta-analysis for this outcome unfeasible. The group of patients in whom sutures were not used presented lower pain and edema on the first day (respectively: MD - 1.08; 95% CI - 1.35 to - 0.81; MD - 1.23; 95% CI - 2.34 to - 0.11) and second day (respectively: MD - 0.50; 95% CI - 0.83 to - 0.17; MD - 10.66; 95% CI - 1.16 to - 0.16) postoperatively, compared to the group where sutures were employed. The group of patients who received sutures exhibited increased trismus on the first day postoperatively (MD 1.04; 95% CI 0.67 to 1.41). CONCLUSION: The omission of postoperative sutures in third molar surgeries appears to favor pain and edema outcomes within the first 24 h after the procedure, as well as trismus within the same timeframe. CLINICAL RELEVANCE: Despite the suture being the standard conduct in tooth extractions. The omission of sutures in third molar extractions may favor inflammatory outcomes of pain, edema, and trismus in the immediate postoperative period.

Photobiomodulation therapy in the treatment of radiotherapy-related trismus of the head and neck.

This study evaluated photobiomodulation therapy (PBMT) for treatment of trismus in patients undergoing radiotherapy for head and neck cancer (HNC). Sixteen patients, 10 men and 6 women, who had a mouth opening < 35 mm and underwent RT were included. The patients were evaluated daily before and after the PBMT application, measuring mouth opening and performing pain scores for the masticatory muscles using the visual analog scale (VAS). We used the infrared laser (~ 808 nm) extraorally, 0.1 W power, 3 J energy, 30 s (107 J/cm2) per point, applied to temporalis anterior, masseter muscles, and temporomandibular joints (TMJ). An intraoral point was made in the trigonoretromolar region towards the medial pterygoid muscle. The mean mouth opening of the patients increased by more than 7 mm throughout the treatment. The pain scores on the initial days showed an immediate reduction after PBMT on the ipsilateral side in the muscles and TMJ. Throughout PBMT applications, there was a significant reduction in pain scores in all muscles and the TMJ. The radiation dose of all patients was above 40 Gy, which is the threshold dose for the risk of developing trismus. SPSS software was used and adopted a confidence of 95%. The Kolmogorov-Smirnov normality test, Wilcoxon test, and Spearman correlation were performed. PBMT controls muscular pain and reduced mouth opening limitation in HNC during radiotherapy. Further studies are needed to evaluate the preventive capacity of PBMT protocols for RT trismus-related HNC.

Effectiveness of low power laser in reducing postoperative signs and symptoms after third molar surgery: a triple-blind clinical trial.

The objective of this research was to evaluate the effectiveness of using LPL (Low power laser) to reduce pain, edema, and trismus after impacted lower third molar extraction. A split-mouth randomized triple-blind clinical trial was conducted at the Federal University of Ceará. For inclusion criteria, it was necessary that the patient presented a clear indication for removal of both lower third molars, in addition to both molars being in similar positions. The third molars (38 and 48) were randomly allocated to the test group that received the LPL application protocol, and to the placebo group that received a simulation of the protocol, making a total sample of 44 surgeries. Patients in the test group used an average of 50% of the amount of analgesics that was used by the placebo group, however, there was a statistically significant difference only on days four and five. Regarding trismus, the test group presented wide mouth openings, both at 48 hours and at 7 days after surgery compared to the placebo group, but without a statistically significant difference. For edema, we noted an equilibrium between the test group and the placebo group, but no measurement obtained a statistically significant difference. The use of LPL presented better pain and trismus indicators after complex extractions. The use of LPL is thus indicated as a complementary therapy to reduce postoperative discomfort caused by complex tooth extractions.

Do blood concentrates influence inflammatory signs and symptoms after mandibular third molar surgery? A systematic review and network meta-analysis of randomized clinical trials.

