Study of Pathological Changes in the Dental Follicle of Disease-Free Impacted Third Molars.

BACKGROUND: The prophylactic extraction of third molars is a common practice in dental offices, but divergent opinions are found in the literature regarding the indication of this procedure. The aim of the present study was to determine the prevalence of pathological changes associated with the pericoronal tissue of asymptomatic impacted third molars that could justify prophylactic extraction. MATERIALS AND METHODS: A cross-sectional observational study was conducted in which 109 pericoronal tissues with no radiographic evidence of pathology were histopathologically analyzed. The specimens were fixed in 10% formalin, embedded in paraffin, stained with hematoxylin and eosin and analyzed individually by two pathologists. RESULT: The frequency of inflammatory infiltrate in the dental follicle of patients older than 20 years of age was significantly higher than that of younger patients (p = 0.004), demonstrating an association between inflammation in the dental follicle and patient age. The occurrence of squamous metaplasia was also greater in patients older than 20 years (p = 0.042), demonstrating that the prevalence of squamous metaplasia increases with age. A significant association was also found between inflammation and squamous metaplasia (p < 0.001). CONCLUSION: Pathological changes may be present in the dental follicle of impacted third molars even in the absence of clinical or radiographic signs of disease.

Efficacy of Benzocaine 20% Topical Anesthetic Compared to Placebo Prior to Administration of Local Anesthesia in the Oral Cavity: A Randomized Controlled Trial.

The aim of the present study was to compare the effects of a topical anesthetic to a placebo on pain perception during administration of local anesthesia in 2 regions of the oral cavity. A split-mouth, double-blind, randomized clinical trial design was used. Thirty-eight subjects, ages 18-50 years, American Society of Anesthesiologists I and II, received 4 anesthetic injections each in regions corresponding to the posterior superior alveolar nerve (PSA) and greater palatine nerve (GPN), totaling 152 sites analyzed. The side of the mouth where the topical anesthetic (benzocaine 20%) or the placebo was to be applied was chosen by a flip of a coin. The needle used was 27G, and the anesthetic used for administration of local anesthesia was 2% lidocaine with 1:100,000 epinephrine. After receiving the administration of local anesthesia, each patient reported pain perception on a visual analog scale (VAS) of 100-mm length. The results showed that the topical anesthetic and the placebo had similar effects: there was no statistically significant VAS difference between the PSA and the GPN pain ratings. A higher value on the VAS for the anesthesia of the GPN, relative to the PSA, was observed for both groups. Regarding gender, male patients had higher values on the VAS compared with female patients, but these differences were not meaningful. The topical anesthetic and the placebo had similar effects on pain perception for injection of local anesthesia for the PSA and GPN.

Titanium alloy miniscrews for orthodontic anchorage: an in vivo study of metal ion release / Minimplantes de liga de titânio para ancoragem ortodôntica: um estudo in vivo de liberação de íon metálico

PURPOSE: To examine and compare the levels of several metal ions released in the saliva of patients with orthodontic appliances, at different time points before and after insertion of a miniscrew. METHODS: Saliva of patients (n=20) was collected at four time points: before miniscrew placement (T1), 10 minutes (T2), 7 days (T3) and 30 days after miniscrew placement (T4). The salivary samples were analyzed by inductively coupled plasma mass spectrometry (ICP-MS) and inductively coupled plasma optical emission spectrometry (ICP-OES). The release of nine different metal ions was observed: titanium (Ti), zinc (Zn), chromium (Cr), nickel (Ni), iron (Fe), copper (Cu), aluminum (Al), Vanadium (V) and cobalt (Co). Data were analyzed by descriptive statistics. Salivary metal concentrations from different time points of miniscrew treatment were compared using Wilcoxon paired tests (a=5 percent). RESULTS: At time point T4, there was a quantitative increase in the salivary concentration of Cu, Ti, V, Zn, as well as a quantitative decrease in the salivary concentration of Al, Co, Cr, Fe, Ni, when compared with T1. CONCLUSION: It can be concluded that the placement of fixed orthodontic appliances associated with miniscrews does not lead to an increase of salivary metal ion concentrations.

