A randomized split-mouth clinical trial comparing pain experienced during palatal injections with traditional syringe versus controlled-flow delivery Calaject technique.

OBJECTIVE: To compare the pain experienced by patients during injections of local anesthesia in the palate using the traditional syringe and the controlled flow technique with the Calaject system. METHOD AND MATERIALS: A single-blind, split-mouth, randomized controlled trial was performed. Twenty-five volunteers were recruited in the Dental Hospital of the University of Barcelona, Spain. Each participant received two injections (0.3 mL of mepivacaine 3%), one with the traditional syringe (control side) and another with the Calaject system (experimental side), both during the same session. Pain intensity was evaluated after each injection with a 100-mm visual analog scale (VAS). A descriptive and bivariate statistical analysis was made. RESULTS: The mean pain experienced was 44.8 mm (standard deviation [SD] 19.0, range 8-72) with the traditional injection and 28.8 mm (SD 19.7, range 8-72) with the Calaject system (P < .001). Moderate/severe pain was more frequently referred in the control side (68%) in comparison with the experimental side (28%). CONCLUSION: Given the parameters of this study's design, the injection of local anesthetics in the palatal area with the Calaject controlled-flow system seems to reduce pain, in comparison to the use of a traditional syringe.

Sunct syndrome. Report of a case and treatment update.

Short-lasting unilateral neuralgiform headache attacks with conjuntival injection and tearing (SUNCT) is considered a rare trigeminal autonomic cephalgias, a group of primary headache disorders characterized by brief episodes of severe unilateral headache in the distribution territory of the trigeminal nerve, accompanied by prominent ipsilateral and cranial parasympathetic autonomic features. The present report describes a SUNCT syndrome in a 64-year-old male who had been diagnosed with trigeminal neuralgia several years ago. The patient reported stabbing pain in the orbital zone and in the left upper maxillary region, of great intensity, brief duration, and a frequency of 20-100 attacks a day. Pain episodes were accompanied by conjunctival injection and tearing. Based on the anamnesis, clinical examination and a magnetic resonance imaging scan, episodic SUNCT syndrome was diagnosed and pharmacological treatment with topiramate was started. This reduced the intensity and number of attacks to 3-6 a day. Key words:Trigeminal autonomic cephalgias, SUNCT, Cluster headache, topiramate.

Study of two MTA cements.

INTRODUCTION: To determine and compare the pH, conductivity and calcium release of an experimental Portland cement (PE) consisting of trioxid mineral aggregate and a comercially available modified Portland cement (C.P.M.) after 1, 2, 3, 4, 8, 10, 15 and 30 days. MATERIAL AND METHODS: Cements were mixed following the manufacturer's instructions, with a powder: liquid ratio of 3:1. Each cement was placed in 12 PVC tubes 1 mm in diameter and 10 mm in length and allowed to set. Four empty tubes were used as negative controls. Tubes were submerged in plastic flasks containing 10 ml deionized water and stored at 37 C and 100% humidity. After 1, 2, 3, 4, 8, 10, 15 and 30 days tubes were removed from the flasks and these were refilled with deionized water. We measured pH, conductivity and calcium content of the recovered solution. Data were analyzed using repeated measures ANOVA. RESULTS: pH was 0.3 units more alkaline with PE cement (p=0.023). pH experienced a slight decrease with time (p<0.001), independently of the cement type (p>0.05). Conductivity of PE and CPM cements diminished at 4 days and almost recovered at 30 days (p<0.001). PE cement had a higher conductivity (p<0.001). Calcium release diminished from the first day and recovered at 30 days (p<0.001) similarly for both cements (p>0.05). CONCLUSIONS: PE cement raised pH slightly more and had higher conductivity than CPM. Calcium release diminished after the first day and recovered at 30 days, similarly for both cements.