OBJECTIVES: To investigate, through a network meta-analysis, the effectiveness of blood concentrates in reducing pain perception, trismus, and edema after mandibular third molar extraction. MATERIALS AND METHODS: An electronic search was performed in nine databases to locate randomized clinical trials comparing blood concentrate use after mandibular third molar extraction. Two authors selected and extracted the data independently. The individual risk of bias in the studies was assessed with the RoB v2.0 tool. A network meta-analysis compared postoperative pain and trismus scores after applying different blood concentrates, using the mean difference (MD) as an effect estimate. The GRADE approach assessed the certainty of evidence. RESULTS: Thirty-one randomized clinical trials were included in the review and 18 in the meta-analysis. Leukocyte- and platelet-rich fibrin (L-PRF) was the most used blood concentrate, followed by platelet-rich plasma (PRP). The network meta-analysis, depending on the analyzed period, evaluated up to 1240 surgeries. Among the analyzed blood concentrates, advanced platelet-rich fibrin (A-PRF) performed better among the analyzed blood concentrates, decreasing postoperative pain in 1, 2, 3, and 7 days and reducing trismus up to the inflammatory peak compared to blood clots. Only two studies had a low risk of bias. CONCLUSIONS: Based on very low certainty of evidence, using concentrates seemed efficient compared to blood clots in reducing pain and trismus after mandibular third molar surgeries. A-PRF decreased postoperative pain throughout the evaluated time and trismus during the acute inflammatory peak. CLINICAL RELEVANCE: A-PRF after mandibular third molar extractions performed better among the analyzed blood concentrates and seemed efficient in improving postoperative quality by decreasing inflammatory signs and symptoms.

Evaluation of Serum Levels of Cytokines in Acute Apical Abscess: A Longitudinal Observational Study.

INTRODUCTION: Cytokine levels are related to the aethiopathogenia of acute apical abscesses (AAA); however, the specific cytokine profiles in these cases are unclear. This study aimed to investigate the changes in systemic cytokine levels in patients with AAA and trismus onset, postantibiotic treatment, and postroot canal disinfection. METHODS: In total, 46 AAA patients with trismus and 32 control subjects were included. After seven days of antibiotic therapy, root canal disinfection was performed in the AAA patients. The serum levels of cytokines were evaluated at basal, seven, and 14 days after endodontic treatment. Quantification of cytokines from T helper (Th) 1, Th2, Th17, and regulatory T cells profiles was determined using the BioPlex MagPix system, and the obtained data were analyzed using SPSS statistical software (P < .05). RESULTS: AAA patients showed higher tumor necrosis factor-alpha (TNF-α), interleukin (IL) -6, and IL-10 levels than control subjects, at basal measurement (P < .05); there were similar levels of interferon gamma, IL-1ß, IL-4, and IL-17 between groups (P > .05). IL-6 and IL-10 levels decreased after antibiotic treatment (P < .05), which was also associated with clinical improvement in patients with AAA and trismus. Patients with AAA had a positive correlation with higher serum levels of IL-6 and IL-10. In addition, TNF-α levels decreased only after antibiotic and endodontic treatment. CONCLUSIONS: In conclusion, patients with AAA had increased systemic serum levels of TNF-α, IL-6, and IL-10. Moreover, increased levels of IL-6 and IL-10 are associated with acute inflammatory symptoms. However, IL-6 and IL-10 levels decreased after antibiotic treatment, while TNF-α levels decreased after antibiotic and endodontic treatment.

Use of Photobiomodulation to Reduce Postoperative Pain, Edema, and Trismus After Third Molar Surgery: A Systematic Review and Meta-Analysis.

PURPOSE: Third molar extraction can cause surgical trauma, which is associated with pain, edema, trismus, and functional limitations. The aim of the present systematic review was to investigate the effects of photobiomodulation (PBM) following the extraction of impacted mandibular third molars. METHODS: An electronic search was conducted in 10 databases from inception up to October 2021 and the grey literature, with no restrictions regarding language or year of publication. Randomized controlled clinical trials (RCT) were included. Studies that were not RCTs were excluded. Reviewers independently analyzed titles and abstracts, followed by full-text analysis. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The exposure variable was the use of PBM and the outcomes were pain, edema, and trismus. Meta-analysis was performed using a random-effects model. The estimate was calculated considering standardized mean differences (SMD) and respective 95% confidence intervals (CI) obtained for each outcome on the first, second, third and seventh postoperative days. The level of evidence was assessed using the GRADE approach. RESULTS: The search resulted in the 3,324 records. Thirty-three RCTs were included in the systematic review and 23 of these were included in the meta-analyses. The studies involved a total of 1,347 participants (56.6% female and 43.4% male) between 16 and 44 years of age. A greater reduction in pain was found in the PBM group compared to the control group on the third postoperative day (SMD: -1.09; 95% CI: -1.63; -0.55; P < .001; low certainty). Edema was discretely lower in the PBM group on the second postoperative day (SMD: -0.61; 95% CI: -1.09; -0.13; P < .001; low certainty) and trismus was discretely lower in the PBM group on the seventh postoperative day (SMD: 0.48; 95% CI: 0.00; 0.96; P < .001; very low certainty). CONCLUSION: The evidence of the effect of PBM regarding the control of pain, edema, and trismus following third molar extractions is low or very low.