OBJETIVO: Examinar e comparar os níveis de diferentes íons metálicos liberados na saliva de pacientes com aparelhos ortodônticos, em diferentes tempos: antes e após a inserção de mini-implantes. METODOLOGIA: A saliva de pacientes (n=20) foi coletada em quatro tempos diferentes: antes da inserção do mini-implante (T1), 10 minutos (T2), 7 dias (T3) e 30 dias após a remoção do mini-implante (T4). As amostras de saliva foram analisadas por espectrometria de massa de plasma com acoplamento por indução (ICP-MS) e espectrometria de emissão ótica por plasma acoplado indutivamente (ICP-OES). A liberação de nove diferentes ions metálicos foi observado: titânio (Ti), zinco (Zn), cromo (Cr), níquel (Ni), ferro (Fe), cobre (Cu), alumínio (Al), vanádio(V) e cobalto (Co). Os dados foram analisados por estatística descritiva. As concentrações de íons metálicos na saliva dos diferentes tempos estudados foram comparados através do teste pareado de Wilcoxon (a=5 por cento). RESULTADOS: No tempo T4, houve um aumento quantitativo na concentração salivar de Cu, Ti, V, Zn, assim como um decréscimo quantitativo na concentração salivar de Al, Co, Cr, Fe, Ni, quando comparados com T1. CONCLUSÃO: Pode ser concluído que a colocação de aparelho fixo ortodôntico associado com mini-implantes não leva a um aumento significativo na concentração salivar de íons metálicos.

BMPs em Implantodontia: uma revisão dos estudos clínicos / BMPs in implant dentistry: a review of clinical studies

As proteínas morfogenéticas ósseas (BMPs) estão presentes no organismo humano e desempenham as mais diferentes funções. Uma, em especial, desperta o interesse da Implantodontia: a regeneração óssea. Por muitos anos, o poder osteoindutor das BMPs vem sendo estudado nas diferentes áreas da saúde e diversos estudos in vitro e experimentais já comprovaram que as BMPs são capazes de induzir crescimento ósseo. Baseado nisso, e mais recentemente em estudos clínicos, é que a Food and Drug Administration (FDA) aprovou o uso da rhBMP-2 associada a uma esponja de colágeno reabsorvível como alternativa de substituto ósseo em enxertias. Sendo assim, objetiva-se realizar uma revisão da literatura dos estudos clínicos realizados com as BMPs na área de interesse da Implantodontia, pois observando-se os diferentes trabalhos sobre o uso das BMPs em alvéolos pós-extrações, o aumento do rebordo edêntulo e o levantamento do assoalho do seio maxilar foi possível concluir que ainda é necessário um número maior de estudos qualificados e de longo prazo; embora, as evidências científicas existentes demonstrem resultados tão eficazes com o uso das BMPs associadas a carreadores quanto os alcançados com o osso autógeno nessas indicações.

Bone morphogenetic proteins (BMPs) are present in our organism and perform a variety of functions. One of these functions, particularly for Implant Dentistry, is bone regeneration. For many years, the BMPs osteoinductive power has been studied in the different health sciences. Many experimental and in vitro studies have already confirmed that BMPs have the capacity to induce bone growth. Based on this, and more recently on clinical studies, the Food and Drug Administration (FDA) approved the use of rhBMP-2 in association with an absorbable collagen sponge as an alternative of bone substitute in case of bone grafting. Therefore, the aim of this study was to review the literature on clinical studies using BMPs in Implant Dentistry. Observing the different studies about the use of BMPs in post-extraction pockets, edentulous ridge augmentation and maxillary sinus lifting, it was possible to conclude that it’s still necessary a greater number of qualified and long-term studies to certify some aspects. However, the existing scientific evidences show that the use of BMPs associated with carriers or autogenous bone in these indications presented the same effective results.

Histological evaluation of the effect of low-level laser on distraction osteogenesis in rabbit mandibles.

