Avaliação da efetividade do laser de baixa potência na redução da dor pós-operatória em cirurgia de terceiros molares inferiores inclusos / Evaluation of the effectiveness of low power laser in reducing postoperative pain in surgery of mandibular third molar

Avaliar a efetividade do laser de baixa intensidade (LLLT) no controle da dor pós-operatória em cirurgia de terceiros molares inferiores inclusos, comparando-o com o lado oposto, que não foi exposto ao LLLT, no mesmo indivíduo.Metodologia: participaram do estudo 16 indivíduos, que apresentaram os dentes 38 e 48 inclusos, em posição similar, e que realizaram a remoção dos dentes no mesmo tempo cirúrgico. O laser foi aplicado imediatamente após a remoção do 48 (lado direito - LD), intra-alvéolo, de forma pontual e sobre a região da sutura, em varredura. O mesmo procedimento foi realizado no 38 (lado esquerdo - LE), com o aparelho desligado garantindo o desconhecimento do paciente sobre qual lado recebeu o laser. Todos foram medicados e orientados quanto aos cuidados pós-operatórios e receberam as escalas visuais análogas (VAS) que variavam de 0-10 cm, anotando a ausência ou presença da dor durante 5 dias do lado direito e esquerdo. Os dados foram tabulados e submetidos ao teste de Wilcoxon (p<0,05) comparando-se as médias da VAS de 1 a 5 dias. Resultados: no 3° dia LD e LE, houve diferença estatística significante (p= 0,0284) e do LD a dor foi menor. No 1° e 5° dia houve redução da dor em ambos os lados (LD:p=0,007; LE:p=0,001).Conclusão: dentro dos limites do presente estudo o laser de baixa intensidade mostrou efetividade no controle da dor pós-operatória...

The purpose of the present study was to analyze the effectiveness of LLLT in pain control after impacted third molar removal, comparing it with the opposite side, note exposed to LLLT in the same patient.Methodology: 16 patients who presented both impacted lower third molar in similar position and accepted to remove them in the same operative time were select to this study. LLLT was used immediately after lower right third molar (R3M), intra-socket and after wound closure. The same procedure was done in the opposite side (L3M) but this time the LLLT was not turned on, warrating thus the patient didn´t no which side had received the irradiation. All patients received visual analogue scale (VAS), where they were instructed to write down the presence or absence of pain in the first five postoperative days. Statistical analysis comprised Wilcoxon test (p<0.05), comparing the VAS average data in the first to the fifth postoperative day.Results: the third postoperative day resulted in a statistically significant (p=0.0284) reduction of pain. In the first and fifth day there was pain reduction in both sides (R3m: p=0.0071; L3M: p=0.0010).Conclusion: within the limits of this study LLLT was effective in postoperative pain control...

Keratocystic odontogenic tumor: case report / Tumor queratocístico odontogênico: relato de caso

The keratocystic odontogenic tumor (KOT) is a relatively common oral and maxillofacial lesion that arises from rests of dental lamina. It has an agressive behavior including high rates of recurrence, rapid growth, and extension into adjacent tissues. Various treatment modalities, and thus differing recurrence rates after treatment, have been reported. Due to the very thin and friable lining, characteristic of the tumor, enucleation can be difficult undertaking and, for this reason it is associated with the highest recurrence rates.Aim: we describe a case of a large KOT in the mandibular body, where due to the presence of an unusual thick lining, removal of the tumor as a single piece was sucessful.Conclusion: this case shows that large KOT can be treated in a conservative approach. Due to the possible recurrences many years after initial treatment, a life-long follow-up schedule is mandatory...

O tumor odontogênico ceratocístico (TOC) é uma lesão oral e maxilofacial relativamente comum que surge de restos da lâmina dental. Ele tem um comportamento agressivo, incluindo altas taxas de recorrência, crescimento rápido e extensão para os tecidos adjacentes. Várias modalidades de tratamento e, assim, diferentes taxas de recorrência após o tratamento, foram relatadas. Devido ao revestimento muito fino e friável, característica do tumor, a enucleação pode ser difícil e, por esta razão ele é associado com as maiores taxas de recorrência. Objetivo: o presente trabalho descreve um caso de um grande TOC no corpo mandibular, onde, devido à presença de um revestimento de espessura incomum, a remoção do tumor como uma peça única foi bem sucedida. Conclusão: o presente caso demonstra que TOC de grandes proporções podem ser tratados de maneira conservadora. Devido à possibilidade de recidiva em muitos anos após o tratamento inicial, acompanhamento a longo prazo é obrigatório...