Comparison of two suture techniques on the inflammatory signs after third molars extraction-A randomized clinical trial.

PURPOSE: Wound closure technique is an operative factor that influences early post-operative complications after third molar surgery. This study investigates and compared the effectiveness of two closure techniques, primary closure and healing by second intention of the oblique incision on postsurgical discomfort after mandibular third molar surgery. MATERIALS AND METHODS: This is a prospective, randomized, double-blind, split mouth controlled trial. Surgical sites were divided into two groups Control group received simple sutures in both alveolar crest incision and oblique incision and intervention group received simple sutures in alveolar crest incision, while the oblique incision healed by second intention. All the patients were instructed to measure pain according to visual analogue scale (VAS) in postoperative period, swelling, mouth opening was assessed at 72h and 7 days after surgery. The wound healing was assessed on day 7. RESULTS: Thirty-five patients, who had bilateral impacted third molars of similar surgical difficulty, were recruited. Thirty-one successfully completed the study. Patients in the second intention group had significantly less pain at 24h (p < 0.27). and 48h (< 0.001), had significantly less swelling (< 0.001) and trismus (< 0.001) and patients submitted to primary closure had a better evaluation of the Landry index (p < 0.001). CONCLUSION: Healing by second intention of the oblique relaxing incision by partial surgical wound closure, in our study, were superior to the primary closure in reduction of post-operative pain, swelling and trismus. TRIAL REGISTRATION: This trial is registered at Brazilian Registry of Clinical Trials-ReBEC -UTN: RBR-5fxbqsf (https://ensaiosclinicos.gov.br/rg/RBR-5fxbqsf).

Is coadministration of preemptive medications an effective strategy for reducing inflammatory clinical events and the need for rescue medication after mandibular third molar surgery? A systematic review of randomized clinical trials.

This study aimed to evaluate the scientific evidence on the effect of preemptive drug coadministration (PDC) for relieving inflammatory events (pain, swelling, and trismus) in mandibular third molar surgery. A PROSPERO-registered systematic review (CRD42022314546) was conducted according to the PRISMA guide. The searches were carried out in six primary databases and the gray literature. Studies not written in languages with the Latin alphabet (Roman) were excluded. Potential randomized controlled trials (RCTs) were screened for eligibility. Cochrane's Risk of Bias-2.0 (RoB) tool was assessed. A synthesis without meta-analysis (SWiM) based on a vote counting and an effect direction plot. Nine studies (low RoB) fulfilled the eligibility criteria and were included for data analysis, with a total of 484 patients. PDC mostly involved corticosteroids (Cort) and non-steroidal anti-inflammatory drugs (NSAIDs). PDC of Cort and other drugs mainly reduced pain scores (6 and 12 h postoperatively) and swelling (48 h postoperatively). PDC of NSAIDs and other drugs mainly reduced pain scores at 6, 8, and 24 h follow-up; swelling and trismus intensity ameliorated at 48 h postoperatively. The most frequently prescribed rescue medication was paracetamol, dipyrone, and paracetamol plus codeine. Results from individual studies have shown reduced consumption of ingested rescue analgesics. In summary, the available evidence from clinical trials included in this SWiM suggests that PDC may provide benefits in reducing the severity of inflammatory outcomes related to mandibular third molar surgery, especially the pain scores in the first hours after surgery, and the rescue analgesic consumption during the postoperative period.

Photobiomodulation using 940-nm laser as an adjuvant therapy on orthognathic surgery: A randomized clinical trial.