OBJECTIVES: This study evaluated the action of low level laser therapy (LLLT) on the percentage of newly formed bone in rabbit mandibles that underwent distraction osteogenesis (DO). STUDY DESIGN: Ten rabbits underwent bone lengthening according to the following protocol: Latency - 3 days; Activation - 7 days 0.7 mm/d; and Consolidation - 10 days. The control group was composed of 4 rabbits. The experimental group, composed of 6 rabbits, received infrared GaAlAs LLLT (wavelength=830 nm, P=40 mW) according to the following protocol: point dose of 10 J/cm(2) applied directly on the bone site that underwent DO during bone consolidation at 48-hour intervals. RESULTS: The percentage of newly formed bone was greater in the LLLT group (57.89%) than in the control group (46.75%) (p=0.006). CONCLUSION: The results suggest that LLLT had a positive effect on the percentage of newly formed bone. Better-quality bone sites may allow early removal of the osteogenic distractors, thus shortening total treatment time.

Patient's perception on mini-screws used for molar distalization / Percepção dos pacientes quanto ao uso de mini-implantes para distalização de molares

Purpose: The objective of this study was to evaluate and compare the perceived pain intensity, side effects and discomfort related to the moment of placement, during mechanics and removal of a mini-screw for molar distalization in orthodontic treatment.Methods: The sample consisted of 30 adult patients with a mean age of 30 years old, with class II malocclusion subdivision right or left. A mini-screw was installed in each patient, in the maxillary arch to provide a molar distalization. The patients answered a questionnaire to assess their opinions on the treatment. Results: Ninety percent of the patients chose mini-screws over pre-molar extraction (orthodontic camouflage), or the use of an extra-oral appliance (Kloehn cervical traction) or another non-compliance treatment to class II. Aphthous ulcer was the side effect most frequent after placement of the mini-screw (30%). The greatest discomfort was felt during infiltration anesthesia (27%), though 23% reported no discomfort during placement. Eighty-three percent of the patients reported no pain during placement, which may be associated with the degree of satisfaction with the treatment (100%) and recommendation of the procedure to other patients (100%). Conclusion: Mini-screws were well accepted by the patients and were efficient for molar distalization when utilized in association with orthodontic treatment for Class II malocclusion.

Objetivo: O objetivo desse estudo foi avaliar e comparar a intensidade de dor, os efeitos colaterais e o desconforto sentido pelo paciente relacionado à colocação do mini-implante, durante a mecânica e na remoção do mesmo, durante a distalização de molares no tratamento ortodôntico. Métodos: A amostra foi composta por 30 pacientes adultos com uma média de idade de 30 anos, com maloclusão Classe II subdivisão direita ou esquerda. Um mini-implante foi instalado em cada paciente, no arco superior para conseguir a distalização de molar. Os pacientes receberam um questionário a respeito de sua opinião sobre o tratamento. Resultados: Noventa por cento dos pacientes escolheram colocar os mini-implantes ao invés de realizar extração de molares (camuflagem ortodôntica), fazer o uso de um aparelhoextraoral (Aparelho extraoral de Kloehn) ou fazer uso de qualquer outro tratamento alternativo para classe II. A úlcera aftosa foi o efeito colateral com a maior incidência após a inserção do mini-implante (30%). O maior desconforto foi sentido durante a infiltração anestésica (27%), embora 23% relataram não ter sentido desconforto durante o tratamento. Um total de 83% dos pacientes não relatou dor durante o tratamento, o que pode ser associado com o grau de satisfação com o tratamento (100%) e a recomendação desse procedimento a outros pacientes (100%). Conclusão: Os mini-implantes foram bem aceitos pelos pacientes e foram eficientes para a distalização de molares quando utilizados em associação com o tratamento ortodôntico para correção da maloclusão de Classe II.

Analysis of the systemic effect of red and infrared laser therapy on wound repair.