Anesthetic efficacy of Oraqix(R) versus Hurricaine(R) and placebo for pain control during non-surgical periodontal treatment

OBJECTIVES: To evaluate the efficacy of Oraqix(R) during scaling and root planing (SRP) in comparison with 20% benzocaine and placebo. Study DESIGN: 15 patients requiring 4 sessions of SRP were enrolled. For each patient, Oraqix(R), Hurricaine(R), vaseline or no anesthetic product were randomly assigned each to a quadrant. Treatment pain was evaluated on a 100 mm Visual Analog Scale (VAS) and on a Verbal Rating Scale (VRS). The amount of product administered, the need to re-anesthetise, patient and operator satisfaction and the onset of side-effects were also recorded. RESULTS: Oraqix(R) was significantly better than nothing, with a reduction of VAS score to 13.3 units, but without significant differences with Vaseline or Hurricaine(R). Oraqix(R) was better in VRS reduction than not using any anesthetic (p = 0.001) or using vaseline (p = 0.024), but similar to Hurricaine(R) (p = 0.232). CONCLUSIONS: Oraqix(R) effectively controls pain in SRP procedures, with few side-effects and a good acceptance on the part of patients and clinicians

Sharp mandibular bone irregularities after lower third molar extraction: Incidence, clinical features and risk factors

Objectives: The purpose of this study was to determine the incidence and clinical symptoms associated with sharp mandibular bone irregularities (SMBI) after lower third molar extraction and to identify possible risk factors for this complication. Study Design: A mixed study design was used. A retrospective cohort study of 1432 lower third molar extractions was done to determine the incidence of SMBI and a retrospective case-control study was done to determine potential demographic and etiologic factors by comparing those patients with postoperative SMBI with controls. Results: Twelve SMBI were found (0.84%). Age was the most important risk factor for this complication. The operated side and the presence of an associated radiolucent image were also significantly related to the development of mandibular bone irregularities. The depth of impaction of the tooth might also be an important factor since erupted or nearly erupted third molars were more frequent in the SMBI group Conclusions: SMBI are a rare postoperative complication after lower third molar removal. Older patients having left side lower third molars removed are more likely to develop this problem. The treatment should be the removal of the irregularity when the patient is symptomatic (AU)

Sharp mandibular bone irregularities after lower third molar extraction: incidence, clinical features and risk factors.

OBJECTIVES: The purpose of this study was to determine the incidence and clinical symptoms associated with sharp mandibular bone irregularities (SMBI) after lower third molar extraction and to identify possible risk factors for this complication. STUDY DESIGN: A mixed study design was used. A retrospective cohort study of 1432 lower third molar extractions was done to determine the incidence of SMBI and a retrospective case-control study was done to determine potential demographic and etiologic factors by comparing those patients with postoperative SMBI with controls. RESULTS: Twelve SMBI were found (0.84%). Age was the most important risk factor for this complication. The operated side and the presence of an associated radiolucent image were also significantly related to the development of mandibular bone irregularities. The depth of impaction of the tooth might also be an important factor since erupted or nearly erupted third molars were more frequent in the SMBI group. CONCLUSIONS: SMBI are a rare postoperative complication after lower third molar removal. Older patients having left side lower third molars removed are more likely to develop this problem. The treatment should be the removal of the irregularity when the patient is symptomatic.

Quality of life following third molar removal under conscious sedation

Aim: The aim of this study was to assess quality of life (QoL) and degree of satisfaction among outpatients subjected to surgical extraction of all four third molars under conscious sedation. A second objective was to describe the evolution of self-reported pain measured in a visual analogue scale (VAS) in the 7 days after extraction. Study design: Fifty patients received a questionnaire assessing social isolation, working isolation, eating and speaking ability, diet modifications, sleep impairment, changes in physical appearance, discomfort at suture removal and overall satisfaction at days 4 and 7 after surgery. Pain was recorded by patients on a 100-mm pain visual analogue scale (VAS) every day after extraction until day 7. Results: Thirty-nine patients fulfilled correctly the questionnaire. Postoperative pain values suffered small fluctuations until day 5 (range: 23 to 33 mm in a 100-mm VAS), when dicreased significantly. A positive association was observed between difficult ranked surgeries and higher postoperative pain levels. The average number of days for which the patient stopped working was 4.9. Conclusion: The removal of all third molars in a single appointment causes an important deterioration of the patient’s QoL during the first postoperative week, especially due to local pain and eating discomfort (AU)

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Quality of life following third molar removal under conscious sedation.