This study aimed to evaluate the effectiveness of photobiomodulation (PBM) therapy using 940-nm laser in patients undergoing orthognathic surgery. Twenty individuals were randomly distributed into laser (n = 10) and control (n = 10) groups. The PBM was conducted immediately after surgery, after 24 h, 48 h, and weekly for up to 4 weeks. All participants were evaluated for pain, edema, trismus and paresthesia. Data were compared by Fisher's and Mann-Whitney or chi-square tests (5%). The pain decreased from 24 h to 4 weeks, with the laser group reaching any pain after 3 weeks (p < 0.001). A significant difference was noticed for trismus on days 14 and 30 (p = 0.002; p = 0.019), without difference in paresthesia (p = 0.198). Edema was lower on the laser group compared to control, without a significant difference for most measurements. Data indicate that 940-nm PBM therapy decreased the occurrence of postoperative pain and significantly improved trismus.

Efficacy of serratiopeptidase in third molar surgery: a systematic review and meta-analysis / Eficacia de la serratiopeptidasa en cirugía del tercer molar: una revisión sistemática y un metanálisis

Objective: To determine the efficacy of serratiopeptidase in third molar surgery. Materials and Methods: A bibliographic search was carried out until April 2022, in the biomedical databases: Pubmed/Medline, Cochrane Central Registry of Clinical Trials, Scopus, Scielo and Google Scholar. Studies reporting the ef-ficacy of serratiopeptidase in third molar surgery, which were randomized clinical trials, in English and without time limits, were included. The RoB 2.0 tool was used to assess the risk of the included studies and the GRADEPro GDT tool to assess Results: The preliminary search yielded a total of 116 articles, discarding those that did not meet the selection criteria, leaving only 10 articles. Six articles entered a meta-analysis and found that serratiopeptidase reduces trismus but not reduce inflammation and pain after third molar surgery. Conclusions: The literature reviewed suggests that ser-ratiopeptidase is effective in reducing trismus after third molar surgery.

Objetivo: Determinar la eficacia de la serratiopeptidasa en la cirugía del tercer molar. Materiales y Métodos: Se realizó una búsqueda bibliográfica hasta abril de 2022, en las bases de datos biomédicas: Pubmed/Medline, Registro Cochrane Central de Ensayos Clínicos, Scopus, Scielo y Google Scholar. Se incluyeron estudios que reportaron la eficacia de la serratiopeptidasa en cirugía de terceros molares, que fueron ensayos clínicos aleatorios, en inglés y sin límite de tiempo. Se utilizó la herramienta RoB 2.0 para evaluar el riesgo de los estudios incluidos y la herramienta GRADEPro GDT para evaluar la calidad de la evidencia y la fuerza de recomendación de los resultados. Resultados: La búsqueda preliminar arrojó un total de 116 artículos, descartando aquellos que no cumplieron con los criterios de selección, quedando solo 10 artículos. Seis artículos participaron en un metanálisis y encontraron que la serratiopeptidasa reduce el trismo, pero no reduce la inflamación y el dolor después de la cirugía del tercer molar. Conclusión: La literatura revisada sugiere que la serratiopeptidasa es efectiva para reducir el trismo después de la cirugía del tercer molar.

Pericoronitis treatment with antimicrobial photodynamic therapy using a new formula of methylene blue: A case report.

Pericoronitis is a common disease that impacts the quality of life of individuals during the eruption of the third molars. Among the main clinical signs and symptoms reported were the presence of gingival operculum, pain, difficulty swallowing, and trismus with functional impairment. The present study shows a case report of pericoronitis treated with antimicrobial photodynamic therapy (aPDT), using a new oral formulation (INPI BR 1020170253902) of methylene blue. A female patient, 27 years old, presenting initial pericoronitis, had her pain, mouth opening, and swelling evaluated. She was submitted to a protocol of irrigation with sterile saline and photodynamic therapy using the new MB at 0.005% concentration and irradiation with low-intensity laser λ = 660 nm, 9 J per point, and radiant exposure of 318 J/cm2. The variables were evaluated on 4th day after aPDT. There was a 100% improvement in pain and an increase of 1,3 cm in mouth opening. There was no difference in the edema before and after aPDT using the new MB formula. Although the results are based on a single case report, suggest the hypothesis that aPDT using the new MB formula is an efficient therapy in the treatment of pain and trismus caused by the early stage of pericoronitis. Well-conducted randomized clinical trials are needed to compare this new formulation with conventional aPDT for further generalization of results.