Fresh-frozen bone allografts in maxillary ridge augmentation: histologic analysis.

Bone allograft has become an alternative to autogenous bone due to its decreased operative trauma and the almost unlimited supply of reconstructive material. The aim of the present study was to histologically evaluate the suitability of fresh-frozen bone graft (test group) used in maxillary ridge augmentation, comparing it to autogenous bone (native maxilla: control group). During the re-entry procedures, 9 months after the fresh-frozen allogeneic bone blocks were placed in the atrophic maxillary ridges, bone cores were removed with a trephine bur from test and control treatments in the same patient. Routine histologic processing using hematoxylin and eosin and Picrosirius staining was performed. Mature and immature collagen area and density analysis were carried out for both groups under polarization. The results of Student's t test for paired samples (P > .05) showed no statistically significant difference in mature and immature collagen area or density percentage between test and control groups. Histologically similar bone formation patterns were observed in both groups. We concluded that fresh-frozen bone allograft is a biologically acceptable alternative for augmentation of the deficient alveolar ridge, showing a similar collagen pattern to that of autogenous bone.

Evaluation of the stress distribution in CFR-PEEK dental implants by the three-dimensional finite element method.

CFR-PEEK (carbon fiber reforced-poly ether ether ketone) has been demonstrated to be excellent substitute titanium in orthopedic applications and can be manufactured with many physical, mechanical, and surface properties, in several shapes. The aim of this study was to compare, using the three-dimensional finite element method, the stress distribution in the peri-implant support bone of distinct models composed of PEEK components and implants reinforced with 30% carbon fiber (30% CFR-PEEK) or titanium. In simulations with a perfect bonding between the bone and the implant, the 30% CFR-PEEK presented higher stress concentration in the implant neck and the adjacent bone, due to the decreased stiffness and higher deformation in relation to the titanium. However, 30% CFR-PEEK implants and components did not exhibit any advantages in relation to the stress distribution compared to the titanium implants and components.

Management of two cases of desquamative gingivitis with clobetasol and Calendula officinalis gel.

BACKGROUND: The purpose of this paper is to describe two cases of desquamative gingivitis (DG) that were treated with a topic gel containing clobetasol propionate and Calendula officinalis L in an acetate tray over two years. METHODS: Two patients with a diagnosis of lichen planus presenting as DG who had undergone previous treatments for this condition with no significant results, were treated by a handling gel containing clobetasol, nystatin, Calendula officinalis L and pectin in custom trays. RESULTS: Both patients had remission of symptoms while using the trays and after they stopped the treatment, the symptomatic outbreaks were delayed and presented as less severe symptoms in the two years follow-up. The treatment is aimed primarily at reducing the length and severity of symptomatic outbreaks desquamative gingivitis. CONCLUSION: This handling gel using a tray may be an efficacious treatment of desquamative gingivitis.

Complications in third molar removal: a retrospective study of 588 patients.

OBJECTIVES: Surgical removal of third molars is a regular surgical procedure, which like all operations, may have complications. The purpose of the study was to analyze the incidence of complications and their relationship with the surgical difficulty in a group of 588 patients treated by the same oral and maxillofacial surgeon. STUDY DESIGN: This retrospective cohort study consisted of 1699 third molars (M3) removed between 2005 and 2008. The teeth were grouped into a 6-class scale of surgical difficulty rated according to the surgical procedure description in the patient's file: I: upper M3 requiring forceps only; II: upper M3 requiring osteotomy; III: upper M3 requiring osteotomy and tooth section; IV: lower M3 requiring forceps only; V: lower M3 requiring osteotomy; VI: lower M3 requiring osteotomy and tooth section. The complications were grouped into each surgical difficulty class and their incidence and management were also described. RESULTS: 59 complications (3.47%), including pain, root tip fracture, paresthesia, alveolar osteitis, temporomandibular joint discomfort, and oroantral fistula were reported. Surgical difficulty class VI presented the higher incidence of complications (n=38). CONCLUSIONS: The risk of complications in third molar surgery will always exist and increases in proportion to the surgical difficulty. Mandibular M3 requiring osteotomy and tooth section have the highest risk of complications.