OBJECTIVE: To evaluate, using histological analysis, the systemic action and repair process of wounds produced on the back of rats and treated with red, infrared, or both lasers applied directly or indirectly to the wounds. BACKGROUND DATA: Skin tissue repair and wound healing are complex processes that involve a series of dynamic events. Many benefits are associated with biomodulation using laser therapy. METHODS: Thirty-six male Wistar rats were divided into four groups: control (without laser), red laser (aluminium gallium indium phosphide (AlGaInP); lambda=685 nm; phi=0.0314 cm2; CW; P=30 mW; D=20 J, time of irradiation=667 sec), infrared laser (gallium-aluminum-arsenide (GaAlAs): lambda=830 nm; phi=0.0314 cm2; CW; P=50 mW; D=20 J, time of irradiation=401 sec), and both lasers (infrared laser: GaAlAs; lambda=830 nm; phi=0.0314 cm2; CW; P=50 mW; D=10 J, time of irradiation=201 sec+red laser: AlGaInP; lambda=685 nm; phi=0.0314 cm2; CW; P=30 mW; D=10 J, time of irradiation=334 sec; total dose=20 J). Three subgroups were formed according to observation time points. Three wounds were produced on the back of each animal. Only the wound closest to the head was irradiated in the experimental groups. For the evaluation of skin reaction and wound healing, three animals of each group were killed at 3, 5, and 7 days postoperatively. The irradiation protocol established 48-hour intervals between applications, with the first application immediately after the surgical procedure. RESULTS: In the red and infrared laser group, healing was more advanced in the wound located furthest from the point of laser application. The most effective healing of a proximal wound was verified in the control group on the 7th postoperative day. CONCLUSION: The combined application of red and infrared lasers resulted in the most evident systemic effect on the repair of skin wounds produced in rats.

Histologic study of the effect of laser therapy on bone repair.

AIM: This study used histologic analysis and HE staining to evaluate laser biomodulation of bone repair in cavities made in the femurs of rats that underwent non-ablative laser irradiation. METHODS AND MATERIALS: Eighteen male Wistar rats weighing 300 to 400 grams were randomly assigned to three groups of six animals each. A surgical defect site was produced with a trephine about 2 mm in diameter under abundant irrigation. In Group I the complete surgical protocol to produce a bone defect was followed but without laser radiation (control). In Group II a continuous wave 830 nm infrared laser was used at 10 J/cm2 and 50 mW at each point of the surgical site. In Group III a continuous wave 685 nm infrared laser at 10J/cm2 and 35 mW was used at each point of surgical site. The animals were irradiated at intervals of 48 hours beginning immediately after the preparation of the defect and were sacrificed on the 15th, 21st, and 30th days. Slides were studied by means of descriptive analysis. RESULTS: Greater degrees of new bone formation and vertical regeneration were found in the irradiated groups than in the control group. CONCLUSION: Laser therapy in this study protocol was efficient in promoting bone repair. CLINICAL SIGNIFICANCE: The use of laser technology has been used to improve the clinical results of bone surgeries and to promote a more comfortable postoperative period and quicker healing.

Fraturas orbitárias blowout: tratamento com telas de titânio / Blowout orbital fractures: treatment with titanium mesh

As fraturas orbitárias blowout são aquelas que acometem exclusivamente o assoalho e/ou a parede medial da órbita. O diagnóstico destas fraturas baseia-se em exame físico e em exames imaginológicos. No exame físico, sinais e sintomas, como equimose periorbitária, limitação de movimentos oculares, diplopia e enoftalmia,podem estar presentes. A tomografia computadorizada é o exame mais eficiente para o diagnóstico dessas fraturas. O tratamento deve ser realizado através da reconstrução das paredes orbitárias fraturadas combiomateriais autógenos, homógenos, heterógenos ou materiais aloplásticos. Neste trabalho, serão apresentados dois casos clínicos de fraturas blowout, tratadas com telas de titânio. Esses materiais mostraram-se eficientes, apresentando bons resultados em relação à capacidade de reconstrução do assoalho orbitário e de suporte ao conteúdo do globo ocular.

Cisto maxilar: caso clinico / cist maxilar: case report

O cisto da região globulomaxilar é encontrado exclusivamente na maxila, no interior do osso, na junção da porção globular do processo nasal mediano com o processo maxilar- a fissura globulomaxilar - geralmente entre o incisivo lateral superior e o canino. Possui a forma de pêra invertida, radiotransparente e circundado por um halo esclerótico. Os dentes adjacentes possuem vitalidade, a não ser que estejam infectados. Este relato de caso clínico refere-se a uma paciente melanoderma, 50 anos, que apareceu na clínica de CTBMF, encaminhada de uma cidade vizinha com uma tumefação dolorida na região esquerda da face, na altura da bochecha. Já no exame clínico, foi feita punção para alívio do edema e dor. A paciente foi submetida à cirurgia, posteriormente, para remoção do cisto e o exame anátomo-patológico confirmou os achados histológicos consistentes com cisto na região globulomaxilar, provavelmente, um cisto residual