Complicaciones de la técnica anestésica mandibular Spix en la clínica odontológica de la Universidad Andrés Bello / Incidence of complications of mandibular anesthetic Spix techniques in the Andrés Bello University dental clinic

Objetivo: Determinar la incidencia de complicaciones de la técnica anestésica Spix en procedimientos odontológicos a pacientes atendidos en la clínica de la Universidad Andrés Bello (UNAB). Material y Métodos: Se analizó a 37 pacientes que fueron atendidos por alumnos de cuarto y quinto año de la clínica odontológica, a los cuales se le realizó la técnica anestésica Spix para realizar el procedimiento odontológico. Se consignó mediante la observación la presencia de formación de hematomas intraorales en el sitio de punción, rotura de la aguja, cantidad de tubos de solución anestésica inyectados, presencia de dolor a la inyección de solución anestésico y la presencia o no de parálisis facial. Mediante la recolección de datos y posterior encuesta a los participantes se consignó la presencia de trismus al día siguiente de la atención y parestesia persistente al día siguiente de la atención. Resultados: De 37 pacientes estudiados que recibieron la técnica anestésica Spix, 6 presentaron hematoma intraoral (16,2%), ninguno reportó rotura de la aguja, 1 presentó parálisis facial (2,7%), 1 presentó parestesia persistente al día siguiente (2,7%), 12 presentaron trismus posterior a la inyección (32,4%). El rango de dolor reportado fue entre 1 y 4 según la escala EVA. Conclusión: Hay una baja incidencia de las complicaciones asociadas a la técnica anestésica Spix en la clínica odontológica de la UNAB, siendo el trismus la complicación más frecuente. Se necesita un mayor número de muestra para entender mejor esta realidad.

Objective: To determine the incidence of complications of the Spix anesthetic technique in the dental procedures of patients attended at the Andrés Bello University dental clinic. Material and Methods: 37 patients who were cared for by fourth- and fifth-year students from the dental clinic of the Andrés Bello University were analyzed, who underwent the Spix anesthetic technique to perform the dental procedure. The presence of intraoral hematoma formation at the puncture site, needle breakage, number of injected anesthesia tubes, presence of pain upon injection of anesthetic and the presence or not of facial paralysis were recorded. Through data collection and subsequent survey of the participants, the presence of trismus was recorded the day after care. Results. Of the 37 cases of patients studied who received the Spix anesthetic technique, 6 had intraoral hematoma (16.2%), no needle break was reported, 1 had facial paralysis (2.7%), 1 had persistent paresthesia at the next day (2.7%), 12 presented trismus after the injection (32.4%), the pain range was between 1 and 4 according to the VAS scale. Conclusion. There is a low incidence of complications associated with the Spix anesthetic technique in the Andrés Bello University dental clinic, trismus being the most frequent (32.4%). A larger sample number should be needed to better understand this reality.

Fotobiomodulação no tratamento do trismo em pacientes tratados por câncer de boca ou orofaringe: um ensaio clínico controlado randomizado / Photobiomodulation in the treatment of trismus in patients treated for oral or oropharyngeal cancer: a randomized controlled clinical trial

RESUMO Objetivo investigar a eficácia da associação entre a fotobiomodulação de baixa frequência e a terapia fonoaudiológica tradicional no tratamento do trismo, em pacientes tratados por câncer de boca ou orofaringe. Métodos ensaio clínico controlado, randomizado, longitudinal e prospectivo, realizado de acordo as normas da declaração CONSORT 2010. Para a coleta de dados, foi utilizado o questionário sociodemográfico, a avaliação clínica, a mensuração da abertura de boca por paquímetro, o protocolo de dor McGuill e o protocolo de qualidade de vida WHOQOL-Bref. A amostra foi composta por 30 participantes, de ambos os gêneros na faixa etária de 35-75 anos, divididos em dois grupos, controle e experimental, de forma controlada, mediante sorteio igualitário no que tange aos critérios de inclusão e exclusão. Resultados por meio dos dados analisados, observou-se que houve aumento da amplitude vertical de mandíbula em ambos os grupos, GC: p<0,005 e GE: p<0,001. Não houve correlação estatística entre os grupos na comparação da abertura de boca, p>0,19, assim como em relação à dor orofacial e à qualidade de vida, p= 0,72, ambas as avaliações após a intervenção fonoaudiológica, porém, com melhores resultados para o GE, p<0,001. Conclusão Conclui-se pela eficácia da intervenção fonoaudiológica tradicional e a associação com a fotobiomodulação de baixa frequência no tratamento do trismo. Para a dor orofacial e qualidade de vida, o tratamento associado é mais benéfico.

