Radiographic Bone Evaluation after Periodontal Full Mouth Disinfection Treatment in Women Undergoing Chemotherapy or Hormone Therapy with Tamoxifen

Objective: To radiographically evaluate the alveolar bone level after periodontal full mouth disinfection (FMD) treatment in women during chemotherapy (CHE) and hormone therapy with Tamoxifen (TAM). Material and Methods: This is an uncontrolled clinical trial with a convenience sample of women in antineoplastic treatment (CHE and TAM) and non-surgical periodontal FMD treatment. The Radiographic examination consisted of four bitewing radiographs and six periapical radiographs of the upper and lower anterior teeth, acquired according to the parallelling standard technique at three times: before (T0), 3 (T3) and 6 (T6) months after periodontal treatment. The alveolar crest level in the interproximal area of each tooth was measured by two calibrated observer using magnifying glass and digital caliper. Statistical analysis was performed for evaluation of the three times in each experimental group using the Friedman test (p < 0.05) and between groups, the Mann Whitney test (p <0.05). Results: Overall, 14 women undergoing treatment for breast cancer participated in this study. A follow-up loss of five (35.71%) women occurred during the study and the final sample size was composed of nine women divided into two groups: CHE (n = 4) and TAM (n = 5). A total of 330 sites were evaluated: 126 (CHE) and 204 (TAM). The alveolar bone level showed statistically significant reduction after 6 months of FMD therapy (p <0.05), but there was no difference between antineoplastic treatment type (p> 0.05). Conclusion: Patients undergoing chemotherapy and hormone therapy with Tamoxifen showed better alveolar bone levels after six months of periodontal FMD treatment. The current antineoplasic therapy did not influence the results obtained with periodontal treatment.

Influência de terceiros molares não erupcionados em fratura de ângulo e côndilo / Influence of unerupted third molars on angle and condyle fracture

Condylar and angle fractures are the most common types of mandibular injuries. There is evidence in the literature suggesting that the presence of unerupted lower third molars increases the risk of angle fracture and reduces the chance of condyle fracture. The present paper reports on a case of a 19-year-old Caucasian man who had bilateral angle fracture associated with the two lower unerupted third molars. No other fracture was detected on the panoramic radiograph. This case suggests that unerupted lower third molars increase the risk of angle fracture whereas preventing condyle fracture. Reduction of the bone mass of the angle in the presence of third molars and disruption of the oblique ridge with partially erupted molars support our findings. As the treatment of condyle fracture is more complex, it might not be appropriate to strengthen the mandibular angle, making the mandible more vulnerable to condylar fractures by means of prophylactic extraction of asymptomatic unerupted third molars.

Côndilo e ângulo são os locais onde as fraturas mandibulares ocorrem com maior frequência. Há evidências na literatura sobre a propensão para fratura de ângulo mandibular na presença de terceiros molares inferiores não-erupcionados, bem como redução da respectiva probabilidade de fratura em côndilo. O caso relatado envolve um homem branco, de 19 anos de idade, que teve fratura bilateral do ângulo em associação com os dois terceiros molares inferiores não-erupcionados. Nenhuma outra fratura foi detectada na radiografia panorâmica. Os achados deste caso ilustram a evidência de que terceiros molares inferiores não irrompidos aumentam o risco de fratura de ângulo, reduzindo, porém, o risco de fratura em côndilo. Algumas teorias sobre essa associação envolvem a redução da massa óssea do ângulo na presença do terceiro molar, além da ruptura da linha oblíqua quando eles estão parcialmente erupcionados. Como a fratura do côndilo tem um tratamento mais complexo, a exodontia profilática de terceiros molares não-erupcionados assintomáticos pode não ser apropriada, por fortalecer o ângulo mandibular e tornar a mandíbula mais vulnerável às fraturas condilares.