AIM: The aim of this study was to assess quality of life (QoL) and degree of satisfaction among outpatients subjected to surgical extraction of all four third molars under conscious sedation. A second objective was to describe the evolution of self-reported pain measured in a visual analogue scale (VAS) in the 7 days after extraction. STUDY DESIGN: Fifty patients received a questionnaire assessing social isolation, working isolation, eating and speaking ability, diet modifications, sleep impairment, changes in physical appearance, discomfort at suture removal and overall satisfaction at days 4 and 7 after surgery. Pain was recorded by patients on a 100-mm pain visual analogue scale (VAS) every day after extraction until day 7. RESULTS: Thirty-nine patients fulfilled correctly the questionnaire. Postoperative pain values suffered small fluctuations until day 5 (range: 23 to 33 mm in a 100-mm VAS), when dicreased significantly. A positive association was observed between difficult ranked surgeries and higher postoperative pain levels. The average number of days for which the patient stopped working was 4.9. CONCLUSION: The removal of all third molars in a single appointment causes an important deterioration of the patient's QoL during the first postoperative week, especially due to local pain and eating discomfort.

Delayed-onset infections after impacted lower third molar extraction: involved bacteria and sensitivity profiles to commonly used antibiotics.

OBJECTIVES: The objectives of this study were to identify the bacteria involved in delayed-onset infections after lower third molar removal and to determine the most suitable antibiotic for such complication. STUDY DESIGN: Bacterial samples were collected from 13 patients who developed delayed-onset infections after lower third molar extraction. After the identification of the bacterial isolates, the in vitro antimicrobial susceptibility of the isolated strains was determined. RESULTS: A total of 11 patients (12 samples) were finally included in the study. Up to 7 bacteria genera were identified. Fusobacterium sp. was present in 11 patients, Prevotella sp. in 8 cases, and Peptostreptococcus sp. in 7. Some strains of these bacteria were not susceptible to amoxicillin, amoxicillin/clavulanate, and metronidazol, whereas no resistances were found to clindamycin. CONCLUSIONS: Fusobacterium sp., Prevotella sp., and Peptostreptococcus sp. are frequently present in delayed-onset infections after lower third molar removal. Based on the results of the microbial susceptibility tests, clindamycin seems to be the most adequate antibiotic for the treatment of this complication.

Sensibility and taste alterations after impacted lower thirdmolar extractions. A prospective cohort study

Objectives: To determine the incidence, severity and duration of lingual tactile and gustatory function impairments after lower third molar removal.Study Design: Prospective cohort study with intra-subject measures of 16 patients undergoing lower third molar extractions. Sensibility and gustatory functions were evaluated in each subject preoperatively, one week and one month after the extraction, using Semmes-Weinstein monofilaments and 5 different concentrations of NaCl, respectively. Additionally, all patients filled a questionnaire to assess subjective perceptions.Results: Although patients did not perceive any sensibility impairments, a statistically significant decrease was detected when Semmes-Weinstein monofilaments. This alteration was present at one week after the surgical procedure and fully recovered one month after the extraction. There were no variations regarding the gustatory function. Conclusions: Lower third molar removal under local anesthesia may cause light lingual sensibility impairment. Most of these alterations remain undetected to patients. These lingual nerve injuries are present one week after the extraction and recover one month after surgery. The taste seems to remain unaffected after these procedures (AU)

Assessment of osteointegrative response around dental implants using technetium 99-methylene diphosphate scintigraphy: a comparison of two implant surfaces in a rabbit model.

PURPOSE: To compare the metabolic activity at the bone-implant interface of implants with machined and rough surfaces using bone scintigraphy during the in vivo process of osseointegration in a rabbit model, as well to establish a correlation between activity index (AI) and the bone-implant contact percentage (%BIC). MATERIALS AND METHODS: Twenty-four implants were placed (12 with a machined surface and 12 with a rough titanium oxide surface) in 12 New Zealand White rabbits. Preoperatively and during the postoperative period (at 15 days and at monthly intervals), animals underwent bone scintigraphy with technetium 99m-methylene diphosphate (Tc-99m-MDP), and the AI for each implant was calculated by planar and pinhole collimator scintigraphy. A total of 240 AIs were obtained; after animal sacrifice at 105 days postsurgery, the %BIC was measured by scanning electron microscopy in 10 samples of each implant surface type. RESULTS: The activity-time curve showed a similar morphology for both implant types and both scintigraphy techniques. The maximum mean AI appeared after 15 days of implantation and was higher in machined implants. Significant differences were not found in the %BIC according to implant type. A significant correlation between the mean activity registered in the first postoperative scintigraph and the mean %BIC at the end of the study was observed for machined implants only. CONCLUSIONS: Tc-99m-MDP is useful for the assessment of osseous metabolic activity associated with different microsurfaces. The association between mean AI and %BIC was only demonstrated for machined implants in the first postoperative scintigraphy image.