ABSTRACT Purpose to investigate the effectiveness of the association between low-frequency photobiomodulation and traditional speech therapy in the treatment of trismus in patients treated for oral or oropharyngeal cancer. Methods controlled, randomized, longitudinal and prospective clinical trial, carried out in accordance with the norms of the CONSORT 2010 declaration. For data collection, a sociodemographic questionnaire, clinical evaluation, measurement of mouth opening by caliper, the protocol of McGuill pain and the WHOQOL-Bref quality of life protocol. The sample consisted of 30 participants, of both genders, aged between 35-75 years, divided into two groups, control and experimental, in a controlled manner, through an equal draw with regard to the inclusion and exclusion criteria. Results through the analyzed data, it was observed that there was an increase in the vertical amplitude of the mandible in both groups, CG: p0.19, as well as in relation to orofacial pain and quality of life, p= 0.72, both assessments after the speech therapy intervention, however, with better results for the EG, p<0.001. Conclusion It is concluded that the traditional speech therapy intervention and its association with low-frequency photobiomodulation are effective in the treatment of trismus. For orofacial pain and quality of life, associated treatment is more beneficial.

Complications post simple exodontia: A systematic review.

Exodontia procedures are not without complications, which are the dentist's responsibility to avoid by taking into account clinical, imaging, systemic, and operative factors, among others. The purpose of this systematic review is to determine and analyze the prevalence of complications post simple exodontia (CPES). The method used in this systematic review was adapted from the Cochrane Handbook and PRISMA statement. A systematic search was conducted in PubMed, Scopus and ScienceDirect using the search terms "Exodontia" AND "Complications". The search was conducted from the starting coverage date to January 31, 2020. The inclusion criteria were studies on simple exodontia, studies on CPES prevalence and human studies. Studies on complications after third molar exodontia, generalities in exodontia, narratives and systematics literature reviews, book chapters, and animal studies were excluded. A total of 1,446 articles were found in the first search using the search strategy (725 in PubMed, 96 in Scopus and 631 in ScienceDirect). After duplicates were removed, 948 articles were obtained. After reading the title and abstract, 9 articles were read in full. Finally, 3 articles were included in the review, with the most common complications being trismus, alveolitis, pain, dehiscence, infections, and retained roots. Trismus of the chewing muscles, alveolitis and retained roots were the most prevalent CPES, which were most likely related to the surgeon's experience, surgery duration and tissue trauma during surgery.

Directrices para el diagnóstico y tratamiento de Molares Retenidos / Guidelines for diagnosis and treatment of impacted molars

Los terceros molares son piezas dentarias correspondientes a la dentición permanente y se encuentran por detrás de los segundos molares. Erupcionan entre los 18 y 27 años aproximadamente, tienen variedad de formas, anomalías y disposición diversa. Normalmente se encuentran total o parcialmente retenidos en el hueso maxilar. La retención es muy frecuente y afecta aproximadamente al 75% de la población. La causa principal es por la falta de espacio dentro de la boca. La patología derivada de la retención de un tercer molar puede generar diferentes alteraciones: abscesos, sinusitis, reabsorción de las raíces de los dientes adyacentes, caries del molar retenido y/o del segundo molar, úlceras en la mucosa contigua, podrían generar quistes, ameloblastomas y ulceraciones leucoqueratósicas que pueden degenerar en carcinomas, alteraciones nerviosas o vasomotoras: dolores faciales, trismus, y parálisis facial ipsilateral. Las extracciones profilácticas de terceros molares asintomáticos están justificadas cuando los terceros molares se encuentran bajo prótesis removible que puede estimular su erupción, molares semierupcionados que pueden generar pericoronitis, caries o problemas periodontales; pacientes que van a ser sometidos a radioterapia; cuando el diente incluido interfiera en una cirugía ortognática. Si el molar retenido presenta sintomatología por parte del paciente está aconsejada su extracción quirúrgica.