Maxillary ridge augmentation with fresh-frozen bone allografts.

PURPOSE: The present investigation clinically and histologically evaluated the use of fresh-frozen bone in the reconstruction of maxillary alveolar ridges to confirm the effective bone fill and support for the placement of dental implants. PATIENTS AND METHODS: Fifteen patients who had atrophic maxillary ridge necessitating bone block grafts prior to implant placement were submitted to maxillary reconstructions performed with human block grafts of tibia fresh-frozen chips. Nine months later the re-entry procedures were carried out and at this time a bone core was removed from the grafts for histological analysis. RESULTS: Thirty-four blocks were placed, and the number of blocks each patient received ranged from 1 to 4. During the re-entry procedures, all of the grafts were found to be firm in consistency, well-incorporated, and vascularized. A total of 51 implants were placed over the grafts with a minimum of 40-Newton torque in all cases. None of the implants were lost. The follow-up period ranged from 24 to 35 months. The histological analysis revealed a living bone that showed features characteristic of mature and compact osseous tissue surrounded by marrow spaces. CONCLUSION: Bone allografts can be successful as graft material for the treatment of maxillary ridge defects. If adequate surgical techniques are adopted, this type of bone graft can be safely used in regions of implant placement as a suitable alternative to autogenous grafts.

Surgical treatment of maxillary transverse deficiency: retrospective study of 14 patients.

INTRODUCTION: The diversity of the proposed techniques in the treatment of maxillary transverse deficiency in adults reflects the conflicting opinions about the primary area of resistance to maxillary expansion in the craniofacial skeleton. In order to evaluate the efficiency of the surgical expansion in which no osteotomies of the pterygomaxillary junction were made, we have carried out a retrospective study with 14 patients with maxillary transverse deficiency, who were treated from 2003 to 2006. MATERIAL AND METHODS: In the study, models were made prior to and after surgery, and the intercanine and intermolar distances and the improvement of the interocclusal relationships were analyzed. Breathing function and the complications that occurred during and after the surgeries were also analyzed. RESULTS: All expansions were carried out according to pre-surgical planning so that expansion completely corrected the crossbite, resulting in the desired final occlusion for all patients. Intraoperative complications were limited to one Hyrax appliance deformation. Two patients had minor postoperative complications that included wound dehiscence and pain. Improvements in nasal breathing were observed in all patients that complained of breathing problems prior to the surgery. CONCLUSION: The satisfactory results obtained turns the surgical protocol described in this study recommended for the treatment of maxillary transverse deficiency in adults. Importantly, we found that pterygomaxillary osteotomy is not essential for maxillary expansion. The morbidity of the procedure was low with fairly minor complications, and surgically assisted rapid maxillary expansion was shown to improve nasal breathing.

Tratamento cirúrgico de mixoma odontogênico com enxerto ósseo autógeno: relato de dois casos / Surgical treatment of odontogenic myxoma with autogenous graft: report of two cases

Tumor odontogênico de origem mesodérmica, com comportamento benigno, embora localmente invasivo e recidivante, o mixoma odontogênico acomete com maior freqüência a mandíbula de adolescentes, com leve predominância no sexo feminino. Clinicamente se manifesta como uma expansão óssea lenta e indolor; radiograficamente observa-se uma imagem radiolúcida de contorno indefinido multi ou unilocular, comumente associada a um dente incluso. O tratamento é cirúrgico e a recidivafreqüente. Acompanhamento pós-operatório de longo prazo é necessário e, no caso de recidiva, nova intervenção cirúrgica, mais radical, deve ser executada. Foram relatados dois casos de mixomas em que foram necessárias novas intervenções cirúrgicas para tratamento de recidivas e a utilização de enxerto ósseo autógeno na reconstrução das áreas lesadas.