Bupivacaine 0.5 % versus articaine 4 % for the removal of lower third molars. A crossover randomized controlled trial

Objective: To compare the anesthetic action of 0.5% bupivacaine in relation to 4% articaine, both with 1:200,000 epinephrine, in the surgical removal of lower third molars. As a secondary objective hemodynamic changes using both anesthetics were analyzed.Study Design: Triple-blind crossover randomized clinical trial. Eighteen patients underwent bilateral removal of impacted lower third molars using 0.5% bupivacaine or 4% articaine in two different appointments. Preoperative, intraoperative and postoperative variables were recorded. Differences were assessed with McNemar tests and repeated measures ANOVA tests. Results: Both solutions exhibited similar latency times and intraoperative efficacy. Statistical significant lower pain levels were observed with bupivacaine between the fifth (p=0.011) and the ninth (p=0.007) postoperative hours. Bupivacaine provided significantly longer lasting soft tissue anesthesia (p<0.05). Systolic blood pressure and heart rate values were significantly higher with articaine.Conclusions: Bupivacaine could be a valid alternative to articaine especially due to its early postoperative pain prevention ability (AU)

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A prospective, randomized, triple-blind comparison of articaine and bupivacaine for maxillary infiltrations

Objectives: To compare the clinical anesthetic efficacy of 0.5% bupivacaine and 4% articaine (both with 1:200.000adrenaline) for anterior maxillary infiltration in healthy volunteers. Material and methods: A triple-blind split-mouth randomized clinical trial was carried out in 20 volunteers. A supraperiosteal buccal injection of 0.9 ml of either solution at the apex of the lateral incisor was done in 2 appointments separated 2 weeks apart. The following outcome variables were measured: latency time, anesthetic efficacy(dental pulp, keratinized gingiva, alveolar mucosa and upper lip mucosa and tissue) and the duration of anesthetic effect. Hemodynamic parameters were monitored during the procedure. Results: Latency time recorded was similar for both anesthetic solutions (p>0.05). No statistically significant differences were found in terms of anesthetic efficacy for dental pulp, keratinized gingiva or alveolar mucosa. Articaine had a significant higher proportion of successful anesthesia at 10 minutes after infiltration in lip mucosa and lip skin (p=0.039). The duration of anesthesia was 336 minutes for bupivacaine and 167 minutes for articaine. (p<0.001). No significant hemodynamic alterations were noted during the procedure. Conclusions: Articaine and bupivacaine exhibited similar anesthetic efficacy for maxillary infiltrations. The duration of anesthesia was longer with the bupivacaine solution, but lip anesthesia was better with articaine (AU)

Sensibility and taste alterations after impacted lower third molar extractions. A prospective cohort study.

OBJECTIVES: To determine the incidence, severity and duration of lingual tactile and gustatory function impairments after lower third molar removal. STUDY DESIGN: Prospective cohort study with intra-subject measures of 16 patients undergoing lower third molar extractions. Sensibility and gustatory functions were evaluated in each subject preoperatively, one week and one month after the extraction, using Semmes-Weinstein monofilaments and 5 different concentrations of NaCl, respectively. Additionally, all patients filled a questionnaire to assess subjective perceptions. RESULTS: Although patients did not perceive any sensibility impairments, a statistically significant decrease was detected when Semmes-Weinstein monofilaments. This alteration was present at one week after the surgical procedure and fully recovered one month after the extraction. There were no variations regarding the gustatory function. CONCLUSIONS: Lower third molar removal under local anesthesia may cause light lingual sensibility impairment. Most of these alterations remain undetected to patients. These lingual nerve injuries are present one week after the extraction and recover one month after surgery. The taste seems to remain unaffected after these procedures.