The third molars are dental pieces corresponding to the permanent dentition and are located behind the second molars. They erupt between the ages of 18 and 27 approximately, have a variety of shapes, anomalies, and diverse dispositions. They are normally fully or partially retained in the maxillary bone. Retention is very frequent and affects approximately 75% of the population. The main cause is due to the lack of space inside the mouth. The pathology derived from the retention of a third molar can generate different alterations: abscesses, sinusitis, resorption of the roots of adjacent teeth, caries of the retained molar and/or second molar, ulcers in the contiguous mucosa, could generate cysts, ameloblastomas and leukokeratotic ulcerations that can degenerate into carcinomas, nervous or vasomotor disorders: facial pain, trismus, and ipsilateral facial paralysis. Prophylactic extractions of asymptomatic third molars are justified when the third molars are under removable prosthesis that can stimulate their eruption, semi-erupted molars that can generate pericoronitis, caries or periodontal problems; patients who are going to undergo radiotherapy; when the included tooth interferes with orthognathic surgery. If the retained molar presents symptoms on the part of the patient, its surgical extraction is recommended.

Double blind randomized clinical trial comparing minimally- invasive envelope flap and conventional envelope flap on impacted lower third molar surgery.

BACKGROUND: The latest trend in surgery is to look for minimally invasive procedures, with fewer complications and a shorter recovery time. This study aims to compare the minimally- invasive envelope flap, with smaller incision and fewer dissection and the conventional envelope flap, with a 20mm incision, on impacted mandibular third molar surgery, focusing on the hypothesis that there were no differences in postoperative outcomes. MATERIAL AND METHODS: A double-blind randomized clinical trial was designed to compare both incisions, focused on determining the approach with minor postoperative side-effects and minor impact on quality-of-life. A total of 60 patients were enrolled for the study if their presented impacted mandibular third molar and was 18-years-old or more. Both groups were evaluated from time elapsed on the surgery, maximum mouth opening, swelling and quality of life assessment. RESULTS: The flap choice influenced facial swelling (p=0,03), pain on the first three days (p=0,037), interference with oral hygiene (p=0,019) and discomfort on speech (p=0,07). Chewing, swallowing, trismus, pain after seven days, postoperative complications and other quality-of-life arrangements were no different between groups. CONCLUSIONS: The minimally- invasive envelope flap could lead to a less painful experience for the patient, with fewer impact on the oral hygiene and speech discomfort.

Tétanos generalizado: reporte de caso y análisis clínico para su diferenciación con otras entidades como las crisis epilépticas / Tetanus as a seizure crisis simulator in a 70-year-old patient, case report

RESUMEN INTRODUCCIÓN: El tétanos es una enfermedad que afecta el sistema nervioso. Su presentación clínica se caracteriza por espasmos musculares en respuesta a la liberación de la neurotoxina producida por la formación de esporas de la bacteria Clostridium tetani. DESCRIPCIÓN DEL CASO: Presentamos el caso de un hombre de 70 años que luego de una caída presentó una herida en la región ocular. Al ingreso se evidenciaron signos de infección local y contracción involuntaria en los músculos maseteros, con imposibilidad de apertura oral. Posteriormente, presentó insuficiencia respiratoria, contracciones generalizadas y necesidad de traslado a unidad de cuidado intensivo. Debido a que entre los diagnósticos diferenciales se encontraba la presencia de crisis epilépticas motoras, se hicieron estudios complementarios para descartar esta posibilidad. DISCUSIÓN: El diagnóstico del tétanos es clínico, es importante sospecharlo en pacientes con antecedentes de lesión en piel e inmunización inadecuada. Por su amplia presentación clínica, puede llevar a confusión con otras patologías. Entre los diagnósticos diferenciales están las crisis epilépticas, sin embargo, el tétano no cumple con las características semiológicas, no compromete el estado de conciencia y no progresa a estado epiléptico, asociado con la normalidad de estudios complementarios como las neuroimágenes, el estudio de líquido cefalorraquídeo y el registro electroencefalográfico. CONCLUSIÓN: El tétanos es una enfermedad altamente prevenible y un reto diagnóstico para el profesional de la salud por su amplio debut de síntomas. Por ello, en el abordaje diagnóstico es importante reconocer los diagnósticos diferenciales, teniendo como base la historia clínica, lo que permite un diagnóstico temprano y oportuno.

ABSTRACT INTRODUCTION: Tetanus is a disease that affects the nervous system and its clinical presentation is characterized by muscle spasms caused by the release of a neurotoxin produced by the formation of spores of the Clostridium tetani bacteria. CASE DESCRIPTION: We present the case of a 70-year-old man who after a fall, presented an injury to the ocular region. On admission, signs of local infection and involuntary contraction of the masseter muscles were evident, with impossibility of oral opening. Subsequently, he presented respiratory failure, generalized contractions and transfer to the intensive care unit, due to its similarity to convulsive events, pathology at the level of the central nervous system is suspected, for which it requires complementary studies and clinical analysis to rule it out. DISCUSSION: The diagnosis of tetanus is clinical, it is important to suspect it in patients with a history of skin lesions and inadequate immunization, due to its extensive clinical presentation, it can lead to confusion with other pathologies. Among the differential diagnoses are epileptic seizures, however, tetanus does not meet the semiological characteristics, does not compromise the state of consciousness and does not progress to status epilepticus, associated with the normality of complementary studies such as neuroimaging, cerebrospinal fluid study and registry electroencephalographic. CONCLUSION: Tetanus is a highly preventable disease and a diagnostic challenge for the health professional due to its wide onset of symptoms. That is why the diagnostic approach is important to recognize the differential diagnoses based on the clinical history, which allows an early and timely diagnosis.

Is the injection of tramadol effective at control of pain after impacted mandibular third molar extractions? A systematic review and meta-analysis.

BACKGROUND: Third molar extraction is among the most common surgical procedures performed by oral-maxillofacial surgeons. Postoperative pain, swelling and trismus are common, especially in wisdom teeth, due to trauma to local tissues and the duration of the surgical procedure, among other factors. MATERIAL AND METHODS: This systematic review was conducted in accordance with the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' in order to answer the focused question: 'Is the local submucosal injection of tramadol effective at the control of postoperative pain in patients submitted to impacted mandibular third molar extractions?'. We analyzed papers published until March 30, 2021 in the MEDLINE|PubMed, Web of Science and Cochrane Library databases. Gray literature was also consulted. Standard pairwise meta-analyses of direct comparisons were performed using a fixed-effect model; I2 ≥ 50 % or ≥ 75 % indicated moderate or high heterogeneity, respectively. Risk of bias was assessed by Cochrane Collaboration's tool. RESULTS: In total, 172 participants (98 males and 74 females, aged 18 or over) from three randomized placebo-controlled trials were considered for analysis. The submucosal injection of 2 ml of tramadol adjacent to the impacted mandibular third molar was effective in controlling pain up to 6-hours after surgery, in increasing the onset of consumption of rescue analgesic and in reducing the total number of rescue analgesics used. CONCLUSIONS: The submucosal injection of tramadol can be considered a safe and effective procedure for pain control after impacted mandibular third molar extractions.

Effect of preemptive photobiomodulation associated with nimesulide on the postsurgical outcomes, oxidative stress, and quality of life after third molar surgery: a randomized, split-mouth, controlled clinical trial.

OBJECTIVE: The aim of this study is to compare the effect of photobiomodulation with low-level laser therapy (LLLT) and nimesulide on inflammatory parameters, biomarkers of oxidative stress and inflammation, and quality of life after lower third molar (L3M) surgery. MATERIAL AND METHODS: A randomized, two-factor, triple-blind, controlled, split-mouth clinical trial was performed with 40 volunteers who required bilateral L3M removal. Patients were allocated depending on the use or not of 100 mg nimesulide 1 hbefore surgery, as well as the use or not of LLLT in the preoperative period. RESULTS: Pain peaks occurred after 6 h (nimesulide-placebo [N-P] group) and 8 h (nimesulide group). In the N-P group, LLLT resulted in significantly lower mean pain scores than the subgroup without LLLT after 4 h (p = 0.009) and 6 h (p = 0.048). As for edema, a shorter distance between the mandibular angle and the outer canthus of the eyes after 7 days (p = 0.037) and a smaller cumulative effect (p = 0.036) were observed in the N-P group associated with LLLT. A direct effect between LLLT (p = 0.047) and a reduction in the mean scores of overall dissatisfaction with quality of life was detected. CONCLUSIONS: Preemptive use of nimesulide only delayed peak pain. LLLT reduced edema, trismus, and contributed to a better perception of quality of life. Nimesulide inhibits peroxidation by increasing GSH and stopping neutrophil migration. The benefit of the association of both strategies was not superior to the use of LLLT alone. CLINICAL RELEVANCE: Translational study with impact on clinical-surgical protocols involving L3M surgery related to pharmacological and non-pharmacological methods.