Central odontogenic fibroma: Retrospective study of 8 clinical cases

Introduction and Objectives: The central odontogenic fibroma (COF) is a benign odontogenic tumour derived from the dental mesenchymal tissues. It is a rare tumour and only 70 cases of it have been published. Bearing in mind the rareness of the tumour, 8 new cases of central odontogenic fibroma have been found by analyzing the clinical, radiological and histopathological characteristics of COF. Patients and Method: A retrospective study was carried out on 3011 biopsies in the Service of Oral and Maxillofacial Surgery of the Dental Clinic of Barcelona University between January 1995 and March 2008. 85 odontogenic tumours were diagnosed of which 8 were central odontogenic fibroma. The radiological study was based on orthopantomographs, periapical and occlusal radiographies and computerised tomographics. The variables collected were: sex, age, clinical characteristics of the lesion, treatment received and possible reappearances of the tumour. Results: The central odontogenic fibroma represents 9.4% of all odontogenic tumours. Of the 8 cases, 5 were diagnosed in men and 3 in women. The average age was 19.9 years with an age range of 11 to 38 years. The most common location of the tumour was in the mandible. All cases were associated with unerupted teeth. Of the 8 tumours, 3provoked rhizolysis of the adjacent teeth and 4 cases caused cortical bone expansion. 50% of the patients complained of pain associated to the lesion. No case of recurrence was recorded up to 2 years after the treatment. Conclusions: Central odontogenic fibromas usually evolve asymptomatically although they can manifest very aggressive lyprovoking dental displacement and rhizolysis. Radiologically, COF manifest as a uni or multilocular radiotransparent image although they can be indistinguishable from other radiotransparent lesions making diagnosis more difficult. COF treatment involves conservative surgery as well as follow-up patient checks (AU)

Central odontogenic fibroma: retrospective study of 8 clinical cases.

INTRODUCTION AND OBJECTIVES: The central odontogenic fibroma (COF) is a benign odontogenic tumour derived from the dental mesenchymal tissues. It is a rare tumour and only 70 cases of it have been published. Bearing in mind the rareness of the tumour, 8 new cases of central odontogenic fibroma have been found by analyzing the clinical, radiological and histopathological characteristics of COF. PATIENTS AND METHOD: A retrospective study was carried out on 3011 biopsies in the Service of Oral and Maxillofacial Surgery of the Dental Clinic of Barcelona University between January 1995 and March 2008. 85 odontogenic tumours were diagnosed of which 8 were central odontogenic fibroma. The radiological study was based on orthopantomographs, periapical and occlusal radiographies and computerised tomographics. The variables collected were: sex, age, clinical characteristics of the lesion, treatment received and possible reappearances of the tumour. RESULTS: The central odontogenic fibroma represents 9.4% of all odontogenic tumours. Of the 8 cases, 5 were diagnosed in men and 3 in women. The average age was 19.9 years with an age range of 11 to 38 years. The most common location of the tumour was in the mandible. All cases were associated with unerupted teeth. Of the 8 tumours, 3 provoked rhizolysis of the adjacent teeth and 4 cases caused cortical bone expansion. 50% of the patients complained of pain associated to the lesion. No case of recurrence was recorded up to 2 years after the treatment. CONCLUSIONS: Central odontogenic fibromas usually evolve asymptomatically although they can manifest very aggressively provoking dental displacement and rhizolysis. Radiologically, COF manifest as a uni or multilocular radiotransparent image although they can be indistinguishable from other radiotransparent lesions making diagnosis more difficult. COF treatment involves conservative surgery as well as follow-up patient checks.

Bupivacaine 0.5% versus articaine 4% for the removal of lower third molars. A crossover randomized controlled trial.

OBJECTIVE: To compare the anesthetic action of 0.5% bupivacaine in relation to 4% articaine, both with 1:200,000 epinephrine, in the surgical removal of lower third molars. As a secondary objective hemodynamic changes using both anesthetics were analyzed. STUDY DESIGN: Triple-blind crossover randomized clinical trial. Eighteen patients underwent bilateral removal of impacted lower third molars using 0.5% bupivacaine or 4% articaine in two different appointments. Preoperative, intraoperative and postoperative variables were recorded. Differences were assessed with McNemar tests and repeated measures ANOVA tests. RESULTS: Both solutions exhibited similar latency times and intraoperative efficacy. Statistical significant lower pain levels were observed with bupivacaine between the fifth (p=0.011) and the ninth (p=0.007) postoperative hours. Bupivacaine provided significantly longer lasting soft tissue anesthesia (p<0.5). Systolic blood pressure and heart rate values were significantly higher with articaine. CONCLUSIONS: Bupivacaine could be a valid alternative to articaine especially due to its early postoperative pain prevention ability.

Giant desmoplastic fibroma in the anterior zone of the maxilla.

Desmoplastic fibroma (DF) is a rare intraosseous benign neoplasm that represents less than 1% of the osseous tumors. This lesion can be locally aggressive, and the rate of recurrence is frequently high.A 34-year-old male patient was referred to our clinic presenting a tumor in the anterior zone of the maxilla. The oral examination revealed a hard and lobulated tumor, affecting teeth 13 to 26. The radiographic examination, orthopantomography, and computed tomography revealed a radiolucent, multilocular, well-defined image, which extended from tooth 13 to the mesial root of tooth 26, provoking marked expansion, thinning, and perforation of the buccal and palatal cortical plates. A provisional diagnosis of aggressive odontogenic tumor was made, and block resection of the tumor was carried out. Intraoperatively, the tumor was lobulated, composed of a homogenous fibrous tissue, hard, and white-yellowish. The histologic analysis leads to a diagnosis of DF.Desmoplastic fibroma of the oral cavity is a rare benign intraosseous tumor, especially when it involves the upper maxilla and the anterior region. The main clinical and pathologic differential diagnosis in our case was central odontogenic fibroma. The most suitable treatment option for DF of the oral cavity is a controversial issue, but block resection is the therapy reporting a lower recurrence. Finally, an interesting feature of this intraosseous neoplasm, if located in the oral cavity, refers to the different clinical pattern that might present depending on location.

Pilomatrixoma. Review of 205 cases

Aims: To determine the incidence and clinical features of patients diagnosed with pilomatrixoma.Patients and Method: A retrospective analysis was made of 205 cases of pilomatrixoma diagnosed according toclinical and histological criteria, with an evaluation of the incidence, patient age at presentation, gender, lesionlocation and size, single or multiple presentation, differential diagnosis, histopathological and clinical findingsand relapses.Results: Pilomatrixoma was seen to account for 1.04% of all benign skin lesions. It tended to present in pediatricpatients – almost 50% corresponding to individuals under 20 years of age – with a slight male predilection(107/98). Approximately 75% of all cases presented as single lesions measuring less than 15 mm in diameter.Multiple presentations were seen in 2.43% of cases. The most frequent locations were the head and orofacialzones (particularly the parotid region), with over 50% of all cases, followed by the upper (23.9%) and lower limbs(12.7%). Only one relapse was documented following simple lesion excision.Conclusions: The frequency of pilomatrixomas was 1.04% of all benign skin lesions – the lesions being predominantlylocated in the maxillofacial area. Due to the benign features of this disorder, simple removal of the lesionis considered to be the treatment of choice, and is associated with a very low relapse rate (AU)

Root resorption caused by a maxillary sinus mucocele: a case report.

A maxillary sinus mucocele is an infrequent but benign lesion that develops from the obstruction of a seromucous glandular duct of the maxillary sinus mucosa. This clinical entity is generally asymptomatic and self-limited. Mucoceles are described as rounded dome-shaped soft tissue masses frequently located on the floor of the maxillary sinus. In this paper, we present a case of a slightly radiopaque well defined shadow arising from the left maxillary sinus floor that produced the root resorption of the upper second left molar. After the surgical removal of the lesion through a Caldwell-Luc approach, histologic study confirmed the initial diagnosis of mucocele. This case report emphasizes the need of clinical and radiologic follow-up to detect any complications associated with these benign lesions, because, in rare occasions, they can show an aggressive growth pattern.